Medical Assistance in Dying for COVID Patients

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“First, do no harm”. Every physician recites this line from the Hippocratic Oath before becoming a doctor. This promise becomes especially relevant in the debate on medical assistance in dying (MAiD).

The first public assisted suicide was videotaped by Dr. Jack Kevorkian, who assisted in the death of Thomas Youk and broadcasted his death on television. Dr. Kevorkian was subsequently charged with murder and “delivery of a controlled substance”, a reference to the drug he injected into his patient [4]. Since then, MAiD has illuminated the controversial question regarding a doctor’s oath to their profession. Are they murdering someone or saving them when they prescribe the lethal medication? Some people believe that physicians do not have the right to end someone’s life even if the patient is conscious and willing, while others believe that patients have free will to decide whether they want to continue living [1].  
 

In the ten states that this is legal in the United States, MAiD is offered to patients experiencing extreme pain or suffering from a terminal illness. In the context of the COVID pandemic, the topic of MAiD has once again become a heated topic of debate. Recently, Connecticut has brought up a bill on this topic in order to help patients that are extremely ill due to COVID. Dr. Jeff Gardere, a clinical psychologist, adds that the 7,600 Connecticut civilians that died due to the pandemic further justifies why passing such a bill is necessary [5].   

Reverend Daniel Warriner writes on The CT Mirror, a newspaper based in Connecticut, in opposition to the potential passing of the bill, “‘we rush to the aid of the suicidal in every other avenue of life, except at the end of life’” [5]. Reverend Warriner believes that hospice services mediate the need to “hasten death” because the terminal patients’ fear of death is confronted and alleviated [5].  

However, in reality the process of medical assisted dying is an arduous process rather than a “hasty” one. For example, the bill in Oregon restricts MaiD to residents older than 18 years old that have been “diagnosed with a terminal illness with a prognosis of six months or less to live” and “are mentally capable of making their own health care decisions and able to self-administer the medication” [4]. Furthermore, two physicians must confirm that the patient fits the above requirements and that they are not being coerced. Therefore, this detailed bill ensures that the patient has truly thought their decision through. That is not to say that disabled people cannot live full lives and should end their life but that patients know how they feel best and if they do not want to spend the rest of their six months of life in hospice, they should not have to. Moreover, a doctor’s assistance in the dignified death of a patient is not necessarily harming the patient; it could still be considered “healing and caring” if having a predictable timeline of death allows the patient to do what they want before their life ends and say goodbye to their families and friends. Having patients in hospice can reduce their pain but interacting with other terminally ill patients may not completely take a person’s pain away.  

Whether or not MAiD should be used in the context of COVID, however, is another matter. Due to the isolation millions of people have suffered due to lockdown, unemployment and lack of human interactions, mental wellness has declined globally [3]. On October 20, 2020, a nursing home resident Nancy Holland received MAiD because of her declining mental health due to the prospect of potentially having to face another lockdown soon. Her daughter lamented that there was “nothing precisely medically wrong with Nancy”, but she was a “social woman for whom social contact was like oxygen” [3]. This begs the question of whether mental disorders like depression could be considered a terminal illness that qualifies for MAiD. Although Nancy initially had no physical conditions, as her mental health declined, numerous physical conditions started to arise. Because of issues like these, Canada began to relax its MAiD regulations so that MaiD is an option for patients with a terminal condition but no immediate foreseeable risk of death such as deteriorating mental health and increased suffering [3].  

Two months after Nancy’s passing, COVID-19 vaccines were invented. If she had known what was coming soon, she may not have decided to end her life when she did. Such a story highlights both the benefits and the dangers of MAiD. Nancy’s story is not the only one in history, and such controversies continue to muddle the bioethics behind MAiD.  

Edited by: Alicia Yang




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