On December 9, 2020, Dying With Dignity Canada (DWDC) heard from three clinicians about the experience of providing health and end-of-life care during COVID-19. Discussion included an overview of what has changed since the start of the pandemic, and what it has been like to provide medical assistance in dying (MAID) during this period of change and uncertainty. This blog post summarizes some of the key takeaways from that presentation.
Please note that the experiences presented in this summary are those of the individual clinicians, and the processes may differ from province to province.
If you prefer to view this content in video format, the full webinar recording can be accessed here.
Dr. Lilian Thorpe, M.D., Ph.D., FRCP, MAID assessor and researcher
Dr. Jonathan Reggler, MB BChir, MAID provider
Julie Campbell, MBA, MN, NP, MAID provider
Key Takeaway #1: COVID-19 has not prevented MAID provisions from taking place, but there have been challenges to overcome.
Because of restrictions in hospitals and long-term care homes across the country, MAID assessors and providers have had to be creative in how they fulfill the legal requirements for MAID. Whether it be transferring a patient to an alternative location for their MAID procedure, or identifying ways to reach patients virtually, when they are in a rural area and/or do not have access to the required technology, assessors and providers have certainly had to pivot throughout the pandemic to ensure equal and timely access to MAID.
Key Takeaway #2: Someone with a high mortality risk from COVID-19 may not have enough time to go through the MAID process, and may consider alternative end-of-life options.
Under current legislation in Canada, a person must have capacity at the time of their MAID provision, which often means reducing or eliminating medications that decrease suffering. A patient may consider palliative care or palliative sedation as alternatives.
“My job as a MAID provider is not to provide as much MAID as possible,” explained Dr. Jonathan Reggler, “but to ensure during my assessments that my patients have all the information they require to choose the best death for themselves; and that is often not MAID.”
Key Takeaway #3: Even with restrictions and limitations on gatherings, it is possible to make your end-of-life experience special and personalized to you.
We have all had to adapt to a new normal because of the COVID-19 pandemic. Virtual gatherings and socially-distanced get-togethers have become a way of life, even for the dying. Some examples of the adaptations people have made include living wakes in the park during warmer months, and virtual MAID provisions using platforms like Zoom. But MAID providers and assessors have also found ways to adapt and ensure the process is as human as possible. Dr. Lilian Thorpe described situations where she would stand at a safe distance from the patient being assessed for MAID, take off her mask to create that personal connection, then put the mask back onbefore getting closer to the patient.
Key Takeaway #4: The introduction of virtual witnessing has streamlined the MAID process and made it more efficient, for both patients and assessors.*
In many cases since the start of the COVID-19 pandemic, the MAID provider has been the only one seeing the patient in person. The second assessment can often be done virtually in some provinces. The provider can bring the paperwork with them to the patient’s residence, and use their technology to support the patient while the second assessment is completed, and the independent witnesses sign virtually. As a result, both assessments and all of the witnessing paperwork can be completed in one visit.
Thanks to these new virtual practices, family members can be present at the initial MAID assessment, no matter where they are located. This opens the line of communication between physicians and nurse practitioners, patients, and their family members so that everyone knows what to expect and how to proceed after an assessment.
*Note from DWDC: Virtual witnessing may or may not be available where you live. We encourage you to speak with your MAID provider to learn more about local requirements.
Key Takeaway #5: COVID-19 has reinforced the importance of Advance Care Planning.
All Canadians, at any age and stage of life, should have open and honest conversations about what they want for end-of-life care. Questions like, “What are my chances of a meaningful recovery” should be asked and answered honestly, particularly when diagnosed with a virus like COVID-19. It is critically important that patients clearly articulate their wishes to their loved ones who may be making decisions for them at a later date.
These are just a few of the insights gathered from our December webinar, “A year in review: End-of-life choice during COVID-19.” To learn more, watch the full webinar.
As the COVID-19 pandemic continues to evolve, some of the information presented in this webinar may no longer be up-to-date. Please consult with your local health authorities for the most timely information.