‘Dad got the death he wanted’
ASSISTED DEATH CRITERIA CHALLENGED
Richard Brown wanted to die. An elderly widower who lived by himself in the same Vancouver house that he had owned for decades, he wasn’t terminally ill. He wasn’t immobile. He had coronary heart disease and he’d endured painful episodes of gout. He’d been in hospital frequently.
In July, around the time of his 94th birthday, he told his eldest son he “wasn’t planning on adding another digit” to his age.
Jeremy Brown knew this was not a casual remark. His father had made comments before about “not wanting to be around much longer.”
An engineer by profession, Brown was “a very independent” person, stoic and solitary, says his son. With his health in decline and his needs increasing, he feared he was becoming a burden. (Names have been changed at the family’s request.)
“This isn’t a joke, is it?” Jeremy asked his father.
“No, it’s not,” Richard said. “I have resources.”
He’d set aside some sedatives, prescribed to his wife before her death almost 10 years earlier. Jeremy investigated and learned the pills would not amount to a lethal dose. “I was really unhappy with his amateur plan for an overdose,” he says.
So the plan changed, to assisted death.
Jeremy says his father was “well-versed” in Canada’s controversial new medical assistance in dying (MAiD) laws, which came into effect in June. The laws permit euthanasia in certain circumstances, but their wording can seem vague. That’s causing disagreement in medical communities and uncertainty among patients and their families.
“Dad wasn’t sure if he qualified,” Jeremy recalls. So he made inquiries on his father’s behalf, and those led them to Ellen Wiebe.
A Vancouver-based doctor with nearly four decades experience in family medicine, Wiebe has lately become one of Canada’s leading advocates for medically assisted death. Since the new laws came into effect, she has provided dozens of people with lethal doses of sedatives, all by intravenous injection.
Richard Brown would be her 32nd. They made an appointment: He would die in his bed, on Thanksgiving Sunday.
“There’s no way he could live (alone in his Vancouver house) any longer. The only alternative to death is assisted care, and he said ‘never,’ to that,” Wiebe told the National Post, a few days before the lethal injection was to take place.
“He’s right at the end,” she added.
Not everyone seemed so sure.
Under the new MAiD laws, a doctor or nurse, with another health-care provider present, can administer a lethal injection or oral formula, but only if the patient matches a number of criteria.
For example, the person must be at least 18 years old and “capable of making decisions with respect to their health.” They must make the request voluntarily. They must give informed consent after “having been informed of the means that are available to relieve their suffering, including palliative care.”
And they must have a “grievous and irremediable medical condition” which, according to the new laws, also means they must have “a serious and incurable illness, disease or disability” and be “in an advanced state of irreversible decline in capability.”
In addition, “their natural death” must be “reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time they have remaining.”
There are problems with the new laws, says Grace Pastine, litigation director at the B.C. Civil Liberties Association. “Doctors are struggling with the term ‘reasonably foreseeable.’ ” It could mean “soon,” or it could mean something else, says Pastine. “It’s a major flaw in the legislation.”
The association is challenging the MAiD laws and has filed a notice of civil claim in B.C. Supreme Court against the Attorney General of Canada, with coplaintiff Julia Lamb, a 25-yearold woman from Chilliwack who suffers from spinal muscular atrophy. They allege the new assisted death laws are unconstitutional.
Lamb was diagnosed when she was six months old, and she’s been in a wheelchair since the age of six. The disease causes weakness and wasting in her voluntary muscles. Lamb “currently is not capable of any daily living activities and requires assistance for bathing, dressing, toileting and preparing meals,” her lawsuit reads. Her lung capacity “is currently only at 30 per cent.”
She wants to plan for the day the disease brings her “to the point of enduring and intolerable suffering.” But even then, she might not qualify for MAiD because she could live for many more years.
She “has no way to know how and when her disease will progress, but she knows that it is possible that it will bring intolerable suffering upon her and that the time period she will be left in that state could be of unknown and unbearable duration,” the lawsuit reads.
“My biggest fear is that if my condition suddenly gets much worse, which can happen any day, I will become trapped,” Lamb told reporters at a press conference in June, after her lawsuit was filed.
“If my suffering becomes intolerable, I would like to be able to make a final choice for how much suffering to endure.”
Richard Brown’s case was different. He was ready to die immediately, or as soon as his death could be arranged.
Medical staff at St. Paul’s Hospital in Vancouver were wellacquainted with him. Brown had been admitted to their hospital in July with a case of gout, and again in August, when he presented with pneumonia and then experienced another heart failure.
During his weeklong recovery in August, Brown told St. Paul’s staff he wanted a medically assisted death. That couldn’t happen in their hospital. St. Paul’s is managed by Providence Health Care, a Catholic, faith-based organization that refuses to provide or counsel euthanasia.
“We have a long-standing moral tradition of compassionate care that neither prolongs dying nor hastens death of patients, placing great emphasis on palliative, hospice and endof-life care,” explains a Providence public affairs official.
St. Paul’s staff held a “family meeting” with Brown and his son Jeremy. According to a dictated note from a St. Paul’s palliative care doctor, Brown indicated at the meeting “that he wished to pursue medical assistance in dying in the community … (but) based on the current criteria, Mr. (Brown) does not qualify as he, in our opinion, does not have an illness that will cause death in the foreseeable future.”
