My cousin called me last week.  He was troubled.  He was just at a farewell party for a good friend.  She was approved for Medical Assistance in Dying, scheduled for a few days after the party.  Close family were in her hospital room, other family and friends were gathered in her family home, site of many happy memories.  People were happy and joking, having a good time.

“She looked good, she was joking, having a great time, why would she want to die now,” he asked me.

The woman was 81, diagnosed with stage 4 cancer and without any prospect of recovery, he told me.  “But,” he said, “She was the life of her own party, so why now?”

My cousin did not know how much pain medication it took for his friend to mount that show of well-being and did not know how much time she would have if her cancer ran its normal course to her death.  I reminded him that, to be approved for MAiD, she had to have two physicians agree she was capable to make that decision and that her condition was intolerable to her.

“But why now,” he asked again, “she was the same fireball she’s always been.”

Without knowing my cousin’s friend, I could only speculate.  I listed the reasons that immediately came to mind:

• She knew what her future held and did not wish to endure it.
• She knew what her future held and did not wish her family to endure it.
• She wants to be remembered as she was during her goodbye party and not as the pain-wracked shell unable to care for herself that she knew was her only future.
• She was a proud person and her sense of personal dignity precluded living to the point that someone else had to attend to her every bodily function and need.
• She wanted to die enveloped with the memories of her friends and family putting their best happy faces on.
• It was an act of defiance: “Cancer will not decide when I”
• She was so fine a human being that she could not countenance the thought of using the scarce medical resources required to continue her life beyond when she would be aware of anything but pain, discomfort and the loss of personal dignity and autonomy.

There are other valid reasons to hurry death.  Whatever the reasons, it is an intensely personal decision by a person who knows, starkly, what their future holds.  It is a final act, sometimes defiant, by a person defining their own personal dignity and autonomy.  And, perhaps also, the decision is to celebrate life rather than mourn death.

Eligibility for MAiD

The Canada.ca website outlines the parameters of eligibility and contains much other useful, relevant information.

https://www.canada.ca/en/health-canada/topics/end-life-care.html

Briefly, to be eligible for Medical Assistance in Dying, the person must:

• be eligible for health services funded by the federal government, or a province or territory (or during the applicable minimum period of residence or waiting period for eligibility)
  • generally, visitors to Canada are not eligible for medical assistance in dying
• be at least 18 years old and mentally competent. This means being capable of making health care decisions for yourself.
• have a grievous and irremediable medical condition
• make a voluntary request for MAiD that is not the result of outside pressure or influence
• give informed consent to receive MAiD

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Mark is a consultant to our firm.  He is a Senior Lawyer Member of Ontario’s Consent and Capacity Board and holds a Master of Health Sciences degree in bioethics from The University of Toronto Joint Centre for Bioethics.  He knows a lot about end of life decision-making for both capable and incapable persons, about mental health law and about mental capacity to make decisions.  Mark is also part of our firm mediation team.  His relevant experience includes over 800 mediations at which he presided as a part time Member of The Ontario Human rights Tribunal from 2008 to 2018.