No link between poverty, choosing medically assisted death, study suggests

A new study led by researchers in Ottawa has found medically assisted dying is not being driven by factors such as poverty, isolation or lack of access to proper palliative care.

The study dispels concerns that vulnerable people are being pushed into requesting medical aid in dying, or MAID, because they lack other options.

Lead author James Downar, palliative care specialist at The Ottawa Hospital and the University of Ottawa, said the data suggests a medically assisted death is not being driven by "socioeconomic vulnerability."

The study looked at clinical and socioeconomic data from 2,241 Ontarians who received the procedure between June 2016 and October 2018.

Researchers compared the results with those of 186,814 Ontario residents who died during the same period. They found 75 per cent of Ontarians who were administered MAID were younger, wealthier and more likely to be married
at their time of their death compared to the general population.

'What is it about?'

Almost half were married, 85 per cent lived in a private home and were more likely to live in a higher-income neighbourhood.

Downar said while it's reassuring that medical aid in dying isn't being driven by socioeconomic vulnerability or lack of access to palliative care, people were suffering enough that they wanted to end their life.

"Because if it's not about palliative care access, it's not about socioeconomic vulnerability, what is it about?" Downar asked. "We have a fair amount of data from Canada and elsewhere suggesting that existential distress is a major driver. So if it's about existential distress, how do we address that?"

Downar said physicians and researchers should focus on improving their understanding of the factors that lead people to request MAID.

MAID was legalized across Canada in June 2016.

Mixed reaction

Advocates for medically assisted dying are welcoming the findings.

"There has been a lot of emphasis on concerns that individuals who could be influenced, or who might be considered vulnerable in some other way, might be overly represented in the statistics of those receiving MAID," said Susan Desjardins, chair of the Ottawa chapter of Dying with Dignity. 

"I think this study makes it clear that's not the case."

"I think it's really important for us to have this kind of information [so] ... people can trust the system," said Dalhousie University professor Jocelyn Downie, who sat on a federal panel reviewing issues relating to assisted death.

But not everyone agrees. Ray Pennings, executive vice-president of faith-based think tank Cardus, sees a need for further study.

"This looks at the accessibility of MAID for those who desire it, and that's important, but equally important is putting forward provisions in which those who are not seeking MAID are protected from being pressured into having it," he said.