She Speaks: What does it take to die in Canada?

Originally published by Huntsville Doppler.

The woman in the photo above is Helle Rannik – a woman more full of life than her very ill body could contain. Three years ago, she decided to die in a way that had been legal for only seven months.

You have two short weeks to formulate an opinion on Medical Assistance in Dying (MAID)—if you haven’t already—and submit those thoughts to the Canadian government.

To do this, which I hope every reader does after they’ve read and commented on this article, just click here and complete the questionnaire.

I’ve always been a pro-choice type of woman, believing our bodies are both temples and gods, and over ourselves we must have the highest degree of control. ‘My body, my choice’ was a rallying cry set to nursery rhyme melodies for me, and so when I researched for an essay in tenth grade about euthanasia, it seemed obvious to me. If I want to die and I think I have good reasons, why shouldn’t that be allowed?

We are more compassionate when it comes to the end of our pets’ lives, I realized.

In June 2016, Canada exempted doctors and nurse practitioners, allowing them to perform end-of-life care if their patient has met the stringent criteria.

They are, simply put, as follows:

  1. The patient must be of sound mind at time of decision, and death;
  2. The patient must be facing imminent death;
  3. The patient must be experiencing intolerable suffering (the physician determines this);
  4. Two independent witnesses must sign off, confirming identity and consent; and
  5. Two independent physicians must approve the request.

Arguments calling this process too strict are abundant. For example, the definitions can get a little watery. What is intolerable for me may be tolerable for you. ‘Sound mind’ can be rather a fleeting time during end of life, leading people to go ahead with medical assistance in dying before they are entirely ready, while the ‘sound mind’ window is still open and before they lose their capacity to dementia or brain damage. Independent witnesses are actually a bit trickier to find than one might think, and volunteers are needed.

Also, many people along the complicated process can conscientiously object to participate. Legally, doctors have to refer their patients to someone who can attend to this request, but others, such as pharmacists, have no such obligation, leaving the patient’s family scrambling to find a pharmacy to fill a very uncommon and complex prescription.

These barriers and many more aside, the Canadian government is seeking input about the concept of “reasonable foreseeability of natural death”. On September 11, 2019, the Quebec Superior Court ruled that it is unconstitutional to limit MAID to those nearing death.

From the questionnaire website:

“The case was brought by two persons living with disabilities, Mr. Truchon, who has lived with cerebral palsy since birth, and Ms. Gladu, who has lived with paralysis and severe scoliosis as a result of poliomyelitis. Practitioners who assessed them were of the view that they met all eligibility criteria for MAID, with the exception of nearing the end of life. The Court declared the ‘reasonable foreseeability of natural death’ criterion in the federal Criminal Code, as well as the ‘end-of-life’ criterion in Quebec’s provincial law on medical assistance in dying, to be unconstitutional.”

Rather than insisting that those who are accepted to receive MAID are nearing inevitable death, the Canadian government as per the Quebec ruling will decide whether or not this is discriminatory, an undue burden. Should Canadian citizens be able to determine their own date of death, regardless of whether a ‘natural’ death is imminent?

Since Canada declared MAID legal, nearly 7,000 Canadians have died this way. In Muskoka, few have done so. The vast majority of people who choose this are elders, and two-thirds of people who choose MAID cite cancer as the underlying cause. MAID accounts for just over one per cent of deaths in Canada. It’s my estimation that in my lifetime, MAID will be the most common cause of death for its affected population, and that conversations about what constitutes a ‘good death’ will be dinnertime fare, not deathbed pleadings.

The last time you were in a long-term care facility, did they have a notice on the bulletin board outlining MAID and end-of-life options? Many people in LTC have been there since before the new law was put into place and practice, and it’s well known that elders can be isolated and often not informed of legal rulings. This information needs to be available to all Canadian citizens as a viable, and some doctors say, “pretty profound” option. Palliative care need not be considered an alternative or oppositional treatment to MAID—the two complement each other, and in conjunction with advance directives, can provide the most holistic treatment a patient could ask for.

(Advanced directives are patient-determined ‘rules’ for when MAID can be performed if they are no longer of sound mind. Currently, this is not relevant as ‘soundness of mind’ is a mandatory condition of receiving MAID. However, the argument is that those with deteriorating cognitive conditions should be able to give advanced consent to medical assistance in dying, and let their families and care providers know about their advanced directions: basically, when it is time to perform MAID after the patient is no longer of sound mind. They vary from person to person, as I’m sure they would for you or me.)

Medical assistance in dying was brought out of the theoretical and into sharp relief for me when I met the woman who would become my partner. In January 2017, Kai Rannik’s mother Helle concluded her journey in her decision to die. Her suffering had been deemed intolerable, her last meal had been heartily consumed, her last joke played out to the teary laughter of her most loved ones, including Kai, who was her support and advocate throughout a complicated and very new process. Since that day, Kai has spoken widely on the journey of MAID from the perspective of a loved one. She is the ‘lived experience’ voice of a highly divisive subject, but she does not preach MAID; she teaches about love, and consent, and the process of grief after a good death.

Since meeting Kai and seeing her speak, I have had the honour of helping Helle’s ashes find their way home; of reading excerpts from a heartbreaking and hilarious diary, and of hearing my loved one say, “I miss my mom” when that feeling strikes her. I feel like I only just missed getting to know a woman who transcended life itself, whose autonomy superseded tradition and social mores, and who blazed a trail that I would be honoured to traipse down, should I make it to 133 years old and finally be ready to call it a day.

Strong opinions should be backed by facts first, then experiences, then feelings. Read about this, talk about it, consider what it may have been like for those you know, since passed, who may have benefited from a choice in death. Other challenges will be coming—MAID for mature minors or those with mental illness diagnoses. We are at the forefront of a very expansive human experience. But death does find us all.

Have your say.

Here’s the questionnaire again.

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