“Doc, we’ve been through thick and thin together, and I need you to come through this one last time.”
In 2016 when Bill C-14 was enacted, allowing medical assistance in dying (MAID) for eligible adult Canadians whose death is reasonably foreseeable, I remember having mixed feelings. I was conflicted by an understanding for those suffering with a terminal illness who wanted this choice versus the thought that I didn’t really want to be a part of the process. I don’t think I was alone in feeling this way; no other recent medical issue has been so polarizing. Those for and against MAID have eloquently and at times passionately expressed their views about this issue in the pages of our journal.
Each year since MAID became law an increasing number of Canadians have decided to end their lives with the assistance of a health professional. The most up-to-date statistics I was able to find ending 31 October 2018 suggest that almost 7000 individuals have used MAID. British Columbia has been a bit of a MAID leader—only Ontario has a higher total number of recorded deaths, but a lower percentage if you consider population differences. Certain health regions in BC have well-organized MAID programs, which are reflected in their high number of assisted deaths. In contrast my health region has struggled to find physician volunteers to meet the needs of individuals requesting MAID.
I can understand the reasoning of a patient with ALS or terminal cancer not wanting to prolong suffering, I just haven’t wanted to be the individual on the other end of the syringe. I feel physicians have a duty to ease pain and suffering, but I entered this profession to save lives, not end them. I’m not sure how a patient taking their last breath due to my deliberate action would affect me. The emotional fallout experienced by physicians involved in MAID doesn’t really get addressed, but I know that it weighs heavily on some.
As a result of the shortage of physicians for this program in the health region in which I practise, two of my close work colleagues became involved in MAID following earnest requests from patients with a terminal illness. Leading up to the procedure I could tell that both of them were under significant mental duress. They experienced a range of emotions and were sleeping poorly. Their stress was palpable as they tried to focus on running their practices under the heavy weight of what was to come. I believe they were both thankful for being able to ease the patients’ suffering, and one of them has continued to be involved in other assisted deaths. This physician’s initial distress has evolved to a sense of compassion and feeling honored to be involved in caring for these patients at this most vulnerable time in their lives. The gratitude expressed by patients and their families has had a profound positive impact on this individual.
I doubt I will be able to say “no” if a longtime patient asks me to do this one last thing for them. I have taken care of some families in my practice for close to 30 years and think of many of them as friends. How can I turn my back when they need me the most? However, I also feel the anxiety developing in my chest when I think about performing MAID and can’t help but wonder how my involvement will affect me.