One of the small number of Vancouver Island physicians providing medically assisted dying has withdrawn his services, and two more are considering doing so. Others have set limits on how far they will travel to see end-of-life patients.
The problem is a fee schedule that is too lean to cover costs. To start with, the schedule doesn’t reimburse travel bills. That’s standard practice, but with only a handful of doctors to cover a huge area, it’s unrealistic.
One example: Dr. Tanja Daws, a family doctor based in Courtenay, travelled to Quadra Island to perform an assisted death, which took her 5.5 hours. She billed MSP $440, but was told she would be paid only $171 for the 75 minutes she spent with the patient.
“I absolutely worked for a total loss that day,” she said.
The schedule also narrows the time doctors may spend with their patients to a degree many providers consider inadequate or unsafe.
Physicians offering this service are limited to an initial patient assessment of 90 minutes, and 75 minutes for a followup. Considering the wide range of issues that must be discussed with patients — their medical history, state of mind, disease progression, clear evidence of informed consent, and much else — the last thing we should be doing is hurrying such a delicate discussion.
There are also legal hurdles to be cleared. The statute covering assisted dying lays down demanding requirements. If these are not met to the letter, the physician could face professional discipline or even criminal charges.
Penny-pinching aside, however, a skeptical observer might wonder if other forces are present. Doctors of B.C., the association that represents physicians in our province, has a leading role in setting the schedule.
Assisted dying is a new service, and it has to compete with traditional specialties that have far more clout within the association. Medical politics might be a factor.
Responding to these concerns, government officials note that the fee schedule is due to be reviewed within three to six months.
But that might be too late. If it came to the worst, Island Health could set up its own medically assisted dying program, and pay the physicians out of its budget (currently they are reimbursed by the provincial Medical Services Plan).
Yet that’s a desperation measure. It would take time to work out the details, and it would expose Island Health to demands from other specialists who might also feel underpaid.
We need those in charge to take a step back, and consider the broader picture. Vancouver Island has one of the highest rates of assisted dying in Canada, with 77 people choosing this option in 2016. This happened because a small group of committed physicians led the way.
Surely this is one of those occasions when standard procedure should be put aside. We are not dealing with a time-honoured field of medicine where a relaxed pace would do.
In this instance, we are poised at the start point of what promises to be a long and difficult journey. How it will progress we cannot say. Medically assisted dying is something new in our corner of the world.
We owe it to the physicians offering this service, and their patients, to do our part in making a success of it. If that means cutting a few corners on travel-reimbursement policies, or funding longer assessment visits, worse things have happened.
But principally, we have to instil a sense of urgency in the bureaucracies that hold the reins. If, after the enormous exertions required to get this far, the assisted-dying program falters, some hard questions will be asked.