“At the time of discharge,” the note continues, “Mr. (Brown) was, in our team’s opinion, able to manage at home alone.”
The note was sent to Wiebe after Brown had left St. Paul’s for the last time.
Wiebe didn’t share the St. Paul’s opinion; she had visited with Brown before his discharge. The visit was somewhat disguised. Wiebe doesn’t have doctor’s privileges at St. Paul’s, so she sometimes arrives at that hospital bearing flowers, looking as if she’s a relative or friend to a patient.
She won’t acknowledge that she “assessed” or consulted when she saw Brown at St. Paul’s.
“People have accused me of practising medicine without hospital privileges,” she says. “I can get into trouble for that.” But she did manage to examine Brown’s records, and she spoke with him for about half an hour. She concluded he qualified for a medically assisted death.
Jeremy was there for the encounter. “Dad said, ‘I can’t take it any more,’ and started weeping. Dr. Wiebe had punctured his armour. For the first time, I saw the emotional weight behind his decision.”
Wiebe wrote back to St. Paul’s, noting that Brown “is 94 and has just been hospitalized with pneumonia and heart failure AND he refuses any further life-prolonging treatment, including antibiotics … I would be very surprised if he lived as long as one year without any life-prolonging treatments.”
Furthermore, Wiebe wrote, “the law is clear that it is the patient’s own assessment that their life is intolerable due to their grievous and irremediable condition that matters. He has the right to MAiD and I will honour his wishes.”
Brown was by then back at his house, preparing for his final days: He wrote some farewell cards to old friends, to be mailed after his death. He made a contribution to the St. Paul’s Foundation, a charity managed by the hospital.
He wanted no obituary, no funeral. He wished to go quietly and “without any fuss,” his son told the Post, three days before Brown was to die.
But things were “a bit complicated,” Jeremy acknowledged. His father had asked that no one else know about his plan, not even his other children. “Dad wants it to be a surprise,” Jeremy said.
Thinking it would be unfair to hide his father’s arrangements, Jeremy decided to inform his two brothers without disclosing the date.
“I just said (his death) would come soon,” Jeremy says. “My brothers are not at all happy about it. They were shocked and angry when I told them. One said he wanted no part of it. They said if it wasn’t for me, this wouldn’t be happening, that it’s very accelerated. It might have been better if we had covered it up.”
Following his father’s wishes, Jeremy agreed he would not be at the house when the doctor arrived, nor would he witness the injection.
The oldest person for whom Wiebe has provided assisted death was 102. The youngest was 42. She has had to decline some requests. “I have to say no when a grievous condition will not shorten a life,” Wiebe says.
She sources the drugs, a combination of muscle relaxants and the sedatives midazolam, propofol and rocuronium. Wiebe says she’d prefer to use barbiturates, which work more quickly, but those aren’t allowed in Canada. That too must change, says Wiebe.
Her patients decide where they will die. Sometimes, it’s at their home. Sometimes, it’s at her clinic, or inside a hospital that allows MAiD.
Family members are usually present. Pets can be included.
“My last one, he’d had three cancers, heart and lung disease. His wife climbed into bed with him,” Wiebe says with a smile. “He was 72. He was counting down the hours. He called me his angel.”
She discusses with the patient for the last time their wish to die. Once confirmed, she administers a muscle relaxant. Then, she injects the lethal dose of sedatives; it usually takes the patient about 10 minutes to die.
The funeral home is then called, and someone comes to pick up the body. Wiebe signs off on the death certificate. The mood can be solemn or happy, even “uplifting,” says Wiebe. It all depends on who is around. If friends and family are grieving, the emotional impact can take a toll.
Wiebe and her nurse arrived at the Brown house on Thanksgiving Sunday, before noon. As he had requested, none of Brown’s children were there; he’d spent time with his sons the day prior. A family friend let the doctor and nurse inside.
“I accepted the offer of a cup of tea while I prepared my syringes,” Wiebe said later. Brown was in bed. He looked outside the window. “It’s a golden day,” he remarked. He turned to Wiebe and apologized for “interfering” with her Thanksgiving.
She administered the drugs and he died.
Jeremy received a phone call and went to the house. When he saw his father, no longer living, emotions overcame him. “I lost it,” he said later.
His brothers knew their father’s death was coming, but they seemed surprised when receiving the news, says Jeremy. They didn’t fly off the handle, much to his relief, and “things have settled down. … Since then, I’ve been filled with a joyous satisfaction. Dad got the death he wanted.”
The type of death, he believes, that his father deserved.
THE LAW IS CLEAR THAT IT IS THE PATIENT’S OWN ASSESSMENT THAT THEIR LIFE IS INTOLERABLE DUE TO THEIR GRIEVOUS AND IRREMEDIABLE CONDITION THAT MATTERS. HE HAS THE RIGHT TO MEDICAL ASSISTANCE IN DYING. — DR. ELLEN WIEBE
Since the new assisted dying laws have come into effect in Canada, Dr. Ellen Wiebe has provided dozens of people with lethal doses of sedatives, all by intravenous injection.