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:
- The patient must be of sound mind at time of decision, and death;
- The patient must be facing imminent death;
- The patient must be experiencing intolerable suffering (the physician determines this);
- Two independent witnesses must sign off, confirming identity and consent; and
- 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 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 mental 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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Thank you Kathleen for this well researched and informative story. It is my hope that all eligible Canadians take the time to fill in the survey. I strongly believe that people should have a choice when deciding how and when their life should end.
A thought provoking and necessary article. Discussions about MAID do not belong in the shadows but at dinner tables and any place where we share our thoughts and feelings especially with loved ones. I for one do see this as an option in my life one day but hope that by then the requirements to qualify for MAID do not push me into it early simply so that I am still if “sound mind” in my very last moments.
Have your say, take the survey; https://justice.survey-sondage.ca/f/s.aspx?s=6E6210A5-E100-4201-A55D-CFB52ADA1C0C
I’m all for assisted death. I have a male cousin who had assisted death last year. He and I where very close and to know that he no longer needed to suffer from cancer, pain from a leg amputation, helped him and all who loved him, in his passing.
This is excellent writing on a difficult subject Kathleen. I particularly like the point you made about strong opinions needing to be backed by facts first, then experiences, then feelings. And I hope that your inclusion of the link will drive readers to the site to make their personal wishes (for and against) known.
As a supporter of Dying with Dignity Canada and having experienced/viewed ‘good deaths’ at hospice and a number of painful and protracted deaths in other settings, my strong opinion is that should I become ill and if/when no truly effective treatment is available, that I could end my own life. Dying with Dignity is an excellent resource for those who feel that they need more information. https://www.dyingwithdignity.ca/
It is not the thought of pain that forms my strong opinions on MAID – pain can be well-managed in a hospice setting – but rather the lack of personal autonomy and the very indignity of a protracted death.
Plus, having cared for a loved one who would never have chosen MAID for religious and other reasons, I would rather die than put my own loved ones through months and years of stress and distress; I provided the care with love and compassion and I do not regret it but it is not what I want for myself or my loved ones.
I love life and I have no desire to die before I need to in order to be able to do so with dignity and without asking my family or a health care provider to break the law: consequently, my fervent hope is that MAID will be expanded to include the ability to make an advanced directive. I can imagine nothing worse than knowing what you want, making those views abundantly clear and then – because I have lost the capacity for consent – my views to be ignored and being left to experience exactly the kind of death I fear.
Thank you again for raising the subject at a critical point when our views will make a difference.
My Mom, Helle, was hyper-aware of the fact that she was the first in her nursing home to choose this path. Despite having always been the type to keep private matters private (indeed, she often admonished me for airing my “dirty laundry in public”), she insisted that staff leave her door open during all discussions pertaining to MAID. When I asked whom I should inform of her decision, she was firm in responding, “everyone.”
Mom eagerly sacrificed her privacy to help ensure that the option that gave her immeasurable peace would truly be available to everyone. Thank you for this, for continuing her legacy.
The removal of “foreseeability of natural death” would basically take us back to the time after the Supreme Court decision in Carter vs. Canada. Given intelligent administration of the law then; I felt strongly that a good balance had been struck.
Of course, such important legislation should always be a living document: But I feel that in making it all things for all people, there will be far too many loopholes. Ensuring that everyone who satisfies the criteria is able to die with dignity is insufficient: Preventing similar individuals from occasionally being captured in the same net is equally important.
As an individual living with bipolar mood disorder, I would have happily embraced MAID several times; if it had been available. Now, an advanced directive would at least get the ball rolling. And future deterioration of my mental health disability may possibly keep it rolling; even though my desire to live life to its fullest could still be intact (assuming a tolerable, dignified existence). Probably, a living will, and a wise choice of Power of Attorney for Health would be my preference.
And dropping the age to include mature minors is a potential minefield; to be subject to endless debate; if it is to be considered at all. Is there going to be a set age?: That would be untenable; as immature minors would be included. The only fair way would be to have a representative panel to evaluate each individual. But how many teenagers are reliably able to make such a decision? And how many panel members can predict the future of medicine; and what it may mean for these young people?
With all due respect, any bells and whistles added to legislation; which should benefit from being concise and understandable (in both official languages); are just plain wrong.
On November 28th, 2019 my mother aged 95 and 9 months old at 9:10 am received MAID. She had stated all of her very active life she would not be in a hospital bed and rott away. 2 weeks before, she had been presented with her 70 year Charter member pin as she was the last remaining Charter Member of the Kingston Airforce Club 416 Wing. She had fulfilled her last wish. We were all there by her side as the doctor asked her one last time if this is what she wanted. She said I’ve been waiting 2 weeks now what has taken you so long and smiled. Mother was told to relax and close her eyes as the doctor injected her with the medication. Mother fell asleep. In all of my life I had never seen such a Humane Death for an individual. The Bravery shown by my mother was equal to anything any other soldier could have shown. This was her decision and hers alone as it was her life and no one else’s. God bless this law. How many times has a person and family be subject to a horrendous death watch while everyone prays by their side. I fully support the rights of the individual in life or death. I suggest we make this option for the individual to choose even less restrictive. Soldier on mom.
