The Plague-Ground – Dying online

Last month, The New York Times reported on the rise of abortions by telemedicine. A doctor assesses the woman online. Then, if she is ‘approved’, she is mailed some pills.

One thing driving this is a clampdown by Trump faithful and conservative courts on abortion clinics in America. But the bigger factor seems to be the rapid infusion of telemedicine across all fields of medicine that don’t actually demand a live person, like removing your appendix, fixing your open heart or delivering your baby.

One new area of medicine in Canada is Medical Assistance in Dying, or MAiD, which began in 2016 after the Supreme Court voted 9-0 in favour of this once-taboo act, saying that not to allow MAiD constituted cruel and unusual punishment.

To qualify for MAiD, two doctors have to assess you to determine if you’re eligible to choose to die. These assessments are nearly always performed in person. After all, this is a life-and-death conversation. Because most people requesting MAiD are very old and/or very ill, an assessing doctor will go to that person’s home or hospital to make the assessment.

Not any more.

Now, virtually all MAiD assessments performed in the community (vs. in a hospital) are done ….virtually. Is this good? Does it work?

I asked my wife, Jean, who’s shifted her entire family practice from her clinic at Bay and Bloor to her computer here on Georgian Bay – and who’s also a MAiD doctor.

She believes she can perform a professional assessment because so much of what determines if a patient qualifies for MAiD concerns their values and quality of life. Last week she assessed a man in his 90s who’s chronically ill. He’s losing weight and his Parkinson’s is getting worse. He lives alone and if he felt isolated before COVID, which he did, he feels painfully so now. He’s lost all the values and people who matter to him.

But what about the physical part of her assessment?

She told another patient that she really needed to see her stand up and walk, and turn around and walk back and sit down again. The woman did that. But not without a whole lot of tech assistance from her adult daughter who was with her and helped her up and down and moved her computer screen around so Jean could ‘see’ her mom and her range of motion.

In fact, it’s vital in performing an online MAiD assessment to have someone other than the patient there to help out. Which creates a risk of infection. Which puts lots of new stress on the family or caregiver, and which is hell for patients who are isolated anyway. What’s worse? Dying alone in your home, or dying alone in a hospital hooked up to a ventilator?

This is the real change that COVID-19 has brought to medically-assisted death. Not so much the assessment, but the act.

Early on in the pandemic, some Ontario cities stopped doing MAiD all together.

But it’s starting to open up again. First, no family members were allowed to be there to see their mother or grand-dad die. It was just the patient and the doctor, a terribly lonely experience for both, since usually the ‘providing doctor’ doesn’t know the person they’re helping to die.

Mercifully that’s changing.  Now, two or three family members can be in the room, provided they’re masked and suitably distant from each other. The doctor, of course, is in full PPE.

Which kind of defeats one purpose of choosing where and how you will die: the celebration before that happens.

Catherine Porter, the Canadian bureau chief for The New York Times,  wrote the seminal article about the power of MAiD to renew life at the very time that it ended life.

That’s one of the quiet, terrible costs of the pandemic we’re in.

Let’s pray that when the fog lifts, we can lift this too.

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No, that’s not me reading today’s podcast. It’s our managing director, Alex Brown, who is waaaaaaaaay better than I am at this. Give her a listen.