5 takeaways from Ottawa’s interim report on assisted dying in Canada

On April 26, the federal government released a report that gives Canadians a clearer picture of how medical assistance in dying (MAID) was implemented across the country after the passage of Bill C-14. The report contains national MAID statistics for the period between June 17, 2016, when Bill C-14 was passed, and December 31, 2016. While the interim update provides helpful and informative statistics on the early roll-out of MAID, it also highlights major deficiencies and inconsistencies in MAID reporting across Canada.

Here are five takeaways from the interim update on MAID in Canada:

1.       We now have information about who accessed MAID in 2016 and how many.

According to the report, at least 970 Canadians died with medical assistance in 2016 — accounting for about 0.6 per cent of all deaths nationwide. Nearly 50 per cent of all assisted deaths, 463 in total, took place in Quebec, whose own end-of-life law came into effect six months before Bill C-14 was passed. In the rest of Canada, there were at least 507 reported assisted deaths in the first six months after Bill C-14's passing, not including figures from Nunavut and the Yukon.

As for who had an assisted death, the numbers were fairly evenly split between women and men, and the average age of individuals who received MAID was 72. We also know that 66 per cent of assisted dying cases took place in large urban centres (meaning communities with more than 100,000 residents).

Of the 507 reported assisted deaths between June 17 and December 31, 2016, only three were self-administered deaths (meaning the individual took a dose of life-ending medication that was prescribed by a physician). The rest were clinician-administered.

2.       Cancer is the most common underlying medical condition among individuals who received MAID in Canada.

Cancer was the most frequently cited underlying medical condition associated with MAID, representing approximately 57 per cent of all assisted dying cases among reporting jurisdictions. This is consistent with international findings.

Neurodegenerative conditions like multiple sclerosis and ALS are the second most common underlying medical conditions for patients who received an assisted death in Canada.

3.       The statistics are a good start, but there are still plenty of inconsistencies between the provinces and territories.

Some provinces, like Manitoba, Alberta, and Saskatchewan, are collecting richer data than others. Neither Ontario nor British Columbia appear to be collecting vital information about how many people requested MAID and how many requests were denied, while the Prairie provinces, for the most part, are.

This tells us that provinces such as Ontario and B.C. need to take steps to bring their reporting measures in line with the Prairie provinces, and that more needs to be done to ensure that reporting for MAID is consistent from one province or territory to the next.

4.       Fifty per cent of assisted deaths took place in hospitals — but there are wild inconsistencies between jurisdictions about where MAID occurs.

National averages show that 50 per cent of MAID cases occurred in hospitals, while 37 per cent took place at home, but these figures varied considerably across provinces. For instance, in Ontario and the Atlantic provinces, most assisted deaths occurred in hospitals. In British Columbia and Manitoba, however, most assisted deaths took place in the home.

What do these figures tell us? This could be evidence of institutional barriers to access in hospitals in certain reporting jurisdictions. When a public hospital, especially one that provides palliative care, refuses to allow MAID on-site, it creates massive barriers to access in the community that the hospital serves. These figures also suggest that more may need to be done to ensure that people who wish to have a peaceful death at home have that option available to them.

5.       We can expect ongoing and more comprehensive monitoring and reporting on MAID in the future.

The federal government has committed to developing regulations for a national MAID monitoring framework. According to the report, the federal monitoring structure will receive data directly from physicians, nurse practitioners, and pharmacists involved with MAID. It will include more detailed data, including how well Bill C-14’s eligibility criteria and safeguards are working.

The government says it will ask for the public’s input on the shape of these draft regulations. This is a positive step.

(Header photo credit: AJ Butler via Panoramio)

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