SAINT JEAN, NL — The same few doctors and nurses who helped introduce medical assistance in dying in Newfoundland and Labrador are fielding an ever-increasing number of requests — so much so that they feel they can no longer do it alone.

Requests for medical assistance in dying in the province are increasing every year and are outpacing the number of health workers available to handle these requests, Dr. Aaron McKim, family physician and head of medical euthanasia for the provincial health authority.

“We faced a challenge for the first time last year when several doctors told us, ‘I can’t do this for a while, I need to take a break,'” said Dr. McKim in a recent interview. So we started getting requests for MAID and had to tell people we didn’t have anyone to perform MAID.”

The situation got so bad that Dr. McKim told his colleagues in a briefing note in April that six people were awaiting assessment for MAID and that at least one patient was waiting approximately five months for assessment.

Newfoundland and Labrador has had the lowest rate of medically assisted deaths in the country over the past four years, according to a report released last month by Health Canada. About 1.5 per cent of deaths in the province in 2022 were treated by a doctor, compared to a national average of about 4.1 per cent.

But in the province’s eastern region, which includes the capital St. John and is home to about 60% of the provincial population, the number of people requesting medical assistance in dying cases rose from 16 in 2019 to 107 in 2022 said Dr. McKim in his report. There were 37 inquiries in the first quarter of 2023.

Each MAID application must be evaluated by at least two reviewers, who may be doctors or nurses. Seven medical professionals conducted 75 percent of the primary assessments for all claims in the region between 2016 and Aug. 31, 2021, McKim’s memo said. Eight individuals completed 76% of primary assessments in 2022.

As of May 25, seven people in the region were awaiting full review of their applications, officials said in an email. Three patients still required two examiners and had to wait up to 113 days.

The vast majority of inquiries concerned medically assisted deaths in the first category, i.e. cases in which a natural death is foreseeable.

Patients whose natural death is not reasonably foreseeable but whose condition causes unbearable suffering may request euthanasia in the second category. In 2021 there were five applications for the second course of study in the East region and nine in 2022. Nine applications were submitted between January and September.

In an emailed statement, the provincial health ministry said it understands access to MAID is important. The doctors’ fees for the assessment were negotiated with the provincial medical association, the statement said.

Not everyone who requests an examination necessarily wants medical assistance in dying, noted Dr. McKim. For example, in the year since September 1, 2022, 10 second reviews were carried out, but no procedures were carried out. During the same period there were 87 initial applications and 46 proceedings.

Sometimes being approved for MAID makes patients feel more in control after receiving a life-changing diagnosis, McKim said.

“This gives people security: if the suffering becomes too serious, they have a way out,” he said. As a MAiD practitioner, my goal is to help someone make a choice. And what he ultimately does is up to him.”