MAID

Frank was born into a staunchly Republican middle-class family in Evanston, Illinois. Raised to be a lawyer, his parents threw up their hands when he decided to study philosophy, marry a Jewish student, and move to Canada for his PhD studies. It was beyond their ken when he joined the Communist Party and voted for Lyndon Johnson because he feared Barry Goldwater would start a nuclear war. (In their eyes, crimes of equal magnitude.) Even after he quit the party, Frank was a socialist for the remainder of his life.

After receiving his doctorate, Frank became a member of the University of Toronto’s faculty. Known for his wit, he was a beloved teacher of philosophy and political science, a writer, an invited lecturer, and a talented administrator for over forty years. That he should choose to end his life through MAID did not surprise anyone.

Frank was a principled nondogmatist who marched to his own drum. He was a rationalist, and as a rationalist, he could see clearly that an assisted death was better not only for him but for those who loved him. He was able to do so because of MAID.

Canada’s MAID program was the result of a decades-long campaign led by three BC women. Sue Rodriguez, a forty-two-year-old mother, was diagnosed with ALS, which causes progressive muscle weakness. But she was unsuccessful in her challenge, Rodriguez v. British Columbia (Attorney General) (1993), to the criminal law that prohibited consenting to her own death and having medical assistance in dying.

Kay Carter had spinal stenosis, a progressive compression of the spinal cord. She told her daughter, Lee, that she did not wish to live out her life as an “ironing board.” She asked her family to help arrange an assisted suicide in Switzerland. She died in early 2010 in a Swiss clinic. Lee subsequently brought a claim for the legalization of physician-assisted death to the BC Supreme Court.

Gloria Taylor also had ALS. She did not want to “live in a bedridden state, stripped of dignity and independence.” She wanted the “legal right to die peacefully, at the time of my choosing, in the embrace of my family and friends.” Ms Taylor could not afford to go to Switzerland. She joined the Carter lawsuit.

In February 2015, the Supreme Court of Canada ruled in Carter v. Canada that the denial of patients’ right to request a physician’s assistance in dying “interfered with their ability to make decisions concerning their bodily integrity and medical care and thus trenches on liberty,” contrary to the Canadian Charter of Rights and Freedoms.

Despite opposition from some in the religious community who believe that life and death should be left in the hands of God and not man, and from disabled organizations who feared the handicapped would feel pressured to end their lives prematurely, the court gave the federal government until June 6, 2016, to change the law. In June 2016, the Canadian Parliament passed legislation to allow Canadian adults the right to receive medical assistance in dying.

The law requires that the applicant be eligible for government-provided health services, be eighteen years old and mentally competent, have a grievous and irremediable medical condition, make a voluntary request for MAID, consent to the procedure, and be experiencing physical or psychological suffering that they find to be intolerable. MAID is covered by Canada’s universal health insurance.

Today MAID is available in the Netherlands, Belgium, Luxembourg, Switzerland, Canada, Colombia, New Zealand, and most of the Australian states. In the United States, Oregon was the first to introduce the law; Washington, Montana, and the District of Columbia followed. Today Americans living in California, Hawaii, Maine, New Jersey, New Mexico, Vermont, and Colorado can access the option of a death that is peaceful, dignified, and painless at the time of their choosing and in the company of their loved ones. Over 20 percent of Americans have access to MAID.

Currently, 4 to 5 percent of deaths in the Netherlands and Belgium are through MAID. In Canada, the figure is 2.5 percent — and my husband’s was one of them.

Frank’s Story

After a few years where things repeatedly seemed to go wrong with his body, Frank had a bone marrow test in July 2020. Dr Charles Li, a hematologist at Vancouver General Hospital (VGH), said that Frank had myelodysplastic syndrome (MDS). On August 4, Dr Barry Kassen, a cardiologist, confirmed that the MDS was progressing to “amylogen” leukemia. Dr Li gave Frank a life expectancy of two years.

Eight days later, he began chemotherapy. It was brutal: two injections of Azacytidine into his stomach seven days a month at the hematology day care clinic at VGH, three weeks off to “recover,” then back to injections of what he called “rat poison.” His stomach was red, swollen, and looked like a pincushion.

