Ontario man granted euthanasia for controversial ‘post COVID-19 vaccination syndrome’

An Ontario man in his late 40s with a history of mental illness died by euthanasia after his assisted death assessors decided that the most reasonable explanation for his physical decline was a post COVID-19 “vaccination syndrome.”

The term is controversial — Canada’s current vaccine reporting system for adverse events doesn’t include “post-vaccine syndrome” — and multiple specialists consulted before his death couldn’t agree on a diagnosis, raising questions as to whether the man’s condition met the criteria for an “irremediable,” meaning a hopeless, incurable condition.

The anonymized case is one of several highlighted in a series of reports issued by a 16-member MAID death review committee struck by Ontario’s chief coroner’s office in January.

Identified as “Mr. A,” the man experienced “suffering and functional decline” following three vaccinations for SARS-CoV-2. He also suffered from depression, post-traumatic stress disorder, anxiety and personality disorders, and, “while navigating his physical symptoms,” was twice admitted to hospital, once involuntarily, with thoughts of suicide.

“Amongst his multiple specialists, no unifying diagnosis was confirmed,” according to the report. However, his MAID assessors “opined that the most reasonable diagnosis for Mr. A’s clinical presentation (severe functional decline) was a post-vaccine syndrome, in keeping with chronic fatigue syndrome.”

There were no “pathological findings” at a post-mortem that could identify any underlying physiological diagnosis, though people’s experiences can’t be discounted just because medicine can’t find what’s wrong with them.

However, Canada’s assisted dying law requires people to have a grievous and irremediable physical condition. Psychiatric experts raised concerns about whether the man’s mental illnesses would or should have rendered him ineligible for MAID.

Some members of the MAID death review panel also questioned whether a condition “previously unrecognized in medicine” — namely, a possible “post-vaccine somatic (meaning affecting the body) syndrome” — could be considered incurable.

The case highlights the challenges and uncertainties of granting euthanasia for people who aren’t terminally ill and whose natural deaths are not reasonably foreseeable — so-called “Track 2” cases.

Another case involved a different man in his late 40s with severe ulcers and multiple mental illnesses, including depression, anxiety, narcissistic personality disorder, bipolar disorder and chronic thoughts of suicide.

A year before he died by an assisted death, he attempted suicide by jumping from a height.

Another case involved an unemployed male in his 40s with inflammatory bowel disease who was living with few social supports, was dependent on family for housing and financial support, and who struggled with alcohol and opioid addictions. He wasn’t offered treatment for his addictions, and his family had concerns about his request for MAID.

During a psychiatric assessment, the man was asked if he was aware of MAID, and given information on the option.

His MAID provider later personally drove the man to the location where he was euthanized, which multiple members of the death review committee considered a transgression of professional boundaries that could be seen as “hastening a person towards death.”

Other members disagreed, and felt the doctor’s actions were “helpful and compassionate.”

Details in the reports are limited. A spokesperson from the coroner’s office said members of the MAID death review committee cannot discuss particulars about cases mentioned due to confidentiality and respect for the families involved.

According to their report, “only a small number of MAID deaths in Ontario have identified concerns,” and the deaths selected “are chosen for the ability to generate discussion, thought and considerations for practice improvement.”

Dr. Sonu Gaind, who is not a conscientious objector to MAID, said he’s troubled “by almost everything in this report.”

“I think we have gone so far over the line with Track 2 that people cannot even see the line that we’ve crossed,” said Gaind, a psychiatrist and professor of medicine at the University of Toronto.

“It’s pretty clear that some providers are going up to that line, and maybe beyond it,” Gaind said. “This is actually suicide facilitation in some cases.”

In the case of the man whose doctor picked him up, “this poor guy could not get access to medical treatment for his addictions but he could be chauffeured by our medical practitioner to receive death,” Gaind said. “I think there is something deeply wrong with that.”

Since 2021, 2.6 per cent of all Ontario MAID provisions have involved people whose natural deaths are not reasonably foreseeable. In 2023, a total of 4,644 MAID deaths were reported; 116 deaths were identified as Track 2.

According to the report, “non reasonably foreseeable death” patients were more likely to live in the most marginalized areas in the province, more likely to require disability supports, more likely to be female and more likely to live alone at all ages.

In the case of Mr. A, “even separate and apart from whether post-vaccine syndrome is a valid entry, it’s very clear that even (the MAID assessors) weren’t sure of it,” Gaind said.

“There was repeated discussion about ‘no determinant diagnostic results,’ no unifying diagnosis. It was really just the MAID assessors who ended up saying the most reasonable diagnosis is post-vaccine syndrome, completely ignoring the fact that the symptoms of depression, trauma and addictions can cause a whole slew of symptoms, including physical ones.”

However, in order to qualify for MAID, a mental illness alone “wouldn’t suffice,” Gaind said. A mental illness can’t be the sole underlying condition for seeking MAID. Canada’s plans to legalize MAID for mental illness have been delayed until 2027.

“So, now we have to say, ‘Well, here’s what we think is a likely medical diagnosis,’ and then, on top of it, with the clear diagnostic uncertainty, they’re able to say, ‘Oh, plus this is now irremediable.’ Because if they can’t say that, obviously you don’t qualify for MAID,” Gaind said.

Rare conditions can occur after vaccination that can have “life-altering consequences,” said McMaster University immunologist Dawn Bowdish. With transverse myelitis, the immune system attacks the nerves of the spinal cord, leading to a condition resembling multiple sclerosis. Guillain-Barre syndrome occurs when the person’s immune system attacks the nerves, causing muscle weakness and, in rare cases, paralysis. Both conditions are diagnosable, she said.

Serious vaccine side effects generally appear within two weeks after the first, and more rarely, second dose of a vaccine, she said.

More than 13 billion doses of COVID vaccines have been given worldwide and have saved millions of lives. A study published last year involving more than 99 million vaccinated people across eight countries found that known serious vaccine side effects are rare.

A chronic post-vaccine syndrome remains controversial.

A rapid review paper prepared by WorkSafeBC, a worker’s compensation company, found no published data supporting the development of chronic fatigue syndrome post mRNA COVID vaccination.

However, in a preprint study published last year that had not yet gone through peer-review, 241 adults who responded to an online survey reported ongoing symptoms after a COVID vaccination, such as excessive fatigue, brain fog and pain, numbness and tingling in different parts of the body. Most received mRNA vaccines.

Led by doctors at the Yale School of Medicine, the researchers cautioned that vaccines against COVID “have saved many lives,” and that the symptoms could be unrelated to the shots, occurring by chance. However, the clustering of symptoms within the first one to 18 days from vaccination “suggests a potential relationship,” they reported.

The study had limitations, including that people self-reported symptoms. Bowdish said she does not want to discount people’s experiences, but that with self-reported data “it’s impossible to validate that they were vaccinated,” and infection with COVID can cause similar lingering symptoms, she said.

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