How the experience of medical assistance in dying changed during the COVID-19 pandemic in Canada: a qualitative study of providers

Abstract

Background:In March 2020, all levels of government introduced various strategies to reduce the impact of the COVID-19 pandemic. The purpose of this study was to document how the experience of providing medical assistance in dying (MAiD) changed during the COVID-19 pandemic. Methods:We conducted a qualitative study using semistructured interviews with key informants in Canada who provided or coordinated MAiD before and during the COVID-19 pandemic. We interviewed participants from April to June 2020 by telephone or email. We collected and analyzed data in an iterative manner and reached theme saturation. Our team reached consensus on the major themes and subthemes. Results:We interviewed 1 MAiD coordinator and 15 providers, including 14 physicians and 1 nurse practitioner. We identified 4 main themes. The most important theme was the perception that the pandemic increased the suffering of patients receiving MAiD by isolating them from loved ones and reducing available services. Providers were distressed by the difficulty of establishing rapport and closeness at the end of life, given the requirements for physical distancing and personal protective equipment. They were concerned about the spread of SARS-CoV-2, and found it difficult to enforce rules about distancing and the number of people present. Logistics and access to MAiD became more difficult because of the new restrictions, but there were many adaptations to solve these problems.Interpretation: Providers and coordinators had many challenges in providing MAiD during the COVID-19 pandemic, including their perception that the suffering of their patients increased. Some changes in how MAiD is provided that have occurred during the pandemic, including more telemedicine assessments and virtual witnessing, are likely to remain after the pandemic and may improve service.

The impact of coronavirus disease 2019 on medical assistance in dying

“…Recent published literature on the impact of COVID-19 on MAiD can be described under the following categories: studies investigating the impact of COVID-19 on MAiD from the healthcare providers’ perspective [ 7 , 8 , 9 ▪ , 10 , 11 , 12 ▪▪ ]; studies investigating the impact of COVID-19 on MAiD from the patient/family perspective [ 13 ]; and literature that reviews the impact of COVID-19 on MAiD from a legal–ethical perspective [ 14 , 15 ]. All publications, except two [ 11 , 15 ], were situated in Canada.…”

“…Ongoing studies in Canada on the implementation of MAiD were able to pivot quickly to respond to questions brought on by the pandemic. All studies collected data during the earlier phases of the COVID-19 pandemic, with most reporting on data collected up until July 2020 [ 7 , 8 , 9 ▪ , 10 ] and only two including data collected in 2021 [ 11 , 13 ].…”

“…Four studies involved surveys or qualitative interviews with MAiD providers and reported on the impact of COVID-19 on MAiD from their perspective. All of these studies were either conducted in Canada [ 7 , 8 , 9 ▪ , 10 ] or included mostly Canadian participants [ 11 , 12 ▪▪ ].…”

The pandemic and the delivery of palliative care and MAiD: What was the impact?

“…MAiD providers are small in numbers, and many found the emotional toll of the pandemic restrictions and the barriers between themselves and their patients, traumatizing and exhausting. 1 The already limited access was worsened by travel and admission restrictions. We do not have statistics on how many patients might have wanted MAiD but were unable to avail of it during the pandemic.…”

“…All clinicians involved in palliative care and MAiD had challenges with both enforcing rules and dealing with the impact of those on themselves and their patients. 1 …”