The ‘social’ arguments put forward by supporters of the legalization of euthanasia are unconvincing. They assume the existence of ideal hospitals, doctors, nurses and families, guided only by compassion for the suffering. Here they are:
After legalization and social acceptance, euthanasia will remain only a voluntary act, which cannot be influenced by persuasion or pressure,
resistance to extending euthanasia to people who are permanently incapable of expressing their will – the request to take their lives – will continue,
Legalization of euthanasia will protect doctors from legal liability,
Legalization of euthanasia will not adversely affect care activities and funding for the development of palliative care and palliative medicine programmes,
as a civilized society, we will never use euthanasia for inappropriate actions.
Even a cursory analysis of the above arguments proves that they do not withstand criticism. The only argument that can be considered ‘justified’ and ‘logical’ is to protect doctors from legal liability. And I guess that’s what this is all about, because the remaining arguments are devoid of legitimacy, logic and possibility of implementation.
Therefore, it is worth looking at the counter-arguments presented by opponents of legalization of euthanasia for social reasons:
The maintenance of the ban on killing patients by doctors far exceeds the possible suggested “benefits” of performing euthanasia in exceptional situations,
According to medical ethics, the relationship between the doctor and the patient is also based on the conviction of the patient that the doctor will never raid his life. Legalizing euthanasia would destroy this trust,
If the ethical assumption is not to do the wrong thing, the doctor should not kill patients for ethical reasons, so there is no justification for the introduction of legalization of euthanasia, as this would be contrary to the above principle,
Legalization of euthanasia would hamper progress in education and research in care and palliative medicine, with the aim of developing even better models of care for suffering patients and producing more effective painkillers,
The legalization of euthanasia could contribute to the conviction that such a solution is beneficial to society and does not constitute any social harm as the lives of old, infirm and sick people are of no value. These people could, through their dependence on others, feel that it is their ‘duty’ to agree to euthanasia in order not to be a burden on society, which would grossly undermine their autonomy,
Legalization of euthanasia due to the patient’s dependence on others will devalue the positive participation of healthy and fit people in the care of patients and enable these patients – although limited – to participate in social life,
Due to problems in determining the competence and autonomy of particularly severely ill people with depression or anxiety, it will be extremely difficult to develop legal rules to protect against abuse of euthanasia,
The finding that quick death is the best solution in many situations for people with consciousness can also be extended to sick, infirm, with limited consciousness, which will result in a shameful degradation of the value of life.
The above arguments convince of the significant harmfulness of euthanasia also for social reasons. These observations are particularly important and valuable in the discussion with people who sympathize with the views of euthanasia, and who stand as non-believers and believe that the Christian moral evaluation does not concern and convince them.
It is worth recalling, however, the position of Christians towards civil law that is contrary to moral law: “… in no area of life can civil law replace conscience or impose norms that exceed its competence. And already specifically when it comes to the legal legalization of euthanasia: “(…) when civil law allows… euthanasia, by the same fact it ceases to be a true law, morally binding”. and ‘(…) euthanasia is a crime that no human law can consider acceptable.
That’s why I will take matters into my own hands. I don’t want anyone to have to,perform this action in my stead. It means that before I am incapacitated, or before my natural time, I plan to end my life quietly, knowing that there appears to be no other way to escape the dehumanizing bureaucracy of MAID. The idea of finding witnesses, doctors who don’t know me, panels who decide whether I am entitled to do what I wish to do, is well beyond reasonable in my mind. In less than 10 years time I believe that MAID will disappear in its present form and people will laugh tha any civilized society spent so much time pussyfooting around death.
Great article; a good matter of fact treatment of an emotionally charged topic. I had already done the survey, and I completely agree with the message here … if you support broadening the currently rather strict criteria of MAID to be better aligned with allowing individuals, for their very own personal reasons, to be allowed the dignity to choose where, when and how to die in a humane way, then by all means go fill out the survey before the opportunity is gone.
Questionnaire completed. Thanks for the nudge, Kathleen! You have a great gift of courage to talk about subjects people don’t like to talk about in your commentaries, and it is a benefit to this community. Thanks also to Helle Rannik for the same kind of courage. Kai, you were very blessed to have such an awesome mom and must be truly proud of her.
Excellent commentary on a subject long overdue.
I would like the right to Die when I can not take care of myself that is when I want to Die I do not want to go in a Old folk Home that would be Hell for me