'I choose to be in control': Some seniors weighing medically assisted death because of COVID-19

From her home in Whitehorse, 71-year-old Liz Richenbach is watching COVID-19 cases sweep across the country,and she finds herself contemplating death.

She's not afraid of dying, nor is her demise imminent. But, as someone with chronic illnesses, she wants a plan for when her time comes.

"I choose to be in control of these things," Richenbach toldCBC Radio's Cross CountryCheckup.

If she were to contract the COVID-19 illness, she "doesn't see the point" in being attached to a ventilator, based on what she understands about her chances of survival.

"In the situation of COVID, I would not want to go on a ventilator because I wouldn't be coming off anyways. I just don't care to go down that route."

Still, she worries about a painful death. Having considered medical assistance in dying (MAID) before, she now wonders if that option will be available during the pandemic.

"My understanding is it takes quite a while to get that authorization," said Richenbach. "I would like to have the option of ending it and not be lingering."

'No ability for an advance request'

Not-for-profit organization Dying With Dignity (DWD) Canada has seen an uptick in calls from Canadians such as Richenbach, wanting to know if MAID will be available if they end up hospitalized with COVID-19.

But the head of DWD Canada says if a senior is fearful about a potentially unpleasant death from COVID-19, applying for assisted dying isn't the solution.

"We're not advocating that people go out and complete a MAID process in preparation. There is no ability for an advance request at this point in time," said Helen Long, CEO of DWD Canada.

Under Canada's assisted dying law, MAID is available to Canadians over the age of 18 who have an illness, disease or disability that is serious and incurable. The disease must be in an "advanced state of irreversible decline in capability" and cause "intolerable" physical and psychological suffering.

Long saidthe MAID application is "a very specific process where someone's death is 'reasonably foreseeable' and the urgency of the COVID situation might make it difficult to get through that process."

While Long saysCanadians may be shocked by the high rates of COVID-19 deaths in long-term care homes, she advises those who don't want to be on a ventilator to fill out advanced care directives. Otherwise, the decision on whether to use a ventilator may fall to a family member, or physician if no family is present.

"It's important that you document those wishes and that you've talked to your loved ones, and if you have a substitute decision maker, that those people know what you want to happen," said Long, who adds that DWD Canada offers an advanced directive kit on its website.

Speeding up MAID applications

Because the condition of COVID-19 patients can deteriorate quickly, MAID may not be the best option but it is still an option, according to a Victoria-based physician who specializes in providing it.

"I have provided for MAID on the same day that I've met someone on certain occasions," said Dr. Stefanie Green, president of the Canadian Association of MAiD Assessors and Providers. "It's not common MAID is a process that requires rigorous procedure and safeguarding and is meant to be that way."

In rare circumstances, Green says, MAID applications can be expedited. If two assessing physicians agree a patient is at "imminent risk" of losing their capacity or life, they can forgo the typical reflection period of 10 days required by law.

"If they're about to die, or we think they're going to die within 10 days, we actually can go ahead and waive that reflection period and move quicker," Green explained.

Nevertheless, she agreesMAID may not be in the best interest of COVID-19 patients, given how rapidly symptoms from the virus can progress.

"Often, in that kind of situation, the best care is probably goodpalliative comfort care."

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Dr. Nadia Alam of Georgetown, Ont., describes how one elderly patient didn't want to be on a ventilator and how her children are afraid that she, too, may get sick.

Provinces adapt MAID processduring pandemic

DWD Canada has also been fielding inquiries from terminally ill patients, worried their scheduled MAID procedures may not go ahead as planned because of the redeployment of health-care professionals and shortages of medical supplies, such as intravenous therapy.

"There's a lot of health care that is not being provided right now because we have a global pandemic. It's scary for Canadians who are used to having access to fairly good quality care in this country," said Green.

She added, though, that her assisted dying practice has remained "quite busy," despite the pandemic.

While some provincial health authorities briefly paused MAID services, DWD Canada saidhospitals and clinicians across Canada have adjusted workloads to deal with the needs of the health-care system and to respond to physical distancing requirements.

Provinces such as Manitoba, Saskatchewan and British Columbiahave changed MAID requirementsby offering "virtual assessments" by doctors as a way to reduce the risk of clinicians getting sick from COVID-19, according to Long.

The MAID law also requires a patient's consent form to be witnessed in writing. Some provinces are now recognizing "virtual witnessing" via video apps, such as FaceTime, Zoom and Skype, in order to comply with physical distancing measures.

Interviews produced by KirthanaSasitharan.