The number of people reaching out to the special team that delivers assisted death in Manitoba has significantly grown since July.
Eighty-five people have contacted the Medical Assistance in Dying (MAID) team from July to Oct. 10, with 14 receiving medically assisted deaths, according to numbers from the Winnipeg Regional Health Authority.
That three-month period nearly matches the 99 people who contacted the team in all of 2016.
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There has been a steady increase since a Supreme Court of Canada decision threw out Canada's laws barring physician-assisted death Feb. 6, 2015. Following that decision, but before Bill C-14 governing medical assistance in dying passed on June 17, 2016, three Manitobans received a physician-assisted death, but it was a long process involving petitioning the court for approval.
In response to the law, Manitoba set up its MAID team under the Winnipeg Regional Health Authority. While the team is Winnipeg-based, it serves the entire province, covering all five regional health authorities.
The number of requests rose quickly after the law came into place and in 2016, 24 people received medically assisted deaths.
At the start of this year the MAID team doubled in size to seven physicians to deal with the demand. It also includes nurses, social workers, pharmacists and a speech-language pathologist, in case patients have difficulty communicating.
All members of the team work on a part-time basis.
So far this year, 237 people have contacted the special team, with 44 receiving medically assisted deaths.
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Of those who contacted the team this year, a significant amount were just inquiring, not necessarily requesting MAID, and 49 were rejected because they didn't meet the criteria outlined in the federal legislation.
Under the law, a person must be 18 years or older, have a serious and incurable illness, be in an advanced state of irreversible decline, endure physical and psychological suffering that's intolerable. Their death must also be reasonably foreseeable.
'They don't have to wait'
Dr. Kim Wiebe, administrative lead of MAID, said particularly at the beginning, people were contacting them when they had mental illness, had lost capacity to make medical decisions for themselves or their natural death wasn't foreseeable. Now that more information is in the public, the number of people being declined has dropped, she said.
"Most people who contact us now do meet criteria," she said.
Seventy-three people who contacted the team died without MAID's help. Wiebe said it's not because the process is too long, it's because people think they have to be in their final weeks to get in touch with the team.
"They can start the approval before they are in the final weeks of life. Their natural death has to be foreseeable, but they don't have to wait to contact us until they are in the final weeks of life," she said.
The process generally takes a minimum of two weeks from when the MAID team is contacted to the earliest date a person could choose to have an assisted death. There is a 10-day waiting period mandated within the legislation.
Patients can have approval but then not use it for an extended period of time based on their own preference.
Of the people who died without MAID's help, many started the assessment process too late, some changed their minds and withdrew the request and others lost capacity to make the decision during the assessment process, Wiebe said.
More women getting medically assisted death
It's too early to really point to any trends, Wiebe said, but the MAID team has seen a drop in medically assisted deaths over the summer months, with more people choosing to do it in the fall.
"Several people shared with us that they were hoping to be able to tolerate their suffering for a few more weeks to enjoy a bit of summer," she said.
There are also more women going through with the medically assisted death in Manitoba than elsewhere in Canada, she said. About 65 per cent of all the deaths in Manitoba have been women, compared to just under 50 per cent for the whole country.
But, like the rest of the country, the vast majority of people seeking help to die in Manitoba have terminal cancer. The rest are people with motor neuron diseases like ALS or end-stage heart failure or lung disease.
While more people are seeking medically assisted death, Wiebe said the MAID team is equipped to respond.
"Our experience to date has been that nobody has died because the process itself is taking too long," she said.
Data brings more questions: advocate
While the numbers from Manitoba's MAID team are on par with most of Canada, the lack of detail brings up more questions, said Shanaaz Gokool, CEO of Dying with Dignity Canada.
She pointed to the people who died without MAID's help and said there's not enough information to reassure her that the patients did not face any barriers trying to get care.
"Some of the information and the statistics just don't tell us enough information and they raise more questions," she said, adding regions across the country are facing the same issue.
She pointed to faith-based hospitals, like St. Boniface, which will not allow medically assisted deaths on site, and what issues that may have caused with people getting information or support in a timely manner.
Over the summer, St. Boniface updated its policy to allow the MAID team to assess patients on-site following a controversial revote that held up the ban on medically assisted dying, leading to multiple resignations.
"What happens when you have trouble getting a referral to the MAID team? What if you are in a hospital that doesn't want to provide? Are there roadblocks?" Gokool asked.
In general, she said Manitoba's MAID team is doing a good job but she hopes there is capacity to expand as medically assisted dying becomes more normalized. In Canada, so far, less than one per cent of all deaths are from medically assisted death, she said.
"I suspect as more people become aware that it's allowed, as more clinicians start to come on board in terms of assessing and providing, that we can expect to see an increase in the numbers," she said.
"People really need to understand what their options are so they can make the best decision that is suitable to them in their circumstances."