In the US, we struggle, state by state, to get medical aid in dying laws passed, while in Canada, the whole country was approved at once in June 2016, through a ruling by the Canadian Supreme Court that required the Parliament of Canada to change the country’s laws to give dying people more control over how their lives end. It all happened relatively suddenly, too. So suddenly that Canadian doctors had to scramble to figure how to best serve patients who wanted to access the new law.
Dr. Stefanie Green tells the whole story in her book, This Is Assisted Dying: A Doctor’s Story of Empowering Patients at the End of Life. She recounts how she and a couple of colleagues from British Columbia went to a conference in Amsterdam just over a month before the new Canadian law was to take effect, to learn from European doctors, who had much more experience with medical aid in dying and euthanasia.
In the past, I have distinguished between medical aid in dying and euthanasia by who administers the life-ending drugs. In the US, doctors prescribe the life-ending drugs, but patients are required to ingest the drugs themselves, without assistance, and the name we have given this is “medical aid in dying.” Under Canadian law, doctors are permitted to administer the drugs to qualified patients through an IV. While we have traditionally called that act “euthanasia,” the Canadians refer to it as “medically assisted dying.” This terminology difference injects a whole new level of confusion into the discussion of end-of-life choices.
While Dr. Green does indeed tell the history of Canada’s medically assisted dying law, she also explains how she decided to give up her practice of serving pregnant mothers and ushering babies into the world, in exchange for a practice of helping dying individuals leave this world on their own terms.
But the most touching part of Dr. Green’s book is the many stories she tells of evaluating patients to make sure they qualify to use the Canadian law, and then helping them achieve the death they had envisioned for themselves. The first story she shares is of an amateur clown who wanted to die in his clown costume, and preferably with a big smile on his face. She talks about the reasons her patients sought assisted deaths, what the events looked like, how their friends and families reacted, and how it felt to administer the medications that hasten death.
If you are interested in the topic of medical aid in dying versus euthanasia, I encourage you to read this book and then share your thoughts. Does this book give you new insights into euthanasia? Is Canada’s version of medically assisted dying/euthanasia more humane than the US system? Is the US system too restrictive in that it prevents dying people with diseases like ALS – who no longer have the capability to ingest drugs themselves – from ending their lives on their own terms? I’d love to hear what you think.