Frank was six feet tall and weighed 165 pounds. But he lost twenty pounds because he had no appetite. An active man, now he was always fatigued and began to lose muscle mass.

This punishing regimen continued monthly throughout 2021. Before every chemo session, Frank was sent to the lab for a blood test. Dr Li prescribed pills for nausea and constipation, as the anti-nausea medicine was painfully constipating.

For twelve months, this became our new normal.

The chemo shots were interspersed with units of blood to replace his cancer-infected cells with healthy ones. However, by mid-summer, Frank began to have violent reactions to the chemo. He would vomit, pass out, fall, and injure himself. The tests ordered by the doctors and hospital were unable to determine the cause.

During the day, Frank experienced “extreme feelings of badness” that weren’t painful but resulted in him spending the day holding his head in his hands. Frank had been a daily fixture in our condo pool. But by now, he was too exhausted to go down to the pool, let alone swim. His fatigue was taking over as he began sleeping in the mornings and afternoons. Any physical activity, like going to VGH or to the lab, would result in his sleeping the rest of the day.

Then there was a new reaction to the injections. On July 6, he passed out on the sofa while vomiting. His breathing was difficult. He was shaky. I supported him to the bathroom to clean up. He vomited again and passed out. I tried to catch him, but he hit his head on the tile floor. I screamed, “No, no!” and struggled to get him up. He had no memory of my screams. We decided he should go to the VGH Emergency Department.

The doctors ordered more tests to discover the cause of his fainting, but they all came back negative. Frank received another bag of blood. The fainting episode was repeated on September 14. This time, Frank received a one-inch cut to the back of his head from the fall. He began taking Gravol after his chemo shots to prevent the vomiting.

We returned to Dr Li’s office to learn the results of the tests. Everything was fine, except his red blood cell count was low, resulting in anemia. The September chemo cycle was the worst ever. Frank continued to vomit, faint, and have seizures. I found sleep impossible because I was afraid he would have another seizure and injure himself.

By this time, Frank was finding it difficult to walk, so we bought a walker. He reluctantly used it at night, whenever he had to go to the bathroom.

Based on the results of the November blood test, Dr Li called and told Frank that the white “blast” cancer cells were taking over, and this was the beginning of the end. Dr Li said that, in the January cycle, he would double the amount of chemo. Frank and I dreaded this, because those were the “bad old days,” months of vomiting, fainting, passing out, and falling.

We got a rollator, a walker with four wheels and a seat. Frank lived on his rollator for eating, sitting around, and getting about the apartment. He was ordered to have weekly blood tests, but this was extremely tiring — walking from the car to the lab just about killed him. When we got home, he was out for the count all day.

2022

On January 10, the heavy-hitter team of double doses of chemo, two needles into the stomach daily for seven days, was started. Frank vomited and had the dry heaves, because by now he had stopped eating and had lost another ten pounds. He fainted on the sofa and lost consciousness.

Dr Li referred us to a colleague, Dr Sujaatha Narayanam. She was very straightforward. Dr Narayanam told Frank that he had “at most days, weeks, or a couple of months left to live,” and that he should “stop chemo.” He agreed. She suggested blood transfusions or palliative care — and told us about medical assistance in dying (MAID).

By this time, Frank complained of chest, stomach, and leg pains, constant urination during the night, and thick mucus discharges from his nose and mouth. Dr Narayanam said the lower-chest pains were caused by a breakdown of the spleen, a common side effect of leukemia. She said there was no point to go “chasing after causes” but to focus on comfort care.

We could feel death breathing down our necks. We had received Frank’s death sentence and the finish line was clearly visible. Frank wanted to die with MAID. It was a relief for him to know that he could end his life quickly and painlessly. I knew that death would be instantaneous, and I told him I wasn’t sure I could bear it.

On January 26, Frank had his “last swim” in our condo pool. Slowly, he used the rollator and entered the pool area. With the aid of a noodle, he managed to float on his back for one lap. The exertion had its cost — he slept the rest of the day.

