In a previous post, I described how my doctor gave me a terminal cancer prognosis and then offered to refer me to palliative care or medical assistance in dying (MAID). What shocked me about the offer of MAID was that my assisted suicide was presented as a treatment choice for the terminally ill.
I can understand how a doctor would offer MAID as a last resort when a patient is experiencing unendurable suffering and all standard treatments have failed. But that was not my situation. In my case, the message was that I had only months to live, and if I preferred, we could end this now. I believe that except for competent adult patients who request MAID in extremis when all appropriate treatments have been tried and failed, physicians should prevent suicide, not facilitate it.
In this post, I want to explain why I believe that the challenge of funding health care, now and in the future, will create an incentive for governments and health care administrators to promote MAID. As this graph shows, the number of Canadians who have died by MAID has increased rapidly since it was legalized in 2016.
As you can see, MAID deaths have increased almost 10-fold in six years, and this growth shows no sign of slowing. In 2021, there were roughly twice as many MAID deaths as other suicides. I worry that this normalization of suicide for the terminally ill will partly continue because of the immense fiscal pressure on the Canadian health care system.
Let me document the health care cost problem. The medical expenses of the average Canadian have more than doubled since 2000. Again, note that this growth is not slowing down.
At least two factors drive this increase in cost. First, medicine has developed many essential but expensive treatments. To treat my cancer, I receive an infusion of pembrolizumab, an immunotherapeutic monoclonal antibody, every three weeks. If I were paying retail, the drug alone would cost almost $10,000 (Canadian) for each infusion. That’s more than we spend on the average Canadian in a year.
The second factor that drives up the cost of health care is that the average Canadian is getting older. The following graph shows that from 2000 to 2035, the proportion of the population that is 65 years or older will almost double.
Elderly patients like me are far more expensive than the average Canadian because we are much more likely to have costly diseases. In 2018, the Conference Board of Canada estimated that the average annual health care cost for those 65 and older was more than four times higher than for younger Canadians. Again, consider my case. The Canadian Institute for Health Information estimated the health care cost for the average Canadian in 2022 was about $8500. My health care costs are easily 20 times that high.
The result of these cost trends is that health care costs are an increasing percentage of the Canadian economy. This graph presents health care spending as a proportion of the Canadian Gross Domestic Product.
In Canada, we pay for health care when we pay our taxes. So if health care becomes more expensive, either taxes have to rise, and we have less discretionary income, or the provincial and federal governments must spend less on defence, roads, education, paid maternity leave, or any other critical government service.
The implications for my home province of Ontario are dire. The Financial Accountability Office of Ontario (FAO) projects that
...health sector spending will grow at an average annual rate of 3.6 percent between 2021-22 and 2027-28 [while] the funding allocated by the Province... grows at an average annual rate of 2.5 percent... [Therefore] the FAO projects that the Province’s health sector spending plan has a net funding shortfall over the six-year period from 2022-23 to 2027-28 of $21.3 billion. The shortfall means that the Province has not allocated sufficient funds to the health sector to support existing programs and announced commitments.
In various places, I have argued that Canada, including Ontario, does not have enough mental health or palliative care specialists to meet the needs of our population. The near collapse of Ontario’s health care system showed that we need more hospital or ICU beds too. But the FAO is telling us that we can’t afford even the inadequate system we have now.
OK, let’s tie this back to MAID. Our health care system is in a crisis caused in large part by the growing expense of caring for sick, older adults like me. Delivering high-quality palliative and mental health care is expensive (and Intensive Care Units are very expensive). MAID is quick, inexpensive, and 100% effective in reducing the demand for palliative care, mental health care, or ICUs. Do the math.
Am I saying that provincial health care administrators will promote MAID to solve their budget problems? No, but I can see them promoting MAID because they believe in MAID (and, just coincidentally, it does help them with their fiscal crisis).
Bill, I need to unsubscribe from your posts now, please. I have appreciated your intelligent, cogent thought process and the beauty of your writing. I’ve tried to walk beside you in empathic care as you passed through different phases of your illness and treatment. You are a lovely, complex, accomplished human being and I wish you well always.
And….
In my humble opinion, you have gone COMPLETELY off the rails with respect to assisted end of life. In the months you’ve written about it, your view is becoming more and more narrow and, to my mind, off-base. I believe you are now actively causing harm to a medical and ethical issue that should be in the forefront of our attention.
You physician offered this to you upfront, as soon as it was clear that your disease was not curable. This should, in my opinion, be standard of care. To most, though evidently not to you, this would be an incredibly-welcome and comforting discussion…..the willingness of one’s physician to offer an escape in the face of unbearable OR UNACCEPTABLE quality of life, however the patient understands this. There is such an incredible need, craving, and desperation for this and you are so unspeakably fortunate to live in Canada where this is permissible. When you respond with affront, that signifies that MAID is not a need that you have. But for the love of God, LET IT GO!!!! To generalize that discussion to disrespect for life, for a cost-management strategy, or a religious travesty is an incredible disservice to the masses of people who would do literally ANYTHING to have this option.
You take care of your end of life trajectory but in the name of all that is holy, leave the rest of us alone. Among most middle aged or older adults, yearning for control over how they leave this world is one of the highest-priority items. You have no right to speak for anyone but yourself in this matter because the underrepresented, desperate need is so vast.
When I read your words over the last few months all I can think is, “Oh please, please stop!" Please abide by your own decision but do NOT generalize motives or best practices to others - not when SO, SO, SO many people consider this a fundamental human right that is denied to them……BY people like you.
I beg you to take care, but stay in your own lane. I will now unsubscribe and pray that the damage your words have the potential to cause is diluted by others’ compassion and reason.
Peace.