As hospitals brace for an influx of patients as part of the COVID-19 pandemic, health-care providers across Canada are becoming increasingly concerned about their ability to provide end-of-life care, a crucial service for Canadians suffering from painful and irreversible medical conditions.

Amid rapid changes being made in hospitals and long-term care facilities across the country, access to medical assistance in dying (MAID) has become uncertain — part of the broader health-care impact of COVID-19, the disease caused by the novel coronavirus that’s infected thousands and killed dozens across the country.

Hospitals in two Ontario regions — including Hamilton Health Sciences, a hospital network with 10 sites — are temporarily suspending assisted-dying services so health care staff can focus on pandemic efforts.

“This was not an easy decision,” said Lillian Badzioch, a spokesperson for Hamilton Health Sciences.

Suddenly, those with grievous and irremediable medical conditions seeking to end their life worry they may no longer have access as health-care resources dwindle. Meanwhile, doctors and nurses venturing into homes and long-term care facilities are afraid for their own safety — and beyond that, about becoming vectors for the disease.

“There is a great unknown,” said Dr. Stefanie Green, a Victoria-based MAID provider and the president of the Canadian Association of MAiD Assessors and Providers (CAMAP).

“It is possible that resources are diverted and it’s possibly appropriate that resources are diverted. I don’t know what to tell people about what it’s going to be like in four weeks … So everybody’s a little on edge.”

“We are starting to see, and would expect to see, continued concern from Canadians who are wishing to access MAiD services and who are already in intolerable suffering,” said Helen Long, CEO of Dying with Dignity, a national end-of-life rights charity.

“This is a situation unlike one we’ve ever faced in Canada before.”

MAiD is available to Canadians over the age of 18 who have an illness, disease or disability that is serious and incurable. The disease must be in an “advanced state of irreversible decline in capability” and cause “intolerable” physical and psychological suffering, according to Dying With Dignity. MAiD can be provided by both doctors and nurse practitioners.

Among the difficult decisions health regions across the country are now weighing: whether to halt some or all MAiD-related in-patient or community services, either to stop the spread of COVID-19, to preserve health-care resources, or both.

According to doctors in the region, among those taking steps to halt MAID services is the Champlain Local Health Integration Network, serving the Ottawa area. A spokesperson did not respond to questions sent by the Star Friday but deferred them to Ontario’s Ministry of Health.

Badzioch said where appropriate, medical death referrals in her network are being sent to MAiD providers within the community, for patients who are still at home or can be discharged from hospital.

A spokesperson for Ontario’s Ministry of Health said the ministry has not taken any action to limit access to MAiD as a result of COVID-19.

“We are actively monitoring the situation, including the availability of services at local levels,” said Hayley Chazan, spokesperson for Health Minister Christine Elliott.

Long said she is hearing some networks are making the decision to halt some services, “and certainly we appreciate that every institution or provider or region has to make the decisions that are best for them,” she said.

However, she stressed that clinicians in “most areas” in Canada are continuing to be able to support end-of-life care.

Amid efforts to socially distance, and as retirement homes and long-term care facilities close their doors to thwart the spread, doctors and nurses providing the procedure face practical challenges.

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“Am I expected to go in and out of people’s homes at this point to do assessment and provisions of MAiD? How safe is that, and how can I do that in a safe way while still keeping their needs at the forefront?” asked Green.

There are also ethical concerns around physical distancing and MAiD, she continued. If MAiD providers follow all COVID-19 social-distancing rules, “we’re talking about not touching the patient, not having their families around, not allowing their loved ones into the facility to say ‘goodbye’ to them … That’s a hard pill to swallow.”

There are also problems accessing personal protective equipment. Dr. Chantal Perrot, a Toronto-based family doctor who devotes a significant part of her practice to providing medical assistance in dying, said she was able to “borrow a couple of masks from colleagues” prior to providing the assistance in dying to a patient this week.

“We’re not really well equipped to go into the community or even to go into the hospitals, because we don’t have the gear,” Perrot said in an interview this week.

Perrot said a major concern prior to the MAiD procedure was whether the nurse from the nursing agency would come and start the IV, a necessary part of the procedure.

“I was almost afraid to answer my messages through the week, wondering if they were going to cancel, but fortunately they didn’t, and the nurse did come.”

But she was not wearing a mask, gown, or gloves, Perrot said.

“Those of us that are still doing it are trying to cobble it together and be as safe as we can, for ourselves as well as for the patients and their families while at the same time providing this service, because we think it is necessary,” Perrot said.

Among other pressing concerns for end-of-life providers: the impact of physical distancing on requirements earlier in the MAiD process. For example, Canadian law requires two independent witnesses to watch as a patient signs a request for MAiD.

In a letter sent to all Canadian medical colleges Thursday, CAMAP called on regulatory bodies to “urgently consider” modifications that would still allow patients seeking MAiD to apply for it while respecting social-distancing requirements.

That includes the recommendation that witnesses be allowed to “watch virtually,” via Skype or Zoom, for example, while a patient reads and signs the required forms,” the letter states.

“We strongly urge that virtual witnessing of MAiD request forms be explicitly allowed and encouraged whenever possible,” the letter says.

British Columbia’s College of Physicians and Surgeons has already made such changes to MAiD practices to account for the COVID-19 pandemic, including letting assessments of the patient be done by telemedicine.

Long said she is hopeful that other regions follow suit and take similar steps to support MAiD amid COVID-19.

“We are encouraging provinces to really think about how they can continue to support Canadians looking for a MAiD solution during the crisis,” Long said.