Providing Legal Assisted Dying and Euthanasia Services in a Global Pandemic: Lessons for Ensuring Service Continuity

Abstract

Background & objectives: Identifying the impacts of COVID-19 on patients’ and practitioners’ access to legal assisted dying and euthanasia (AD&E) services is vital to informing service continuity in an ongoing pandemic. Methods: An anonymous online survey collected qualitative and quantitative data from health practitioners and agencies providing legal AD&E services ( n = 89), complemented by semi-structured interviews with 18 survey respondents who volunteered. Results: Following governments’ responses to the dynamic pandemic context, rates of AD&E inquiries and requests fluctuated across and within jurisdictions, based on a complex interaction of factors affecting patient access to AD&E agencies and assessors as services were disrupted. Service flexibility and nimbleness became key elements in continuing service availability and included calculated ‘rule-breaking’ considered justifiable to adhere to established bioethics. Making innovative adjustments to usual practice led to reviewing the effectiveness of AD&E services and laws, resulting in providers now improving services and lobbying for legislative change.

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. The over-representation of the Canadian context in the literature is likely as MAiD was only recently legalized in Canada and is currently receiving much research attention.…”

“…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 ▪▪ ].…”

“…In another survey-based study, conducted by Oliver et al [ 11 , 12 ▪▪ ], 89 respondents who were involved in MAiD provision completed an online survey about the impact of the pandemic on MAiD services during the first wave of COVID-19 (from July to August 2020). Most of the participants (55%) were from Canada, and others were from 10 other jurisdictions in which MAiD is legal.…”

“…The study also included qualitative interviews from August 2020 to January 2021 with a subsample of 18 participants, but it is unclear in which jurisdictions they were located. Oliver et al 's [ 11 , 12 ▪▪ ] analysis uncovers how MAiD providers responded and adapted to the disruptions created by the pandemic by employing flexibility and ‘calculated rule-breaking’ (e.g. in regards to witnessing requirements or public health restrictions on the number of people present for MAiD assessment or procedure).…”