Q&A on grief, MAID and preparing for a loved one’s scheduled death

On October 29, 2020, Dying With Dignity Canada presented a special webinar on grief, MAID, and preparing for a loved one’s scheduled death. Through a series of questions and answers, Kelsey and Tanis discussed what happens during a MAID death, shed light on some common concerns and provided recommendations for moving forward. This blog post is a summary of the questions and answers that weren’t addressed live during the webinar.

What are the COVID-19 guidelines when it comes to MAID?

COVID-19 guidelines will vary by province/territory, by region and even by health care institution. Generally, in a number of areas across the country, there are limitations on how many individuals can be present for a MAID death, especially if it is happening in a health care institution or retirement home. Prior to MAID, some people would have large gatherings such as living wakes but COVID-19 has certainly impacted that possibility in many cases.

One’s MAID provider would be able to most accurately speak to local guidelines. You may also be interested in watching the recording of DWDC’s June 2020 webinar, “MAID and COVID-19: Impacts of the pandemic on end-of-life choice.”

What happens to the body after a MAID death?

What happens to the body after a MAID death is the same in many ways to what happens after a non-MAID death. If a person dies at home, the funeral home is contacted to come pick up the body. In some provinces, the coroner must be called prior to the body being released to the funeral home.

How long can we keep our loved one with us at home after a MAID death?

Organizations such as Community Deathcare Canada should be able to speak to the specifics of your province/territory.

What if someone does not want any family or friends present?

The decision to have family or friends present is an individual one. There have certainly been instances where a person has accessed MAID with just the providing doctor or nurse practitioner present. That said, it is important to explore your own preference for end of life and the reasons why you would or would not want someone present.

What about the patients who may have become communication challenged in their speaking or hearing since making their original application? How do you manage this situation? Are they still eligible for provision?

There is no requirement that one needs to verbally consent to MAID at the time of the procedure. Individuals can express their consent in other ways. In some cases, a speech pathologist may be involved to aid with communication.

What are the costs involved in MAID and how are they covered?

MAID is covered under provincial/territorial health insurance. Canadian citizens and permanent residences who are eligible for health services in their province or territory would not pay out of pocket for the expenses associated with MAID (medications, appointments with clinicians, etc.).

Is self-administration on the rise? What are the trends?

According to Health Canada’s First Annual Report on Medical Assistance in Dying in Canada 2019, less than seven individuals chose self-administered MAID last year. According to the report, it is not unusual for those in jurisdictions with both options (self-administered and clinician administered), to prefer to have a practitioner administer the medications.

Does the MAID provider have to be a physician?

The MAID provider must either be a physician or a nurse practitioner. Those are the only two types of clinicians legally permitted to assess for MAID eligibility and do the actual procedure.

Do you have book recommendations for preparing children for the death of a loved one (for parents or for children to read)?

For parents, the book “How To Go On Living When Someone You Love Dies” by Therese Rando is a good resource. It has comprehensive information on grief, as well as a chapter specifically on children and grief. For children, a helpful starting point might be “The Goodbye Book” by Todd Parr.

Can a person with dementia or Alzheimer’s qualify for MAID?

A person with dementia or Alzheimer’s may qualify for MAID, if they meet all the criteria in the law. Under the current assisted dying law, C-14, there is a requirement that a person accessing MAID must have capacity at the time of the MAID procedure. Some people with dementia or Alzheimer’s have chosen to die earlier than they would have liked because of the uncertainty around when they would lose capacity and never regain it.

Why can’t people prepare a video recording outlining their MAID wishes for after they lose capacity?

Under the current law, one must have capacity at the time of death so a video recording or written document outlining one’s wishes would not be honoured.

If Bill C-7 passes as is, it will allow for some people to access MAID after they have lost capacity in limited circumstances.

Does one’s choice to have MAID affect their life insurance?

While DWDC hasn’t heard of anyone’s life insurance being affected by their decision to have MAID, it is best to follow up with your insurance company directly.

It is our understanding that most Canadian companies are following the Canadian Life and Health Insurance Association’s policy which states that “If MAID takes place and it is in accordance with the rules and processes set out by the government(s), then MAID will not be considered to be “suicide” for the purposes of life insurance.” However, as mentioned, it is best to inquire with your individual life insurance company.

Have people experienced bad reactions to the medications?

DWDC hasn’t heard of bad reactions to medications, however, there is a risk of IV failure in some cases. To mitigate this risk, two IV lines are usually inserted just in case one fails. Most assisted dying providers will also carry with them an extra set of the assisted dying medications as a backup. The Canadian Association of MAID Assessors and Providers (CAMAP) has a document called “Complications with Medical Assistance in Dying (MAID) in the Community in Canada: Review and Recommendations,” if you are interested in further reading.