The same handful of doctors and nurses who helped introduce medically assisted dying in Newfoundland and Labrador are handling the majority of a growing number of requests for service, and they say they can no longer do it alone.
Requests for medically assisted dying in the province are increasing year over year, outstripping the number of health-care workers available to assess those requests, said Dr. Aaron McKim, a family physician and the authority’s head of medical assistance in dying. provincial health. MAID.
“Last year was the first year we hit the wall, where several of the practitioners who were our stalwarts came back and said, ‘I can’t do this for a while, I need to take a break.'” McKim said in a recent interview. “So we got requests for MAID and we had to tell people that we don’t have anyone to be their MAID practitioner.”
The situation became so serious that in April he told colleagues in a briefing note that there were six people waiting to be evaluated for MAID and that at least one patient had waited about five months for an evaluation.
Newfoundland and Labrador has had the lowest rate of medically assisted deaths in the country for the past four years, according to a report last month from Health Canada. About 1.5 per cent of the province’s deaths in 2022 were doctor-assisted, compared to a national average of about 4.1 per cent.
Requests multiplied over a period of 3 years
But in the eastern region of the province, which includes the capital of St. John’s and is home to about three-fifths of the provincial population, the number of people seeking a medically assisted death rose from 16 in 2019 to 107 in 2022, McKim said. in his informative note. There were 37 applications in the first quarter of 2023.
Each MAID application must be evaluated by at least two evaluators, who may be physicians or nurse practitioners. Seven medical professionals performed 75 percent of the primary evaluations for all applications in the region between 2016 and August 31, 2021, according to McKim’s note. Eight people performed 76 percent of primary assessments in 2022.
McKim said this small core group of health care workers has performed the majority of MAID evaluations and procedures in the region since the program began.
Nurse practitioners provided assessments and supplies for free until July, when they signed a new collective agreement with the province, a spokesperson for their union said.
Eastern Newfoundland includes dozens of small communities scattered along remote, rocky coastlines, and many have no MAID professionals, let alone family doctors nearby. McKim said members of that core group of MAID practitioners have driven for “hours and hours and hours” to these communities, “to allow someone to have the option they wanted.”
The work can be emotionally draining and some in that group helped “one or two dozen” assisted deaths each year, he added.
As of May 25, there were seven people in the region waiting to have their applications fully evaluated, officials said in an email. Three patients still needed two evaluators and faced a waiting time of up to 113 days.
Things had only improved slightly by early November, when McKim said there were “a couple of cases” without evaluators.
The vast majority of requests referred to first category medically assisted deaths, which are cases in which a natural death is foreseeable.
Access to MAID is important, province says
Patients whose natural deaths are not reasonably foreseeable but whose condition causes intolerable suffering may request a second-line assisted death. There were five second track applications in the eastern region in 2021 and nine in 2022. Nine applications were submitted between January and September.
MAID evaluations include meeting with the patient, speaking with their care providers, examining the care options they have pursued, and ensuring their request meets federal guidelines. Pathway one assessments take five or six hours, but pathway two assessments can take “dozens” of hours, McKim said. Doctors in the province can only bill for up to five hours of assessment work, so they often end up performing most second-level assessments for free.
“It’s essentially a volunteer thing. And it’s a pretty difficult role to play even when you get paid for it,” he said, adding that he believes more professionals would accept track two MAID assessments if they were compensated appropriately.
In an emailed statement, the provincial Department of Health said it understands that access to MAID is important. Doctors’ fees for evaluations were negotiated with the province’s medical association, he said.
Not everyone who seeks an evaluation will ultimately want a medically assisted death, McKim noted. For example, 10 second-stage evaluations were carried out in the year from September 1, 2022, but no procedures. In that same period, there were 87 track one applications and 46 dispositions.
Sometimes, simply being approved for MAID allows patients to feel more in control after receiving a life-changing diagnosis, McKim said.
“This helps give people some peace of mind that if the suffering gets too bad, they will have a back door,” he said. “As a MAID practitioner, my goal is to be able to help someone have a choice. And what they choose to do at the end of the day, that’s up to them.”
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