Will Canadians suffering from long-term COVID be able to opt for medical assistance in dying?
Doctors are wondering if long-term COVID, a disease that is still poorly understood, could meet the criteria for medical assistance in dying. The case of a Toronto woman with the disease who recently applied for it could offer one of the first possible answers.
Little did Tracey Thompson know 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 have trouble listening," she says. "My heart rate is also often high." When she first spoke to experts, she was asked if she was hiding a substance use problem: "It was scary and discouraging," she says.
Due to the effects of long-term COVID, she has not been working for more than two years, an important factor in her decision to seek medical assistance in dying. This element alone makes his case complex — even disturbing — according to experts consulted by Le Devoir. But so is Tracey Thompson's very condition.
Researchis underway, in Canada and around the world, to increase understanding of long-term COVID and the possibilities for recovery.
According to Toronto physician Kieran Quinn, who is interested in post-COVID syndrome, Tracey Thompson's case for using medical assistance in dying is based primarily on the criterion of "serious and irremediable health problem" and one of its sub-criteria, namely that the person has an "advanced state of decline" and irreversible. Long-term COVID, however, is only two years old, and it may be too early 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 is also studying 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 "We have data, unpublished and not
yet peer-reviewed, that demonstrates some recovery," she says.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 may be reluctant [to grant her medical assistance in dying] because they do not know enough about the disease," says dr.re Chantal Perrot, Co-Chair of the Clinician Advisory Board of Dying with Dignity Canada.
The constant suffering due to the disease alone did not motivate Tracey Thompson's decision to turn to medical assistance in dying. "My story isn't just about long-term COVID, it's also about what happens to poor people with disabilities," says the Torontonian. Without income for two years, she can hardly see herself ending her life without a fixed home. Even the $1169 monthly support, which varies by 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 M finds himselfme Thompson. "We allow medical assistance in dying to people who are not approaching their death, but who have suffering related to poverty," he laments, referring to the new version of the law. In March 2021, the federal government eliminated
the requirement that natural death be reasonably foreseeable.
Little did Tracey Thompson know 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 have trouble listening," she says. "My heart rate is also often high." When she first spoke to experts, she was asked if she was hiding a substance use problem: "It was scary and discouraging," she says.
Due to the effects of long-term COVID, she has not been working for more than two years, an important factor in her decision to seek medical assistance in dying. This element alone makes his case complex — even disturbing — according to experts consulted by Le Devoir. But so is Tracey Thompson's very condition.
Researchis underway, in Canada and around the world, to increase understanding of long-term COVID and the possibilities for recovery.
According to Toronto physician Kieran Quinn, who is interested in post-COVID syndrome, Tracey Thompson's case for using medical assistance in dying is based primarily on the criterion of "serious and irremediable health problem" and one of its sub-criteria, namely that the person has an "advanced state of decline" and irreversible. Long-term COVID, however, is only two years old, and it may be too early 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 is also studying 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 may be reluctant [to grant her medical assistance in dying] because they do not know enough about the disease," says dr.re Chantal Perrot, Co-Chair of the Clinician Advisory Board of Dying with Dignity Canada.
The constant suffering due to the disease alone did not motivate Tracey Thompson's decision to turn to medical assistance in dying. "My story isn't just about long-term COVID, it's also about what happens to poor people with disabilities," says the Torontonian. Without income for two years, she can hardly see herself ending her life without a fixed home. Even the $1169 monthly support, which varies by 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 M finds himselfme Thompson. "We allow medical assistance in dying to people who are not approaching their death, but who have suffering related to poverty," he laments, referring to the new version of the law. In March 2021, the federal government eliminated
the requirement that natural death be reasonably foreseeable.
"This 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 accused the federal government of having "put the cart before the horse" by expanding the law even before having made an extensive assessment. Medical assistance in dying is expected to be expanded again in 2023: people with mental health issues will be able to access it.
Mr. Lemmens also asks for a commission of inquiry that would analyze the "slippages" of the law, as in the case, according to him, of Mr.me Thompson. Moreover, the speed with which the law is being expanded "profoundly violates the precautionary principle in the development of health policies," he believes.
A person cannot be eligible for medical assistance in dying simply because they have financial problems, nuances the Dre Chantal Perrot. But the doctor concedes that these factors can contribute to suffering, which the evaluator cannot ignore, she notes.
More hopeTracey Thompson submitted an initial request for an evaluation to a doctor a month ago and is still waiting for a response. Two experts – including a long-term COVID specialist – will have to give the green light. The process takes at least three months.
In the meantime, the Torontonian is still hopeful that a cure will be found. "If someone said to me tomorrow, 'Try this drug,' I'd be happy to do it," she says. According to the law, specialists must offer her recovery options, but she can refuse them.
The Ministry of Health says it has not been informed of other requests for marketing authorisation from patients suffering from long COVID. It could therefore be one of the very first requests for medical assistance in dying related to long-term COVID.
For his part, the Dr Kieran Quinn, who works in two Toronto hospitals, is worried that cases similar to Tracey Thompson's are multiplying: "I don't know what the solution is," he admits. "We have to ask ourselves why health professionals
end patients' lives because of poverty," says Professor Lemmens.
Mr. Lemmens also asks for a commission of inquiry that would analyze the "slippages" of the law, as in the case, according to him, of Mr.me Thompson. Moreover, the speed with which the law is being expanded "profoundly violates the precautionary principle in the development of health policies," he believes.
A person cannot be eligible for medical assistance in dying simply because they have financial problems, nuances the Dre Chantal Perrot. But the doctor concedes that these factors can contribute to suffering, which the evaluator cannot ignore, she notes.
More hopeTracey Thompson submitted an initial request for an evaluation to a doctor a month ago and is still waiting for a response. Two experts – including a long-term COVID specialist – will have to give the green light. The process takes at least three months.
In the meantime, the Torontonian is still hopeful that a cure will be found. "If someone said to me tomorrow, 'Try this drug,' I'd be happy to do it," she says. According to the law, specialists must offer her recovery options, but she can refuse them.
The Ministry of Health says it has not been informed of other requests for marketing authorisation from patients suffering from long COVID. It could therefore be one of the very first requests for medical assistance in dying related to long-term COVID.
For his part, the Dr Kieran Quinn, who works in two Toronto hospitals, is worried that cases similar to Tracey Thompson's are multiplying: "I don't know what the solution is," he admits. "We have to ask ourselves why health professionals
end patients' lives because of poverty," says Professor Lemmens.