Death isn’t optional

I am a semi-retired physician, having practiced for years in different ICUs in Ontario as well as in private practice.Since my retirement from my private practice, I have been working as a MAiD assessor and provider and have been reading with dismay and distress some of the recent articles about MAiD, in Canada and abroad. I think there are many misconceptions and outright lies circulating about the process and I would like to give my views, as someone who has dealt with death in ways that have been painful, prolonged and traumatizing and others that were peaceful, loving and uplifting.Many people seem to believe that doctors shouldn’t deal with death. I wonder how that perception can possibly exist. Death remains a certainty. Not talking about it doesn’t change it, deferring it by a few days or weeks or months also doesn’t make it stop happening. We all would like to have a peaceful death surrounded by loved ones. And yet, we subject our patients to unnecessary procedures, painful interventions and deprive them of the ability to say their goodbyes. When we put someone on life support, we are often aware of the very slim chance of ever getting off of it. After a length of time, we have difficult discussions with the POA about withdrawing care. This is a brutal decision for a family member to make, one that is often made even more difficult if there are complicated family dynamics or unresolved conflicts (a sadly common situation). The patient has no say at this point in time, they are out of the discussion. If they are lucky, their POA is actually trying to give directions according to what the patient would have wanted, rather than making decisions according to their own beliefs or emotional confusion. When a patient chooses MAiD, they make that decision for themselves. It isn’t even legal in Canada for a substitute decision maker to request it. Already, we see that the person has control over their own destiny. The family is left to play the part that they should always play, that of support. We are all going to die. Most of us don’t know how or when, but some people certainly do have a strong idea of how, but not clearly when. For these people, forcing them to live beyond what they have chosen is just plain cruel.I use the following analogy to explain why I don’t believe that MAiD has anything to do with suicide (in particular track 1 patients). Remember back to 9/11 when the planes hit the Twin Towers. One of the most haunting images of that day was of people jumping from the towers. Were they suicidal? Had they gone to work that day planning to jump to their deaths? Of course not. So why did they jump? Because they were faced with the horrible alternative of burning to death. If a helicopter had come by and was able to rescue them, they would have chosen that. Or if they had a cyanide capsule they could take instead, they would have chosen that. Our MAiD patients have chosen not to burn to death. Being in a room with a person who has chosen a peaceful painless end, has had a chance to say their goodbyes, to hold the hands of their loved ones and go quietly, it is incredibly moving and beautiful. Could they have lived another day? Yes, probably. Would it change anything? Absolutely not. Dying is part of life, ironically. As physicians, if we don’t help our patients have a good death, we may be condemning them to a very bad one, one not of their own choosing. When religion is brought up, I say that if you are personally against it, that remains entirely your choice. MAiD is about consent. But your religion should not affect my choices. When a Jehovah’s Witness chooses to bleed to death rather than be saved by a transfusion, it is not my place to force them to live (assuming they are competent adults). I decided to be part of this beautiful rewarding work in part because I hope it will be available for me should I need it at some point in the future. It is imperative to continue to ensure that safeguards are maintained, that there is never any coercion or misunderstanding. The laws are changing and evolving. There are ongoing court challenges and it will continue to evolve. This is a sign of a healthy and just society, one that I am relieved to live in. Dr. Jackie Nemni is a semi-retired respirologist, now focused on MAiD assessments.

Death isn’t optional

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