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Limited palliative care is forcing patients to chose assisted suicide, say Quebec doctors

14 June 2018

 
Dr Saba is challenging Quebec's medical aid in dying law.

They argue lack of care means patients cannot properly consent to euthanasia

When the Canadian province of Quebec first brought in assisted suicide legislation, 262 people died under it in the first seven months - about three times more than anticipated.

Now, doctors are voicing concern that patients are being forced into choosing physician assisted suicide, because of a shortage of palliative care. Moreover, some are saying that lack of access to proper care is depriving patients of free and informed consent to having their lives ended.

College of Physicians

At the end of May, the Quebec College of Physicians wrote a letter to Health Minister Gaetan Barrette expressing concern that physician assisted death may be causing patients to turn to lethal injections because of the lack of palliative care.

Dr. Charles Bernard, President of the College of Physicians said that there are "difficulties with the accessibility of palliative care for many end-of-life patients.

"In certain well-identified cases, patients, not benefiting from such care, could have had no choice but to request medical assistance in dying to end their days 'in dignity'." The College also advised that "end-of-life care can not be limited to access to medical assistance in dying."

Inequality of options

Some doctors are saying that since Quebec’s medical aid in dying law came into effect in 2016, access to palliative care has gone down, while patient requests for assisted suicide have increased steadily.  "The issue of medical aid in dying is available to 100 per cent of the population and [in] palliative care the resources are only available to 30 per cent of the population,"said Teresa Dellar, Director of the West Island Palliative Care Residence.

Mr Barrette denied on Tuesday that there had been any cuts to palliative care. His office released a statement just before a group of ten Montreal area physicians held a press conference saying that lack of palliative care was forcing patients to accept assisted suicide. 

Support, not suicide

Dr. Paul Saba, a family physician who is leading the group, said fewer doctors have entered the field of palliative care since the law came into effect and that patients are suffering as a result.  "People really are feeling a burden, financial stress, psychological stress and lack of autonomy," he said. "So what we want do is we want to give people what they need, and they need care and support."

The group also said the provincial government has provided them with little information on how they’re managing the issue.  "We were promised that there would be a plan for the development of palliative care in Quebec and the [government] commission asked for five years to develop this plan," Dr. Laurence Normand-Rivest said after the press conference. "We’re in 2018, and for now, there’s no plan."

Dr Saba also argues that the provincial government is not respecting its own law by effectively denying patients the right to informed consent because access to palliative care is poor. He is presenting his case before the Quebec Court of Appeals after losing his bid to overturn the province’s assisted-dying law.

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