In the nearly two years since assisted dying became legal across Canada, Toronto family doctor Chantal Perrot has cared for a handful of patients who wanted to die in a home-like place, but not in their own homes.
Some recoiled at the thought of their surviving spouses having to use the bedroom or living room where the death took place. Others feared a lack of privacy, particularly if they lived in an apartment – they did not want their neighbours to see the body being taken away.
“Funeral homes have come up,” Dr. Perrot said, as one possible alternative for grievously ill patients looking for a place to end their lives, although she does not know of any patients who actually died in one.
Dr. Perrot prefers a more comforting alternative. She is part of a group of Toronto family and palliative-care doctors and assisted-dying proponents who are trying to establish a home dedicated to medical assistance in dying (MAID,) a project they are calling MAIDHouse.
Their vision is to rent a cozy space in Toronto, decorate it like a home, then open it to qualifying patients who are seeking a place to die. The patients’ doctors would meet them there with the minimal medical equipment needed to administer lethal drugs intravenously.
The group, which was incorporated earlier this month, has already set up a bare-bones website, engaged a real-estate agent to scout Toronto rental properties, and submitted a funding proposal to the Ontario Ministry of Health and Long-Term Care.
The proposal is currently under review, a spokesman for the ministry said.
“It’s a unique project. It’s the only one of its kind in the country,” said Shanaaz Gokool, the chief executive officer of the advocacy group Dying With Dignity Canada, and a member of MAIDHouse’s startup board of directors.
“I think it will really meet the needs of people who – for whatever reason – don’t want to die at home, but want a safe space where their friends and family can gather with them when they’re having an assisted death.”
Thomas Foreman, a hospital ethicist and the executive director of MAIDHouse, said he hopes the province can be persuaded to finance the project because of the money and space it might save the Greater Toronto Area’s chronically overcrowded hospitals.
“If you do not want MAID at home, or if you do not have a home in which MAID could be performed, at present, your alternative is to go to a hospital,” he explained.
An Ontario woman known publicly as A.B. who won a court case last year clearing the way for her assisted death eventually checked into a health-care facility to end her life. But beyond anecdotes like this one, it is hard to say precisely how many patients in Toronto or Ontario are being admitted to hospitals expressly for assisted dying.
The ministry is not monitoring the practice, the spokesman said.
The Office of the Chief Coroner of Ontario said that of the 1,146 assisted deaths completed in Ontario as of the end of January, 52 per cent took place in hospital. (Of the total assisted deaths, 224 were in Toronto.)
What is not known is how many of those grievously ill patients were already in the hospital when they sought an assisted death, and how many were admitted solely to die.
Mr. Foreman informally surveyed hospital MAID co-ordinators and ethicists (many hospitals have put their ethics offices in charge of the MAID program) and found that between one-quarter and half of all patients receiving assisted death were admitted to a hospital bed for the purpose.
“Providing MAID in hospital is very expensive, very inefficient and not entirely patient- and family-friendly,” Mr. Foreman said.
Another purpose MAIDHouse could serve would be to welcome patients who have been asked to leave hospitals or nursing homes that forbid assisted deaths, usually for religious reasons.
However, MAIDHouse would be able to accommodate only patients who do not require medical equipment to keep them comfortable before the procedure.
Ms. Gokool of Dying With Dignity would prefer that MAIDHouse did not become a release valve for religious hospitals struggling to find a place to send assisted-dying patients – although it would not turn away patients who qualify.
“This project is not designed to give a free pass to publicly funded health-care facilities that opt out of allowing MAID on its premises,” she said. “Instead, MAIDHouse will provide an alternative community model for assisted dying in a safe, non-institutional environment for people who would prefer not to die in their homes, but want to feel at home at the time of their death.”
MAIDHouse’s backers still have a lot of work to do to make that dream a reality, including finding the right location.
When the group first discussed the idea, some members envisioned renting a handsome old home on a leafy Toronto street.
Now they are open to a bungalow, or even a two-bedroom condo, because they realize the space would need wheelchair accessibility and parking, said Maureen Taylor, a CBC health reporter turned physician assistant who became an assisted-dying advocate after her husband died of brain cancer before the Supreme Court of Canada struck down the part of the Criminal Code that prohibited assisted dying in 2015.
After that decision, Ms. Taylor co-chaired a provincial-territorial advisory group on physician-assisted dying.
She was also among the organizers who met with provincial officials to discuss the plan for MAIDHouse.
“We pitched this to the province as a pilot project that could start in Toronto, but then perhaps be adopted in other regions,” she said. “If they say no to any funding, we’re going to have to get out there and fundraise ourselves and then that’s just going to make it that much more of a distant realization.”
The group is seeking charitable status, just in case. They are hoping to open MAIDHouse before the end of this year.
“There’s so much suffering that happens in the last days and weeks and even months for patients who are anticipating having to navigate the unknowns of all of this,” Dr. Perrot said. “The idea of having a friendly place where people are kind and thoughtful and doing the work because they want to … I feel good when I think about that.”