Nav: Home

MAiD is not driven by socioeconomic vulnerability or poor access to palliative care

February 12, 2020

A new study of people who received medical assistance in dying (MAiD) in Ontario found that about three-quarters were cared for by palliative care practitioners at the time of their request for MAiD, and MAiD recipients were younger, wealthier and more likely to be married than the general population at time of death. These findings dispel 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. http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200016

MAiD was legalized in Canada in June 2016, and as of October 2018, 6749 Canadians received MAiD.

The federal government and the government of Quebec are currently in consultation around drafting new eligibility criteria for MAiD, after 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 The Ottawa Hospital and University of Ottawa, Ottawa, Ontario. "Since this study represents the comparison of MAiD recipients to all deaths overall, and uses Canadian data, it could help inform this discussion and the upcoming legislation."

Researchers analyzed clinical and socioeconomic data from 2241 Ontarians who received MAiD, and compared this with data from all 186 814 people in the province who died between June 2016 to October 2018, from databases kept by the Office of the Chief Coroner for Ontario and ICES. Among those who received MAiD, the median age was 75 years and half were women; almost two-thirds of patients (64%) had cancer, 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 psychologic (96.4%) suffering.

"[W]e found that people who chose MAiD reported physical or psychologic suffering as the primary reason, despite engagement of palliative care in [77%] of patients, which suggests that for many patients the MAiD requests were not because of poor access to palliative care," write the authors.

Almost half of MAiD recipients 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, which suggests that MAiD requests are unlikely to be driven by social or economic vulnerability, say the authors.

Requests for MAiD can be emotionally difficult for patients and families, and any delays can exacerbate distress. The study found that only 6.6% of families reported challenges with access to MAiD and these delays were not associated with socioeconomic status. The authors noted, however, that the MAiD data set included only people who actually received MAiD, so these findings would not reflect the experience of patients who requested MAiD but never received it.

"The data presented here do not address the moral question of whether any amount of suffering can justify the hastening of death. However, the growing trend toward legalization and use of MAiD in many parts of the world should prompt the health care and research community to improve our understanding and treatment of the type of distress that leads to a MAiD request," the authors conclude.

In a related editorial, Dr. Andreas Laupacis, CMAJ's editor-in-chief, writes, "Downar and colleagues' findings should allay fears that people living in Ontario are choosing MAiD because they have little social support or have poor access to health care. This study found the opposite, which suggests that more attention needs to be paid to ensure that those who are socially or economically vulnerable and eligible for MAiD are aware that MAiD is an option." http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200213

He cautions that as we move into a new era in which the Canadian government is considering expanding eligibility to MAiD to minors, people with severe mental illness and to those who anticipate losing the capacity to request MAiD in future, Canada will need new safeguards.

"If access to MAiD is expanded, new safeguards, specifically tailored to each new indication for MAiD, should be put in place. Then, we must once more proceed with caution, measure carefully and reassess," concludes Dr. Laupacis.
-end-
Podcast permanent link: https://soundcloud.com/cmajpodcasts/200016-res

The study was conducted by researchers from The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario; Sunnybrook Research Institute, The Joint Centre for Bioethics, University of Toronto, Office of the Chief Coroner, Government of Ontario; Queen's University, Kingston.

"Early experience with medical assistant in dying in Ontario, Canada: a cohort study" is early-released February 12, 2020.

Canadian Medical Association Journal

Related Health Care Articles:

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.
Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.
Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.
MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).
Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.
International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.
The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .
Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.
High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.
Medical expenditures rise in most categories except primary care physicians and home health care
This article was published in the July/August 2017 issue of Annals of Family Medicine research journal.
More Health Care News and Health Care Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.