A commentary by a retired physician who lives on Salt Spring Island.
Nietzsche warned “whoever fights monsters should see to it that in the process he does not become a monster.”
With this caution in mind, we should perhaps ask ourselves as Canadians: “In our struggle as a society to deal with the increased demand for control of pain and suffering have we, under the cloak of compassion, leapt blindly in despair to the taking of life (Medical Assistance in Dying)?”
In fairness to provincial governments, the cost of health care, constitutionally its jurisdiction, has increased greater than inflation year after year and the federal government has consistently reneged on the original agreement to cost-share at 50 per cent.
At present these two levels of government are attempting a more acceptable and workable arrangement, but MAID is already the law of the land. How did this happen, when, to my knowledge, there is no structured curriculum or oversight to have initiated or managed the activity. So how did we get there?
Our governments are administrative bodies and not revenue-producing. Therefore their budget is determined and funded by taxpayers dollars, but has many competing responsibilities pertaining to those dollars.
Provincially, health care approaches 40 per cent of that budget in some provinces, so it made sense that cost containment in the area of health care draws the greatest attention and restraint. Federally, the government is indirectly responsible by mandating compliance to the Canada Health Care Acts of 1966 and 1984.
Since acute care (hospital services) comprised the largest part of health-care costs (ICU, operating rooms, acute care beds, emergency departments, psychiatry beds) this was dealt with in the late 1980s and early 1990s by decreasing beds from 3.5 per 1,000 population in Alberta to about 2.0 per 1,000 population in Alberta and some provinces.
This had a dramatic negative ripple effect on many areas of health care while other changes were also taking place and adjustments made.
Family physicians and nurses fled to the United States by the thousands, usually young grads. They were recruited actively by health management organizations in the U.S. since they were young, well-trained and had an excellent work ethic.
Doctors, nurses and their associations, for the most part, had little say since they were considered to be turf protectors and having little incentive for cost containment.
Moratoriums were put on new construction of nursing homes. No expansion of training facilities for doctors and nurses were put in place to plan for an aging population and “baby boomers.”
Nurses required four years of training (BSc) instead of three (RN). Medical students chose specialties instead of family practice.
Only the most disabled and dependent patients had access to care facilities, the others were downloaded to the community to the care of family and volunteers.
While all this was going on, community facilities such as X-ray, ultrasounds and laboratories were being closed and were being more centralized, causing the very frail and elderly to have access problems to much of the care they required.
Home-care and palliative-care community nurses had the highest rate of burnout in the nursing profession as time went on. That has likely now shifted to acute care thanks to COVID and continuing budget shortfalls.
The continuing backlog of medical needs (much could be described as suffering) in the community has steadily risen and the only rough measurement of this need is the ever-lengthening time of access to specialists, the ever-lengthening of surgical wait lists, and the demands in our emergency departments.
The mainstream news media and society as a whole have not had any way to quantify suffering and medical need in the community. We now have, via the community demand for MAID, those indicators, but at what cost?
Some reports have British Columbia MAID deaths at 4.8 per cent of all deaths in 2021 and Canada at 3.5 per cent, almost rivalling Switzerland at 5.0 as the world leader.
Further, we must ask ourselves whether the high rate of overdose deaths is also a reflection of lack of community resources.
At a recent infomercial for MAID at the Salt Spring Library, a very professional presentation was done on the multiple approaches to access MAID, leaving one with feelings of trepidation.
Why has MAID become relatively easy to access at these times in our Canadian health-care system when all other access for care has become such a struggle?
I’m told that in our lifetime, 70 per cent of our health-care costs are in the last two years of our lives. With this in mind, governments at several levels will be saving hundreds of millions of dollars, possibly billions of dollars, through effective utilization of MAID and decreasing that time interval to a few weeks.
Is there not some type of conflict of interest here? Canadians do not allow conflict of interest in our courts and other areas to ensure fairness and prevent manipulation.
Is it not time for our governments to focus on addressing the necessities of hope and the underlying needs for the most vulnerable for living in our communities instead of efficiencies of MAID?
Have we become that monster that Nietzsche warned about?
