Referrals to physician-assisted dying have been cut off due to increased demand and COVID tensions in Nova Scotia



HALIFAX – An increase in demand that has led Nova Scotia to temporarily suspend referrals for physician-assisted dying is a symptom of stress – including COVID-related stress – on our healthcare system, and a former Senator closely involved in the problem said other provinces could soon face the same pressures.

The province’s Clinical Director for Assisted Dying, Dr Gord Gubitz, said this week that Nova Scotia Health will suspend requests for medical assistance in dying by 30 days as province faces “significant backlog “.

Referrals for MAID in Nova Scotia this year have already exceeded last year’s total. In 2020, there were 373 references; in September of this year, there were already 395.

Since the passage of the original MAID legislation in 2016, Nova Scotia has recorded 1,465 referrals, increasing steadily each year from 36 in the first year to 395 so far in 2021. Of these, Marketing Authorization was carried out in 667 cases.

“As we receive more referrals than ever before, we are also struggling to find enough clinicians to perform assessments and procedures according to patient requests,” Gubitz said in an emailed statement. “Maybe we can attribute a little of that to the demands of our health care system while dealing with the pandemic.”

Senator Jim Cowan, a board member for Dying With Dignity, said the organization had heard of an increase in referrals for assisted suicides across the country that reflects the situation in Nova Scotia, spurred by part by legislative changes this year that made eligibility criteria easier to meet.

“I think it’s fair to say that as Canadians become more aware of the availability of and the possibility of accessing physician-assisted dying, it increases the demand,” said Cowan said.

“We’re worried, but we understand the reasons why this needs to be done,” Cowan said of the Nova Scotia break. “I think the government should be commended for at least being transparent about the situation and not just letting people wonder why.

“It highlights that there are problems in our health care system accessing services, not just medical assistance in dying. Wait times are a big issue for so many procedures, even outside of COVID times. “

In March, changes to Canada’s MAID law made referral easier by changing some of the eligibility criteria. With the changes, the law no longer requires that a person’s natural death be “reasonably foreseeable”.

The law still requires that people wishing to be referred be at least 18 years old, able to give their informed consent to receive MAID, suffer from a serious and incurable illness, disease or disability, excluding – until March 2023 – mental illnesses and are in an advanced state of irreversible decline in abilities.

The law also stipulates that the applicant must suffer “lasting and intolerable physical or psychological suffering which cannot be alleviated under conditions which the person considers acceptable”.

According to statistics from Health Canada, there have been 21,589 deaths from MAID nationwide since the law was enacted in 2016. Of these, 7,595 – 35% – occurred in 2020 alone, latest year for which the federal government has statistics. Deaths related to MAID in Nova Scotia increased by 28% from 2019 to 2020. By comparison, these numbers increased by 42% in Quebec, 35% in Ontario and 47% in Alberta.

At the same time as announcing the suspension of referrals in Nova Scotia, Gubitz sent out a call offering training to physicians and nurse practitioners who may have the capacity to become involved in the MAID process. He also said Health Nova Scotia would hire a full-time nurse practitioner to help ease the workload.

“Our priority is to focus on those who are currently waiting to support them throughout the process,” said Gubitz. “It is important that we are transparent about our situation and the potential for extended wait times.

“We know that waiting for an assessment or MAID procedure can be a source of increased distress and anxiety for patients, their families and others who support them, and we want to minimize that as much. as possible. “



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