I empower my patients by letting them know they are eligible for an assisted death. This doesn’t mean they have to do it, and it doesn’t mean they will. It means they can proceed if they ever feel the need to, and the result is a reduction in suffering. How do I feel when I do this work? As if I have been a part of something profound. As if I have had the privilege of helping someone in need.
I found This Is Assisted Dying to be quite surprising: After the Canadian Parliament legalised what it called “medical assistance in dying,” or MAiD, in June of 2016, it was up to Canadian medical professionals (doctors and nurse practitioners) to come up with the protocols and processes for offering the procedure, without precise pharmacological, legal, or bureaucratic guidance from the government. As one of the first doctors to begin a MAiD practice, Dr Stefanie Green was instrumental in setting the standards for termination of life care, and the story that she tells of her first year in this practice is fascinating and moving. Filled with stories of MAiD in action, Green brings us into the rooms of those terminal patients who insist on controlling their final moments — most often surrounded by loving friends and family, sometimes proceeding despite angry opposition — and the picture she paints is of peaceful passings; the end of suffering; the “good death” we all want for ourselves and the ones we love. Eye-opening and provocative, this is the kind of book you really want to talk to people about; totally recommended. (Note: I read an ARC through NetGalley and passages quoted may not be in their final forms.)
A birth plan, a death plan. It struck a deep chord. This was the first time I made the connection between my skills in maternity care and the skills required to provide a good death. Both situations involved intense emotional experiences and carried a strong sense of the event’s significance. Both called up complex family dynamics and required a patient-centered approach to care. Perhaps my expertise would be transferable after all. Perhaps I was not as inexperienced as I felt.
After over a decade in a maternity/neonatal practice — with long and unpredictable hours, middle-of-the-night deliveries, and the colleagues in her practise beginning to retire — Dr Green started thinking about changing her focus. And when the Canadian Supreme Court struck down its blanket prohibition of assisted dying, Green began to wonder what providing medically assisted death might look like. She attended a conference in Amsterdam — where she was shocked to see only a handful of other Canadian physicians in attendance — and recognising the urgency and importance of what they could learn there, this small group went to every seminar, shared notes on what other jurisdictions had settled on as best practises, and brought that learning back to Canada in order to start offering MAiD to those patients who were already clamouring for it. This was the part that I found most surprising: That this small group of doctors would have happened upon the knowledge they needed (the necessary pharmaceutical cocktails, proven delivery methods, what to expect at every step of the process), and without a lot of direction from the government — Parliamentary language states that a patient must be suffering from a “grievous and irremediable condition”, that suffering had to be intolerable, their decline irreversible, and their natural death “reasonably foreseeable” — these doctors began to provide MAiD, often to the distaste of other medical (and particularly palliative) professionals, and wary of complying with laws that weren’t exactly clear. Also surprising: When they began, the service was so new that these doctors didn’t even have proper billing codes to get paid for their work through the various Provincial Health plans. It’s amazing to think of all of those people who were suffering through painful, lingering deaths — people who must have thought, “MAiD is now legal, so I just have to ask for it” — but there were still just a few practitioners, and most of them were on Vancouver Island, like Green herself. (She writes of Vancouver Island that it’s “a region that has turned out to have the highest percentage of assisted death, not just in the province or in the country but worldwide.” WHAT?) As that first year proceeded and more Canadian practitioners began offering the service, they would discuss their experiences on an online forum and this eventually grew into the professional group known as the Canadian Association of MAiD Assessors and Providers — CAMAP — and Dr Green was chosen to be their first president. And again, it was surprising to me that all of this grew from the ground up instead of the government somehow imposing structure from the top, but as Green says, these sorts of decisions are more properly made in the clinic than in the boardroom (and while that totally makes sense, it's still surprising that the government didn't want to get involved and mess things up.)
All of this information about how MAiD first became available, and how those doctors discovered their own protocols and created CAMAP, was totally fascinating to me. But This Is Assisted Dying is marketed as a memoir, and despite my appreciation for how Green shares her personal reactions to all of the events she describes — and despite the fact that I do read and like memoir — I don’t know if descriptions of her childhood and family life added much to this topic for me, but others' reactions might vary:
In my mother, I saw the seed of my own emotional fortitude. I’d had a turbulent childhood at times, and I’d learned at an early age to protect myself by building some emotional armor, some emotional walls to help keep the intensity at bay. Although this coping mechanism had not always been helpful in my personal relationships — making me more cautious about becoming vulnerable — it was perhaps due to this inner toughness modeled on my mother, and the lessons in protecting myself from difficult feelings, that I was able to compartmentalize my life, such that I could do my MAiD work and not be wrecked or overwhelmed by it.
Also: I was moved by all of the stories Green shares about her patients; specific cases are, naturally, more affecting than general debate. So, while it wasn’t totally unexpected, it was a little disappointing to read in the Author’s Note, “other than where I have obtained express consent to describe real events, characters and cases have been purposefully altered — including name, age, gender, ethnicity, profession, familial relationship, place of residence, and diagnosis — and in some instances reflect fictional composites.” On a more positive note: It was very interesting to read the other information Green adds at the end — how Canadian termination of life care compares to other countries (I had no idea how few countries have legalised the procedure or how comparatively liberal our rules are), what legal issues are still being debated (whether MAiD should be offered to mature minors, if it should be offered to those suffering debilitating mental illness, whether it can be asked for in advance for dementia patients), and how COVID protocols affected the delivery of service.
Fascinating and surprising, This Is Assisted Dying makes for a compelling, necessary, read. Rounded up to four stars.
