Early experience with medical assistance in dying in Ontario, Canada: a cohort study

Concern about quality of palliative care

“…In their article in CMAJ, Downar and colleagues draw conclusions that could have a far-reaching impact on the public's perception of medical assistance in dying (MAiD), based on potentially misleading data. 1 According to an article in the Globe and Mail, "The authors of the new Ontario research say its findings -which are based on reviews of every assisted-dying case in the province over 2 years -counter fears that the procedure would become a final refuge for patients too poor and vulnerable to access highquality health services, including palliative care. Instead, the opposite has proved true: It is the affluent, not the marginalized, who most often avail themselves of the assisted-dying law that Canada enacted nearly four years ago."…”

The well-off can also be vulnerable toward the end of life

“…On the basis of only the number of palliative care contacts among patients who die from MAiD, Downar and colleagues conclude both that palliative care was unable to relieve patients' suffering, and that a lack of palliative care access was not driving requests. 1 The variability in quality and training among services that call themselves "palliative care" is well known. Moreover, the study does not distinguish between a single visit and fullservice palliative care.…”

“…The authors also conclude that, as "traditionally vulnerable demographic groups" were underrepresented in the group dying from MAiD, it is "unlikely to be driven by social or economic vulnerability." 1 Dr. Balfour Mount tells the story of a patient, a prominent businessman who was given a diagnosis of advanced cancer. 2 At the time of admission to the palliative care unit of Montréal's Royal Victoria Hospital, the patient was silent while his wife explained that he had had enough and pleaded for things to be over quickly.…”

Le gouvernement du Canada doit continuer à jouer de prudence dans le dossier de l’aide médicale à mourir

“…Actuellement, le gouvernement du Canada examine la possibilité d'élargir ces critères. L'analyse des 2241 premiers cas d'aide médicale à mourir en Ontario par Downar et ses collaborateurs arrive donc à point 1 . Les chercheurs ont relevé que par rapport à l'ensemble des personnes décédées dans la province, celles qui avaient reçu l'aide médicale à mourir étaient proportionnellement plus nombreuses à avoir un diagnostic de cancer, à être mariées et à vivre dans un quartier nanti.…”