Assisted-dying advocates discouraged over inadequate fees

Doctors say provincially dictated fee codes feel like a ‘planned disincentive’

Assisted-dying advocates discouraged over inadequate fees
Dr. Tanja Daws was a vocal supporter of medical assistance in dying (MAID) long before it became legal. When it was legalized just over a year ago, she became one of the first assisted-dying providers in the country; she and seven other BC doctors did the work for free, assuming that they would be paid retroactively and fairly.

That hasn’t happened. In fact, Daws and other doctors providing the service have realized that the fees BC has mandated for the service are not enough to cover their expenses, according to Macleans.

“It struck me that I can’t keep doing this,” she told the publication. “I can work for nothing, but I can’t work for a loss.”

At least one doctor in BC has withdrawn from providing the service, and others have stopped travelling to do it. Daws is considering reducing her MAID work as well, although she said she’s heartbroken for patients who “will have to suffer and die without it.”

A BC physician doing an initial MAID eligibility assessment gets $40 for every 15 minutes with a patient, which is capped at 90 minutes. A second assessment by a different physician has the same rate, capped at 75 minutes. There’s a flat fee of $200 for administering the drugs, and another flat fee of $113.15 for travel.

According to BC MAID providers, those rates aren’t enough to cover variable expenses they have to deal with. Considering all the work needed for MAID, most providers say it takes at least three and a half hours. Spending that time on routine office work would get a family doctor twice the MAID rate; specialists doing their day job could earn triple the rate in that time. Counting all the practice-related expenses that they have to deal with, doctors say they end up losing money doing MAID.

Citing a study by the University of Toronto, Macleans reported that doctors’ attitudes toward cesarian sections changed depending on financial incentives. Based on data from five million hospital records, the researchers found that doubling the compensation for C-sections relative to vaginal deliveries increased doctors’ likelihood to deliver the baby via C-section by 5.6%.

That supports the idea that setting MAID fees below doctors’ normal compensation will likely discourage them from administering the service. “It feels like a planned disincentive to do the work,” said BC doctor Stephanie Green, who has stopped travelling to offer the service.

A 2015 survey by the Canadian Medical Association found only 29% of doctors would consider providing the service; that was only based on ethical considerations. With providers pulling out because they feel they’re not paid fairly, the service will likely become even less available.

“Intentionally or not, the outcome is the same: you’re putting up barriers to access,” said Shanaz Gokool, CEO of end-of-life rights organization Dying with Dignity. “And now that [policy-makers] know, it’s their responsibility to make changes ASAP … [Assisted dying] is only a right, it’s only a choice, if you have meaningful access to it.”

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Medical assistance in dying suffers setback over physicians’ fee concerns