Medically assisted dying team in Manitoba doubles in size

The MAID team in Manitoba has expanded from three physicians to seven, including two now in rural communities, after more than 100 people contact the medically assisted dying group in less than a year.

More than 100 people have contacted the MAID team since February 2016; 4 doctors added in response

Dr. Brock Wright, chief medical officer for the WRHA, says medically assisted death services are being expanded. (CBC)

The Winnipeg Regional Health Authority has more than doubled the number of physicians involved in medically assisted deaths in Manitoba after more patients requested the help than the province initially expected. 

More than 100 patients have contacted the Medical Assistance in Dying (MAID) team with 24 receiving medically assisted deaths as of Jan. 6, according to statistics provided to CBC Manitoba by the Winnipeg Regional Health Authority.

In June, the federal government amended the Criminal Code with Bill C-14, which allows doctors and nurse practitioners to help patients with "grievous and irremediable" illnesses to die. In response, Manitoba set up its MAID team under the Winnipeg Regional Health Authority.

Manitoba Health Minister Kelvin Goertzen estimated in November that about a dozen patients a year would request MAID, but the number is already a lot higher.

According to the Winnipeg Regional Health Authority:

  • 102 patients or family members have contacted the MAID team as of Jan. 6.
  • 24 have received medically assisted deaths.
  • 28 died before completing the process.
  • 14 are actively going through assessment.
  • 18 were declined.
  • 18 made inquiries.

Dr. Brock Wright, senior vice-president and chief medical officer for the health authority, said the majority of the patients who were granted medically assisted deaths had cancer and were over 65. Nine died in a hospital, one in a hospice, and 14 chose to die at home with the help of a physician.

Of those who were turned down, five had mental illness with no other condition, said Wright.

"The rest were declined because they had a chronic illness but their death was not reasonably foreseeable."

Four doctors added

The Winnipeg-based MAID team serves the entire province, covering all five regional health authorities. All members of the team work on a part-time basis.

The province started to set up the medical assistance in dying team in February with three physicians, two nurses, two social workers and two pharmacists. It now has seven physicians, including three in rural communities, said Wright. He won't identify the smaller communities in order to protect the identity of patients. 

Two of the doctors are bilingual.

All seven physicians are "part of an evolving network of providers who are interested and capable of providing the service," Wright said. 

Another social worker also has been added, along with a speech-language pathologist, in case patients have difficulty communicating.

Rural outreach

Before the Criminal Code was amended, the College of Physicians and Surgeons of Manitoba held meetings to come up with a draft policy on how it would respond to assisted dying. There was talk about the possibility of a truck with a team that would travel to rural and remote communities.

Wright said while members of the team are travelling to rural and remote areas, they're not in a mobile unit.

"I wouldn't want to create that optic in the mind of the public. The MAID team is structured so it is capable of travelling outside of Winnipeg and it has, but the whole team doesn't go — one or two physicians, a nurse, a social worker and perhaps a pharmacist. They will travel to an institution, a hospital or someone's home," said Wright.

While he can't say where the team has gone because of privacy issues, it has been across the province and in northern communities, he said.

Conscientious objection 

Three faith-based hospitals in Winnipeg — St. Boniface, Concordia and Misericordia — have exercised their right to conscientiously object to providing doctor-assisted deaths. 

The Winnipeg Regional Health Authority is in discussions with personal care homes both inside and outside of Winnipeg to determine which are faith-based and will not provide doctor-assisted death, Wright said.

All of the facilities banning assisted dying have indicated they will respect the right of patients who chose MAID and will provide timely information, he said. 

Tracking the cases

Medically assisted deaths are being tracked by the health authority, and amendments to death certificates have been approved to indicate the person died as the result of assisted dying, Wright said. 

"The death certificate now does enable you to differentiate and determine it was in fact an assisted death. It was an issue early on but it has now been resolved," said Wright. 

The WRHA is also working closely with the University of Manitoba to develop medical educational modules on assisted dying for medical students.

The modules are not mandatory for medical students, Wright said.

The federal legislation also allows nurse practitioners to deliver medical assistance in dying, but there are none in Manitoba providing the service at this time, Wright said.

He said if any nurse practitioners were interested in participating, the province would have to address some issues such as the fact that they can't sign death certificates.

Last option

Wright said when medically assisted dying was legalized, it heightened everyone's awareness of the need to ensure access to adequate palliative care.

Patients applying for MAID are given two separate assessments and every option is considered, he said. The patient has to be mentally competent and a request has to be made in writing.

"The team turns over every rock to make sure every other option has been made available to the patient, that the diagnosis is clear, the treatment options have been provided, and with respect to the suffering, to know they have access to palliative care," said Wright.

"You would never want a situation where a patient is opting for MAID and would not have made that choice if they had access to palliative care."