Access to assistance to die is highly uneven across the regions

L’accès à l’aide à mourir hautement inégal selon les régions

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The proportion of medical aid to die (AMM) unmanaged stands out in particular in the regions of Laval and Lanaudière, where, by 2017, 53% and 46% of applicants have seen their applications fail, more than anywhere else in Quebec.

Three years after the entry into force of the act, access to assistance to die remains highly unequal in Quebec for people who want to put an end to their days. In general, an application on three is not realized in Quebec, and up to half of the requests remain in the plan in the regions of Laval, Lanaudière and, to a lesser extent, in Montreal.

This is according to data compiled by The Duty from the most recent report tabled in the national Assembly by the Commission on end of life care (CSFV), which oversees the application of the law, and recognises each year the number of requests made across the province of Quebec.

Marked differences

The proportion of medical aid to die (AMM) unmanaged stands out in particular in the regions of Laval and Lanaudière, where, by 2017, 53 % and 46 % of applicants have seen their applications fail, more than anywhere else in Quebec. In spite of everything, the situation has improved in the Lanaudière region, where the share of requests that have not been administered had reached 60 % last year.

Lanaudière seems to be a special case, as it was observed in 2017, the highest rate of requests for assistance to die per 100 000 inhabitants in Québec (29/100 000) and the highest proportion of deaths following a procedure help to die (2.1 per cent). And this, even if it is a region where the proportion of older people is lower than the average in Quebec.

L’accès à l’aide à mourir hautement inégal selon les régions

In fact, the rate of requests for assistance to die per 100 000 inhabitants, all things considered, there is two times more important than in the Montérégie region or in the eastern Townships, and nearly three times more than Montreal.

“We are seeing a substantial increase in the demand and adjust constantly the teams to cope with the demand,” replied Tuesday, Pascale Lamy, assistant to the p.-d. g. of public relations, adding that the medical recruitment remained a ” constant challenge “.

In Laval, where more than half (53 %) of applications is not realized, it is explained that the different way of compiling and managing applications explains the high rate. As soon as ” the first step in a process of marketing authorisation, the CISSS de Laval supports the patient in his willingness to go forward and does not assess, at this stage, the legitimacy of legal demand. This explains […] the proportion of AMM in non-administered higher in Laval “, submitted by e-mail Pierre-Yves Séguin, communications advisor and public relations for this regional organization. To be clear, this CISSS includes in its data for total all requests made by the patient, before even those that don’t seem to immediately respond to the criteria of the act.

In Montreal, where a high proportion of doctors, remains opposed in principle to the assistance to die, the rate of applications remained in the plan in 2017 remained almost unchanged, at 42 %.

Conversely, certain regions stand out clearly in 2017 for the ability to respond to requests, in particular the regions of Chaudière-Appalaches and Gaspésie regions, where 83 % of the patients at the end of life who wanted help to die were able to give their last breath as they wanted to. The most significant movement in Quebec has also been observed in the region Gaspésie–Îles-de-la-Madeleine, where the percentage of requests that have not been administered has dropped by 36 % in recent years to 17 % in 2017. The Gaspésie is the region with the highest proportion of people aged 65 years and older and the highest rate of fatalities per 100,000 inhabitants in Quebec.

Gaps unacceptable

But the gap marked observed in the access to assistance to die, according to the regions raises the grumbling among some doctors, who believe that access to this care and any other care end-of-life should be the same everywhere in Québec.

“The disease is the same for all patients in Quebec. Why are there so many differences in certain areas ? If there are blunders, they are there. The mandate of the Commission on end of life care is to protect vulnerable people. What happens to those who have made a legitimate request and have not had ? ” said Dr. Alain Naud, a medical doctor specializing in palliative care and in helping to die at the CHU de Québec.

In general, the balance of end of life care provided in Quebec since December 2015 demonstrates that the high rate of unauthorized claims is maintained, year after year. For the past three years, no less than 36 % of the patients have not seen their request to materialize for reasons beyond their control. In the vast majority of cases (38 %), the time to assess or process applications before the patients die or become incapacitated (36 %) are concerned. Last year, on 1125 authorisation applications made, only 805 were able to come to fruition.

“The problems are primarily located in 805 patients, of which has accepted the request and that have not been obtained, sometimes after several weeks of waiting. This is unacceptable. However, no examination of these cases is fact. These abnormal situations are perpetuated with impunity, ” says Dr. Naud, who believes that the CSFV does not give any accountability to this issue, and does not disclose publicly its own criteria to decide if a person is beautiful and well end-of-life or unable to consent to the marketing authorisation.

The College of physicians confirms that the review of the forms of assistance to die for and the frequent request for additional information made to physicians by the Commission of end of life care (CSFV) continues to weigh down the work of doctors who administer the WMA. A new form, required since November by the federal government, just to add to this burden. “It doubles the work for the doctors. There are important developments to make, ” says Dr. Yves Robert, secretary and director general of the CMQ. Some see it as a way to discourage the doctors from doing their job. “

The streamlining of administrative tasks is all the more important that the number of applications continues to grow, and that as of 2019, a committee will make public a report on the relevance of expanding access to assistance in dying to patients who are currently excluded, particularly those considered ” unfit “. Even more, several of the houses of palliative care, once a highly refractory to provide the assistance to die, now accept to include this treatment in the options for end-of-life.

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