Lack of palliative care pushing Quebecers toward medically assisted death, College of Physicians says

Quebec's College of Physicians says a lack of doctors and uneven levels of palliative care service across the province has left some patients with little choice but to ask for medical help to die.

'Patients ... could have had no other choice but to ask for medical aid in dying to end their days in dignity'

Quebec's College of Physicians says a lack of doctors and uneven levels of palliative care service across the province has left some patients with little choice but to ask for medical help to die. (Shaun Best/Reuters)

A lack of palliative care services in parts of Quebec may be forcing patients to choose medical aid in dying as a way to end their lives with dignity, says Quebec's College of Physicians.

In a letter sent to Quebec Health Minister Gaétan Barrette this week, the group said Quebec is suffering from a lack of specialized, palliative care doctors and uneven levels of service are being offered across the province.

"Patients, failing to benefit from such care, could have had no other choice but to ask for medical aid in dying to end their days in dignity," the letter reads.

The college said patients requesting medical aid in dying are getting priority access to available resources, "to the detriment of other patients" at the end of their lives.

"Palliative care cannot be limited to access to medical aid in dying," its letter reads.

The group's president, Dr. Charles Bernard, said fewer physicians and medical professionals have chosen to specialize in palliative care over the last two years.

"We are getting worried," Bernard told CBC News.

"If we don't recruit and if we don't give a little help, in a few years from now, we will have a real problem."

In 2016, the first year after Quebec's medical aid in dying law took effect, a total of 461 patients were granted doctor-assisted death.

Quebec Health Minister Gaétan Barrette's cabinet said the province's palliative care plan has led to an increase in the number of people accessing services at home. (Jacques Boissinot/Canadian Press)

More access to home-based care, ministry says

In a written response to Radio-Canada, the health minister's office said it wanted to "qualify the college's presumptions."

The province's palliative care plan, launched in 2015, has led to an increase in the number of people accessing services at home, it said.

When our patient tells us, 'because I don't have enough help at home, because I'm stuck at a hospital, I'm going to request medical aid in dying,' doctors are uncomfortable.- Dr. Christiane Martel, president of the Quebec Society for Palliative Care

Speaking to reporters in Quebec City on Thursday, Barrette said the province's five-year palliative care plan is progressing at a good pace.

The priority for the government has been to ensure there are enough beds for patients in need, Barrette said.

He said some changes might be considered to make doctors feel more comfortable when offering palliative care, but he did not specify what those changes could be.

"What I care about today, first of all, is whether our rules are being respected," Barrette said.

"Is the procedure, at that moment [in a patient's life], being carried out humanely, with dignity? All the reports we have, all the comments we've received, [are positive] in that sense, and I say bravo to those working in the field."

Radio-Canada reported 24,000 people accessed palliative care at home in 2017-2018, compared to 22,000 in 2014-2015.

However, the Quebec Society for Palliative Care said the province's plan has resulted in uneven access to support.

"In some places, there are improvements. Sometimes, it's stagnant. And, in some places, it's deteriorating," the group's president, Dr. Christiane Martel, told Radio-Canada.

Martel agreed with the college's letter, saying deficiencies in the system can lead patients to opt for medical aid in dying.

"When our patient tells us, 'because I don't have enough help at home, because I'm stuck at a hospital, I'm going to request medical aid in dying,' doctors are uncomfortable," she said.

Dr. Elisa Pucella of the Maison des soins palliatifs de Laval says the system must meet patients' needs in order for a dying patient to make an informed decision as to what end-of-life treatment works best for them. (Verity Stevenson/CBC)

Most palliative care recipients in Montreal

According to Quebec Health Ministry data compiled by Radio-Canada, the Montreal area had the highest number of palliative care recipients from June to December 2017, with 5,833 people accessing services.

The Montérégie region counted 5,029 people accessing palliative care over that same period, followed by the Quebec City region, with 3,391 patients.

The numbers drop off after that — with 1,348 patients accessing care in the Laurentians, 1,044 in Laval, 621 in Abitibi-Témiscamingue and only 52 in Quebec's north.

"We see that people don't have access to palliative care, or [the services] are poorly organized in their region," reads the college's letter.

Dr. Elisa Pucella, a palliative care physician at the Maison des soins palliatifs de Laval, said the system must respond to patients' needs for Quebecers to be able to make an informed choice as to what end-of-life treatment works best for them.

"The person has to have a true choice, and certainly, [we must] not make the situation worse by [a] lack of care," Pucella told CBC News.

Based on a report by Radio-Canada, with files from CBC's Verity Stevenson