Medical Assistance in Dying is not driven by socioeconomic vulnerability or poor access to palliative care
A new study of people who received medical assistance in dying (MAiD) in Ontario found that about three quarters were followed by palliative care at the time of their request for MAiD, and recipients were younger, wealthier, more likely to be married and substantially less likely to live in an institution than the general population at time of death. These findings call into question common concerns that MAiD requests are driven by lack of access to palliative care services, or by socioeconomic vulnerabilities.
The article is published in CMAJ (Canadian Medical Association Journal) along with a related editorial.
MAiD was legalized in Canada in June 2016 and as of October 2018, 6749 Canadians have received MAiD.
The federal government and the government of Quebec are currently in consultation around MAiD and the drafting of new eligibility criteria following a decision of the Quebec Superior Court that one provision of the previous laws violated the Canadian Charter of Rights and Freedoms.
“There has been and will be much discussion about socioeconomic vulnerability and access to palliative care, and how these factors influence requests for MAiD,” says Dr. James Downar, lead author of the study and a specialist in critical care and palliative care at uOttawa and The Ottawa Hospital. “Since this study represents the largest published study comparing MAiD recipients to all deaths overall, and is Canadian data, it could help inform this discussion and the upcoming legislation.”
Researchers analyzed clinical and socioeconomic data from 2241 people who died following MAiD, and compared this with data from all 186 814 Ontarians who died between June 2016 to October 2018, using databases kept by the Office of the Chief Coroner for Ontario and ICES. Among those who died following MAiD, the median age was 75 years and half were women; almost two-thirds of patients (64%) had cancer, and 12% of patients had neurodegenerative disease, 8.5% had cardiovascular disease and 7.5% had respiratory disease.
Patients who received MAiD reported both physical (99.5%) and psychological (96.4%) suffering. Palliative care providers were involved at any point in 77% of patients and with 74.4% of patients at time of their request for MAiD.
“We found that everyone who received MAiD reported either physical or psychological suffering or both, even though palliative care was involved at the time of the request in about 3 quarters of cases. This indicates that for most patients, the MAiD requests could not have been due to poor access to palliative care,” write the authors.
Almost half (48.5%) were married and the majority (85%) lived in a private home before receiving MAiD. They were younger than people who did not receive MAiD and more likely to live in a higher income neighbourhood. The authors state that these findings suggest that MAiD requests are unlikely to be driven by social or economic vulnerability.