I don't think that it's a failure of palliative care. It's unlikely a person will just wake up one morning.... But the wish to hasten death is very common in our field. At times, despite our best efforts...like anything in medicine, there are limitations to what we can do. It may be that we are just unable to address the suffering in ways that are acceptable to the patient.
Ultimately, Canadians have that access for eligibility, but it's also true that the presence of the MAID law allows us to deliver palliative care.
I had a patient with HIV and ALS, and he had no use of his upper body or his arms. He was completely dependent on others for feeding and for personal hygiene. He lived on the 22nd floor of a high-rise in Toronto, where I cared for him, and he told me it was the MAID law and his opportunity to choose or to have that choice when he was ready.... Otherwise, he accepted everything that we could do in palliative care. It was the MAID law that allowed him to accept palliative care, or he stated clearly that he would have jumped. The overall answer is that it doesn't happen immediately. We have limitations, and the presence of the MAID law often allows us to deliver excellent palliative care to the best of our ability.