Monday, November 28, 2022

Dying Indignity. Witnessing my father's medically assisted death.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On November 26, Christopher Lyon shared an article on his site concerning the medically assisted death (euthanasia) of his father. I have republished parts of the story. Lyon begins his story this way:
My father was killed, in front of my family and me, by his Medical Assistance in Dying (MAiD) provider, a physician, in some numbered hospital room in Victoria, British Columbia, in the summer of 2021. Though he was mid-way through the 90-day assessment period required for Track 2 MAiD requests (non-foreseeable death), he was quickly moved from Track 2 to Track 1 (foreseeable death), having passed both required assessments.

One week before dying, he had moved into a newly renovated and appointed Assisted Living apartment and said the food was good and he was keen for the in-house barber shop. Two days later, he began refusing solid food. Two or three days after that, he fell, during a heat wave that overtaxed local ambulances and paramedics. As a result, he was left on the floor of his apartment for six or seven hours before an ambulance could reach him, and the staff had a ‘no lift’ policy. He was incensed. The first time my family and I heard from his MAiD Provider was at this time – forty-eight hours before death. My father indicated that his assessors could contact the family at any time, so it is unknown why we were not previously notified. We were told simply that Dad had been track-moved, and that we should get flights now if we wanted to attend his death in two days.

The provider told me that he was track-moved because a) he started refusing solid food (but not, as we discovered, caloric liquids), and b) that his elevated white blood cell count indicated an infection that he did not immediately want to investigate. Apparently, those fugitive choices were the basis for labelling his death as fixed and foreseeable. Yet it was never explained to me how either choice was irremediable or constituted imminent death or loss of capacity.
His father experienced several falls.
My family used his hospitalisations as an opportunity to convince social services to intervene and accelerate him into either assisted living or safe and sanitary accommodation. He had been very resistant to moving for several years and had a long history of suicidal expression that peaked during periods of change. Social services worked their wonders and managed to find him an urgent placement in a local assisted living residential facility.

He often appeared anxious about his move to assisted living and was fixated on the seventy percent deduction to his low, mostly Canada Pension Plan income ($1400/month as I recall) it would cost to reside there. He was never very skilled with money and would be left with barely enough to cover his mobile phone bill and living costs. Family help was always available. We offered to supplement his costs and had planned to buy him a mobility scooter before he was killed.

During one of our weekly calls, following his second-last hospitalisation, he claimed that he was bedridden and immobile and therefore needed MAiD. However, he was seated in a chair, got up to use the toilet, and was able to move about the room on his own. When we confronted him about this and other claims and inconsistencies, he would either become enraged and threaten to kill himself or, without explaining his decision, demand that we not question it.

His dad was suicidal.

In the months before he applied for MAiD, Dad was acutely suicidal. He cited the suicides of people like Robin Williams and Ernest Hemingway as inspirations – men who “just knew when it was their time to go”. He said he looked up ways to kill himself, online, such as starvation. Other times, he would say things like “ashes to ashes” and “we are dust in the wind,” as in previous bouts. When he said this, I arranged for the BC suicide hotline to phone him, and he had a conversation with them where he noted these deaths and claimed that he was not depressed.

...His suicidality became acute during involuntary upheavals in his life, such as the loss of his business, marital separation, and residential moves in ways that adversely impacted every member of my family. In my younger years, he threatened my mother with his suicide, an event in which I physically intervened. He also said he picked his MAiD provider because of her attractiveness to him, and declared her a second spouse or love, again suggestive of his romantic view of self-annihilation.

In his darkest moments, he used suicide to manipulate family members. In the weeks before MAiD, he said that when his family asked for an explanation or called him out on his inconsistencies or apparent dishonesty, it made him “want to do it more”. He threatened suicide if he was denied MAiD. While in the hospital, a family member asked him about his ideation, and he replied with a surly, “I’ll find a bit of cord”. He would back down from his threats when a family member very patiently walked him through how much of a burden and problem a suicide on their watch would create for the hospital staff doing their best to look after him. I believe the hospital staff was aware that he was suicidal.
The MAiD assessment.
During the period of his falls and hospitals, Bill C-7 passed and MAiD for Track 2, non-reasonably foreseeable natural death, became newly available. When he first told me he was looking at MAiD, weeks before he applied, he said that “a doctor” he spoke to in the hospital “told me I should have it”. I did not believe him due to his tendency for selective hearing and deferring responsibility. Yet I now have doubts, after learning that Vancouver Island hosts some of Canada’s most prolific and ideological MAiD assessors and providers, who favour vivisectional ideas of amputated autonomy and eligibility expansion, as well as the highest medically assisted death rate in the world. It is sickening to ponder.

His 90-day assessment period would have ended on his deceased mother’s birthday, and he took this as a ‘sign’ that he should proceed with MAiD. This echoed his later reaction when his assessment period was halved with his track-move and fell on the earliest day his chosen provider was available, also another family member’s birthday for whom he had often expressed a simmering resentment.
He wanted to make sure that his father's MAiD assessment was robust.
Within days of his application, I looked up and contacted a leading MAiD psychiatrist and expressed my concerns. I was advised to make a list of my family’s knowledge and worries about mental illness, suicide, and personality issues and to push hard to get it to his assessors to arrange a psychiatric evaluation. Unable to get the assessors' contact details, my family and I put together this information. I sent it to the local MAiD coordinator who said they would pass it on to his assessors.

