Dr. Bouchard is proud to be part of a group of healthcare professionals that provide palliative care. He considers caring ​for the seriously ill and dying to be an important aspect of the Hippocratic Oath. As someone who works closely with ​palliative care and people with disabilities and life limiting illnesses, Dr. Bouchard is concerned about the impact of ​MAID on physicians.

“There have often been reports of moral distress [among physicians administering MAiD], and this is really ​understandable. If you go into a line of work to help comfort people and instead you’re involved in helping them die, ​there can be some mental or moral distress,” said Dr. Bouchard. This moral distress goes beyond just physicians who ​are conscientious objectors. Dr. Bouchard believes that even current MAID providers are at risk given the proposed ​expansion of MAID to include mental illness. “Everybody has a line in the sand, even current MAID providers,” he said.

Indeed, we are already seeing this happen. Following the proposal to ​include mental illness as a sole reason for MAiD eligibility, some ​MAID providers have said that they are no longer comfortable with ​participating in the practice.

Despite many physicians not wanting to perform MAID, physicians ​who are uncomfortable or refuse to participate face stigma. In ​addition, there is a misconception that, since MAID is a legal right and ​every province is required to ensure access, all physicians must refer ​if a request is made. However, this is not actually the case in every ​province. In Alberta, for example, it is not required that a physician ​refer for MAID.

“I think at the end of the day there is an expectation that you’ll tell a ​patient who asks about it that it is available and it’s something that ​they can access if they so choose, but how exactly they access it is ​dependent on what kind of system the province worked out,” said Dr. ​Bouchard.

In British Columbia, Newfoundland and Labrador, Ontario, Quebec, PEI, Saskatchewan, New Brunswick, Manitoba, and the ​Yukon physicians are required to either directly refer, notify the proper healthcare authorities who will refer, or provide ​information to the patient about how to access MAID. In Nova Scotia physicians are not required to make referrals, however it ​is recommended by the college of physicians. In Alberta it is not required, but the college states that physicians have “an ​obligation” to refer. The Northwest Territories and Nunavut have set up a Central Coordinating Service to connect patients to ​physicians who are willing to provide MAID in the event that their attending physician is a conscientious objector.

This does not mean that medical facilities haven’t felt pressure to perform MAID. In British Columbia, the Delta Hospice ​recently lost funding following their refusal to provide MAID. When asked his thoughts on this, Dr. Bouchard explained:

“I think there will be enough government-sourced beds and places that will provide MAID. You don’t have to demand that ​every single facility provide it. Many patients themselves also want to have safe places to be.”

Dr. Bouchard feels strongly that allowing facilities and healthcare workers the choice to participate in MAID is an important ​part of living in a democracy.

“I think creating safe spaces is just part of what a pluralistic society should do,” he stated. He sees it as a way to ensure that all ​patients and healthcare workers feel safe. “Some of the colleagues I work with are specifically working at my site because they ​know MAID is not provided there,” said Dr. Bouchard. “In my experience with patients in our facilities, there’s a great sense of ​safety that this isn’t a place where we consider MAID. People are free to choose a facility where that’s available, so I think ​people who are choosing our sites are very happy to know that there’s not going to be a time when MAID is suggested; I think ​it's a very patient-centred thing to have facilities where people feel safe,” Dr. Bouchard stated.

Dr. Bouchard hopes that in the future facilities such as his own will no longer feel the need to fly under the radar, and that a ​plurality of views on this topic will be respected. He also hopes to bring some positivity into the debate.

“I don’t think we convince people of our position by being morose, pessimistic, and negative about things. Affirming life and ​promoting a culture of life is something that should make us very cheerful,” he said.

Alberta’s population is rapidly aging. It is expected that the number of people 65 and over in Alberta will reach 20% by 2046. ​This will no doubt place stresses on the Albertan healthcare system - especially when it comes to palliative care. In 2023, there ​were 257 publicly funded community designated palliative care beds and 126 publicly funded acute palliative care beds across ​the province. Edmonton also had 12 privately funded hospice beds. While this is only enough for less than 1% of the ​population, the province is still moving in the right direction overall.

In response to concerns over Alberta’s aging population, the province has taken great strides in recent years to improve ​palliative care access. In 2019, the province began an initiative to spend $20 million over four years on improving palliative ​care.

Alberta also recently implemented the Emergency Medical Services Palliative and End of Life Care Assess, Treat, and Refer Program. ​This program allows palliative care patients or their clinicians to call 911 during a palliative emergency and receive palliative ​care at home. This program has been quite successful in improving Albertans’ access to palliative home care.

The largest percentage increase of MAID deaths in Alberta between two years took place from 2016 and 2017; the 2017 number ​was a 225% increase from the 2016 number. Across the six years accounted for in the report, MAID deaths in Alberta increased ​838%, going from 63 deaths in 2016 to 591 in 2021.

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“Here's a List of the Strict Assisted Death Guidelines across Most of Canada | CBC News.” CBCnews, CBC Radio Canada, 26 May 2016, ​https://www.cbc.ca/news/canada/nova-scotia/assisted-death-guidelines-canadian-provinces-1.3600738.

Levitz, Stephanie. “Canada's Medical Assistance in Dying Review Was Biased and Ignored Us, Expert Witnesses Say.” Thestar.com, Toronto Star, 8 Mar. 2023, ​https://www.thestar.com/politics/federal/2023/03/07/canadas-medical-assistance-in-dying-review-was-biased-and-ignored-us-expert-witnesses-say.html.

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Syed, Ronna, director. Is It Too Easy to Die in Canada? Surprising Approvals for Medically Assisted Death -The Fifth Estate. YouTube, CBC News Media Centre, ​19 Jan. 2023, https://www.youtube.com/watch?v=plinQAHZRvk&t=1163s&ab_channel=TheFifthEstate. Accessed 17 Apr. 2023.