The introduction of euthanasia and assisted suicide as “medical assistance in dying” (MAiD) into Canadian health care was not a solitary event. This one move carried with it a litany of concerns about its effects on the provision of palliative care for Canadians who do not want MAiD. Unlike MAiD, which intentionally ends life through the administration of lethal drugs, palliative care provides a holistic approach to supporting the lives of patients with life-limiting or life-threatening illnesses or conditions as well as their families, providing for physical symptoms and needs as well as broader psychosocial needs.

Palliative care’s positive impact, not only for patients and their quality of life but also for the entire health system, was never in dispute. Neither were the known existing inadequacies with access to and availability of quality palliative care, particularly significant among Indigenous populations, as well as others in remote, marginalized, or economically disadvantaged situations. Universal palliative care, as such, was needed before euthanasia’s introduction. As the B.C. Supreme Court dealt with the Carter v Canada case, it heard from the Canadian Medical Association that the “provision of palliative care for all who are in need is a mandatory precondition to the contemplation of permissive legislative change.”

And yet, although the federal government offered assurances and established both a national Framework and Action Plan for palliative care in 2018 and 2019 respectively, it failed to establish any right to palliative care. This is a stark contrast even with euthanasia pioneers like Belgium, which established a right to palliative care at the same time as legalizing euthanasia.

Despite this, part of the process of informed consent to receive MAiD was predicated on being offered palliative care. In this way, describes legal scholar Dr. Mary Shariff, palliative care became part of the safeguards for MAiD. However, without actual meaningful access to palliative care at an appropriate time, which is at the time of the diagnosis of a life-limiting or life-threatening illness or condition, this safeguard is largely meaningless. It is far too little and too late to mention palliative care only after a patient has already asked to be killed due to feeling that their suffering—whether physical or existential, or their fear of future suffering—is too great to bear.

So, five years after the establishment of the Framework for Palliative Care in Canada, significant problems remain with both access and quality of care, particularly within some marginalized communities. The Quality End-of-Life Care Coalition noted the embarrassing reality of how “Canada lags behind in international counterparts in terms of access to quality end-of-life care.”

Furthermore, some palliative care doctors are sounding the alarm that palliative resources and personnel are being reallocated to provide MAiD—further eroding the already limited availability and quality of palliative care Canadians can receive. Moreover, it can reduce patients’ trust in the medical system and their medical teams, while also causing moral distress to clinicians. As a result, some are leaving their professions.

These developments have far-reaching implications for Canadians, particularly in the context of an aging population. Governments at both the federal and provincial levels need to make good on their commitments to palliative care. They must ensure that the appropriate resources and funds are available. Governments must also draw a clear dividing line between care that provides assistance in living—palliative care—and MAiD, which deliberately causes death.

• Dr. Leonie Herx is a Cardus Senior Fellow, Palliative Medicine specialist practicing in Alberta, and Clinical Professor in the Cumming School of Medicine, University of Calgary.
• Dr. Eric Wasylenko is a Cardus Senior Fellow, a clinical ethicist and a retired palliative care physician based in Alberta.
• Rebecca Vachon is the program director for health at Cardus. She holds a PhD in public administration from the University of Ottawa.