Like The Hub?
Join our community.
Join

Opinion: Palliative Care was supposed to be a ‘safeguard’ for MAiD. Instead, it’s becoming a casualty

Commentary

The introduction of euthanasia and assisted suicide as “medical assistance in dying” (MAiD) into Canadian health care was not a solitary event. This one move carried with it a litany of concerns about its effects on the provision of palliative care for Canadians who do not want MAiD. Unlike MAiD, which intentionally ends life through the administration of lethal drugs, palliative care provides a holistic approach to supporting the lives of patients with life-limiting or life-threatening illnesses or conditions as well as their families, providing for physical symptoms and needs as well as broader psychosocial needs.

Palliative care’s positive impact, not only for patients and their quality of life but also for the entire health system, was never in dispute. Neither were the known existing inadequacies with access to and availability of quality palliative care, particularly significant among Indigenous populations, as well as others in remote, marginalized, or economically disadvantaged situations. Universal palliative care, as such, was needed before euthanasia’s introduction. As the B.C. Supreme Court dealt with the Carter v Canada case, it heard from the Canadian Medical Association that the “provision of palliative care for all who are in need is a mandatory precondition to the contemplation of permissive legislative change.”

And yet, although the federal government offered assurances and established both a national Framework and Action Plan for palliative care in 2018 and 2019 respectively, it failed to establish any right to palliative care. This is a stark contrast even with euthanasia pioneers like Belgium, which established a right to palliative care at the same time as legalizing euthanasia.

Despite this, part of the process of informed consent to receive MAiD was predicated on being offered palliative care. In this way, describes legal scholar Dr. Mary Shariff, palliative care became part of the safeguards for MAiD. However, without actual meaningful access to palliative care at an appropriate time, which is at the time of the diagnosis of a life-limiting or life-threatening illness or condition, this safeguard is largely meaningless. It is far too little and too late to mention palliative care only after a patient has already asked to be killed due to feeling that their suffering—whether physical or existential, or their fear of future suffering—is too great to bear. 

So, five years after the establishment of the Framework for Palliative Care in Canada, significant problems remain with both access and quality of care, particularly within some marginalized communities. The Quality End-of-Life Care Coalition noted the embarrassing reality of how “Canada lags behind in international counterparts in terms of access to quality end-of-life care.”

Furthermore, some palliative care doctors are sounding the alarm that palliative resources and personnel are being reallocated to provide MAiD—further eroding the already limited availability and quality of palliative care Canadians can receive. Moreover, it can reduce patients’ trust in the medical system and their medical teams, while also causing moral distress to clinicians. As a result, some are leaving their professions.

These developments have far-reaching implications for Canadians, particularly in the context of an aging population. Governments at both the federal and provincial levels need to make good on their commitments to palliative care. They must ensure that the appropriate resources and funds are available. Governments must also draw a clear dividing line between care that provides assistance in living—palliative care—and MAiD, which deliberately causes death. 

‘The promotion or endorsement of violence should be where that line is drawn’: The best comments from Hub readers this week

Commentary

As the Israel-Hamas war rages on into another week, The Hub has continued to explore and contextualize how the war has affected the diasporas in Canada and the reactions from our government.

The goal of Hub Forum is to bring the impressive knowledge and experience of The Hub community into one place and with that in mind, here are some of the most interesting comments this week.

Sign up for our daily Hub Forum email newsletter today.

As war rages, we’re standing in the crumbling ruins of the academic Left

Monday, Oct. 23, 2023

“Israel’s response to Hamas’ massacre is understandable. But I can’t help thinking a more centrist Israeli government might’ve led to peace talks sooner, thereby avoiding thousands of innocents’ deaths and a full scale war.

Unfortunately, warring is an extremist game, and we’re dealing with extremists.”

Solange

“Open, civil, fair, and democratic societies that value a free market of ideas, of which universities should be the epitome, are best positioned to keep such power-seekers in a place commensurate with the quality and appeal of their “ideas”. That is, forever at the very margins.”

