As support for euthanasia grows across the country, the line between genuine and holistic palliative care and medical assistance in dying has become increasingly blurred nearly inconclusively according to palliative care professionals in Canada.

“There are a lot of misunderstandings about what palliative care actually entails,” said Rebecca Vachon, Health Program Director at Cardus. “People don't want it because they think that means we're giving up, which is not the case. It can be used in parallel with curative treatments and help mitigate side effects and things like that.”

 The concept of medical assistance in dying (MAiD) was introduced in Canada back in June 2016, when Parliament passed legislation that allowed eligible adults to request medical assistance in dying. From there, the slope has only gotten more slippery.

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While the delivery of healthcare is still the responsibility of each province or territory, the federal law in Canada defines MAiD as legal, requiring the service to be available in every jurisdiction in the country. Once again, the term “available” is left to the hands of provincial regulators, making things increasingly unpredictable and difficult to pin down to an exact definition.

“It depends on what province you are in,” Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition confirmed. “From the very beginning, British Columbia decided that if you are not receiving government money unless you're religiously affiliated, you must provide MAiD. Not that employees must do it, but that they must have the provision offered.” 

“The whole orientation of palliative care is to care for the person, the symptoms and care for them with dignity. When you add in euthanasia, which is actually killing, it changes the whole orientation of what palliative care is about and that is becoming a serious problem.”

As outlined by Vachon and others, forcing MAiD recommendations while the service continues to be lumped in with existing methods of palliative care, which already have pre-existing inadequacies, could be doing more harm than good to Canadians according to experts.

 “The other reason we don't accept MAiD as part of palliative care is because we see this time in life as being extremely important and meaningful for people. We feel that when people say "well you're dying anyways..." it devalues this time and devalues these people's lives. (We want to) make the best of this time rather than throw it away,” said Romayne Gallagher, a fellow palliative care specialist. “Our medical principles present before Christianity, say that we do not poison people, nor do we encourage them to poison themselves.”

Gallagher, who last worked as a physician at Providence Healthcare Hospital in Vancouver, also argued that the vast majority of problems with the current MAiD model stem from the blurred lines between palliative care and euthanasia, including when it comes to patients of all ages.

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While the government did institute the National Framework and the Action Plan in 2018 and 2019, they didn't establish an exclusive right to palliative care, meaning that there is a legal duty to provide access to MAiD, but not for palliative care.

“Patients have told palliative care providers that they were more fearful when the doctor suggested MAiD, as the doctor made that suggestion because they knew they would have a hard time with the illness. People who are fearful and have little experience with illness may take this as a suggestion rather than an option,” Gallagher said, speaking to the dangers of confusing the two options.

As Vachon and fellow senior Cardus member and palliative care specialist Dr. Leonie Herx stressed in an op-ed written for The Hub, MAiD is now functioning as a casualty to palliative care, rather than the initially promised safeguard.

“Part of the process of informed consent to receive MAiD was predicated on being offered palliative care. In this way, describes legal scholar Dr. Mary Shariff, palliative care became part of the safeguards for MAiD. However, without actual meaningful access to palliative care at an appropriate time, which is at the time of the diagnosis of a life-limiting or life-threatening illness or condition, this safeguard is largely meaningless,” the article reads. “It is far too little and too late to mention palliative care only after a patient has already asked to be killed due to feeling that their suffering—whether physical or existential or their fear of future suffering is too great to bear.”

Through Cardus, Vachon has also voiced concerns over the state of pediatric palliative care due in part to a lack of accessible care for children combined with the growing culture of MAiD in Canada. These concerns were highlighted in a research report this February.

There, she reveals that too many Canadian kids who need palliative care are not receiving it, highlighting that as of November 2023, the Canadian Network of Palliative Care for Children identified PPC programs within thirteen urban hospitals and eight urban pediatric hospices. That leaves Canada with zero PPC programs listed as available in any of the country's territories, and only one in all of Atlantic Canada.

“The rapid adoption of euthanasia and assisted suicide in Canada, however, makes the issues of accessible and quality pediatric palliative care more critical, as the public conversation has begun to consider expansion of MAiD for “mature minors,” that is, children deemed capable of consent,” Vachon wrote. “Given the problems in the existing provision of PPC noted in this report, Canadians must ensure that children with serious illnesses or conditions do not feel that MAiD is their only option.”

Both Gallagher and Vachon feel that MAiD is not being pushed as a direct replacement for palliative care, but rather that the increase in MAiD attention in combination with lacking support for holistic palliative care is what is causing the illusion of a takeover.

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“I believe there is a huge push to convince people that MAiD is no different from palliative care and that it is a "tool in the toolbox of palliative care,” Gallagher said. “Most palliative care providers are against this, as the principle of palliative care since its inception 60+ years ago was that it neither hastens nor prolongs death.”As the expansion of MAiD continues to develop across the country, the work of organizations like Cardus is working diligently to provide clarity around the dividing line between care that provides assistance in living, and one which deliberately causes death.

“We want to provide our information to policymakers to make sure that they understand what palliative care is and what it can offer. Hopefully providing better information can spark political will to address the needs that Canadians are experiencing so they don’t feel like they're in a place of unbearable suffering or afraid that they won’t have good, quality and timely palliative care access,” Vachon concluded.