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Forced to choose

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14th June 2018

A new report from Quebec picks up a recurring theme of patients being driven towards assisted suicide and euthanasia - now 'healthcare' - by a failure to provide wanted care and treatment

Forced to choose

Advocates of assisted suicide are always keen to stress that they wish to complement, rather than supplant, palliative care - yet time and again we find that after legalisation, patients are being steered towards the more cost-effective, resource-light option of assisted suicide in place of real care and treatment.

CTV in Canada reports that 'since Quebec's medical aid in dying law came into effect in 2016, doctors and workers say that access to palliative care has gone down, while patient requests for medical aid to end their lives have increased steadily.'

'"The issue of medical aid in dying is available to 100 per cent of the population and palliative care the resources are only available to 30 per cent of the population," said Teresa Dellar, Director of the West Island Palliative Care Residence.

'The Kirkland home has 23 beds, with physicians, nurses, and counsellors on site. However, just a third of its funding comes from the government, with the rest raised by the community.

'Doctors say that the lack of funding is forcing patients to seek medical help to end their lives.

'They claim there has been little communication with the provincial government on the issue.

'"We were promised there would be a plan for palliative care in Quebec and the commission asked for 5 years to develop this plan," Dr. Laurence Normand-Rivest said.

'"We're in 2018 and for now, there's no data that is publically accessible to the access of palliative care and no plan of intervention to serve the population."

'Since the legislation was passed two years ago, fewer doctors are entering the field.

'Quebec's College of Physicians has gotten involved, writing a letter to Health Minister Gaetan Barrette asking for more funds.

'"People are feeling a burden, financial stress, psychological stress and lack of autonomy," said Dr. Paul Saba, a family physician.

'"So what we want is to give people is…care and support."'

Quebec's legislation preceded the federal legislation prompted by a 2015 Supreme Court of Canada ruling - and the federal legislation is also causing problems for some patients. It was reported earlier this year that Roger Foley, of London, Ontario, who is living with 'limiting conditions, including cerebellar ataxia... a progressive condition affecting movement and speech', has initiated a legal challenge before Ontario Supreme Court, contending that his

'Charter rights have been violated through official "failures to relieve the plaintiff's intolerable suffering, [instead] providing the option of assisted suicide rather than assisted life." Foley's condition is in his own words "grievous and irremediable," the standard by which the Supreme Court judged medical assistance in dying is to be available to all. But while the condition is irremediable... that does not mean his life quality is unsustainable. With proper and qualified home aides and support Foley could live a safe and full if restricted life... Hospital officials threatened to bill him $1,800 a day for his hospital room if he would not return home to what he describes a substandard, injurious care. Alternately, they offered him medical aid in dying.'

The principle is well-established, with the much-lauded Oregon model providing stark examples:

'Barbara Wagner had recurrent lung cancer and Randy Stroup had prostate cancer. Both were on Medicaid, the state's health insurance plan for the poor that, like some NHS services, is rationed. The state denied both treatment, but told them it would pay for their assisted suicide. "It dropped my chin to the floor," Stroup told the media. "[How could they] not pay for medication that would help my life, and yet offer to pay to end my life?" (Wagner eventually received free medication from the drug manufacturer. She has since died. The denial of chemotherapy to Stroup was reversed on appeal after his story hit the media.)

'Despite Wagner and Stroup's cases, advocates continue to insist that Oregon proves assisted suicide can be legalised with no abuses. But the more one learns about the actual experience, the shakier such assurances become.' (Source)

As US states have replicated Oregon's model, so they have adopted its grave shortcomings. California passed its legislation in 2015; in 2016, the canon was once again extended, with The Washington Times reporting:

'Stephanie Packer, a wife and mother of four who was diagnosed with a terminal form of scleroderma, said her insurance company initially indicated it would pay for her to switch to a different chemotherapy drug at the recommendation of her doctors.'

'But shortly after California's End of Life Option Act, which authorizes physicians to diagnose a life-ending dose of medication to patients with a prognosis of six months or less to live, went into effect, Ms. Packer's insurance company had a change of heart.'

'She said she called her insurance company to find out why her coverage had been denied. On the call, she also asked whether suicide pills were covered under her plan.

'"And she says, 'Yes, we do provide that to our patients, and you would only have to pay $1.20 for the medication,'" Ms. Packer said.

'Ms. Packer said her doctors have appealed the insurance company's decision twice, to no avail. She said the assisted-suicide law creates an incentive for insurance companies to deny terminally ill patients coverage.

'"As soon as this law was passed — and you see it everywhere when these laws are passed — patients fighting for a longer life end up getting denied treatment, because this will always be the cheapest option," she said.'

'After the right-to-die movement began garnering national attention, Ms. Packer said she noticed a change in tone at her support groups for terminally ill patients. While the meetings were formerly positive and encouraging, she said the specter [sic] of suicide now hangs above them like a dark cloud.

'"And people, once they became depressed, it became negative, and it started consuming people," she said in the video. "And then they said, 'You know what? I wish I could just end it.'"'

The journal Palliative Medicine this month published a paper which

'presents the first national-level description of the duration of UK hospice-based palliative care prior to death. We found that over half of all patients were referred to hospice-based palliative care less than 7 weeks before death, and 40% were referred less than 30 days before death.'

The paper made headlines with its findings on regional variations:

'On average, patients in the North were referred to hospices 35 days before death compared to 55 days in the South, Midlands and East of England.'

'Researchers from the University of Leeds and palliative care charity Hospice UK said some adults with incurable conditions including dementia, liver failure and stroke were not receiving palliative care from hospices early enough.

'According to previous clinical trial research, patients with progressive diseases should be referred for palliative care between three and six months before they die to benefit fully.

'However, hospices have limited control over the referrals they receive from other health services, which can lead to patients being referred late or not at all, the report said.'

This paper is just the very latest example of how British healthcare would be no less vulnerable to repeating the experiences of other jurisdictions, where patients less able to access suitable care where assisted suicide is deemed 'healthcare' are steered towards death.

© Image copyright of 'duncan c' and licensed for reuse under Creative Commons License 2.0

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