When, at last, I heard from Provider before his death, I asked if she had received our list of concerns and received an evasive response. The provider seemed to want to hurry off the phone and appeared to be in a busy place, like a hospital corridor, as I could hear voices in the background. I therefore only had a few seconds to describe my father’s complex history. Provider also appeared to regard my father’s suicidal history and previous depression diagnosis as news. During that call, I also relayed, as had my other family members, that I had spoken to a MAiD psychiatrist who had advised me to push hard for a psychiatric assessment. Upon learning this, Provider reluctantly agreed to try to get a last-minute psychiatric evaluation but was unsure if a psychiatrist could be found so close to scheduled death.

A psychiatrist was found. Provider bluntly told me before my father’s evaluation that the psychiatrist would “just agree” and “provide cover” for her, yet also said he would be ineligible for MAiD if mental illness was found. However, “finding” mental illness would only be a comorbidity and not a sole diagnosis, given the approval and track move rationales, so this comment does not make sense to me. Despite my advisement that Dad had previously been diagnosed, the provider said she did not think he was depressed. I was very disturbed by Provider’s presumption of the outcome of the psychiatric assessment, which suggested to me the evaluation would lack independence and rigour.
The days approaching his father's death.
In his last days, under medical supervision, Dad drank juice, coffee, and wine with no reservations. He had hospital meals delivered, at which he poked, but disliked the food. He was drinking wine the evening and morning before he was killed. He may not have been sober for his final consent.

When my family arrived, my father or a clinical staff member informed us that he had “special permission” to drink alcohol. The evening before he died, he drank wine (about ½ bottle) after several days without solid food. At this point, my family managed to convince him to postpone his death so we could spend more time with him. The next morning, however, he appeared to have forgotten this conversation. He seemed confused and thought that day might also have been another assessment. I warned Provider about this, but she said only that she would “start from the beginning” and disappeared into his room alone. The provider later cancelled an early afternoon meeting with the family. My father drank coffee and wine that morning and fell asleep from about noon to two pm. I believe that this sleep could have been alcohol induced.

He also appeared confused during the previous weeks of his assessment period. He could not seem to differentiate between assessors and other clinicians who saw him. He may have been on (opioid) painkillers, as I recall him being offered, and possibly accepting them, by nursing staff before he died. In his earlier hospital stays he had demanded higher doses so that he could “feel” them, suggesting to me that he may have wanted their narcotic effect more than pain relief.

The day of his death was a family member’s birthday (not mine), and he declared this was his “special gift” after initially apologising that he had forgotten, but then decided otherwise. This family member witnessed the death and considered his choice a final act of malice or resentment. To my great distress, the Provider also knew about the birthday and made comments to that effect. In a moment alone together, I tried to deter my father, and explain why it was wrong, but he only reacted aggressively and dismissively.

No capacity assessment was done immediately before final consent was taken.
His father's death.
Provider was meant to arrive between three-thirty and four, but turned-up late, at about five past four, and voiced, callous and cheery, “I hear it’s someone’s birthday!” before proceeding to ‘obtain final consent’ for the suicide-homicide. My father declared his consent with a belligerent “Get me the hell out of here!” and Provider became Death.

Death tried one arm and then the other for an injection site, settling on his right side, and sat body-warm beside me on the small, smooth, clinical sofa. Death then delivered her long poison-parade of prepared syringes, fished out in order from a plastic toolbox - the chemicals, like the box, repurposed for something their makers did not intend. Adrift somewhere on the slow white river of propofol, flowing into him from three or four milk-bottle syringes, Dad disappeared. His warm face blanched and his head lolled where he was left propped upon the bed. It took him twenty minutes to die.

Death’s last words to me, just as she left a short time later, were a demand not to bring the concerns or issues I had raised “forward”.

He was 77.
Trying to find out why his father was approved for being killed.
My father’s Executor/Next-of-Kin and I later submitted a request for his MAiD records. The records officer denied us access to all records, except for the psychiatric evaluation report because it was not in the deceased patient’s interest to release them to us and enclosed a printout of the relevant legislation. However, we discovered that the psychiatric evaluation report is limited solely to ruling out depression, and no other mental illness. The report mostly claims the opposite of his medical history, stating: no suicidality, occasional drinker, and non-smoker (despite his lifelong tobacco use). It also records him as dwelling in assisted living for about a month, though he was there a mere five days before he fell and was hospitalised – a week before MAiD and death. Appropriately, no chronic clinical illnesses (mainly arthritis, diabetes, claudication) are listed as terminal. Yet the report does not mention any of the allegedly terminal conditions cited by Provider for the track move; rather, it only states that he had been moved. The information in this report is therefore largely wrong and inaccurate, indicating to me a gross failure of this final safeguard.

Some of the information Provider and the psychiatrist dismissed or got wrong would likely have been available in his normal GP medical records. I had passed this material on to the regional MAiD coordinator and told the provider before my father was killed. Because the Vancouver Island Health Authority did not release his full MAiD records, I do not know what information was accessed or used to approve his death.

I protested this in a text message (much contact with Provider was by text), stating that I was astounded that nothing was found, and reiterated my concerns. I asked if anyone in the process had tried to save his life. In response, the provider told me that due diligence had been done, and not to contact her again, as it was her private number and speaking on it was inappropriate. I read this as an implicit threat that I would be barred from the hospital if I kept pushing for answers. Provider had, however, initiated contact with me on her personal phone, which was the only means she used to contact my family and me.
Thank you Christopher Lyon for sharing the story of your father's death. It is not easy to share such a story but it is important for Canadians to know how cavalier the assessment and death of your father was treated by the "provider", the psychiatrist and the medical system.

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