I would like to take the opportunity to bring awareness to the challenges of practising medicine in First Nations and remote communities, where patients don’t receive equal access to care as in the city.
To illustrate this with an example from Siksika, I have a patient who suffers from Interstitial Lung Disease, which causes him to be short of breath even with simple tasks such as going to the washroom or going to the kitchen to get something to eat. He has poor mobility requiring the use of a walker, and he cannot walk for more than 2 minutes without gasping for breath. His stamina will improve greatly with home oxygen, but regretfully, his lab values on testing falls just short of qualifying for funding through Non-insured health benefits for First Nations. Without funding, his family does not have the finances to afford oxygen. There is no cure for his disease, and he is increasingly tired of living. His only choice at this time is to wait until his condition deteriorates. Under Bill C7, this patient would qualify for MAID. But I would advocate that what he needs is home oxygen for a better quality of life, and not assisted death to end it. Going further, it would go against one’s conscience to administer MAID to him knowing that there are other ways to relieve his suffering that are available but haven’t been provided.
If I was to arrange psychiatric consultation, it will currently take upwards of 8 weeks for that to take place from our rural community. Add to that another 6 or more weeks to optimize medications, the 90-day waiting period is not enough time to give this patient the help he needs, and I would argue, not enough time for a lot of chronic conditions.
All that is to say, Bill C7 should be amended to include as a requirement, appropriate trial of therapies aimed at relieving suffering, such as management from a palliative care physician, psychiatrist, pain specialist or physical medicine and rehab specialist. Social determinants of health, such as finances, housing, and vocational training should also be addressed prior to qualifying for MAID.
Assisted death should be an option of last resort, and not the path of least resistance for the vulnerable and disadvantaged. Conscience protection is needed in this bill, as no one should be forced to participate in the intentional death of another person against their good will. Thank you.
Dr. Thomas Fung is the Physician Lead for Siksika Nation, where he has been a family physician for the past 13 years. He also practises in Calgary where he manages residents in supportive living and long term care.