End-of-life planning and COVID

Photo by Romain Dancre

The COVID pandemic has turned out to be a “call to action” for end-of-life planning. News reports suggest that requests for wills have gone up dramatically.

More people are discussing their end-of-life preferences with loved ones and are preparing Personal Directives. This is a great improvement on our society’s usual head-in-the-sands approach to death.

In that sense, COVID has done us a favour by forcing people to consider what they would prefer the end of their life to look like and how they can help to ensure — to the extent possible — that it ends up that way.

Medical Assistance in Dying (MAID) is unlikely to be a suitable measure in cases of COVID because of the disease’s potentially rapid progression and due to the need to be mentally competent to request MAID.

Being placed on a ventilator often requires patients to be put into a medically induced coma due to the discomfort of the tube being inserted into the throat.

And even prior to being put on a ventilator, you may be so ill that you have to rely on others to make decisions for you.

But greater consideration of end-of-life issues as a result of the pandemic means there will be more interest, going forward, in MAID as a general end-of-life option. In January 2020, the federal government launched an online consultation to hear Canadians’ opinions on MAID.

The responses were unparalleled: over 300,000 people completed the questionnaire, ten times more than the average of 30,000 responses for consultations on issues like prostitution or marijuana. This level of interest was BEFORE the pandemic. Imagine what it would look like now!

Bill C-14, Canada’s assisted dying legislation, was passed in June, 2016. The bill gave Canadians with incurable and intolerable suffering the constitutional right to a medically assisted death. But there were, and are, stringent conditions that must be satisfied. Bill C-7, which is currently before Parliament, would remove some of these barriers.

A particularly cruel requirement under the current legislation is that patients must be mentally competent not only in order to request MAID but also immediately prior to receiving it. The fear of losing capacity has resulted in several cases of people requesting MAID well before they want it.

Another amendment proposed by Bill C-7 will remove the requirement that natural death be “reasonably foreseeable”. If passed, Bill C-7 will allow people who are chronically ill and suffering intolerably — but whose deaths are not imminent — to request MAID. Significant — some might say excessive – safeguards ensure that approval for such requests will not be easy to achieve. However, it is a step forward.

These changes are important but there is still much to be done. Bill C-7 will not allow mental illness on its own to be sufficient grounds for accessing MAID and it will still prohibit access to MAID by mature minors.

Finally, advance requests — whereby a competent person makes a request for assisted dying to be honoured later, after they lose the ability to make medical decisions for themselves — will still not be permitted.

Thus, people with capacity-eroding conditions, such as dementia, are denied their right to MAID. This is despite overwhelming public support for advance requests.

In an Ipsos survey conducted on behalf of Dying With Dignity Canada in January 2020, 82 per cent of respondents were in favour of advance requests where the patient has been diagnosed with dementia.

Dying With Dignity Canada was founded 40 years ago. Since then, the history of assisted dying in Canada has been a prime example of democracy in action and the power of the public’s dedication to a cause.

People across the country were already raising their voices and as society’s awareness of end-of-life issues increases during the COVID pandemic, demands for more choice will become even louder. This promises to be a landmark period in Canada’s history of compassionate end-of-life choice.

The opinions, beliefs and viewpoints expressed by the author of this piece do not necessarily reflect the opinions, beliefs and viewpoints of the Kerby Centre.