Will Canadians with long-term COVID be able to opt for medical assistance in dying?

Doctors wonder if long-lasting COVID, a still poorly understood disease, could qualify for medical assistance in dying. The file of a Torontonian with the disease who recently made the request could offer one of the first answers.

Tracey Thompson had no idea she would still have symptoms of COVID-19 in 2022 when she first contracted it in March 2020, before the vaccines and when little was known about the disease. Her first symptoms were mild, she says on the phone: “I didn’t need to be hospitalized, but my situation never improved. »

These days, the Torontonian often spends her days in bed. “My memory is not good; I am sensitive to screens; I have difficulty reading; some days I find it hard to listen,” she says. “My heart rate is also often elevated. When she first spoke to experts about it, she was asked if she was hiding a substance use problem: “It was scary and disheartening,” she says.

Due to the effects of long-lasting COVID, she has been out of work for more than two years, a major factor in her decision to seek medical assistance in dying. This element alone makes his case complex – even troubling – according to experts consulted by The duty. But the very condition of Tracey Thompson is just as important.

Dare looking forare in progressin Canada and around the world, to better understand long-term COVID and the possibilities for recovery.

According to Toronto physician Kieran Quinn, who is interested in the post-COVID syndrome, Tracey Thompson’s case for resorting to medical assistance in dying is based above all on the criterion of “grievous and irremediable health problem” and the one of its sub-criteria is that the person has an “advanced state of irreversible decline”. The long-lasting COVID is only two years old, however, and it may be too soon to conclude that the disease is “irremediable”, he warns. But the decision will ultimately depend on the assessment made by the specialists consulted by the Torontonian.

Western University professor Grace Parraga, who also studies the disease, agrees. The situation of people suffering from long-term COVID is “terrible”, she laments, but there is a “ray of hope”. “We have data, unpublished and not yet peer-reviewed, that demonstrates some recovery,” she says.

“Some doctors consulted by the patient might hesitate [à lui accorder l’aide médicale à mourir] since they don’t know enough about the disease,” says Dr.D Chantal Perrot, Co-Chair of the Clinician Advisory Council for Dying with Dignity Canada.

The constant suffering from illness alone was not the reason for Tracey Thompson’s decision to seek medical assistance in dying. “My story is not just about long-term COVID: it is also about what happens to poor people who have a disability,” explains the Torontonian. Without income for two years, she sees herself ending her life with no fixed address. Even the $1,169 monthly support, variable depending on the situation and not automatic for long-term COVID, from the Ontario Disability Support Program would not be “sustainable”, she says.

University of Toronto professor Trudo Lemmens, a specialist in health law, protests against the situation in which Thompson. “We allow medical assistance in dying for people who are not nearing death, but who are suffering from poverty,” he laments, referring to the new version of the law. In March 2021, the federal government eliminated the requirement that natural death had to be reasonably foreseeable.

“It is a sign of a system adrift. I think it’s a shame for our society,” says Professor Lemmens. Before a parliamentary committee, in June 2021, he had also accused the federal government of having “put the cart before the horse” by expanding the law even before having made a detailed assessment of it. Medical assistance in dying should be expanded again in 2023: people with mental health problems will be able to access it.

Mr. Lemmens is also asking for a commission of inquiry which would analyze the “slippage” of the law, as in the case, according to him, of Thompson. Moreover, the speed with which the law is extended “deeply violates the precautionary principle in the development of health policies”, he believes.

A person cannot qualify for medical assistance in dying simply because they have financial problems, nuances the DD Chantal Perrot. But the doctor concedes that these factors can contribute to suffering, which the evaluator cannot ignore, she notes.

Still hope

Tracey Thompson submitted an initial request for a doctor’s evaluation a month ago and is still awaiting a response. Two experts — including a long-term COVID specialist — will have to give the green light. The process takes a minimum of three months.

In the meantime, the Torontonian still has hope that a cure will be found. “If someone said to me tomorrow, ‘Try this medicine,’ I’d be happy to,” she says. By law, specialists must offer her recovery options, but she can refuse them.

According to the Ontario Ministry of Health, this is the first-ever request for medical assistance in dying related to long-term COVID.

For his part, the Dr Kieran Quinn, who works in two hospitals in Toronto, is concerned to see cases similar to Tracey Thompson’s multiply: “I don’t know what the solution is,” he admits. “We have to ask ourselves why health professionals put an end to the lives of patients because of poverty”, launches for his part Professor Lemmens.

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