When the federal government authorized health-care providers to deliberately end patients’ lives at their request, it entered the sort of unfamiliar policy ground that merits careful monitoring.
For more than two years since doctor-assisted-dying legislation was enacted, Canada has made do with an interim reporting system. It offers useful information, including the average age of Canadians who received a medically assisted death last year (73) and total number of approved requests since the law was enacted (3,714), but not nearly enough.
Finally, Ottawa this month unveiled more comprehensive regulations, to come into effect on Nov. 1. They’re a big and much-needed improvement, but still don’t go far enough in giving patients a chance to express contributing factors from their social lives and medical care that led them to decide their suffering was “intolerable.”
Starting next year, the government will have to prepare an annual report that includes data from each province on the nature of patients’ suffering, whether patients consulted about their health with other medical workers before requesting assisted death, and whether the doctors (in most cases) who provided them consulted with other health-care and social workers about the requests.
Useful though those figures will be in offering a sense of the scope of deliberations before decisions are made, they still fall short of where some other jurisdictions have gone in measuring whether social or medical factors that could potentially be mitigated contribute to lives being ended.
In Oregon, where assisted dying has been legal since 1997, the patient’s attending physician has to fill out a form saying whether a series of standard considerations led to the request. Such documentation most recently revealed, for instance, that “inadequate pain control or concerns about it” was a factor in 21 per cent of Oregon’s assisted deaths in 2017. And it provided further information about how many patients were swayed by the financial cost of other treatments, burden on family and loss of autonomy.
Were Canada to collect that sort of information as well, it could be invaluable in keeping track of whether vulnerable patients are choosing to end their lives for preventable reasons – and in ensuring it is never allowed to become a backstop for gaps in other care.