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

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.

Forced and chosen transfers for medical assistance in dying (MAiD) before and during the COVID 19 pandemic: A mixed methods study.

The purpose of this study was to describe the experience of people who transferred locations for MAiD. It used mixed methods with a chart review from one health authority and interviews with key informants across Canada. In the chart review, we found that of 444 MAiD deaths, 42 (9.5%) were forced to transfer due to the religious affiliation of the facility and 33 (7.4%) chose to transfer. In 23 interviews with 18 key informants we found that the most important theme was the suffering caused by forced transfers. COVID-19 restrictions led to fewer choices and more suffering.

The impact of the COVID-19 pandemic on medical assistance in dying in Canada and the relationship of public health laws to private understandings of the legal order.

Drawing on interviews we conducted with 15 medical assistance in dying (MAiD) providers from across Canada, we examine how physicians and nurse practitioners reconcile respect for the new, changing rules brought upon by the coronavirus disease 2019 (COVID-19) pandemic, along with their existing legal obligations and ethical commitments as health care professionals and MAiD providers. Our respondents reported situations where they did not follow or did not insist on others following the applicable public health rules. We identify a variety of techniques that they deployed either to minimize, rationalize, justify or excuse deviations from the relevant public health rules. They implicitly invoked the exceptionality and emotionality of the MAiD context, especially in the time of COVID, when offering their accounts and explanations. What respondents relate about their experiences providing MAiD during the COVID pandemic offers occasion to reflect on the role actors themselves play in giving meaning (if not coherence) to the potentially conflicting normative expectations to which they are subject.