Providing Legal Assisted Dying and Euthanasia Services in a Global Pandemic: Lessons for Ensuring Service Continuity.

Background & objectives: Identifying the impacts of COVID-19 on patients' and practitioners' access to legal assisted dying and euthanasia (AD&E) services is vital to informing service continuity in an ongoing pandemic.Methods: An anonymous online survey collected qualitative and quantitative data from health practitioners and agencies providing legal AD&E services (n = 89), complemented by semi-structured interviews with 18 survey respondents who volunteered.Results: Following governments' responses to the dynamic pandemic context, rates of AD&E inquiries and requests fluctuated across and within jurisdictions, based on a complex interaction of factors affecting patient access to AD&E agencies and assessors as services were disrupted. Service flexibility and nimbleness became key elements in continuing service availability and included calculated 'rule-breaking' considered justifiable to adhere to established bioethics. Making innovative adjustments to usual practice led to reviewing the effectiveness of AD&E services and laws, resulting in providers now improving services and lobbying for legislative change.