An Ontario woman in her 80s was euthanized even though she had changed her mind and wanted palliative care instead, a provincial review says.
One case in the report involved the woman in her 80s, referred to as Mrs. B, who had several complications after coronary artery bypass graft surgery. She experienced physical and functional decline following her heart surgery, opted for palliative care, and was discharged home with palliative support services.
Mrs. B reportedly told her family she wanted MAID, and her husband contacted a referral service on her behalf the same day. A MAID practitioner assessed Mrs. B the next day for MAID eligibility, but Mrs. B told the MAID practitioner that she wanted to withdraw her request, citing “personal and religious values and beliefs.” She said she wanted to pursue in-patient palliative care or hospice care instead.
Her husband took her to the local hospital’s emergency department the following morning, and was “noted to be experiencing caregiver burnout,” according to the death review committee’s report. However, Mrs. B appeared to be in stable condition and was discharged home with continued palliative care.
While her palliative care doctor referred her for in-patient palliative or hospice care due to her husband’s burnout, the request was denied for not meeting “hospice criteria for end-of-life,” and a long-term care application was offered instead.
Mrs. B’s husband contacted the MAID coordination centre the same day requesting an “urgent” assessment, and a different MAID practitioner assessed Mrs. B and determined she was eligible.
The initial practitioner was contacted and raised concerns about the necessity for “urgency” versus the need for more comprehensive evaluation. That practitioner also expressed concerns about the “seemingly drastic change in perspective of end-of-life goals” and the possibility of “coercion or undue influence” due to her husband’s burnout.
“The initial MAID practitioner requested an opportunity to visit with Mrs. B the following day to re-assess; however, this opportunity was declined by the MAID provider due to their clinical opinion that the clinical circumstances necessitated an urgent provision,” the report said.
‘Against Her Will’
Most members of the Ontario MAID Death Review Committee raised concerns that there was “no clinical indication” for the MAID assessments and provision to occur within the same day. Meanwhile, some members said Mrs. B’s declining function and palliative performance scale score may have indicated she was “at risk for death or a loss of capacity” and therefore necessitated the urgency.“Most members believed the short timeline did not allow all aspects of Mrs. B’s social and end-of-life circumstances and care needs to be explored,” the report said.
“Members indicated areas that required further opportunity to explore or navigate as: the impact of being denied hospice care, additional care options, caregiver burden, consistency of the MAID request, and divergent MAID practitioner perspectives.”
Many members were concerned about “possible external coercion arising from the caregiver’s experience of burnout” as well as a lack of access to palliative care in an in-patient or hospice setting. They also had concerns about the husband being the primary advocate for MAID with “limited documentation” of the process being self-directed.
Some members also raised concerns that access to MAID was “more easily organized and accessible” in this case than the in-patient palliative care or hospice care that Mrs. B had requested and preferred.
Fellow Tory MP David Bexte called the case “horrible” and said his “blood froze” when he read about it.
