Province must provide better palliative care, conference told

A nurse practitioner is worried people might consider medically assisted dying (MAID) as a last resort because of the lack of palliative care services in Saskatchewan.

“Will people be desperate for MAID just because they aren’t able to have quality of life?” asked Maureen Klenk of Regina.

“Palliative care is symptom control for quality of life. If we can’t do that, what are our options as individuals?”

There’s a problem when MAID is more accessible than palliative care, said Dr. Trish Hizo-Abes, a palliative care physician who splits her time between Saskatoon and Windsor, Ont., and is a clinical assistant professor at the University of Saskatchewan.

There must be a true choice between the two options, she said.

“MAID has arrived and there is a push to make it accessible, but the same push did not happen for palliative care,” Hizo-Abes said. “I think it’s problematic when the option for MAID is easier, it’s more accessible and it’s cheaper.”

One benefit of MAID could be patient-directed care, Klenk said.

“Ultimately, we need to enable the people in Saskatchewan to direct their own care and MAID does that,” she said.

However, she noted the criteria around the new law, passed on June 17, 2016, is challenging.

To qualify for MAID, people must be 18 or older and mentally competent, be eligible for health services funded by a provincial or the federal government, have a grievous and irremediable medical condition, make a voluntary request that isn’t the result of outside pressure and give informed consent.

“We don’t have a lot to base our decisions on from a historical perspective,” Klenk said. “We don’t have a lot of evidence.”

Under the law, a doctor or nurse practitioner must determine if a person is eligible for MAID according to all of the criteria.

A second physician or nurse practitioner must provide a written opinion confirming the patient qualifies.

It might be challenging to find an independent practitioner in rural or northern areas of the province, Klenk said.

“We don’t want to add more stress to the individual making the request for MAID,” she said. “If they live in Wollaston Lake, and there is only one provider, who pays the expense to bring the other provider there?”

That’s one of many unanswered questions.

“Can it be done over the phone, can it be done by Skype — I don’t know how that’s going to play out and I haven’t seen any rules and regulations around that come forward yet,” Klenk said.

She hasn’t been asked to provide medical assistance in dying.

“You never know until you’re faced with that, but I believe I would,” Klenk said.

Hizo-Abes has had a few requests for MAID, but she’s referred them to other physicians.

“My perspectives are changing almost daily,” she said.

“Before I get to the point where I’d consider helping a patient complete MAID, I would have to see a lot of change in terms of what’s available in palliative care and supports for them before that would even cross my mind.”

Klenk and Hizo-Abes spoke Thursday at a conference held in Regina by the Saskatchewan Seniors Mechanism (SSM).

The conference featured a number of presenters who provided information about MAID from legal, medical, personal and caregiver perspectives.