UNBC faculty consider the implications of physician assisted dying

Two UNBC faculty members are looking into the possible repercussions of the upcoming legalization of physician assisted dying in Canada.

Dr. Shannon Freeman, who teaches at UNBC’s School of Nursing, assessed the records of 4,840 palliative home care clients and her study could have big implications for impending federal legislation.

Dr. Freeman found that, of the palliative care patients she studied, nearly 7% expressed a voluntary wish to die. She says who those patients are might surprise people.

“I think one of the most important findings that we had was that pain was not the most strongly associated factor predicting persons expressing a wish to die now. I think that’s a really important thing.”

Last year, the Supreme Court of Canada ruled that competent adults experiencing “unbearable suffering” due to serious, incurable medical conditions should be granted access to physician assisted dying.

So far, discussion around the issue has focused on pain and suffering as the main factor justifying physician assisted dying. But, according to Dr. Freeman’s findings, not all who might want a physician’s help in dying experience unbearable pain.

“A lot of persons who expressed a wish to die now were not experiencing intolerable levels of pain and suffering or high levels of psychosocial distress.”

Dr. Freeman says those expressing a voluntary wish to die had varied reasons for doing so. She says she found two main groups during her review. One group, 23.8% of those wishing to die, had symptoms of depression and were more likely to be experiencing cognitive impairment and weight loss. They were also more likely to have a less positive outlook on life and to be “struggling with the meaning of life.”

The second group is probably the more surprising, in many ways. These people were more likely to be unmarried or to be widows/widowers. They were also more likely to have a worse prognosis (less time left to live) and to be experiencing functional impairment such as loss of mobility. They also reported excessive sleep and feeling “a sense of completion” regarding matters in their life.

“The results of these studies show it can really mean different things for different people,” says Dr. Freeman. “It’s so important that there’s further conversation to better understand the whole person and what factors are affecting them and what are their motivations and reasons behind why they are expressing that wish to die.”

Dr. Freeman’s findings could add interesting insight into who is likely to ask for access to physician assisted dying when it becomes legal later this year.

But what if they can’t get to a doctor?

Catharine Schiller, a nurse and lawyer who also teaches at UNBC’s School of Nursing, says that could be a reality for many sick people living in rural communities.

“It may not be feasible to start asking the health care providers who can provide this option to start travelling all over the country. What options are there? Are there things like telemedicine that could help make these kinds of assessments?”

The Supreme Court’s ruling seems to imply that aid in dying would only be provided by physicians. But Schiller says many rural communities don’t have a doctor, relying instead on nurse practitioners for care.

“How do we access those people and how can we ensure that there is fair and equitable access to people?,” asks Schiller. “Because if you are in the end stages of an illness, the last thing you want to have to do is travel to the nearest big city to find somebody to help you.”

Schiller says the federal government will need to be specific about who can provide aid in dying and ensure the option is open to all Canadians.

“We need to have clarity on who can be involved in providing this option and what protections there are for the other health care team members who are part of that provision of care.”

She says a holistic and realistic look at medical care in Canada will be needed to draft appropriate, comprehensive legislation on the issue.

“We need to start thinking really creatively to make sure that whatever end of life care strategy we put into place is appropriate and accessible for people in various situations across the country, not just those in urban settings.”

The federal government is expected to present its legislative framework regarding physician assisted dying in June. Aid in dying is already an option for some patients in Quebec.

You can read Dr. Freeman’s article in BioMed Central here.