Personal reflection: Medical Assistance in Dying

Personal reflection: Medical Assistance in Dying

Life & Death Matters Post

Today Bill C-14 was presented to parliament. big smooth rock in water

Today the Canadian Government introduced legislation to make medical assistance in dying legal. The facts about the proposed legislation can be found here.

People have asked what I think about Medical Assistance in Dying. I have not presented my thoughts openly on this topic, for a number of reasons. Tonight, I will respond to those who have asked, and I will share a few very personal thoughts.

April 14th. My reflection on Medical Assistance in Dying

In an ideal world it would be nice to not have this issue before us. But we do not live in an ideal world.

In an ideal world, people would have access to hospice and palliative care services, holistic person centered care would be available from time of diagnosis through to and following death. But we do not live in an ideal world.

In an ideal world, community would care for one another, people would not be lonely, and needs would be addressed from childhood on, fear would not exist. But we do not live in an ideal world.

In an ideal world, there would be funding to assist community to address sorrows and suffering. But we do not live in an ideal world.

In an ideal world, people would not struggle for air, pain would not saturate a person’s being… but again, we do not live in an ideal world.

Ideal is defined as a standard of perfection or excellence, existing only in the imagination, not real or actual…  And this type of ideal does not exist.

So, for these reasons, I know that there are situations where medical assistance in dying is needed.

I understand that for many people, that this is not about the degree of suffering, but rather the desire to have control over how, when and where people die. I appreciate that as Canadian, North Americans, that autonomy is a most important value. And so, I am satisfied that this is what the Canadian people want.

For me, the lesson that I am forever having to learn, is to let go of control, and to allow life. I think that this may yet be one of my lessons in dying, to let go and let life – and death – occur.

Years ago I heard of a midwife in Australia who commented on the decision that some women were making to choose and plan a cesarean section in advance, preferring the surgery over natural childbirth. The midwife asked, “Have women lost confidence in their ability to birth naturally?” and in reflecting on that comment, I wonder, “Will we… or more importantly, will I have the confidence to die naturally?”

I understand the rationale for this new legislation. I understand the desire to want to choose.

And I will continue to hope that my living and my dying, will afford me the opportunity to go sweetly and naturally into that good night.


PS, another day I will write about the specifics of this legislation… there are a few things that I am especially glad about.

PPS, You are invited to share your thoughts and feelings here. Please be kind and respectful though. I have no space and time for turning this into a debate… the decision to allow Medical Assistance in Dying has been made. We now look ahead to developing and influencing policy to protect the vulnerable, those who want the service, those who don’t, those who want to assist, and those who do not want to be involved in any way. How are we going to do that? And, as evening and night falls around you, what are your thoughts and feelings? What are your concerns as a person and as a professional? What do you worry about? What are you glad about? What process are you using for understanding and grasping this new legislation?

PPPS, I am honoured to have David Wright from the University of Ottawa provide a piece on Medical Assistance in Dying for the new text for nurses that we are working on. He is a gifted writer, and has done some great research on this topic.


14 Responses

  1. I am a psw and love what I do, tonight I had a man tell me he went to doctors, doctor told him his heart was very weak. He said to me its OK honey I pray every night for god to take me……..I think how is that fair this poor man knows its coming , why let him suffer anymore????… is about living not praying to die!!!!

    1. Hi Tammy
      How wonderful to hear your enthusiasm for being a PSW!
      I hear your concern for this man, and your suggestion that he is suffering. I can’t hear his tone of voice in your writing. Is he in fact suffering, or is he just commenting and at peace that dying is nearing?
      Is knowing that death is coming a painful experience?

      Thanks for sharing 🙂

  2. Very well said Kath! I also believe that if folks had access to expert end of life care, this may be less of a discussion… however, as you mentioned, this discussion is more around people wanting to have choice… control over a situation where they feel helpless. I have faith that I do not need to know the answer or understanding to every situation in my life… or in my death. Jim.

    1. Jim
      THanks so much for your feedback. Personal reflections are just that, personal and reflective.
      I wonder what you are doing in developing policy for the Lodge in anticipation of the new legislation.
      Please pass along my regards to the teams at the Lodge!!!

  3. Hi Kath, I always really appreciate your perspective. I’m so interested in the articles you chose to post and your comments about them. Thank you for writing this great perspective. You are so right when you note that this is about control. What really stood out for me was when you wrote that you are forever learning to “let go of control, and to let life” and YES “let go and let life – and death occur”. These points as well as the reflection from the midwife in Australia have really helped me reflect on this issue (and my own life) in a different light. I too am forever learning to “let go and let life – and death”. And so interesting – “Will I have the confidence to die naturally?”
    What great words Kath. Thank you so much for this.

    1. Karena,
      The research from Oregon and other places where PAD has been legal for several years, does indicate that having control is important. I am sure that when a disease takes control of your body, and you have so little control, it is nice to be able to control something! Interesting also that those who get a prescription to use “at a later time”, do not often need to use it. It is like having a safety net. That must be so comforting.

      The new legislation will allow people to self administer a prescription, as well as have a physician or nurse practitioner provide an injection. This allows the person the privacy and the control, allows for flexibility, and change.

      Warm regards Karena to you and your team!


