The hardest choice

Safeguards require that the patient:


Twenty-six Albertans have ended their lives since February, when medical assistance in dying became legal for Canadians who meet specific criteria.

Nancy Campbell, co-ordinator of the MAID care team in the southern zone, has been there for some of those deaths.

One man’s words stick with her.

“I asked him, ‘if I had the opportunity to tell people, what would you have me tell them?’ And he said, ‘tell them not to be afraid. They don’t have to suffer.’ That was his words and it’s a privilege to be able to share it with you.”

Campbell did that sharing as part of a panel on MAID Sept. 27 organized by the Southern Alberta Council on Public Affairs.

The federal MAID law, which came into effect June 17, remains controversial and is the subject of at least two court challenges from those who say it goes too far and from those who say it doesn’t go far enough.

But since the Supreme Court of Canada in February ruled the old law prohibiting physician assisted dying was unconstitutional, and the subsequent passing of Liberal government legislation in June, provinces have been developing ways to meet requests from citizens.

In Alberta, it has led to the formation of special care teams that deal with each case.

“This is the largest change in health care that most of us will see in our careers,” said senior Alberta Health Services program manager Leeca Sonnema.

Every province is expected to develop a policy with which to deliver MAID. Sonnema said Alberta has been working on its policy for more than a year because legislation was initially expected in 2015.

Now AHS has a protocol that is aligned with both federal law and provincial regulations.

“We’ve shared our policy. We’ve shared a lot of our documents. We shared our pharmacy protocol and we’ve seen iterations of that from other provinces, so I think we’re relatively well aligned across the country,” said Sonnema.

There are five phases involved in MAID: pre-contemplative, when the patient makes inquiries about options; contemplative, when it is considered more seriously; determination to proceed; action and care after death.

Those who opt for MAID can choose administration of lethal drugs either intravenously or orally. To date, all Albertans who have used MAID chose intravenous delivery, Sonnema said.

The latter method involves a combination of drugs given in a particular order to induce sleepiness, provide pain control, induce sleep and then paralyze the body. Death occurs in “no more than 20 minutes.”

The oral method involves three different medications mixed and ingested in water. Death is said to occur within two to three hours.

“The protocol is very effective,” said Sonnema.

Every death through MAID is supervised by medical practitioners.

After that, protocol dictates that the person’s body be taken to one of the two medical examiner offices in Alberta, either Calgary or Edmonton. The medical examiner is given information on the case and the drugs given, examines the body and completes the necessary paperwork. The body is then returned.

Should a person not qualify for MAID, the protocol directs the team to connect them with another service, such as palliative or hospice care, said Campbell.

The protocol also allows for the team to work with family members of the person choosing MAID.

“This is a tough journey for family members,” said Campbell. ”There’s a lot of tears on this entire journey. It’s hard work for everyone involved. In the end, it’s been a grief process but it’s been a unique grief process.”

The wellness of medical professionals who provide MAID is part of the protocol as well.

“This is very weighted work,” said Sonnema, adding the views of health-care professionals who object to MAID must be respected as well.

Despite legislation and the protocol, three situations have yet to be addressed.

Requests for MAID from patients with mental health issues cannot be met, nor can those from minors under age 18.

As well, the legislation doesn’t recognize advanced directives for MAID, as in the case of Alzheimer’s patients who ask for it before becoming mentally incapacitated and unable to provide the required consent later.

John Warren, past-president of Dying with Dignity, said the legislation is a positive step but is still too restrictive.

Eligibility criteria demand that MAID can be provided only if natural death is “reasonably foreseeable.”

“The definition of reasonably foreseeable is very loose,” said Warren.

“It’s now (been interpreted to mean) almost imminent, and what that means is the choice of Canadians to be able to decide on whether to choose MAID or not has been very limited.

“So there are thousands of people with ALS, (Lou Gehrig’s disease) Parkinson’s, MS (multiple sclerosis) Huntington’s, all sorts of diseases that last a long time and cause immeasurable suffering but these people are unable to take advantage of this new law.”

He cited the case of LM, a person who died this summer “horribly and by her own hand.”

Warren said LM suffered from MS for 20 years and reached a point, near age 70, when she considered the pain intolerable.

She applied for MAID from four doctors, all of whom refused because her death was not reasonably foreseeable.

“She decided to quit eating and quit drinking. It took 15 long days before she died,” said Warren.

“This legislation obviously needs to be broadened to allow people to make their own decision on when they want to die.”

He also cited the issue of people with dementia, suggesting those diagnosed while still having full mental capacity could establish a “benchmark” cited in a personal directive, indicating the point at which they would like MAID.

For more information, visit www.ahs.ca/MAID.

Eligibility criteria for medical assistance in dying

To qualify for MAID, a patient must:

  • be at least 18 years old and competent
  • have a grievous and irremediable medical condition (serious or incurable illness, disease, disability)
  • be in an advanced state of irreversible decline in capabilities
  • give informed consent
  • have enduring physical or psychological suffering caused by the medical condition that is intolerable
  • face a natural death that has become reasonably foreseeable
  • make a voluntary request for MAID
  • be eligible for publicly funded health-care services

Safeguards require that the patient:

  • obtain a medical opinion confirming the patient meets the criteria
  • obtain a second independent medical opinion confirming patient meets criteria
  • make the request in writing before two independent witnesses
  • has the right to withdraw request at any time
  • abide by a 10-day waiting period unless death or loss of capacity is imminent
  • give confirmed consent immediately before MAID is provided
  • Source: Alberta Health Services

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