Why don't more Ontario doctors provide medically assisted dying? It's not the money

While physicians in other provinces have raised the touchy subject of how much they should get paid for ending a life, Dr. James Downar says money is not what’s stopping more doctors from providing the service in Ontario.

Ontario government looking at changes to fee and referral system to make it easier for doctors

The Ontario government is working with doctors and nurses to improve the way medical aid in dying is provided in the province. (Radio-Canada)

While physicians in other provinces have raised the touchy subject of how much they should get paid for ending a life, Dr. James Downar says that money is not what's stopping more doctors from providing medically assisted dying in Ontario.

"Nobody is getting rich off this and nobody should think they're going to get rich off this," Downar, a critical and palliative care physician in Toronto, said in an interview.

He's one of just six physicians in Toronto registered to provide medical aid in dying. There are 74 in all of Ontario.

Downar says compensation for the procedure is on the "low-end" and that a physician could make more money doing "almost anything else."

"It's not ideal, but not problematic the way it is in other provinces," Downar said.

The "barriers" keeping more doctors from providing medical aid in dying, Downar says, have more to do with the bureaucratic framework for billing and connecting patients with providers, known as the care-coordination service.

Ministry changes

It's something Ontario's Ministry of Health and Long-term Care is reviewing and considering changes to.

"Our government's commitment is to ensure end-of-life care is provided in a safe, sensitive and compassionate manner. We want to have the necessary supports in place to help health-care providers deliver this care," a ministry spokesperson said in a statement.

"We're continuing to work alongside our clinician partners to further develop the care co-ordination service so that patients who want to access this new service receive the most seamless, prompt and responsive support as possible," the statement said.

Dr. James Downar is one of just six physicians registered to provide assisted dying in Toronto. He says the system could be improved to attract more. (Photo submitted)

Downar says under the current system, physicians are responsible for several administrative duties along with performing the procedure: connecting the patient with other specialists such as psychiatrists or social workers, and acquiring and returning the special supplies needed for lethal injections.

This, Downar says, is often on top a physician's regular full-time practice.

"It's a bit daunting. It can be quite the deterrent," he said.

Downar says a more "robust" referral system that possibly includes more administrative staff to help doctors, would help attract more of them to the field.

No fee codes

Money is still a concern as the government has yet to develop what are known as "fee codes" for specific activities related to assisted dying.

Doctors are still getting paid by using fee codes for costs related to palliative care, for example.

According to the ministry statement, the government is consulting with the Ontario Medical Association and nurses about "creating codes and compensation for medical assistance in dying services."

Downar says fixing the fee codes in Ontario would be "helpful," and he hopes other jurisdictions fairly compensate for assisted dying.

Physicians who provide assisted dying are still "stigmatized" by some in the medical community, Downar says, and they shouldn't be taking a "financial hit."

"Enough is enough. If the government wants this service provided, it needs to step up and make sure that happens," he said.