Medically assisted dying team in Manitoba doubles in size

The Winnipeg Regional Health Authority has more than doubled the number of physicians involved in medically assisted deathsin Manitoba aftermore patients requested the help than the province initiallyexpected.

More than 100 patients have contacted the Medical Assistance in Dying (MAID) team with 24 receiving medically assisted deathsas of Jan. 6, according to statistics provided toCBC Manitoba by the Winnipeg Regional Health Authority.

In June, the federal government amended the Criminal Code with Bill C-14, whichallows doctors and nurse practitioners to help patients with "grievous and irremediable" illnesses to die. In response, Manitoba set up its MAID team under the Winnipeg Regional Health Authority.

ManitobaHealth MinisterKelvinGoertzenestimated in November that about a dozen patients a year would request MAID, but the number is already a lot higher.

According to the Winnipeg Regional Health Authority:

• 102 patients orfamily members have contacted the MAID team as of Jan. 6.
• 24 have received medically assisted deaths.
• 28 died before completing the process.
• 14 are actively going through assessment.
• 18 were declined.
• 18 made inquiries.

Dr. Brock Wright, senior vice-president and chief medical officerfor the health authority, said the majority of the patients who were granted medically assisted deathshad cancer and were over 65. Nine died in a hospital, one in a hospice, and 14 chose to die at home with the help of a physician.

Of those who were turned down, five had mental illness with no other condition, said Wright.

"The rest were declined because they had a chronic illness but their death was not reasonably foreseeable."

Four doctors added

The Winnipeg-basedMAID team serves the entire province, covering all five regional health authorities. All members of the team work on a part-time basis.

• Manitoba introduces doctor-assisted death policy
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The provincestarted to set up the medicalassistance in dying team in February with three physicians, two nurses, two social workers and two pharmacists. It now has seven physicians, including threein rural communities, said Wright. He won't identify the smaller communities in order to protect the identity of patients.

Two of the doctors are bilingual.

All seven physicians are "part of an evolving network of providers who are interested and capable of providing the service," Wright said.

Another social worker also has been added, alongwitha speech-language pathologist, in case patients have difficulty communicating.

Rural outreach

Before the Criminal Code was amended, the College of Physicians and Surgeons of Manitoba heldmeetings to come up with a draft policy onhow it would respond to assisted dying.There was talk about the possibility of a truck with a team that would travel to rural and remote communities.

Wright said while members of the team are travelling to rural and remote areas, they're not in a mobile unit.

"I wouldn't want to create that optic in the mind of the public. The MAID team is structured so it is capable oftravelling outside of Winnipeg and it has, but the whole team doesn't go one or two physicians, a nurse, a social worker and perhaps a pharmacist. They will travel to an institution, a hospitalor someone's home," said Wright.

While he can't say where the team has gone because of privacy issues, it hasbeen across the province and innorthern communities, he said.

Conscientious objection

Three faith-based hospitals in Winnipeg St. Boniface, Concordia and Misericordia have exercised their right to conscientiously object to providing doctor-assisted deaths.

• Faith-based hospitals in Winnipeg ban medically assisted deaths

The Winnipeg Regional Health Authorityis in discussions with personal care homes both inside and outside of Winnipeg to determine which are faith-based and will not provide doctor-assisted death, Wright said.

All of the facilities banning assisted dying have indicated theywillrespect the right of patients who chose MAID and will provide timely information, he said.

Tracking the cases

Medically assisted deathsare being tracked by the health authority, and amendmentstodeath certificates have been approvedto indicate the person died as the result of assisted dying, Wright said.

"The death certificate now does enable you to differentiate and determine it was in fact an assisted death. It was an issue early on but it has now been resolved," said Wright.

The WRHA is also working closely with the University of Manitoba to developmedical educational modules on assisted dying for medical students.

The modules are not mandatory for medical students, Wright said.

The federal legislationalso allows nurse practitionersto deliver medicalassistance in dying, but thereare none in Manitoba providing the service at this time, Wright said.

He said if any nurse practitioners were interested in participating, the province would have to address some issues such as the fact that they can't sign death certificates.

Last option

Wright said when medically assisted dying was legalized, it heightened everyone's awareness of the need to ensure access to adequate palliative care.

Patientsapplying for MAID are given two separate assessments and every option is considered, he said. The patient has to be mentally competentand a request has to be made in writing.

"The team turns over every rock to make sure every other option has been made available to the patient, that the diagnosis is clear, the treatment options have been provided, and with respect to the suffering, to know they have access to palliative care," said Wright.

"You would never want a situation where a patient is opting for MAID and would not have made that choice if they had access to palliative care."