The pandemic is making it harder to deliver medically assisted death, doctors say

Some doctors say the pandemic is making it harder to provide medically assisted deaths to patients who request them, due to shortages of protective masks and gowns and last-minute scrambles to find places to perform the procedure.

The pandemic also is being cited as the cause of a reported surge in public interest in assisted death.

Dying with Dignity Canada CEO Helen Long told CBC News hundreds of people have contacted her organization in recent weeks to learn more about end-of-life planning. Some have been asking whether they could obtain medical assistance in dying (MAID) if they fall ill with COVID-19 and wind up on a ventilator.

“A medically assisted death is probably not the solution for most people, but there are other things that can be put in place to ensure your wishes are granted and that you do get quality end-of-life care and choice,” said Long.

One Toronto doctor said she is seeing a surge in demand for the service — and some patients are trying to move up their medically assisted deaths because of the social isolation that pandemic measures impose.

“Some of them actually have said, ‘You know, I was planning to do this anyway and I’m cooped up. I can’t go anywhere. Nobody can come and see me. So what’s the point of hanging around?'” said Dr. Chantal Perrot, who is also a director with Dying with Dignity Canada.

“It’s sad when anybody chooses to end their life, but when they feel they have to do it under circumstances that are so isolating and challenging, it just makes it that much more sad.”

Mental health advocate and Order of Canada recipient Pat Capponi recently ended her life with a medically assisted death. Her close friend Cynthia Good said Capponi moved up the date of her passing because she feared she would lose access or fall ill with COVID-19.

“She did not want to die that way, if she should contract it,” she said.

Dying in a funeral home

But the pandemic is making it more challenging to provide medically assisted deaths, say doctors. Not all facilities are willing to permit the procedure on their premises — and with inter-facility transfers curtailed by pandemic restrictions, some families have had to get “creative,” said Dr. Stefanie Green, founder of the Canadian Association of MAID Assessors.

One patient in Ontario had the procedure performed in a funeral home, she said.

“After getting two ‘nos’  in the first two calls, [the patient’s family] found another funeral home that was certainly willing to do so,” said Dr. Green.

The patient was given a room and had their life ended with medical help on the premises, she said. The patient’s funeral arrangements also took place there, she added.

Dr. Perrot said she believes it’s not the first time a medically assisted death has taken place at a funeral home in Canada.

A run on drugs, equipment

Beyond the logistics involved in finding a place to deliver the procedure, physicians performing medically assisted deaths are facing the same problem facing health professionals everywhere: shortages of the necessary tools.

Dr. Green said doctors are worried about shortages in the drugs used in medically assisted deaths. Many of those drugs are used in intubating patients being placed on ventilators and in palliative sedation, she said — which means they’re in high demand among health professionals caring for victims of the pandemic.

Dr. Perrot said one pressing concern is the shortage of personal protective equipment. Before the pandemic struck, she said, she would wear gloves while attending to an assisted death; now, she and her colleagues also need masks, gowns and sometimes goggles or visors, depending on the health status of the patient.

“We’ve got no gowns,” she said. “I resurrected an old lab coat from my medical school days going back decades. I’m using that as opposed to a gown but it’s definitely not ideal and not very comforting.”

Virtual assessments

The pandemic also has imposed changes on the MAID process itself.

Before a patient can obtain permission for a medically assisted death, two doctors or nurse-practitioners have to give medical opinions saying the patient qualifies under a number of criteria; among other things, the patient must have an incurable medical condition and be experiencing intolerable suffering.

Usually, getting at least one of those medical opinions involves an in-person exam. Dr. Green said that, whenever possible, patients are now being assessed remotely or online to prevent in-person contact.

“Often our work is very up close and personal. So how can we do this work in a way that’s safe for everyone, but still compassionate?” she said.

The regulations on medical opinions for MAID patients differ from province to province. Dr. Green said her organization is asking medical regulating bodies to allow for more virtual assessments. And more provinces are now allowing the two independent witnesses who sign off on MAID requests to do so virtually.

Legislation delayed

The pandemic is affecting medical aid in dying in another way — by delaying the federal government’s planned changes to the MAID law.

Back in March, the House of Commons was debating a proposed law that would allow people whose deaths are not “reasonably foreseeable” to get medical help to die. That was before the novel coronavirus brought Parliament to a screeching halt.

The House of Commons has returned in a very limited form, with just two special meetings of MPs each week. According to the terms of an agreement among the parties, the government can only bring forward business related to COVID-19 for the next month.

MPs participated in a dry run of a virtual sitting of the House of Commons on April 28, 2020. (Michelle Rempel Garner/Twitter)

The government was prompted to change the law in the first place in response to a ruling by the Quebec Superior Court, which found that the current law violates the Constitution. The government asked for a four-month extension on the court’s deadline for changing the law.

That extension was granted before the pandemic hit; the government now has until July 11 to  pass a new law. If it does not, the part of the law that currently says someone’s death must be reasonably foreseeable in order to qualify for medical assistance in death will no longer apply in Quebec. Officials have indicated they want to avoid such an imbalance.

A fast-approaching deadline

Right now, Justice Minister David Lametti isn’t saying whether he’ll seek another extension or try to find a way to get the legislation passed before the deadline.

“We are aware of the time-sensitive nature of this file and we continue to work with the Minister of Health, as well as other key actors, to examine options for next steps,” says a statement from Lametti’s office. “No decision has been taken at the present time.”

MAID advocates say they’re still hoping the legislation can be passed soon.

“While we recognize everything that is going on, this is something important and it needs to remain a priority,” said Long.

In the meantime, Long said, the best thing people can do if they’re worried about their end-of-life care is draft an advanced care plan and talk to their loved ones about their wishes. She said her group recently offered a webinar on the topic that saw more than 600 people sign up.

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