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Letter to the Editor

Response to Letter to the Editor

Sera Whitelaw, MSc, Trudo Lemmens, LicJur LLM DCL, Harriette GC Van Spall, MD, MPH FRCPC

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To the Editor:

We would like to thank you for the opportunity to respond to the issues raised in Ms. Campbell and Dr. Lees’ letter and to clarify information in relation to these concerns.

Table 1 of our manuscript1 correctly listed the causes of intolerable suffering identified by individuals who received MAiD, as reported the Health Canada First Annual Report on MAiD.2 Our text listed and correctly quantified causes of suffering that could be addressed via palliative care and social supports. We also synthesized survey results from a study in British Columbia.3 The phrase, “the most commonly cited reasons” should read “commonly cited reasons”.

Of the 2223 MAiD recipients requiring disability supports, 89.8% received them according to the Health Canada First Annual Report on MAiD.2 Our interpretation was that the remainder (10.2%) did not receive supports, but in fact, 10.2% either had no documentation of receiving supports (6.3%) or did not receive them (3.9%).

As referenced within our text, the stat palliative care statistics were based on an analysis of the Health Canada First Annual Report on MAiD.4 According to this report, of the 5389 patients who received MAiD, only 82.1% received palliative care. The rest (17.9%) either did not receive any palliative care (16.2%) or had no documentation of receiving palliative care (1.7%). Among those who received palliative care, 19.3% received it less than 2 weeks before they chose to die, which many would argue is inadequate.4 While we agree with the authors that a proportion of people may have declined palliative care, it is also true that an unacceptably large proportion of people receiving MAiD either did not receive any palliative care or received it only in the last days of life, arguably inadequate.4

Our call for equitable access to compassionate and high-quality care is a counterpoint to paternalism. It is meant to ensure that all patients, including those who are historically marginalized in our healthcare system, receive medical therapies and health services to enhance their quality of life. Meaningful autonomy in decisions about ending life requires, at a minimum, the availability of reasonable alternatives. As recent media reports have all-too powerfully exemplified, when the state offers fast-track access to death without sufficient support for a dignified life, the core conditions for autonomous choice are lacking.5-8

We thank the authors for their thoughtful comments.

Sincerely,

Sera Whitelaw, MSc

Trudo Lemmens, LicJur LLM DCL

Harriette GC Van Spall, MD MPH FRCPC

REFERENCES

1. Whitelaw S, Lemmens T, Van Spall HGC. The expansion of medical assistance in dying in the COVID-19 pandemic era and beyond: implications for vulnerable Canadians. Can Journ Gen Int Med. 2022;17:17–21.

2. Government of Canada. First annual report on medical assistance in dying in Canada 2019. [cited 2022 July 14] Available from: https://www.canada.ca/content/dam/hc-sc/documents/services/medical-assistance-dying-annual-report-2019/maid-annual-report-eng.pdf.

3. Wiebe E, Shaw J, Green S, Trouton K, Kelly M. Reasons for requesting medical assistance in dying. Can Fam Physician. 2018;64:674–679.

4. Gallagher R. Lack of palliative care is a failure in too many MAiD requests. [cited 2022 July 14]. Available from: https://policyoptions.irpp.org/magazines/october-2020/lack-of-palliative-care-is-a-failure-in-too-many-maid-requests/.

5. CTV News. Woman with chemical sensitivities chose medically-assisted death after failed bid to get better housing. [cited 2022 July 17] Available from: https://www.ctvnews.ca/health/woman-with-chemical-sensitivities-chose-medically-assisted-death-after-failed-bid-to-get-better-housing-1.5860579.

6. CTV News. ‘Easier to let go’ without support: B.C. woman approved for medically assisted death speaks out. [cited 2022 July 17] Available from: https://bc.ctvnews.ca/easier-to-let-go-without-support-b-c-woman-approved-for-medically-assisted-death-speaks-out-1.5937496.

7. CTV News. Woman with disabilities nears medically assisted death after futile bid for affordable housing. [cited 2022 July 17] Available from: https://www.ctvnews.ca/health/woman-with-disabilities-nears-medically-assisted-death-after-futile-bid-for-affordable-housing-1.5882202.

8. CTV News. Ontario woman enduring effects of long COVID begins process for medically assisted death. [cited 2022 July 17] Available from: https://toronto.ctvnews.ca/ontario-woman-enduring-effects-of-long-covid-begins-process-for-medically-assisted-death-1.5976944.