Introduction

Webcast Archive: MAiD during the pandemic

This week, we ask the question: "if elective procedures are suspended during the COVID-19 pandemic, why has euthanasia continued?"

Webcast Archive: MAiD during the pandemic

During the COVID-19 pandemic, we will not present our webcast, due to technical problems caused by heavy internet usage. However we are providing the text as a bulletin to offer up-to-date information about assisted suicide, euthanasia and ending-of-life practices for the disability community.

MAiD DURING THE PANDEMIC

  • One of the early steps taken to combat the Coronavirus pandemic was cancelling or postponing elective medical procedures; operations that don’t need to be done immediately to save a person’s life or health, or where putting off surgery won’t make the condition worse. An article in the journal of Patient Safety in Surgery (published March 31) listed five priority levels for medical procedures:
    • “Emergent” operations, like removing a bowel blockage, an emergency C-Section, or repairing a blood vessel, that need to be done within an hour;
    • “Urgent” procedures include removing an appendix, setting open fractures (where the bone breaks through the skin), or stabilizing nerve or spinal-cord injuries which must be done within 24 hours.
    • “Urgent-Elective” procedures are those that should be done within two weeks, and include heart and lung operations, skin grafts, and setting broken bones.
    • “Elective-Essential” surgeries include biopsies and cancer removal, non-urgent heart valve replacement, hernia repair and hysterectomy which need to be done within three months.
    • Elective-discretionary operations are those that can wait three months or more and include cosmetic surgery, sports medicine, sterilization, weight-loss surgery and joint replacements. 
  • Where would assisted suicide and euthanasia (AS & E) fall on the scale of required versus elective procedures?  Unlike the “emergent” and “urgent” treatments, Medical assistance in dying (MAiD) does not save lives or maintain a person’s health, so it would be in the “elective” group.  
  • Even euthanasia providers seem to admit that MAiD isn’t necessary to ease pain. The COVID-19 guidance issued by the Canadian Association of MAiD Assessors and Providers (CAMAP) state that “MAiD procedures are generally elective.” The CAMAP guidelines caution against delaying MAiD, not due to concerns about pain, but because “postponement of a MAiD procedure could result in the person not receiving MAiD due to loss of capacity or death.” CAMAP points out that MAiD will probably be unnecessary for people with COVID-19 “because, ideally, these patients will readily receive palliative care and sedation, and have a peaceful death,” These are surprisingly honest admissions from people who promote AS & E.
  • While some providers stopped doing euthanasia in March, one network serving the Ottawa region resumed after a week, while others referred people to different facilities. Media reports (probably triggered by a press release from Dying with Dignity) claim that demand for MAiD has increased  and that there have been some access problems.
    • Shortages of personal protective equipment, and outbreaks of COVID-19 in facilities where people who want euthanasia are located have made it difficult to, in the words of the CAMAP, “ensure the safety of medical and nursing staff is of “paramount importance.” (“The safety of patients and their loved ones is a priority.”) 
    • A possible shortage of drugs is causing worry, but not affecting access to AS & E.  The sedatives used in the euthanasia procedure are the same as those that enable someone to use a ventilator via an inserted breathing tube. With the high demand by people with COVID-19, and no Canadian companies producing the drugs, some doctors fear there won’t be enough for providing euthanasia. So far, doctors have made up the shortfall by cutting back on the number of back-up doses they bring with them to perform euthanasia. 
    • Eligibility assessments must be done via video or phone, rather than in-person. “Ideally both assessments should be carried out using telemedicine” according to the CAMAP guidelines.
    • Quarantine conditions have put limits on who can be present at the euthanasia, and require that those people be screened for possible COVID-19 exposure, whether the procedure is done at a health-care facility or at the person’s home.
    • Because not all hospice or palliative care units allow MAiD, the usual practice of transferring the person to another facility has been limited during the pandemic.
  • One thing that hasn’t changed during the pandemic; the media continue in their role as cheerleaders for AS & E, relying on Dying with Dignity as an important source for information about the practice, and glamourising euthanasia.
  • If a public health emergency requires that elective procedures be cancelled, why has MAiD continued?  If even MAiD providers admit that euthanasia is an elective procedure, why has MAiD continued during this pandemic?  If we are trying to save as many lives as possible, it’s a scandal that MAiD has continued.