On Friday, January 28, Frank and I were interviewed by Dr Ellen Wiebe, who would be our MAID doctor. Dr Wiebe had received Frank’s medical reports and reviewed his history. Frank described how his life had become “intolerable.” He was a noted professor, author of seven books, published over one hundred papers, and presented more than three hundred invited papers all over the world. But now he could no longer do intellectual work or speak with his colleagues and friends because it was too tiring.

Dr Wiebe said that he was eligible for MAID. Frank could choose the time, location, and date of his death.

Dr Wiebe described the process. A nurse would put in the IV, through which Dr Wiebe would give him three medications. One would relax him, the second would put him in a deep coma, and the third would stop his heart. There would be no pain, and death would be instantaneous. The entire procedure would be over in five minutes. Frank agreed.

Before Dr Wiebe left, she suggested things to do in preparation for death. We were pleased to have Dr Wiebe. She had been a medical doctor for forty-six years, an abortion provider at her women’s clinic, and had taken training in the Netherlands in 2015 to prepare for the launch of MAID in Canada. She is a founding member of the MAID association for doctors and has participated in 410 deaths to date.

On Sunday, January 30, Frank had his worst night ever, up and down to the bathroom and then so exhausted that he would fall into a coma-like sleep. We began talking about his death. He told me sadly how he had no pleasures left in life — months ago, he had stopped enjoying eating and drinking; more recently, he was unable to speak with friends and colleagues for more than a few minutes; he no longer listened to music or read, things he had enjoyed his entire life.

Frank selected his death date and began organizing his affairs: his books, papers, his pension for me, his funeral home and cremation. He wrote his own obituary, and we selected the photo that would accompany it. He repeated his desire to die at home with me by his side.

MAID Day

On February 1, two Vancouver Coastal Health community nurses dropped by to support Frank. During the interview, he began to bleed spontaneously from his mouth, continuing for several hours.

Frank was so fatigued that he napped for the rest of the day. He had problems swallowing. His mucus was now dark colored and mixed with blood. He was constantly nauseous, although he hadn’t eaten anything for days. He only drank cold water. He was having memory problems.

On February 2, Dr Heather Fleming, the second palliative care MAID doctor, came by to interview Frank. She concurred with Dr Wiebe’s assessment. Frank signed the required consent forms. He was unable to sleep but was too tired to read or watch TV. He sat in the semi-dark on his rollator.

As Dr Fleming was leaving, Frank had a nosebleed. Dr Fleming stated, “Your platelets are breaking down.” The bleed continued sporadically for two days. He was afraid that if he continued bleeding, he would have to go to the hospital. Frank called Dr Wiebe and asked if he could move his death date forward to Friday, February 4. Dr Wiebe agreed and said she would arrive at 11:30 AM.

February 3 was Frank’s last full day. We went through our photo albums reminiscing, and he napped intermittently. On his last evening, he accepted the invitation of a friend and neighbor, Jackie, to watch the Toronto Raptor’s game at her house — about the only outing Frank had during the last month of his life, going to Jackie’s to see the Raptors play basketball. I was surprised that he was able to stay for the entire game, even through overtime. (Happily, the Raptors won.) As we left, he told Jackie, “I guess that’s the last basketball game that I’ll see.”

Friday, February 4, was MAID Day. I was very sad and tearful. The Japanese have a custom of washing the deceased’s body in preparation for cremation. Frank knew I intended to do this; however, he said he would prefer it if I washed him before death.

This was an intimate and loving ritual. I helped him dress. He selected the clothes he wanted to die in, and we sat together holding hands, saying our farewells. Dr Wiebe and the nurse, Mikaela LaChance, came at 11:30 AM. Frank wanted to die reclining on the living room sofa that overlooked Vancouver’s English Bay. I held his hand, and by 11:45 AM, he was dead.

While the nurse was inserting the IV, she asked Frank how he had slept. He replied, “Very poorly. I woke up every hour or so. But I will sleep well tonight.” Frank died as he had lived: with courage and true to his convictions.

Frank loved life. But his body was decomposing from the inside at a rapidly increasing rate. He wanted nothing more than to live, but not as a shell of his former self.

He died with dignity. And he died fervently hoping that anyone whose suffering similarly outweighed any hope of a life worth living might enjoy the same right to choose the time and place of their end.