Emotions are rising even as I begin typing. Thank you for this beautiful, articulate essay. I love the evolution of your opinion on euthanasia as you matured.
My Dad, 97, still living in the 4 level split I grew up in (ONT) has typed out a clause and added it to his will, saying to give him pain relief as necessary, but not to the point that it kills/takes him early. He has a lifelong, steadfast faith in God/Jesus, and believes it is not God's will that we euthanize/kill any person of any age. That God himself has withstood and brought eternal good from suffering himself.
My bff's Dad, a few months into the Covid Hysteria Era, was newly diagnosed at 96 (he was healthy and "mall-walking", catching a bus there independently, weeks before) with an extreme, fast brain cancer (he went in with a headache, very unusual for him). Within, 10 MINUTES of his diagnosis, Dr. Death, as my bff calls him, casually walked into Mr. B's room and said casually, "We have MAID available, if you'd like."
Mr. B was shocked, in every sense of the word: firstly, from his sudden, awful diagnosis, as he was a healthy, active senior, full mental faculties and 2) while not a particularly religious man, he is fully against euthanasia. So, to have a doctor, whom many of his generation respect and trust as "Do no harm" trustworthy authorities, looking out for his best health, offer to 'put him down' like we used to do with a suffering pet, was stunning.
I taught The Giver for several years to grade 9's, but felt it would be far more powerful re-taught at gr 11-12, where their critical thinking skills are sharpened. Like Animal Farm, it's so simple, but so profound in Lois Lowry foreseeing where we are now in Canada! - especially with the euphemizing of what MAID actually is.
We are desperately in need of many more scholarly debates (like the Munk Debate: Can we trust mainstream media?), but instead debating this macabre slippery slope with MAID in Canada. At heart, it is a religious issue, but if you don't believe in God, it is such an important human issue.
We need more input like this essay, Dr. Milburn - from both the doctor and patient sides to help Canadians grapple with the complexities of assisted suicide.
Thank you for writing with wisdom, humility and transparency. I value both yours and your wife's critical thinking/articulate writing, giving me hope the past year. You are both on my Canadian heroes list, beside Dr. Byram Bridle.
Merry Christmas! And may 2023 see you vindicated and your influence multiplied exponentially as more Cdns awaken to question unhealthy govt authority.
Can you post a link to "The Giver" - not something I've read.
The story of your friend's dad is very disturbing. The conversation about limits of care is important. For instance: do you really want chemo, because you might be getting a little more time but losing a lot of quality of what time you have left. Or, given that you have a deadly cancer, would you want to be put on life support if your heart stops? That is appropriate and important to discuss. OFFERING euthanasia is truly creepy and macabre, and disrespectful. Sadly I have had patients who say that is one of the first things that gets offered to them as a potential "opportunity" to use an ironic word.
Thank you so much for bringing this discussion. It is very near and dear to me.
I worked as an RN for 10 years in Palliative Care. I have had those meaningful moments with patients who wanted to die for their families, not themselves. I have been privileged to participate in the last moments of someones life in this realm. I feel blessed for having had those experiences. I have worked in every area of healthcare, yes, and with dementia patients and I agree it is so very hard on everyone. I do not have the energy to explain my opinion in this regard. I feel it is a loss of family and community that has driven us away from support for these people. It is a culture shift for the worse. We should help. How have we come to think this is okay, in any faith? We convince ourselves that God is okay with this, He is pretty clear He isn't okay with this..
So you are an atheist, okay....
On a more practical note, why are my tax dollars paying for this service for you or your loved one. People have been killing themselves forever. I agree, we have to better understand suffering and what it means for everyone; again, to long to discuss here.
It is absolutely ridiculous that we went down this road here in Canada and especially here in Nova Scotia. I am embarrassed of my country, but even more of what I thought was a beautiful province.
I did not become a nurse to kill and I am shocked that this has become so commonplace and nurses are now "acclimated" to participating in this deed, because it is not a medical intervention. If this is something that someone chooses to do for themselves or their families go ahead, that is your prerogative, (there are simple ways to complete this task) and it is for God alone to judge. Dare I mention God lol.
This may be what Tommy Douglass planned, but I do not agree. Lets us go back to private pay. The government should not be involved in murder or even making these decisions. For heavens sake, this is barbaric and we are letting this happen. You do not need a healthcare professional to do this for you!
The other consideration is the time taken from patients who actually require our care in an already overtaxed system and placing undo pain and suffering on individuals who do not want to participate in this act. I know nurses who have left the bedside because of MAID. Regardless of being the one who performs the murder, the nurses are left with the psych-social and physical demands of this "event".
We have become a culture of death, good luck to us from here on in....
Are we playing God, or just relieving suffering.... my answer is
In your story about Mr O, I have no ethical qualms about your actions. And I did not forsee the widening of permissions so much. But now, even for babies? I don't think that's right.
At least two women with MCS (Multiple Chemical Sensitivity) took MAID earlier this year when they were unable to find or afford tolerable housing. Housing that was smoke-free, laundry scent free etc... housing that didn't give them the equivalent of continuous migraines or similar.
I feel guilty and very angry. We as a society have let these people down. Are not lives worth more than housing?
The government refuses to acknowledge the MCS illness/diagnosis and complex needs that are associated with it, such as housing. The disability allowance is tiny, way below the cost of living. There are no dedicated funds, groups, charities, celebrities etc. Many women with MCS are unable to go out in society and some are left behind by family because of the complexity of the illness. It is an invisible, ignored, isolating illness with a ton of suffering if unable to get good housing and food.
I know there are many other sad stories of people who took MAID for other "reasons." As you stated, sometimes a suicide/attempt is a plea for help, a plea to be heard, a plea for care and compassion, a plea to do something.
Way at the bottom of the slope is MAID being given without permission (faked permission?). Perhaps for people who are so "mentally ill" that they "disagree with the medical consensus". For the good of society, of course. That could never happen, could it?
We can't fix everyone! JHC! It is normal to die. People who are too sick to get along in life should die. Our healthcare system was never designed to provide forever life, it was designed to fix booboos.
The only way get out of healthcare what you're asking is to tax us to death, and lock us down. That is exactly what Trudeau will do.
Not supporting euthanasia and not knowing when to stop trying to keep people alive are very different. ie: it's different to not put a person with end stage lung cancer on life support if their heart stops, versus giving them a lethal injection a year before they would have died naturally. I think we all agree on the first approach, the latter is much more controversial and ethically fraught.
I agree. So disturbing. And, how sickeningly ironic to use the euphemism, "opportunity".
I went through the harrowing cancer journey with my beloved. We were able to fly to Tijuana, Mexico, where I learned so much about real cancer care. They are advanced in many ways compared to the treatment at hospital we experienced here in Okanagan, Canada. Mild chemo is available, but there are so many other alternative (and cutting edge) treatments they offered (2012-13), and they encourage family support, prayer, - even the natural lighting in the hospital is different than the glaring fluorescent lighting in our hospitals.
EX: Two doctors drained Chris's bloated belly with a combined massage, and targeted the area needed to drain. (In Penticton, they put a drain tube in, and his two siblings and I sat by him for 3-4 hours for the drain, that in Tijuana, took one hour.)
The entire experience awakened me to question Cda's "best health care", and all I thought I knew about cancer.
Above is a link to Lois Lowry's, The Giver. Like 1984, and Brave New World, her prescient novel is aging very well - never more relevant - esp'ly in Canada.
Thank you. The best thing I have read on this horrifying, accelerating and expanding practice. Much to ponder. Canadian practice is getting world wide coverage now, mainly very critical. I would love to see this essay published in a national medical journal to stimulate debate etc but good luck with that, eh?
This is a discussion with no easy answers. I just finished Being Mortal by Atul Gawande (himself, a surgeon) which addresses how physicians aren't trained to help patients through the process of dying. The last chapter talks some about euthanasia, but much of the book deals with how medicine ruins the end of life experience for many people, leaving them to die in ICUs, intubated, unconscious, or delirious.
As a fellow psychiatric provider (psychiatric nurse practitioner in America in my case), I have worked with countless patients who struggle with suicidal ideation. Some are hospitalized countless times and make repeated serious, genuine suicide attempts but don't succeed. While I definitely agree that there is a slippery slope with euthanasia, I sometimes wonder if there should be a point where these patients are allowed to end their own life by being provided with the means rather than the options of jumping into traffic, suicide by police, or overdose (which often leads to ICU time or even disability).
Thanks for much for your candor. I look forward to reading more of what you write, especially knowing that some of what is written is from a psychiatrist unafraid to speak her mind. We don't find that much in our field. As a side note, I would love to hear your thoughts on my recent articles on homelessness in America. While I'm not sure how the homeless situation is in Canada, I would presume it has worsened over the past few decades...
Thanks so much for the comment. Our homelessness situation in Canada is FAR worse now than 20 years ago. That said, calling it a "homelessness" situation is not accurate, since something like 98% of the homeless are addicts, and end up on the street not because there is no social safety net, but because it's unfair to have someone in a shelter who is unstable/violent/using drugs/dropping needles on the floor. Shelters quite reasonably say "no drug use here", which leaves people on the street. Political polarization has made it into a facile argument where one side just says "if we spent enough money on this problem we could solve it". Vancouver now spends a million dollars per day on programs for "harm reduction" and housing, and the problem keeps getting bigger. Which to me says we're on the wrong track. (As an aside, harm reduction and addiction is on the agenda for 2023 FSIM Conference. Stay tuned at freespeechinmedicine.com)
I've thought a lot about your point about helping depressed people to kill themselves. My conclusion is that the slope is just too slippery. How do you set an age limit, or a minimum time that someone feels depressed, or a minimum treatment requirement (ie: should ECT be mandatory first? How long on drugs,, and how many different drugs before saying that their depression is untreatable?) Whether life is worth living or not is subjective and not amenable to rules and guidelines. Which means that in the end we must simply accept a patient's subjective evaluation that they would be better off dead. Which will inevitably mean we end up helping kill depressed 32 -year-old BPD patients. (This has already started happening in other countries).
Yes. You tackled the homeless problem much more succinctly than me! But your critiques are valid. There is a significant distinction between "homeless" and "chronically homeless." And most of me loves the idea of harm reduction rather than another war on drugs, but I see another slippery slope there. I would love to hear more about that upcoming conference! I would love to come in person, but family and work (yadda yadda) may only allow if I could attend virtually.
And regarding assisting (or even allowing) the mentally ill with suicide, I have no clear answers, even when I see these patients daily. I'm currently treating about 20 treatment-resistant patients at my clinic with ketamine (this is a small percent of our total number of patients), but like all treatments at this stage, the results are marginal. Please let me know once a solution is found 🙃
Great summary of some of the key ideas - a good reference piece for future conversations. I particularly appreciate your personal experiences. Doctors helping their patients leave with some dignity at the end is an age old practice that we rarely talk about. We need to talk about it, and we need to thank those doctors that do this difficult work. I really appreciate you talking about it. The problem is that we have swung from "taboo" to "normalization" and even "celebration" of death for even young people with depression etc. At a time when our young people are becoming increasingly nihilistic or "black pilled" about the world and their place in it, the last thing we want to do is encourage death. Many thanks for your work.
The “Catch 22” - I don’t like it and wish it wasn’t this way. I was the caregiver for my mother who passed away from dementia. She was once a vibrant, strong, independent woman and I loved her deeply. I knew her well enough to know she wouldn’t want to live the way she was the last 3 years of her life. She believed, as I do, in quality of life over quantity. I will be 65 next year and I wish I could put in place a document that stated I would select MAID if I get this horrible disease. The law does not allow me to do this - I know as I went to a lawyer to have it put in place and he said it is illegal. If I get the disease, I won’t be lucid or able to communicate my wishes.
Dementia is so hard. We lose someone with dementia twice - first when their mind leaves them, and then again when their body dies. And sadly, on the other extreme from euthanasia we have the phenomenon of doctors (and many families, sadly) working far too hard to extend length of life in patients who have no quality of life left.
It is very very hard, I agree and you are a wonderful daughter for being there for your mother. I pray you are fit and healthy until you're 100!
I simply do not agree that this should be part of my healing profession. I do not want to do this to people, it goes against everything I believe as a nurse and as a Christian. We are being forced to be in this environment, why should we? If I speak up, I can lose my license to practice, that is just wrong. Abortions happen and I do not have to work on the units where they happen. I disagree with abortion too but at least I am not forced to hold the hand or clean up after. Can we at least agree I should have a choice?
I believe every single human has worth regardless of our suffering. It is not my place to end someone's life.....
Oh how I now struggle with MAiD-I believe we have passed the slippery slope. I am old enough to remember when not even a DO Not Resuscitate could be written on a chart. I recall as a student nurse hearing a seasoned doctor say when called in to reinsert a feeding tube “ don’t they know he wants to die” . The Doc was right, the patient wanted to die.
I recall being terrified when I gave a shot to a very ill patient and a few minutes later he passed away, I told the senior nurse “ I think I killed him” she nonchalantly said “oh you probably did” and went on to explain about depressed respirations.
I too remember Sue Rodriquez-Lou Gerigs is a rotten disease! My heart literally broke for Robert Latimar and his daughter who even the physicians said was in uncontrollable pain. I believe society failed him AND his daughter!
I worked hospice and did everything in my power to ease the suffering this included trying to convince a woman with terminal illness NOT to take her own life, -hospice could ease her discomfort -BUT for her, the mental anguish was more than she could bare and she followed the guidelines in Final Exit!
I continue to believe there is a very narrow need for MAiD. Still that being said I would NOT offer it. I would encourage life for the very reasons you wrote about, “if relatively pain free “ much love transpires at the end. BUT to keep a body alive in excruciating discomfort is cruel.
Proposed MAiD suggestion I would have to stand against, NEVER to be used because of lack of funding, services etc! NEVER! Death is not the enemy BUT excruciating pain is! God bless you as you make your way in this strange new world! Thank you for your story it resonated with me!
Wonderful and thoughtful comment, thank you for taking the time to write it. I think this post generated the most interesting and thoughtful comments of any we have done so far. It's a VERY difficult subject.
The problem is the government getting involved. Government ruins everything it touches. It's between an individual and his doctor. It's none of the governments' business.
If I make the decision to preemptively end my suffering, and my doctor refuses to give me any advice or prescriptions, I will find another doctor or I will take it into my own hands and choose an inelegant but effective manner to terminate my life.
I agree, when we think the solution is for the government to have complete control and come up with a one-size-fits-all solution, it ends up being an overly-expensive one-size-fits-none solution instead.
Very well written! The best thing I have read on this topic. I laughed, I cried, I nodded in agreement and shook my head in discouragement with the state our health care is in. Then prayed for others to see what you see and fight for better. Thank you for always giving me the best nighttime reading material ❤️
I signed up for a "Dying with Dignity" Newsletter. I couldn't believe what I was reading on-line. Below I've copied and pasted the most recent. I feel that the government is setting up doctors to look bad. I know of a guy in his thirties who is depressed and has been hospitalized was thinking about MAID. When it hits home - when you know of someone whom you deeply care for and love mention this - you panic. It's like you want to rescue a person from the very facility that should be helping them. If they can't as they primarily deal with medications and ECT...then should they be killing them? If this happens - my thoughts will be - that the doctors killed him. Why are we normalizing this? I think we've lost our way...I sure hope that some of us will be able to find another path and a way forward.
Shelly,
One of the most frustrating comments I’ve received from assisted dying skeptics is that medical assistance in dying (MAID) should only be for aging seniors or those with a terminal illness. It’s infuriating because it’s not true.
MAID should be available for the person who, at the prime of their life, was diagnosed with a devastating illness that will see their body and mind steadily decline over the next few years — and who want to take back some autonomy and control.
MAID should be available for the person who has suffered for years, even decades, from a chronic condition that has severely limited their quality of life — and who want a say in how much suffering is enough.
End-of-life choice is for families like mine, who are fortunately healthy now, but want their directives made clear should they ever wish to exercise their right to an assisted death — a right they currently don’t have under Canada’s assisted dying law.
These assumptions about medical assistance in dying (MAID) and end-of-life rights drive our Support and Education team at Dying With Dignity Canada to get the right information out to the public — and why our plans for 2023 are so essential.
Shelly, will you do your part to help us further our patient support and public education efforts in 2023 by making your first donation of $100 or more today?
Donate today
I’m sure this comes as no surprise to you, Shelly: in response to the critical amendments in MAID law — amendments that the DWDC community has been advocating for — our patient support and education work has increased substantially over the past few years as more and more people became aware of MAID. In turn, however, our team has remained at just three people to support the entire country.
I’m not telling you this because it’s a problem. In fact, we have been — and will continue to be — up for the challenge.
I’m telling you this because, at the end of the day, it’s about the people. It’s clear from the hundreds upon hundreds of one-on-one conversations that we have had with people this year that they are looking for more resources and community-building opportunities — so that the end-of-life process doesn’t feel clinical or isolating.
We know that with DWDC’s success in advocacy comes a very real responsibility to inform, educate and support those who now qualify for an assisted death — including changing the conversation about MAID so that it is understood as a compassionate and dignified option within all other choices available for end-of-life care.
Shelly, I promise you that Melissa, Amanda and I will continue to show up for people in 2023 as we expand our support and education work even further to include two new resources: “How to be a patient advocate” and “What to expect at a MAID death,” a ground-breaking Death Dialogues program to promote death literacy, and much, much more.
To get to the bottom line here, we do need your support — and generous contribution — to give my small three-person team a fighting chance next year.
Shelly, I hope you’ll join me in advancing end-of-life choice in Canada even further in 2023 by making your first — tax receiptable — gift of $100 or more now.
Very strange. I do agree that suicide should not be illegal as it once was (a silly law, when you consider it!). But we are trending towards a society where we have normalized killing yourself if you have a medical problem. That's not normal, and feels like it is a symptom of a deep spiritual (? and religious) malaise.
This is the compromise I have always envisioned. Assisted suicide should be JUST THAT. I believe the patient should be given the means, but the patient should be the one to do the deed. That should be the case in 99% of contexts. There are of course situations where the patient is unable to, then it's a slightly different situation of course.
But, I think we are skirting the main problem, the Medical Industrial Complex is treating our walking dead bodies as profit generating machines.
The normal lifespan of all living beings is the reproductive lifespan. What is biologically NORMAL is for high mortality in neonates and a very short old age. In this way, the problem didn't so much exist before the advent of effective modern medicine, once we were sick, or had serious breaks, or caught pneumonia, we just didn't stick around for bloody decades expecting everyone to take care of us. DEATH IS NORMAL, our society has become crazy. People EXPECT to live to 100.
People EXPECT to work from 25 to 55 and people EXPECT 45 years of "healthy" retirement. Bloody hell, it's complete insanity.
In the old days, the only ones who got to 80, 90,100 were the unuasally fit and unsually lucky. There is no amount of money that can possibly pay for the insanity that people have come to expect... well not without saddling youth with death and lockdowns, to preserve the walking dead as long as possible.
No, our problem is death, our problem is the lunatic expectations we have.
Statistically, in Canada, this is the reality
-20 years of retirement
-10 of which are sick.
No thanks! I will be getting off this stupid bandwagon before our "healthcare" system forces me to live in a hospital or hospice. And if a Canadian doctor won't give me the means, I will find an illegal way to do so.
Being staunchly pro-life at death is no different than being staunchly pro-life at birth. The pro-lifers DEMAND life, but never want to pay or care for that damned life. Honestly, any person who is pro-life should take on the responsibilities of the lives they impose, otherwise they should shut up, because their demands are empty virtue-signalling. They need to put their money where their mouth is.
I meet many, many seniors who are 70, 80 and beyond who have great qualities-of-life despite challenges. I meet many young, handicapped people with serious challenges who have great qualities-of-life. You paint a picture which is far more bleak than that which I see in my work, and my day-to-day life in my family and community.
It may be interesting to know that people who are spinal-cord-injured have a period of depression and bleakness but usually settle into having a very good quality of life and after a year or two are as happy as someone without a spinal cord injury. Many lead very full lives and contribute to their family and community.
I do agree with your point (see my above reply to an earlier comment) that the flip side of euthanasia is keeping people alive beyond when they would actually want to be alive. That is also an impingement on autonomy.
I agree. People live too long. When I can’t do for myself anymore I am out of here, MAID or not. Long term care, assisted living, burden on my family - no thanks.
Emotions are rising even as I begin typing. Thank you for this beautiful, articulate essay. I love the evolution of your opinion on euthanasia as you matured.
My Dad, 97, still living in the 4 level split I grew up in (ONT) has typed out a clause and added it to his will, saying to give him pain relief as necessary, but not to the point that it kills/takes him early. He has a lifelong, steadfast faith in God/Jesus, and believes it is not God's will that we euthanize/kill any person of any age. That God himself has withstood and brought eternal good from suffering himself.
My bff's Dad, a few months into the Covid Hysteria Era, was newly diagnosed at 96 (he was healthy and "mall-walking", catching a bus there independently, weeks before) with an extreme, fast brain cancer (he went in with a headache, very unusual for him). Within, 10 MINUTES of his diagnosis, Dr. Death, as my bff calls him, casually walked into Mr. B's room and said casually, "We have MAID available, if you'd like."
Mr. B was shocked, in every sense of the word: firstly, from his sudden, awful diagnosis, as he was a healthy, active senior, full mental faculties and 2) while not a particularly religious man, he is fully against euthanasia. So, to have a doctor, whom many of his generation respect and trust as "Do no harm" trustworthy authorities, looking out for his best health, offer to 'put him down' like we used to do with a suffering pet, was stunning.
I taught The Giver for several years to grade 9's, but felt it would be far more powerful re-taught at gr 11-12, where their critical thinking skills are sharpened. Like Animal Farm, it's so simple, but so profound in Lois Lowry foreseeing where we are now in Canada! - especially with the euphemizing of what MAID actually is.
We are desperately in need of many more scholarly debates (like the Munk Debate: Can we trust mainstream media?), but instead debating this macabre slippery slope with MAID in Canada. At heart, it is a religious issue, but if you don't believe in God, it is such an important human issue.
We need more input like this essay, Dr. Milburn - from both the doctor and patient sides to help Canadians grapple with the complexities of assisted suicide.
Thank you for writing with wisdom, humility and transparency. I value both yours and your wife's critical thinking/articulate writing, giving me hope the past year. You are both on my Canadian heroes list, beside Dr. Byram Bridle.
Merry Christmas! And may 2023 see you vindicated and your influence multiplied exponentially as more Cdns awaken to question unhealthy govt authority.
Wonderful comment and story.
Can you post a link to "The Giver" - not something I've read.
The story of your friend's dad is very disturbing. The conversation about limits of care is important. For instance: do you really want chemo, because you might be getting a little more time but losing a lot of quality of what time you have left. Or, given that you have a deadly cancer, would you want to be put on life support if your heart stops? That is appropriate and important to discuss. OFFERING euthanasia is truly creepy and macabre, and disrespectful. Sadly I have had patients who say that is one of the first things that gets offered to them as a potential "opportunity" to use an ironic word.
Thank you so much for bringing this discussion. It is very near and dear to me.
I worked as an RN for 10 years in Palliative Care. I have had those meaningful moments with patients who wanted to die for their families, not themselves. I have been privileged to participate in the last moments of someones life in this realm. I feel blessed for having had those experiences. I have worked in every area of healthcare, yes, and with dementia patients and I agree it is so very hard on everyone. I do not have the energy to explain my opinion in this regard. I feel it is a loss of family and community that has driven us away from support for these people. It is a culture shift for the worse. We should help. How have we come to think this is okay, in any faith? We convince ourselves that God is okay with this, He is pretty clear He isn't okay with this..
So you are an atheist, okay....
On a more practical note, why are my tax dollars paying for this service for you or your loved one. People have been killing themselves forever. I agree, we have to better understand suffering and what it means for everyone; again, to long to discuss here.
It is absolutely ridiculous that we went down this road here in Canada and especially here in Nova Scotia. I am embarrassed of my country, but even more of what I thought was a beautiful province.
I did not become a nurse to kill and I am shocked that this has become so commonplace and nurses are now "acclimated" to participating in this deed, because it is not a medical intervention. If this is something that someone chooses to do for themselves or their families go ahead, that is your prerogative, (there are simple ways to complete this task) and it is for God alone to judge. Dare I mention God lol.
This may be what Tommy Douglass planned, but I do not agree. Lets us go back to private pay. The government should not be involved in murder or even making these decisions. For heavens sake, this is barbaric and we are letting this happen. You do not need a healthcare professional to do this for you!
The other consideration is the time taken from patients who actually require our care in an already overtaxed system and placing undo pain and suffering on individuals who do not want to participate in this act. I know nurses who have left the bedside because of MAID. Regardless of being the one who performs the murder, the nurses are left with the psych-social and physical demands of this "event".
We have become a culture of death, good luck to us from here on in....
Are we playing God, or just relieving suffering.... my answer is
may God have mercy on our souls.
In your story about Mr O, I have no ethical qualms about your actions. And I did not forsee the widening of permissions so much. But now, even for babies? I don't think that's right.
At least two women with MCS (Multiple Chemical Sensitivity) took MAID earlier this year when they were unable to find or afford tolerable housing. Housing that was smoke-free, laundry scent free etc... housing that didn't give them the equivalent of continuous migraines or similar.
I feel guilty and very angry. We as a society have let these people down. Are not lives worth more than housing?
The government refuses to acknowledge the MCS illness/diagnosis and complex needs that are associated with it, such as housing. The disability allowance is tiny, way below the cost of living. There are no dedicated funds, groups, charities, celebrities etc. Many women with MCS are unable to go out in society and some are left behind by family because of the complexity of the illness. It is an invisible, ignored, isolating illness with a ton of suffering if unable to get good housing and food.
I know there are many other sad stories of people who took MAID for other "reasons." As you stated, sometimes a suicide/attempt is a plea for help, a plea to be heard, a plea for care and compassion, a plea to do something.
Way at the bottom of the slope is MAID being given without permission (faked permission?). Perhaps for people who are so "mentally ill" that they "disagree with the medical consensus". For the good of society, of course. That could never happen, could it?
We can't fix everyone! JHC! It is normal to die. People who are too sick to get along in life should die. Our healthcare system was never designed to provide forever life, it was designed to fix booboos.
The only way get out of healthcare what you're asking is to tax us to death, and lock us down. That is exactly what Trudeau will do.
Not supporting euthanasia and not knowing when to stop trying to keep people alive are very different. ie: it's different to not put a person with end stage lung cancer on life support if their heart stops, versus giving them a lethal injection a year before they would have died naturally. I think we all agree on the first approach, the latter is much more controversial and ethically fraught.
I don't think arguing about the "date" has any value.
Isn't the solution to not force the doctor to pull the trigger? Hospitals should simply provide the means, not the pulling of the trigger.
I agree. So disturbing. And, how sickeningly ironic to use the euphemism, "opportunity".
I went through the harrowing cancer journey with my beloved. We were able to fly to Tijuana, Mexico, where I learned so much about real cancer care. They are advanced in many ways compared to the treatment at hospital we experienced here in Okanagan, Canada. Mild chemo is available, but there are so many other alternative (and cutting edge) treatments they offered (2012-13), and they encourage family support, prayer, - even the natural lighting in the hospital is different than the glaring fluorescent lighting in our hospitals.
EX: Two doctors drained Chris's bloated belly with a combined massage, and targeted the area needed to drain. (In Penticton, they put a drain tube in, and his two siblings and I sat by him for 3-4 hours for the drain, that in Tijuana, took one hour.)
The entire experience awakened me to question Cda's "best health care", and all I thought I knew about cancer.
https://www.amazon.ca/Giver-25th-Anniversary-Lois-Lowry/dp/1328471225/ref=sr_1_1?crid=CQNNOBT7W4CA&keywords=the+giver+lois+lowry&qid=1671675410&sprefix=The+Giver+Lois+Lowry%2Caps%2C147&sr=8-1
Above is a link to Lois Lowry's, The Giver. Like 1984, and Brave New World, her prescient novel is aging very well - never more relevant - esp'ly in Canada.
Thank you. The best thing I have read on this horrifying, accelerating and expanding practice. Much to ponder. Canadian practice is getting world wide coverage now, mainly very critical. I would love to see this essay published in a national medical journal to stimulate debate etc but good luck with that, eh?
I don't think my views have been fit for polite company in quite some time.
This is a discussion with no easy answers. I just finished Being Mortal by Atul Gawande (himself, a surgeon) which addresses how physicians aren't trained to help patients through the process of dying. The last chapter talks some about euthanasia, but much of the book deals with how medicine ruins the end of life experience for many people, leaving them to die in ICUs, intubated, unconscious, or delirious.
As a fellow psychiatric provider (psychiatric nurse practitioner in America in my case), I have worked with countless patients who struggle with suicidal ideation. Some are hospitalized countless times and make repeated serious, genuine suicide attempts but don't succeed. While I definitely agree that there is a slippery slope with euthanasia, I sometimes wonder if there should be a point where these patients are allowed to end their own life by being provided with the means rather than the options of jumping into traffic, suicide by police, or overdose (which often leads to ICU time or even disability).
Thanks for much for your candor. I look forward to reading more of what you write, especially knowing that some of what is written is from a psychiatrist unafraid to speak her mind. We don't find that much in our field. As a side note, I would love to hear your thoughts on my recent articles on homelessness in America. While I'm not sure how the homeless situation is in Canada, I would presume it has worsened over the past few decades...
Thanks so much for the comment. Our homelessness situation in Canada is FAR worse now than 20 years ago. That said, calling it a "homelessness" situation is not accurate, since something like 98% of the homeless are addicts, and end up on the street not because there is no social safety net, but because it's unfair to have someone in a shelter who is unstable/violent/using drugs/dropping needles on the floor. Shelters quite reasonably say "no drug use here", which leaves people on the street. Political polarization has made it into a facile argument where one side just says "if we spent enough money on this problem we could solve it". Vancouver now spends a million dollars per day on programs for "harm reduction" and housing, and the problem keeps getting bigger. Which to me says we're on the wrong track. (As an aside, harm reduction and addiction is on the agenda for 2023 FSIM Conference. Stay tuned at freespeechinmedicine.com)
I've thought a lot about your point about helping depressed people to kill themselves. My conclusion is that the slope is just too slippery. How do you set an age limit, or a minimum time that someone feels depressed, or a minimum treatment requirement (ie: should ECT be mandatory first? How long on drugs,, and how many different drugs before saying that their depression is untreatable?) Whether life is worth living or not is subjective and not amenable to rules and guidelines. Which means that in the end we must simply accept a patient's subjective evaluation that they would be better off dead. Which will inevitably mean we end up helping kill depressed 32 -year-old BPD patients. (This has already started happening in other countries).
Yes. You tackled the homeless problem much more succinctly than me! But your critiques are valid. There is a significant distinction between "homeless" and "chronically homeless." And most of me loves the idea of harm reduction rather than another war on drugs, but I see another slippery slope there. I would love to hear more about that upcoming conference! I would love to come in person, but family and work (yadda yadda) may only allow if I could attend virtually.
And regarding assisting (or even allowing) the mentally ill with suicide, I have no clear answers, even when I see these patients daily. I'm currently treating about 20 treatment-resistant patients at my clinic with ketamine (this is a small percent of our total number of patients), but like all treatments at this stage, the results are marginal. Please let me know once a solution is found 🙃
Great summary of some of the key ideas - a good reference piece for future conversations. I particularly appreciate your personal experiences. Doctors helping their patients leave with some dignity at the end is an age old practice that we rarely talk about. We need to talk about it, and we need to thank those doctors that do this difficult work. I really appreciate you talking about it. The problem is that we have swung from "taboo" to "normalization" and even "celebration" of death for even young people with depression etc. At a time when our young people are becoming increasingly nihilistic or "black pilled" about the world and their place in it, the last thing we want to do is encourage death. Many thanks for your work.
What a powerful piece, Chris! I am now changing my view on MAID, thanks to you!
The “Catch 22” - I don’t like it and wish it wasn’t this way. I was the caregiver for my mother who passed away from dementia. She was once a vibrant, strong, independent woman and I loved her deeply. I knew her well enough to know she wouldn’t want to live the way she was the last 3 years of her life. She believed, as I do, in quality of life over quantity. I will be 65 next year and I wish I could put in place a document that stated I would select MAID if I get this horrible disease. The law does not allow me to do this - I know as I went to a lawyer to have it put in place and he said it is illegal. If I get the disease, I won’t be lucid or able to communicate my wishes.
Dementia is so hard. We lose someone with dementia twice - first when their mind leaves them, and then again when their body dies. And sadly, on the other extreme from euthanasia we have the phenomenon of doctors (and many families, sadly) working far too hard to extend length of life in patients who have no quality of life left.
I promise I will not go down the road of who determines quality of life lol
It is very very hard, I agree and you are a wonderful daughter for being there for your mother. I pray you are fit and healthy until you're 100!
I simply do not agree that this should be part of my healing profession. I do not want to do this to people, it goes against everything I believe as a nurse and as a Christian. We are being forced to be in this environment, why should we? If I speak up, I can lose my license to practice, that is just wrong. Abortions happen and I do not have to work on the units where they happen. I disagree with abortion too but at least I am not forced to hold the hand or clean up after. Can we at least agree I should have a choice?
I believe every single human has worth regardless of our suffering. It is not my place to end someone's life.....
Oh how I now struggle with MAiD-I believe we have passed the slippery slope. I am old enough to remember when not even a DO Not Resuscitate could be written on a chart. I recall as a student nurse hearing a seasoned doctor say when called in to reinsert a feeding tube “ don’t they know he wants to die” . The Doc was right, the patient wanted to die.
I recall being terrified when I gave a shot to a very ill patient and a few minutes later he passed away, I told the senior nurse “ I think I killed him” she nonchalantly said “oh you probably did” and went on to explain about depressed respirations.
I too remember Sue Rodriquez-Lou Gerigs is a rotten disease! My heart literally broke for Robert Latimar and his daughter who even the physicians said was in uncontrollable pain. I believe society failed him AND his daughter!
I worked hospice and did everything in my power to ease the suffering this included trying to convince a woman with terminal illness NOT to take her own life, -hospice could ease her discomfort -BUT for her, the mental anguish was more than she could bare and she followed the guidelines in Final Exit!
I continue to believe there is a very narrow need for MAiD. Still that being said I would NOT offer it. I would encourage life for the very reasons you wrote about, “if relatively pain free “ much love transpires at the end. BUT to keep a body alive in excruciating discomfort is cruel.
Proposed MAiD suggestion I would have to stand against, NEVER to be used because of lack of funding, services etc! NEVER! Death is not the enemy BUT excruciating pain is! God bless you as you make your way in this strange new world! Thank you for your story it resonated with me!
Wonderful and thoughtful comment, thank you for taking the time to write it. I think this post generated the most interesting and thoughtful comments of any we have done so far. It's a VERY difficult subject.
The problem is the government getting involved. Government ruins everything it touches. It's between an individual and his doctor. It's none of the governments' business.
If I make the decision to preemptively end my suffering, and my doctor refuses to give me any advice or prescriptions, I will find another doctor or I will take it into my own hands and choose an inelegant but effective manner to terminate my life.
I agree, when we think the solution is for the government to have complete control and come up with a one-size-fits-all solution, it ends up being an overly-expensive one-size-fits-none solution instead.
Very well written! The best thing I have read on this topic. I laughed, I cried, I nodded in agreement and shook my head in discouragement with the state our health care is in. Then prayed for others to see what you see and fight for better. Thank you for always giving me the best nighttime reading material ❤️
I signed up for a "Dying with Dignity" Newsletter. I couldn't believe what I was reading on-line. Below I've copied and pasted the most recent. I feel that the government is setting up doctors to look bad. I know of a guy in his thirties who is depressed and has been hospitalized was thinking about MAID. When it hits home - when you know of someone whom you deeply care for and love mention this - you panic. It's like you want to rescue a person from the very facility that should be helping them. If they can't as they primarily deal with medications and ECT...then should they be killing them? If this happens - my thoughts will be - that the doctors killed him. Why are we normalizing this? I think we've lost our way...I sure hope that some of us will be able to find another path and a way forward.
Shelly,
One of the most frustrating comments I’ve received from assisted dying skeptics is that medical assistance in dying (MAID) should only be for aging seniors or those with a terminal illness. It’s infuriating because it’s not true.
MAID should be available for the person who, at the prime of their life, was diagnosed with a devastating illness that will see their body and mind steadily decline over the next few years — and who want to take back some autonomy and control.
MAID should be available for the person who has suffered for years, even decades, from a chronic condition that has severely limited their quality of life — and who want a say in how much suffering is enough.
End-of-life choice is for families like mine, who are fortunately healthy now, but want their directives made clear should they ever wish to exercise their right to an assisted death — a right they currently don’t have under Canada’s assisted dying law.
These assumptions about medical assistance in dying (MAID) and end-of-life rights drive our Support and Education team at Dying With Dignity Canada to get the right information out to the public — and why our plans for 2023 are so essential.
Shelly, will you do your part to help us further our patient support and public education efforts in 2023 by making your first donation of $100 or more today?
Donate today
I’m sure this comes as no surprise to you, Shelly: in response to the critical amendments in MAID law — amendments that the DWDC community has been advocating for — our patient support and education work has increased substantially over the past few years as more and more people became aware of MAID. In turn, however, our team has remained at just three people to support the entire country.
I’m not telling you this because it’s a problem. In fact, we have been — and will continue to be — up for the challenge.
I’m telling you this because, at the end of the day, it’s about the people. It’s clear from the hundreds upon hundreds of one-on-one conversations that we have had with people this year that they are looking for more resources and community-building opportunities — so that the end-of-life process doesn’t feel clinical or isolating.
We know that with DWDC’s success in advocacy comes a very real responsibility to inform, educate and support those who now qualify for an assisted death — including changing the conversation about MAID so that it is understood as a compassionate and dignified option within all other choices available for end-of-life care.
Shelly, I promise you that Melissa, Amanda and I will continue to show up for people in 2023 as we expand our support and education work even further to include two new resources: “How to be a patient advocate” and “What to expect at a MAID death,” a ground-breaking Death Dialogues program to promote death literacy, and much, much more.
To get to the bottom line here, we do need your support — and generous contribution — to give my small three-person team a fighting chance next year.
Shelly, I hope you’ll join me in advancing end-of-life choice in Canada even further in 2023 by making your first — tax receiptable — gift of $100 or more now.
In solidarity,
Kelsey
Kelsey Goforth
Director of Programs
Dying With Dignity Canada
Very strange. I do agree that suicide should not be illegal as it once was (a silly law, when you consider it!). But we are trending towards a society where we have normalized killing yourself if you have a medical problem. That's not normal, and feels like it is a symptom of a deep spiritual (? and religious) malaise.
This is the compromise I have always envisioned. Assisted suicide should be JUST THAT. I believe the patient should be given the means, but the patient should be the one to do the deed. That should be the case in 99% of contexts. There are of course situations where the patient is unable to, then it's a slightly different situation of course.
But, I think we are skirting the main problem, the Medical Industrial Complex is treating our walking dead bodies as profit generating machines.
The normal lifespan of all living beings is the reproductive lifespan. What is biologically NORMAL is for high mortality in neonates and a very short old age. In this way, the problem didn't so much exist before the advent of effective modern medicine, once we were sick, or had serious breaks, or caught pneumonia, we just didn't stick around for bloody decades expecting everyone to take care of us. DEATH IS NORMAL, our society has become crazy. People EXPECT to live to 100.
People EXPECT to work from 25 to 55 and people EXPECT 45 years of "healthy" retirement. Bloody hell, it's complete insanity.
In the old days, the only ones who got to 80, 90,100 were the unuasally fit and unsually lucky. There is no amount of money that can possibly pay for the insanity that people have come to expect... well not without saddling youth with death and lockdowns, to preserve the walking dead as long as possible.
No, our problem is death, our problem is the lunatic expectations we have.
Statistically, in Canada, this is the reality
-20 years of retirement
-10 of which are sick.
No thanks! I will be getting off this stupid bandwagon before our "healthcare" system forces me to live in a hospital or hospice. And if a Canadian doctor won't give me the means, I will find an illegal way to do so.
Being staunchly pro-life at death is no different than being staunchly pro-life at birth. The pro-lifers DEMAND life, but never want to pay or care for that damned life. Honestly, any person who is pro-life should take on the responsibilities of the lives they impose, otherwise they should shut up, because their demands are empty virtue-signalling. They need to put their money where their mouth is.
I meet many, many seniors who are 70, 80 and beyond who have great qualities-of-life despite challenges. I meet many young, handicapped people with serious challenges who have great qualities-of-life. You paint a picture which is far more bleak than that which I see in my work, and my day-to-day life in my family and community.
It may be interesting to know that people who are spinal-cord-injured have a period of depression and bleakness but usually settle into having a very good quality of life and after a year or two are as happy as someone without a spinal cord injury. Many lead very full lives and contribute to their family and community.
I do agree with your point (see my above reply to an earlier comment) that the flip side of euthanasia is keeping people alive beyond when they would actually want to be alive. That is also an impingement on autonomy.
why should my taxes pay for it though?
Those who NATURALLY CAN should of course.
What I am against is the EXPECTATION that eternal life is due to us and that we should sacrifice so much of our national budget for the walking dead.
I agree. People live too long. When I can’t do for myself anymore I am out of here, MAID or not. Long term care, assisted living, burden on my family - no thanks.
not on my dime, sorry....