Doctor describes medical assistance in dying in new book

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After more than 20 years of giving birth around the world, Dr. Stefanie Green decided to specialize in the delivery of suffering people.

She was among the first Canadian doctors to offer medical assistance in dying, known as MAID, once it became legal in this country in 2016.

Green has now written a book, “This is Assisted Dying: A Doctor’s Story of Empowering Patients at the End of Life,” describing the first year of her new practice.

She provides harrowing details about the patients she helped, and those she couldn’t due to the restrictive nature of the new law, which limited the procedure to people whose natural deaths were ‘reasonably foreseeable’ .

She describes the gratitude of the grieving family members but also of the man who framed her for the murder of her aunt. The last words of love exchanged between a husband and wife, lying naked together in their bed, and the patient whose parting words to her good-for-nothing grandson were “clean up your shit”.

Green also describes in great detail the care taken in assessing a patient’s eligibility for assisted death and the series of lethal injections designed to gently lull a patient into a deep coma before the heart fails. finally stop.

The book, Green said in an interview, was in part an attempt to stimulate discussion about the end of life, a topic most people are afraid to talk about. But it was also therapeutic for her.

“The real raw truth is that as soon as I started doing this job, I was kind of overwhelmed with the incredible experiences I was having…The job itself and the intimate relationships I’ve been in kind of threw it right away and the interactions I had between people and their families were just amazing,” said Green, who heads the Canadian Association of MAID Assessors and Providers.

“At some point I decided that I’d like to be able to tell someone what’s going on, what I’m doing, what I’m seeing, what it feels like, how it looks, how it works, you know, dispelling those myths… It’s almost like I need to tell someone.”

In a bizarre way, Green said her work as a maternity doctor was “a good fit” for providing medical assistance in dying, dealing with intense emotions and the family dynamics that accompany happy and unhappy events. Within her family and loved ones, she describes assisted deaths as “childbirth”.

A doctor describes what it’s like to provide medical assistance in dying in a new book. #MAID #AssistedDying

Indeed, she said helping to end people’s suffering has been the most rewarding experience of her career – although initially it was a feeling she felt she had to keep to herself.

“What I felt was the satisfaction of being able as a clinician – as a person – to offer that help. But it occurred to me that I probably shouldn’t tell nobody,” she wrote in the book.

“What would they think? ‘I helped someone die today and I feel really good about it.’ I could be considered a psychopath.”

But for Green, the experience was “profound” and a “privilege” to help those in need. She recounts in the book how “the feeling of relief was palpable” when she told someone they were eligible for assisted death.

“Once my patients were no longer afraid of how they might die, they focused on living and allowed themselves to more fully embrace the life they had left behind. MAID, in this way, was less about death and more about how people wanted to live.”

Six years later, there are still relatively few doctors and nurse practitioners in Canada who assess eligibility or offer medical assistance in dying — about 1,300, according to Green’s estimate.

In part, she thinks it’s because of the new law’s initial ambiguity and confusion over how the term “reasonably foreseeable death” should be interpreted. She admits in the book that the fear of interpreting the term too broadly – ​​and potentially 14 years in prison if she did – has led to agonizing decisions to turn away some desperate patients, for which she still feels guilty.

The foreseeable death requirement was removed from the law earlier this year, in response to a Quebec court ruling that declared it unconstitutional. People suffering intolerable suffering who are not close to the natural end of their life are now eligible for medical assistance in dying, although they face stricter eligibility rules than those who are close to death. dead.

But Green said Canadians weren’t rushing to take advantage of the expanded access. Additionally, she said MAID providers have been “very, very careful” about applying the expanded eligibility criteria, with some refusing to provide the procedure to anyone who is not close to the procedure. dead because the eligibility rules are “too complex and they can’t commit the time it takes,” especially during a pandemic.

It will get more complicated too. Among the amendments to the law passed last March is one that will lift the ban on assisted dying for people with only mental illnesses in 2023. This will likely require a whole new set of safeguards and rules eligibility for this group of patients.

And a joint parliamentary committee is yet to consider whether to expand access to include mature minors and whether to allow advance requests for assisted dying from people who fear losing their mental capacity due to dementia. or other skill eroding conditions.

The latter is popular among Canadians, but is particularly complicated, according to Green. In the book, she notes that people often say they wish they could specify in advance the conditions under which they would want an assisted death – for example, when they no longer recognize family members.

But she asks, would the condition be met the first time a patient didn’t recognize a family member? ” The second time ? When is it consistent? Over how long? »

She also asked: Who decides when the condition is met? And what if that patient seems to be living comfortably in a specialized care facility, enjoying the little things even though they are no longer the person they used to be?

“Who suffers should we take into account? The person who suffered or the person who suffers now? It’s just not that simple. »

This report from The Canadian Press was first published on March 21, 2022.

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