Supporting Palliative Care in a Post-Carter World

Traditionally, most Palliative Care physicians have adhered to the World Health Organization’s definition of Palliative Care, according to which it “intends neither to hasten nor postpone death.” The 2016 legalization of Medical Assistance in Dying (MAiD) in Canada, however, has thrown this understanding into question, and has forced Palliative Care physicians to reconceive their role in caring for patients who experience intolerable suffering. The role of Palliative Care in MAiD, in particular, has provoked intense debate amongst Canadian Palliative Care physicians and their representative organizations. In November of 2019, three national organizations—the Canadian Society of Palliative Care Physicians (CSPCP) in conjunction with the Canadian Hospice and Palliative Care Association (CHPCA), and the Canadian Association of MAiD Assessors and Providers (CAMAP)—each issued conflicting policy statements that addressed the role of Palliative Care in MAiD. The CSPCP and the CHPCA distanced the practice of Palliative Care from MAiD, arguing that MAiD differs substantially from Palliative Care in “philosophy, intention, and approach,” and should not be considered part of Palliative medicine. Alternatively, CAMAP strongly advocated for the integration of MAiD and Palliative Care to support the needs of patients. This national divide caused distress amongst the Palliative Care community, as many physicians are still deciding how they will continue to respond to MAiD, and are turning to their professional organizations for guidance. Given this sharp division, my dissertation aims to understand two things: first, the challenges that Palliative Care and its physicians face in the era of MAiD, and second, the best way of conceiving of the relationship between Palliative Care and MAiD. In order to advance this conceptual understanding, I conducted interviews with 51 Palliative Care physicians. This dissertation is grounded in the voices of those physicians who have a particular, nuanced understanding of Palliative Care practice, and what supports it needs going forward. It is from these interviews that I offer systems and policy recommendations that are designed to support Palliative Care overall, and those whom it serves