Rob Tyrrell

Israel’s civic strength in response to the Hamas attacks should stiffen Canada’s spine

Tuesday, Oct. 24, 2023

“I think Canada should have offered Israel peace keeping units to assist on their Northern border as an added deterrent to Hezbollah and a not the symbolic we stand with “Israel to defend itself” with the caveat to do so in “accordance with International law”.”

Mike Ruddell

“While Israel is not without fault, the root cause of this 75 year Nakba is the failure of the Palestinian leadership to accept reality and put their people first. There is no reason that the Palestinians should not have a standard of living, education, a welfare system, and the hope that Israeli children aspire to.”

Ned

‘I knew I had to get back as soon as possible’: Why this Canadian-based Israeli hurried back home to fight in the war

Wednesday, Oct. 25, 2023

“We did, however, keep some details from the kids and instead said that I had to go back home to help my mother who lives in Ashdod.”

Heartbreaking but heroic stuff. This piece really underscored to me the extent to which Israel really is the Jewish people’s only option and they won’t, with good reason, let it fall or fail.”

Luke Smith (Deputy Editor, The Hub)

Censuring an NDP MPP for pro-Palestine comments is not a free speech issue

Thursday, Oct. 26, 2023

“True, Hamas committed heinous crimes but that doesn’t absolve the Israelis from the madness they are following in the name of self defense. To block humanitarian aid, to displace millions of people and deny them the basic needs for life, is not defense. We might not like what we hear when Israel is criticized but when a government or party silences a member, it is a strike against free speech and each strike weakens that right until it no longer exists. When social conservatives speak out against inclusion or threaten the well being of the transgendered, as in Saskatchewan or New Brunswick, no one questions their right to say what they think even if it is harmful. It is either free speech for all or no free speech at all. Let Jama have her say but work to show that it is not what the party believes. There is a danger when government censures members.”

A. Chezzi

“I am concerned about the potential for overreaction as those supporting Israel could adopt the cancel culture tactics successfully wielded by the social justice movement in recent years. Limits on free speech, even informal ones imposed by society at large, need to be very cautiously applied. If someone is concerned about free speech in other cases, such as parents being shut out at School Board meetings for questioning gender ideology or critical race theory inspired lessons, he or she should also be concerned about the free speech of even those they disagree with strongly.

However, there can be point at which speech has consequences. I would say the promotion or endorsement of violence (actual violence; not the imaginary kind) should be where that line is drawn.”

Gordon Edwards

The Left has a self-policing problem

Friday, Oct. 27, 2023

“In this particular case, it is unclear to me whether this issue of antisemitism is a left or right issue. May be it is a broader social issue, independent of political or social stripe. But with respect to the current conflict in the middle east, it is my point of view that we need to distinguish between three parties here: Israel, Hamas, Palestinians. Hamas is of course the terrorist group. Israel has clearly suffered from their attack. Based on the reports I have heard it appears Palestinians also suffer Hamas, and for many years. Palestine does not equal Hamas. Hamas does not equal Palestine. I think we need to be a little more nuanced in our understanding; I don’t assume people who voice concern about the Palestinian’s plight are supporting Hamas nor do I assume they are antisemitic. Bombing civilian populations is a questionable practice. Is it being proposed that two wrongs make a right?”

Bill Hertha

“The genesis of this Long March was obvious- to those willing to see – 20 years ago. It was apparent in things as simple as the speaker’s lists at teacher’s conventions, the radicalization of what once was a perfectly sensible LGBT movement, those chosen to lecture at journalism schools (as an aside I have offered my occasional services to those pro bono and been soundly rejected) etc. But none are so blind as those who will not see. Personally, and watching what can most politely be called the delicate response of our political class, I think it’s probably too late.”

Peter Menzies

If you enjoy The Hub, be sure to check out more insightful commentary on The Hub’s YouTube page: