Professor Harvey Chochinov:

I did not indicate that my position was neutral. In fact, I feel that including medical aid in dying within the scope of palliative care is not good for end-of-life care. It is not good for clinicians and it is not good for patients. I raise this not on moral grounds but on clinical grounds. Many aspects of palliative care are about the quality of the relationship between the patient and the healthcare providers. We have done studies that have looked at what are the things that are most determinant of whether or not a patient's sense of dignity is upheld towards the end of life. Over and above anything else is the idea of being respected and of being understood at the end of the day. I published a paper in the Journal of Clinical Oncology titled "Dignity and the eye of the beholder" showing that the disposition of the healthcare provider and the ability to affirm the worth and the ongoing connection with that healthcare provider was the thing that most determined a patient's dignity. From other studies we know that when patients feel they no longer have that kind of ongoing solid connectedness, it heightens their suicidality, and not offering follow-up care is one of the predictors of suicidality in patients who are experiencing advanced illness.