  4. Beautifully written, Kath! Everyone asks me as well. Guess it goes with who we are. This is my answer:
    What I believe about assisted dying is neither here nor there. I am not in this to fight for or against. Because, like it or not, assisted dying has arrived. And so I choose to be the gap-filler; the voice who brings logic to the conversation, before end of life decisions need to be made. We need to talk about, plan and prepare long before we are faced with end of life. We need to dig deep down inside, and discover why we are scared to death of death, and diffuse our fear. We need to sit in the quiet, and figure out what we believe about life and death. If we choose to believe something that gives us comfort in life and in death, we will suffer less. If we choose to take good care of ourselves and each other, we will suffer less. And did I mention? Grief is coming.

    So I am here to empower compassionate people, to diffuse the fear of death so we can make logical decisions, to discuss the fact that dying is a process and that dying with dignity has nothing to do with bodily functions or control. If you’ve lived your life with dignity, you will die with dignity. That’s what I choose to believe. We create excessive suffering when we won’t allow the natural process of dying and death. It is a part of this journey. And we can create a good death. We just need to get better at it.

    At the end of the day, I don’t think my opinion should matter. But what I will say is this; I don’t believe it is my right to choose for someone else. I also believe that if we talk about plan and prepare for life and end of life, if we empower ourselves… We will fear assisted dying less, and we will need it less.

  5. So well said, Kath. I have spent a lot of hours pondering this question. During the ‘heat’ of the moments when all there seems to be is agony and more of the same tomorrow I am so in agreement. But BUT somewhere in all of the pain for both the individual and the care givers there is mutual ground where its safe to talk about. What does PAD do to a physicians heart? What does it do to the caregivers at the bedside? Tough subject for sure. Thank you for sharing and bringing so many new thoughts into my mind. You are a gift to us when you can approach a subject like this and bring us into a safe place to talk. Sometimes that in itself is enough.

    1. Hugh,
      Wonderful to “hear” your voice.
      I missed you at the CLPNA conference last week.

      Yes, these issues hit at the very heart of why we came into nursing/health care professions.

  6. Hey Kath
    Howdy from the rock…Kath I’m working my way through an LLM in Health law so spending a lot of time with this item. Also, I’m working with Medical Services and note the College of Physicians and Surgeons NL has put a few things in place to support practice. I think we in health care have some important work still to do, yes the decision has been taken but the original recommendations from the house of commons committee were very broad and have been noted as subject to a revisit in 12 to 24 months (I think those are the recommended timelines). The Quebec guidelines were perhaps clearer, and I remain concerned that ‘irremediable’ suffering is very different from ‘terminal’ . I wish it was simpler to manage and I hope that for the many who want no part of this; that the ‘referral’ requirement is mitigated, though I doubt it will be.
    The committee’s original recommendations, which are to be revisited’ would include mature minors and the mentally ill, too big a net, we would have had the broadest scope for Physician Assisted Dying (PAD) in any jurisdiction. On some items we hope not to ‘lead the pack’. Thanks for letting me put my oar in…such difficult work for all affected.

    1. Evelyn
      At HPCO conference, I heard about a group of health care professionals who met to discuss what they believed and felt about this topic. Those who did not feel comfortable in providing a “referral” were able to identify what they were comfortable doing… and it was determined that they were comfortable recording in a book when someone asked about assisted dying. Then those who feel comfortable in having discussions with people about assisted dying and are willing to participate, made a commitment to checking “the book” on a daily basis. This means that those who are conscientious objectors are able to do what feels comfortable for them, and the people who request assisted dying or who want to talk about it, are able to get the services that they request.

      Yes< Evelyn, this is difficult work. I am very concerned about the additional stress on health care providers and health care teams. I am sure that you are having a wonderful time working on "the rock".

  7. Kath, so good to hear you opinion and I agree with you, it is a matter of having control. Like in Oregon how much it will be used is to be determined. One thing we as health care providers can not forget is the person. No matter their choice they need our care, compassion, we need to respect their wishes . We need to be so careful that our morals, values and beliefs do not impact on how we provide care and that is easier said than done. keep up the great work, best wishes from the other side of Canada

  8. Enjoying my retirement, and even spending time on Gabriola – so beautiful and peaceful! I am the daughter of a woman whose death was a journey of 18 years, almost half of which was spent in an unresponsive state. I cared for her while I was raising my 3 children, who grew up helping to look after “Umma”, and when she needed to be placed in care we took turns spending time with her.
    I am almost 75 years old now, 3 years shy of my mother’s age when she passed on. I know that my mother would not have wanted to be alive for all those years when her strong heart wouldn’t let her go, and I know that I will not put my family through that kind of suffering. I wish to have the control of the end of my life’s journey so that my children and grandchildren can remember me as the Umma who went on “ventures” and baked with them, not the woman who could not remember their names or know that you are supposed to eat with a fork or a spoon, not hands.
    I have lapses of memory now and then, sometimes more worrisome than others, none so severe as to affect my quality of life or to endanger others’. I am following the discussion about PAD very closely, as I have for many years talked about how someone will just have to drive me to the bridge in case I can’t drive any more when it is time.
    Kath, I am comforted by the thought that you are as involved as you are. Thank you for sharing your lessons with our students and staff – more than a few years ago, but permanently etched in our caring.

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Courtney Murrell is a PSW who works in hospice palliative care.

When she is not at work, she is spending time with her family, going on hikes or writing. Courtney is a lifelong learner and loves to share her passion for writing as a wellness practice.

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