A recent article in The Gazette explains how Homecare in Quebec is in critical condition. The story describes the situation for people receiving homecare, and how patients are sent home from hospitals and rehab centres earlier than in the past, due to a shift in policy. Many people are unable to access all the services they need due to costs. This could be an incentive for people to choose euthanasia.
According to the article, Quebec will now focus on homecare. They are investing an additional $100 million a year for an insurance fund for homecare and support services. Homecare is generally less costly than hospital or institutional care, so on the surface, this is a good move. Of course, the way homecare is administered will have an impact on costs - The more bureaucracy, the more expensive.
The article states: "Provision, however, for home support other than medical care — cooking, housecleaning, bathing, dressing, and feeding and transportation, etc. — remains sketchy." The article tells the story of a woman who is not receiving the support she needs. She is having to pay nearly $10,000 a month out-of-pocket to private agencies for nursing, physiotherapy and overnight care. The lack of access to services is bankrupting her. The article mentions several other people who are facing similar situations.
It is difficult enough to deal with chronic illness and pain. It is not unusual for people in such situations to develop depression. When the situation is made worse by critical financial problems, an individual can feel hopeless.
One of the so-called "safeguards" in An Act respecting end-of-life care is that the individual should not be coerced into deciding to resort to "medical aid in dying". Measuring whether someone was coerced or not can be very difficult. Coercion comes from different sources and doesn't only happen when someone is standing with a (figurative) gun to the person's head.
One form of coercion could originate in the State not fully providing a patient with needed services, yet offering euthanasia (which is significantly cheaper). An individual could easily feel pushed toward "medical aid in dying".
Of course, there are people who receive services that they could afford to pay for themselves while others don't. Some people's needs are greater than others', yet they receive less. Thus are the vagaries of a public safety net system. A physician told me recently that "measuring people's needs and resources in real life is next to impossible".
Quebec's resources are not limitless. We cannot give everything to everyone. But neither can we place people in a position where they feel that their only option is to opt for "medical aid in dying" because they can't afford anything else. We cannot put money before people, economy before life.
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2014