Some assisted dying appointments to go forward amid pandemic, others on hold

TORONTO — When Dr. Chantal Perrot called one of her patients to let him know that he would still receive medical assistance in dying next week as scheduled, he was grateful.

“You’re my hero. Thank you so much,” she recalled him saying Thursday over the phone. “That was all he needed to hear and he could rest easy until next week.”

The Toronto patient, who is scheduled to undergo a medical assistance in dying (MAID) procedure this month, was one of many Canadians worried they might not be able to access the service during the COVID-19 pandemic as health care workers are redeployed and medical supplies are threatened by shortages. For some Canadians, it means their suffering could be prolonged.

Last week, a Hamilton, Ont., hospital network said it would be halting its MAID program as staff are moved to work the front lines of the coronavirus crisis. Hamilton Health Sciences told CTVNews.ca that it would issue referrals to community-based providers like Perrot where appropriate.

“This was not an easy decision,” a spokesperson for Hamilton Health Sciences said in an email. “All of our [MAID] team members are focused on helping with the pandemic efforts. In addition, the limited movement of staff and physicians between sites (and wards) is making the conduct of appropriate assessments and provision difficult.”

In Ottawa, the Champlain Regional MAID Network issued a similar notice, but reversed its decision this week for patients at risk of losing the ability to consent (a requirement until the last minute during a MAID procedure) and to patients whose death is imminent, telling Postmedia on Thursday that the pause had been for safety reasons:

“We wanted to make sure… that we weren’t serving as vectors of the virus going into patients’ homes or long-term care facilities,” Medical Director Dr. Viren Naik told the Ottawa Citizen.

In Toronto, Dr. Perrot, who believes MAID should be considered an essential service, has been hearing from patients and families concerned that scheduled procedures won’t be able to go forward as planned. About half of MAID procedures are done in hospitals, said Perrot. Some of those people are already hospitalized, while others choose to die in hospital, some for religious reasons or housing issues. Her patients are all within the community. For both subsets of MAID patients, there’s concern of a lack of resources, including intravenous therapy (IV) access as well as specific medication, said Perrot. Some of the medications used in MAID procedures are also used in hospitals for intubation, in which a tube is inserted into a patient’s airway so they can be placed on a ventilator.

“In the midst of a crisis resources are scarce and some may need to be reallocated and reassessed,” said Perrot. “But I think medical assistance in dying needs to be deemed an essential service because these people are at end-of-life.”

In Nova Scotia last month, some temporary changes to the MAID laws were made to allow people who work for the provincial health authority to act as a witness to a patient’s consent form signature as health care facilities clamp down on the number of permitted visitors.

Some non-profits committed to providing witnesses for patients have been forced to suspend their programs because of physical distancing measures. Perrot hopes the government will allow patients to sign consent forms virtually and allow for virtual witnessing in the interim.

In B.C., all six health authorities in the province are continuing to support patients exploring requests for MAID. The Provincial Health Services Authority (PHSA) said it will recognize "virtual witnessing" via video apps like FaceTime, Zoom and Skype to follow physical distancing.

At a federal level, proposed changes were on the way to MAID laws, which went into effect in 2016. Among a slew of tweaks, the new laws would allow for MAID whether or not an eligible patient’s death is “reasonably foreseeable.” The deadline for amendments was recently pushed from March 11 to July 11, but it’s unclear whether the bill will be reviewed remotely in the meantime.

CTVNews.ca reached out to the Justice Minister’s Office to get clarity on the new bill, but did not hear back at time of writing.

As the COVID-19 pandemic intensified around the world, the threat of suspending or delaying MAID services might not only mean prolonged personal suffering for Perrot’s patients and many others. It could mean stressing the country’s already overwhelmed hospital networks.

“The consequences for (losing MAID) are that they continue to deteriorate and their conditions get worse, and ultimately, their families or nursing services are unable to care for them in the community and they end up in hospital,” said Perrot.

“That’s not how they would want to end their lives and it’s certainly not what the health care system needs right now.”