While Canadian law prevents doctors from fulfilling these requests and instead leads doctors and nurses to focus on providing patients with care to make them as comfortable as possible in their final days, Dr. Mike Harlos, medical director of palliative care for the Winnipeg Regional Health Authority explains that doctors are under-prepared for conversations about patient death. As Harlos explains, while doctors receive five years of specialty training, they receive next to no instruction on how to approach the topic of death.
To address this lack of training, Dr. Librach has developed a program through the University of Toronto’s Joint Centre for Bioethics to guide health professionals in dealing with requests for assisted-death. The program explains that requests for assisted-death are often indicators of unaddressed suffering. Therefore, the program guides health-care workers on how to identify these underlying issues. With this said, Dr. Librach also acknowledges that even with training on how to approach patients who desire a speedier death, health professionals do not always have the right answers or the ability to deliver a comfortable ending for patients. Dr. Librach explains that there are still cases where patients are receiving insufficient medication and dying experiencing large amounts of pain.
Ultimately, as Dr. Robin Fainsinger, a palliative-care physician at the University of Alberta, explains, the conversation is never going to be easy and the motivations for these requests vary. For example, while untreated pain is often the underlying issue at hand, the sentiment can also arise from other factors such as a feeling of loss of control or concern of burdening family members. Although, both Dr. Harlos and Dr. Fainsinger explain that with the right type of medical help and counseling these sentiments can be reduced. In fact, over the last several years the number of patients requesting assisted-death has declined as palliative care services have increased and improved.