Woman in severe cognitive decline receives MAiD despite inability to provide clear consent

CALGARY — A woman in her 80s with dementia was euthanized through Canada's Medical Assistance in Dying (MAiD) program despite assessors being unable to confirm her consent.A report by the Ontario MAiD Death Review Committee (OMDRC) reveals that Mrs. 6F lived in a retirement home due to cognitive impairment, which demanded she receive daily functional support.Nine months before receiving MAiD, she had been admitted to the hospital several times for falls which contributed further to her care needs.While hospitalized, she was diagnosed with "moderately high dementia.".She was also found to need assistance with most basic activities, requiring step-by-step instructions to complete tasks, and needed supervision for eating, all due to her severe short-term memory loss.Her diagnosis led her transfer to complex continuing care, where she awaited placement in a long-term care facility.Mrs. 6F reportedly told a family member she "wished to die."The family member interpreted her request as a request for MAiD..This was communicated to the care team, resulting in Mrs. 6F receiving a MAiD assessment.A physician advised the family that MAiD eligibility would be difficult to establish due to Ms. 6F's significant cognitive impairment and aphasia, a disorder that affects a person's communication, including speech and understanding language.This is because under MAiD provisions, an eligible MAiD patient must be mentally competent, and provide a voluntary request, while getting informed consent.This assessment was echoed by the MAiD navigator, who met with Mrs. 6F, and determined her cognitive limitations made it inappropriate to proceed with an assessment..The navigator referred Mrs. 6F to a MAiD practitioner with clinical expertise in complex MAiD requests.After speaking with the practitioner, Mrs. 6F chose instead to transition to a long-term care facility and not to pursue MAiD.Once in the long-term care facility, Mrs. 6F requested another MAiD assessment, with the process executed with the help of a family member.At the time, Mrs. 6F was largely bedbound experiencing additional pain and psychological distress related to her increasing dependency and cognitive decline..The MAiD provider assessed her MAiD eligibility in a single interaction, with the family member present.The provider determined since Mrs. 6F had dementia, chronic comorbidities, and terminal frailty she met the incurable condition requirement for MAiD.The provider noted she had "marked existential suffering" and "clear she did not want to continue to live as she [was]."During the assessment, the provider acknowledged it was difficult to communicate with Mrs. 6F, but they stated the process was "managed in a way that worked for her.".The MAiD practitioner's documentation of the evaluation of Mrs. 6F's cognitive impairment was limited.Her condition was described as "moderately advanced dementia."Her short-term memory loss, insight, judgement, or aphasia were not documented in the assessment.The documentation recorded Mrs. 6F was able to repeat questions verbatim, respond appropriately, and understood she could continue to receive care instead of MAiD..But there was no direct quotes from Mrs. 6F in the documentation to support the eligibility determination.When the practitioner was completing the final written request, Mrs. 6F's signature was deemed ineligible, and a member of the MAiD provider's staff had to help.The second MAiD assessor evaluated her eligibility similarly and did not provide insights into their interaction with Mrs. 6F. Mrs. 6F was scheduled for MAiD a week later.She was reportedly overwhelmed with the number of people in the room prior to being euthanized and provided her final consent by squeezing the provider's hand. .OMDRC members emphasized this case as an example of how MAiD assessors should be "documenting a clear and comprehensive understanding of a person's cognitive capabilities as part of the MAiD eligibility assessment."Members were concerned in Mrs. 6F's case, the absence of a structured cognitive assessment resulted in a limited ability for them to understand how her eligibility and capacity to give informed consent were determined. The report states that since this is a life-ending decision a higher threshold should be used to determine eligibility, noting the general statements in Mrs. 6F's case do not provide sufficient insight into her decisional capabilities.

Woman in severe cognitive decline receives MAiD despite inability to provide clear consent

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