Dying with Dignity in Cape Breton

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The last thing Weldon Bona wanted was for his very private decision to have an assisted death to become a news story, but that’s exactly what happened last week.

Bona had done everything asked of him when he chose to take this step, having been diagnosed with a disease that would take his life and aware that assisted death, under certain circumstances, had been the law in Canada since June 2016.

Weldon Bona. (Photo via Facebook)

Weldon Bona. (Photo via Facebook)

Personally, I had never heard of the acronym “MAID” (Medical Assistance In Dying), but it’s not hard to find the information a person would need to arrange to end their life with dignity in the presence of family and friends. Clinicians willing to be involved in MAID must first meet with patients to assess their eligibility for the procedure, supply all the necessary information as to how it will be done and finally, fill out the form required by the government. The form must be signed by the patient or a designated family member or friend who is not a beneficiary. It states the medical reasons why assisted death should be an option and also indicates that the patient is of sound mind and has made the decision to proceed. It also makes very clear the person can change their mind right up to the last minute before the procedure takes place.

The patient has a choice in the manner in which assisted death is carried out – a physician or nurse practitioner injects the patient with a substance that causes death (previously referred to as voluntary euthanasia, now “clinician-assisted MAID) or provides the patient with a substance they take that causes death (previously referred to as assisted suicide, now self-administered MAID). Suicide has been legal in Canada since 1972, and while under the new law, physicians and nurse practitioners may provide assistance, it is still illegal for anyone other than a medical person to do so.

The most recent statistics on assisted death available from the province of Nova Scotia are from June 2017 and show there were 64 inquiries into assisted death, with 23 procedures completed. Of the remaining 41, some did not act upon it, some lost the capacity to apply for it and others died while the process was in the planning stages. The average age of applicants was 64 and a slightly higher number were male.

Interestingly, according to Road to Mercy, a documentary on assisted dying presented on the CBC in August 2017, statistics show that most who opt for assisted death are professionals, those accustomed to “being in charge” — doctors, lawyers, successful businesspeople. They tend to be older, educated, independent and, of course, terminally ill. Most assisted deaths take place at home.

The new law has not been without its detractors, including medical personnel who want nothing to do with it, problems with compensation for those who do participate and complaints from patients who do not qualify because they do not face “imminent” death. A 2015 survey by the Canadian Medical Association (CMA) found that while 80% of Canadians supported assisted death, 63% of doctors were unwilling to be involved in it. By 2016, a followup survey showed the number of doctors willing to provide assisted death had fallen to 25%.

Here in Nova Scotia, Dr. Tim Holland, then-president elect of Doctors Nova Scotia and a MAID supporter, told the CBC that the core group of seven doctors willing to participate in MAID were having “billing issues” which he felt the Nova Scotia Health Authority (NSHA) was working to solve, but that he had not been paid for eight assisted deaths for which he had billed.

Physicians’ fees for the procedure, which can include travel outside their practice areas, can range from a high of $621.20 in Alberta to a low of $292.20 in Nova Scotia. Moreover, hospitals and nursing homes run by faith-based groups are exempt from the assisted death law, which prompted Dying With Dignity, an assisted death advocacy group, to consider challenging the exemption in court, given that all such facilities are tax-payer funded.

 

Some doctors have quoted the Hippocratic Oath, which adjures them to “first, do no harm,” as a reason for refusing to be involved in assisted death. But the oath also tells them “to cure sometimes, treat often and comfort always.” Isn’t it possible that “comfort” for a suffering patient who is ready to die would include helping them to do so? It would seem few doctors in our area are persuaded of this. Still others cite their religious beliefs as a reason for declining to be involved.

Dr. Gerald Ashe. (Photo via Upper Canada Family Health Team http://www.ucfht.com/displayPage.php?page=Employer)

Dr. Gerald Ashe. (Photo via Upper Canada Family Health Team)

Medical personnel who participate in assisted death are not untouched by it. Although they are exposed to death on a regular basis, being an active participant in the process is something that can have a negative effect on them. Dr. Jeff Blackmer, CMA’s vice president of medical professionalism, told CTV that he has talked to doctors who are “experiencing post-traumatic stress” after being involved in assisted deaths and “that they are losing sleep and talking to therapists.” This is to be expected since, as Blackmer makes clear, no practicing physician in Canada “went into the profession expecting to have to provide aid in dying.” He expects that a network of participating doctors will be set up to support each other. Dr. Ellen Wiebe, a Vancouver physician, has a different view. In the same CTV item, in response to those quoting “first, do no harm,” she responds: “I don’t consider giving someone a good death to be causing them harm.”

Dr. Rob Jonquierre, a retired family physician in the Netherlands, told CTV that in the late 1970s, before his country had developed an assisted death protocol, he went through “the most horrible experience” when he was asked by a nurse to help her die. She was suffering from a very painful type of cancer and Jonquierre agreed to help her end her life but realized he really had no idea how to do it. Giving her a heavy dose of morphine didn’t work. He was told by a friend in whom he confided that he would have to provide another drug that would stop her heart, all in all a process that took 30 hours. Jonquierre said his greatest and only regret was that it had taken him so long to accomplish the procedure.

Dr. Gerald Ashe, a Brockville, Ontario palliative care doctor and adviser to Dying With Dignity, told the Ottawa Citizen’s Joanne Lauchius, that his palliative care experience has shown him there are some situations that can’t be controlled by such care, whether they be spiritual, emotional or physical, and that assisted death is the answer for those patients. “The beauty of dying where and when you want and with whom is pretty amazing,” he said.

The information about MAID on the Government of Canada’s website is comprehensive, straight forward and well explained. Still, making such a decision obviously requires much thought and discussion with family and close friends, as well as with a family doctor or a designated doctor willing to answer all the questions a dying person would have. I think it takes tremendous courage to make such a decision, and is also very emotional for those who are present and not at all familiar with death in this form. For some who are terminally ill, it offers them a chance to spare family and friends the hardship of caring day in and day out for a person with a life-ending illness. Others opt for MAID rather than spending days or months waiting for the relief that only death can bring. Either way, having made the necessary preparations, there is a 10-day period of reflection during which an applicant may change their mind about undergoing the procedure.

Weldon Bona had followed all the rules and set the date for last Wednesday, having invited family and special friends to be with him, to make their good-byes and to share a final meal. Some had traveled a distance only to discover that he had been told on Tuesday that the procedure “might take place the following Monday.” His heart-wrenching interview with the CBC said it all. In the end, his assisted death took place on Friday. The nurse-practitioner who accommodated his final wish was compassionate and caring, and he passed away peacefully.

Featured image: Sunset, Big Pond, CB (cropped) by Capercanuck, own work, CC BY-SA 4.0, via Wikimedia Commons.

 

Dolores Campbell

 

Dolores Campbell, a lifelong resident of Sydney, is a freelance writer whose work has appeared in The Cape Breton Highlander, the Nova Scotian, Cape Breton Magazine, Catholic New Times and The Cape Breton Post.

 

 

 

 

 

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