>CASE 4B Case Overview Mrs. B was a female in her 80s who had a challenging medical trajectory following coronary artery bypass graft (CABG) surgery. She experienced several post-operative sequelae, including wound dehiscence, osteomyelitis, and respiratory failure. She required specialized care in hospital, including additional surgical procedures. Due to physical and functional decline, Mrs. B elected for a palliative approach to care. She was discharged home with palliative supports (i.e., palliative care team and home care support services, including adaptive aids and personal support services). Mrs. B reportedly expressed her desire for MAiD to her family. In response, and on the same day, her spouse contacted a referral service on her behalf. The following day, a MAiD practitioner assessed her for MAiD eligibility. She reportedly told the MAiD assessor that she wanted to withdraw her request, citing personal and religious values and beliefs. She communicated that pursuing in-patient palliative care/hospice care and palliative sedation was more in-keeping with her end-of-life goals. The next morning, Mrs. B presented to the emergency department (ED) of her local hospital. Her spouse was noted to be experiencing caregiver burnout. Mrs. B was assessed to be in stable condition, and thereby discharged home with continued palliative care. Her palliative care physician completed a referral for in-patient palliative care / hospice care due to her social circumstances (i.e., caregiver burnout). Her request was denied for not meeting hospice criteria for end-of-life, and a long-term care application was offered.

On the same day, Mrs. B’s spouse contacted the provincial MAiD coordination service requesting an urgent assessment. A different MAiD assessor from the previous day completed a primary assessment and determined Mrs. B to be eligible for MAiD. The former MAiD practitioner was contacted. This MAiD practitioner expressed concerns regarding the necessity for ‘urgency’ and shared belief for the need for more comprehensive evaluation, the seemingly drastic change in perspective of end-of-life goals, and the possibility of coercion or undue influence (i.e., due to caregiver burnout). The initial MAiD practitioner requested an opportunity to visit with Mrs. B the following day to re-assess; however, this opportunity was declined by the MAiD provider due to their clinical opinion that the clinical circumstances necessitated an urgent provision. An additional MAiD practitioner was arranged by the MAiD coordination service to complete a virtual assessment. Mrs. B was found eligible for MAiD by this third assessor. The provision of MAiD was completed later that evening.