SACPA hears about medical assistance in dying experiences in context of rural living

The Southern Alberta Council on Public Affairs offered attendees an opportunity to learn about in what way Medical Assistance in Dying (MAID) experiences are different in the context of rural living on Thursday at its weekly session.

Associate professor at the University of Lethbridge, Faculty of Health Sciences Julia Brassolotto spoke about a study done on MAID in rural communities.

She said the idea came from attending a South Zone ethics committee meeting for Alberta Health Services that talked about MAID and how they have started to notice some differences between rural and urban settings.

“Maybe less access to information in some rural communities, maybe some different attitudes, but this wasn’t something that they really explored in depth. I had a research chair looking at rural health at that time and I reached out to her afterwards and said this is something I’d be really curious about exploring,” said Brassolotto.

She said her team looked into MAID laws and policies and highlighted some key rural considerations.

• “We looked at are these policies and these laws attentive to rural considerations? And the broad conclusion is that no, not really. So we published those results,” said Brassolotto. She said her team also looked at academic literature on MAID and found that people were sometimes speculating about what MAID might mean in rural communities. But people were not actually going out and interviewing folks in rural communities about their experiences.

• “We thought this was an important gap. We wanted to probe this because rurality is a significant and often overlooked determinant of health, it has lots of implications for our health and well-being where we live,” said Brassolotto. She said some concerns highlighted in the literature her team found revolved around fewer health services available, fewer social services and greater distances to travel in rural communities.

• “There was a bit of a concern that people might turn to MAID as a default option,” said Brassolotto.

During their study her team went out to rural communities and talked to people who one way or another have been involved with the MAID program. She said this included people from different categories, including family members of those who had used the program, health care professionals and people who had requested MAID but were waiting for the right time to use it,

“We had nine nurses, seven physicians, two clinical ethicists, eight family members and three patients. This was also done during peak COVID so it was a challenging time in healthcare, so we were very fortunate to get this many people who were able to meet with us,” said Brassolotto.

She explained the study found three specific findings: Emplacing MAID, the specifics of southern Alberta, getting into the fact that context matters, and the specifics of place really informed people’s thinking and experiences. Secondly, the realities of the relational rural, looking at the fact that relationships and close connections are an important part of rural living. And thirdly, the notion of working with what you’ve got when there may be fewer services or resource in a rural community than there are in a bigger setting.

While explaining this more in-depth to the audience, Barssolotto said when it comes to emplacing MAID in Southern Alberta they looked into the influence that the reputation or culture of the region has on people’s experiences and expectations, the connection to ranching and farming and how that informed people’s thinking about MAID and the rural landscape itself and what that meant to people.

In regards of the realities of the relational rural, Brassolotto shared the dual roles some members of a small rural community played within it were considered an asset of rural care provision as this made it easier for patients to go through it because of the trust in their known providers, and in turn, it made it easier on providers to care for their patients knowing their personal stories.

She said that while those were assets, living in a smaller community where everyone knows each other also brings challenges including stigma for using MAID, fear of backlash, and a need to balance transparency and confidentiality when it comes to documentation of the process.

She said in rural communities they deal with a small number of participating health care workers in MAID, while also dealing with a general shortage of physicians and nurses. Rural communities also find it challenging to access palliative care, chronic pain support and that created a worry about many turning to MAID as a solution.

“In conclusion our findings confirmed, refined and challenged some of the ideas from the existing literature there are some difficulties in rural, but there are also some real assets. We found that place matters and that rurality is significant for social and geographic reasons, and as a result we suggested that policies and service provision should be more context- sensitive,” said Brassolotto.

She said they understand the need for federal and provincial policies, but within that, providers might need special supports depending on their context, things that address anonymity, things that address the grief that comes with providing for someone you know personally.