Canadians need to get better at talking about death, says pioneer in medically assisted dying
Most people have not had the opportunity to openly discuss their end-of-life options, says Dr. Stefanie Green
When Dr. Stefanie Green meets a patient to discuss medical assistance in dying (MAID), she's upfront about the conversation they're about to have.
"We're going to talk about death today. We're going to talk about dying," she tells them. "We're going to talk about your death. And we're going to talk about assisted dying."
"People thank me at that moment," often because they have not yet had an open conversation about their death, or end-of-life options, said Green, a physician based in Victoria, B.C.
Green was one of the first doctors to offer MAID after it was legalized in 2016. The law offers the procedure to Canadians suffering grievous and irremediable conditions, provided they have the capacity to understand the choice, as well as their own health issues, and any potential treatment or palliative care options. Providers perform checks to ensure there is no coercion involved.
Combining previous reports and the latest data released in January, Statistics Canada has recorded more than 21,000 medically assisted deaths between 2016 and 2020. As of last summer, there were about 1,300 providers offering MAID across the country.
After six years working closely with people at the end of life, Green hopes to help people have easier conversations about MAID.
"We're not very good in Canada about talking about death and dying," she told The Current's Matt Galloway.
"I think we need to get better at this conversation."
Her new book, This is Assisted Dying: A Doctor's Story of Empowering Patients at the End of Life, tells the stories of people she has helped — with names and details changed for privacy — and also looks at how Canadians approach the topic.
Getting better at talking about death
Green's very first patient was a man she calls Harvey in the book. He was suffering from end-stage liver disease, and had already decided to access MAID when it became legal.
When the time came, he died surrounded by his wife and children as he'd hoped.
In her book, Green recounts a moment between Harvey and his wife: "She tells him to let go, that she's here with him. And as on most nights of his life, hers are the last words he hears, as he falls asleep."
LISTEN | Stefanie Green reads an excerpt from her book about a man receiving MAID
Harvey had the support of his family, but when that's not forthcoming, Green encourages respectful dialogue, with the help of a counsellor if necessary.
The aim is for a patient to express what they want, but also why they want it. And at the same time, for loved ones to express their fears or concerns about the procedure.
"The majority of times people can come to a respectful resolution together, maybe not agreeing with each other, but agreeing to at least disagree," Green said.
I will not be bullied into not doing my job and I will not allow my patients to be bullied.- Dr. Stefanie Green
In a minority of cases she has overseen, the family will never agree to the procedure, as happened with a woman Green calls Edna in the book, whose loved ones objected on personal moral grounds.
"We did have some counselling, but in the end, there was some yelling and screaming and finger pointing — that is never a pleasant situation," Green said.
But the decision ultimately lies with the patient, she said, provided they meet the eligibility, are capable of making the choice, and there is no evidence of coercion.
"I will not be bullied into not doing my job and I will not allow my patients to be bullied," she said.
"I take my direction from the patient who has the right to make this request."
Disability advocates want support to live
Last year, the federal government passed Bill C-7, which expanded access to MAID to include those whose deaths are not "reasonably foreseeable" after a 2019 court challenge by two Quebecers.
The changes included a temporary ban on accessing MAID solely on the basis of mental illness until March 2023. That delay allows the federal government's expert panel to assess how MAID in cases of mental illness can be safely provided.
WATCH | New law on medically assisted death passes
Some disability advocates have said the expansion in MAID access, without additional supports to live full lives, is tantamount to discrimination against people living with disabilities.
Earlier this year, Krista Carr, executive vice-president of disability rights organization Inclusion Canada, said it poses a threat to Canadians with disabilities.
"One of the things the disability community fought really hard to do was keep [MAID] at end-of-life," she told CBC News in January.
"They don't actually want to die, they want to live. But they want to live a life on par with other people, which is entirely possible with proper support. But yet we're not prepared to provide that."
Green said debates about whether the law is "too loose or too tight" will continue for years, "but it's my job to work within that law."
She added that as much as she may want to help people, she won't break the law to do so.
That makes telling some people they're ineligible for MAID "probably the hardest thing I do," she said.
"These are patients who've approached me, who very much believe … that they are suffering intolerably," she said.
"When I need to tell someone that they're ineligible, it's often devastating for them."
Latest figures show that three-quarters of the 12,808 requests in 2019 and 2020 were granted.
By contrast, she sees an "immediate relief" when telling patients they are eligible.
"There's an immediate sense of forgetting about how they're going to die and a grabbing on to the time that is left," she said.
Those patients focus on things like who they want to spend time with, what they want to say, and what's left on their bucket lists, she said.
"I'm always amazed at how people focus more on life and living once they know how they're going to die."
Written by Padraig Moran. Produced by Alison Masemann.
