Assisted Dying: A doctor's perspective

March 2018
Dr. Rachelle Sender, PhD, MD, CCFP

In June 2016, with the passage of Bill C-14, Medical Assistance in Dying (MAiD) became legal in Canada. Bill C-14, which is far more restrictive than the original Supreme Court decision on the topic, allows for an assisted death provided all of the following conditions are met:
The patient is suffering from a ‘grievous and irremediable’ medical condition;
there is an advanced state of irreversible decline; death is ‘reasonably foreseeable’;
the patient is experiencing enduring physical and/or psychological suffering that cannot be relieved by any means that the patient considers acceptable;
the patient is capable of providing informed consent; minors and patients whose suffering is related to a mental illness are not eligible for MAiD;
neither are patients with dementia, since advance directives are not allowed. There is also provision for healthcare providers who are conscientious objectors.

The procedure for arranging a medically assisted death is challenging; patients must fill out a formal, written request witnessed by two people not part of their health care team and not included in their will. They must also undergo two separate, detailed assessments, by two unrelated medical practitioners, as to whether or not they are eligible. There is also a 10- day waiting period after a formal request is made. 
At present, the vast majority of assisted deaths in Canada are by euthanasia: a combination of lethal drugs are administered intravenously. However, death by oral medications, which patients can self- administer, is also legal.
The passage of Bill C-14 unleashed a storm of controversy in Canada. In particular there have been strong objections from religious groups. Jewish law traditionally has opposed suicide and assisted suicide. However, some Reform rabbis, such as Rabbi Peter Knobel, have pointed out that Judaism does not make a virtue of suffering. Knobel argues that “assisted suicide is permitted when the decision is rational and can be demonstrated to be consistent with the person’s own biography”.
In Hamilton, Temple Anshe Shalom’s Rabbi Jordan Cohen stated during a sermon on Yom Kippur, this past October, that he personally has changed his opinion on assisted suicide. Having spoken with the families of congregants who have died by MAiD in the past year he now believes that assisted death is consistent with Jewish values inasmuch as it is compassionate and relieves suffering. 
There is no formal breakdown available on MAiD deaths in Hamilton by religion but it appears, anecdotally, that Jews are likely overrepresented among patients who have received a MAiD death (and perhaps underrepresented among MAiD providers). Such overrepresentation is likely due to the fact that patients requesting and receiving MAiD tend to be better educated and more affluent than the population as a whole. Still, overall, total MAiD deaths in Hamilton are a very small proportion, less then one per cent of total deaths.
I am a family physician and have been involved with MAiD assessments and provisions since June 2016. I did this because I believe my role as a physician is to relieve suffering and provide compassionate care.  MAiD does exactly that. In healthcare one often gives lip service to the ideal of ‘patient centered care’ but the steps leading up to a MAiD death truly exemplify such care since the whole process is driven by patients’ requests.
As a Jewish physician, I have struggled with the disconnect between my strong personal belief in the morality of MAiD and the official position of much of Judaism. Along my journey, I have received support from many Jewish friends and colleagues. I am also comforted by the belief that my mother, Blanka Sender MD, a physician who escaped Poland in 1939, would have agreed with this work. Finally, I found Rabbi Cohen’s sermon and the support of other members of TAS immensely comforting.
The typical patients requesting MAiD are dying of metastatic cancer; they have been ill for months or years and have undergone surgery, chemotherapy and radiation. This is not a request made lightly, because of some passing indisposition. In Hamilton, every patient I have assessed has been offered and (most often received) high quality palliative care to help control their pain and other symptoms. 
When a patient is assessed and found eligible for MAiD, the relief and even joy he or she expresses is remarkable, as if having been given the best gift possible as a huge weight of dread and fear has been removed. Indeed many patients, knowing that they now have a way out, are able to put up with things that previously seemed unbearable. Even the act of signing the request for MAiD form can be comforting, as it gives back control to people who have had none for a long time: one recent patient signed his MAiD request months ago but, having that ‘insurance,’ was able to live a fulfilling life for another half a year.
Opponents of MAiD often warn that MAiD is a slippery slope in which the poorest and most vulnerable patients will be coerced into having such deaths. There is, however, not a shred of evidence for this; the real situation is quite the opposite. In every jurisdiction where MAiD is legal, it has been found (as mentioned above) that patients receiving such deaths are more affluent and better educated than the average. In Canada, Vancouver Island, which has more than its share of affluent seniors, has the highest percentage of MAiD deaths in the country, 10 times the rate in Hamilton.
One final issue about MAiD that pertains to the Jewish community is the issue of whether Holocaust survivors would be particularly offended by the legalization and implementation of MAiD. Again, there is no evidence to support this view. One patient expressed that MAiD was actually anathema to Hitler’s plan as it restored his autonomy to make his own life choices. Another survivor, in choosing MAiD, stated that she had already suffered enough.
MAiD deaths are obviously not for everyone. But, having witnessed many difficult ‘natural’ deaths, I strongly believe that MAiD can provide a peaceful, dignified and compassionate alternative to those who desire it. The availability of MAiD is inconsistent across the country; in Hamilton, patients are lucky to have access to MAiD both through Hamilton Health Sciences (primarily for hospital in-patients) and through the Hamilton Family Health Team.


Add Comment