In an editorial published in Gaceta Sanitaria, Dr. Emmanuelle Bélanger, assistant professor of health services, policy and practice at Brown University School of Public Health, along with colleague Mr. Pierre Deschamps, discuss the legislative context surrounding the decriminalization of medical assistance in dying passed by the Canadian parliament in 2016.
The researchers also discuss important public health questions regarding the implementation of medical assistance in dying in Québec and in Canada. An important research question concerns how palliative care services are managing requests and adapting to the practical implications of the new legislation. Requests for a hastened death are not uncommon in palliative care practice, and some have argued that exploring the reasons for these requests can contribute to alleviate distress.
There is also concern with differential access to both palliative care and medical assistance in dying across regions, which warrant more data and research. Countries that have adopted systematic and transparent assessments of end-of-life care practices should serve as an example, the authors argue. In the Netherlands, for example, a nationwide survey is conducted for a stratified sample of decedents every five years. Anonymous surveys can contribute to document the occurrence of practices that are not sanctioned by current laws and that may not be otherwise reported as part of standard documentation practices. Finally, the impact of medical assistance in dying on health care providers and family members remains underexplored in most countries, including Canada.
Medical assistance in dying is now part of the Canadian legal and medical landscape. Preliminary data show that a growing number of Canadians are choosing it as an end-of-life care option. Recent court challenges and the study of specific issues related to eligibility by expert committees might eventually lead the way to even more Canadians being eligible. Continued attention should be paid to the ways these new legislations are being implemented in different regions of Québec and Canada, the authors argue, and how they are shaping end-of-life care practices. Medical assistance in dying should not come at the expense of those who are most vulnerable and the impact on the resources dedicated to palliative care should be assessed, especially given that these services were deemed insufficient to meet the demand by those developing the new legislations.
This editorial was published by Gaceta Sanitaria.