My First Experience with Medical Assistance in Dying (MAID)

Written on August 26, 2016 – 6:00 am | by Dr. Ken Shulman

After approval of the legislation, it did not take long for one of my patients (identity disguised) to request access to MAID.  I knew that this was a possibility because of previous discussions regarding the eventual outcome of her debilitating and progressive medical condition.  However, it had been couched in terms of a sense of security just to know that the option was available.  In recent months, her condition deteriorated and her quality of life drastically declined from the productive, satisfying and enjoyable career and family life she had previously enjoyed.  It was painful to watch.  This was indeed “intolerable suffering from an irremediable condition”.

My somewhat peripheral role was related to a co-morbid psychiatric disorder which was in remission and did not influence her decision to access MAID. This was of course critical in the assessment of her capacity to make this decision.  In the end, an interdisciplinary team of physicians ensured that this case met all the legal and ethical criteria.  The team worked closely with a supportive and loving family to ensure that her wishes with respect to MAID were consistent over time. After the requisite waiting period when she signed off on the request, a humane and painless death ensued at her home exactly as was requested.

What was not anticipated was the intensity and nature of the mixed emotional response of the physician team. There was admiration for the bravery and determination of the patient and her family, profound sadness at the loss and yet in the end, a feeling of satisfaction that suffering had been relieved and that proper care and the right decision had been taken. Lesson learned is that until we move from the theoretical to real world experience, it is difficult to anticipate all of the consequences. All the more reason to proceed with caution.

Where do our taxes go?

Written on August 25, 2016 – 6:50 am | by Audrey Miller

Making a decision about your future or the future of an aging loved one can feel overwhelming. Not only does it take an emotional toll, but it involves knowing what care options are out there, understanding how those options can work for you and evaluating the cost of those options to pick what is best and most affordable. I have previously blogged on the out of pocket cost of care, and  thought it would be helpful to understand the cost breakdown for senior care in Ontario, to the taxpayer.  So let’s see what the costs are associated with hospital, long-term care and home care.

So what do we know? We know that the Canadian Institute for Health Information reports that seniors 65+ make up 15.6% of the population of Ontario. We also know that as a person ages, they develop increasing risk of hospitalization due to illness or injury.

The cost per patient stay in an acute care hospital, averages $5,407 in Ontario and it is even higher in Toronto at $5,910.  Analysis of this chart shows that the cost of care at home, and even in long-term care, is a fraction of the cost of hospital care.

Average Cost of Care (for one week for 424 seniors)
Hospital Bed $2.5 million ($842/person/day)
Long-term Care Bed $374,000.00 ($126/person/day)
Care at Home $125,000.00 ($42/person/day)

The costs per patient usage from the Community Care Access Centre services ranges between $2,892 and $3,775 per person; the average was about $3,400 per person. (Source:  Table: (2011) HOME First Shifts care of Seniors to HOME. LHINfo Minute, Northeastern Ontario Health Care Update).

While care at home is often the preferred option, it is not always possible, especially for frail seniors who are alone, without family or friends closeby. Many of these seniors end up in the hospital and from there they have no place to go.

The challenges continue as there is a shortage of Long Term Care beds. Many seniors who are awaiting placement find themselves now labeled as Alternative Level of Care. (ALC).  The Provincial ALC definition is:When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (Acute, Complex Continuing Care, Mental Health or Rehabilitation), the patient must be designated Alternate Level of Care (ALC) at that time by the physician or her/his delegate. The ALC wait period starts at the time of designation and ends at the time of discharge/transfer to a discharge destination (or when the patient’s needs or condition changes and the designation of ALC no longer applies).”

I have a client who has spent 3 years awaiting placement and he continues to live under ALC status in a downtown hospital. A very sad and costly situation for everyone, including taxpayers.



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