*Caitlin Lees is a member of the Canadian Society of Palliative Care Physicians and the Canadian Association of MAID Assessors and Providers. Julie Campbell is board member of the Canadian Association of MAID Assessors and Providers and a member of the clinical advisory committee for Dying with Dignity Canada.
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Dear Dr. Douketis,
Drs. Whitelaw and colleagues have unfortunately misrepresented statistics from the First Annual Report on Medical Assistance in Dying in Canada.1 The most cited reasons for intolerable suffering resulting in a request for MAID are loss of ability to engage in meaningful life activities (82.1%) and to perform activities of daily living (78.1%), not, as noted in the text, inadequate pain or symptom control.1
Further, the authors indicate that 10.2% of patients were without disability supports. In fact, of those who required disability supports, just 3.9% did not receive them, with 6.3% listed as ‘unknown.’1 It appears the authors may have conflated missing with known data to strengthen their argument.
Lastly, statistics regarding palliative care were inaccurate. It is not 16% of people who received palliative care for the first time less than two weeks before they chose to die, but 19.3%. Likewise, it is not 18% of patients who did not receive any palliative care prior to receiving MAID, but 16.2%. Importantly, of those 16.2%, 89.6% of them had access to palliative care but chose not to engage with the service.1 This last omitted statistic is certainly in keeping with our clinical experience, which is that some patients who opt for MAID are either already receiving excellent primary palliative care from a family physician or other healthcare provider, or simply have no interest in the service as MAID is their preferred mode of death.
While we do agree with the need to ensure high quality, equitable, and accessible healthcare and social supports for all, we fundamentally disagree with the overly paternalistic argument that the focus should be “improved services rather than further expanding MAID.” MAID and healthcare are not antithetical, rather, co-exist, such that an individual patient, vulnerable or not, is able to exercise their autonomy with regards to living and dying.
Julie Campbell MBA, MN, NP(PHC)
Dr. Caitlin Lees, MA, MSc, MD, FRCPC
Assistant professor, Division of Palliative Medicine, Dalhousie University
1. Government of Canada. First annual report on medical assistance in dying in Canada 2019. [cited 2022 June 25]. Available from: https://www.canada.ca/content/dam/hc-sc/documents/services/medical-assistance-dying-annual-report-2019/maid-annual-report-eng.pdf