Complicated grief: When a family member dies by euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article by Erin Anderssen published by the Globe and Mail on January 18 concerns the experience of several families as they grieve the death of family members who died by euthanasia. Anderssen begins with the story of Gary Hertgers:

Gary Hertgers learned that his sister, Wilma, had received a medically assisted death when her apartment manager called to say that her body was being carried out into the street.

“You mean, my sister is dead?” he asked.

“I thought you knew,” the manager said. “She told me the family knew.”

But, in fact, none of her immediate family knew that Ms. Hertgers had been approved for medical assistance in dying, let alone set a date. Not her 88-year-old mother, whom she called twice a day. Not her older brother, who lived one town over. And not Mr. Hertgers, 61, who had only that Friday, after driving the four hours to Chilliwack, B.C., shared a pot of tea at Ms. Hertgers’s kitchen table.

Gary Hertgers

Anderssen continues:

They’d chatted as usual, mostly about Ms. Hertgers’s health; at 63, she experienced chronic pain, and wrestled with depression. She told him the location of her will. But she had done that before, so the clue didn’t register. They parted with a hug. See you soon, he said.

Two days later, in the same apartment, someone said a prayer at her side while she died. At least, that’s what Mr. Hertgers was later told by the doctor who delivered the fatal medication. The identity of that person is still a mystery, like many of the details around his sister’s death.

When Canadians receive MAID, families and caregivers are often with them, providing comfort along the way. But the situation becomes much more fraught, ethically and emotionally, when patients don’t want relatives and friends involved.

Anderssen explains that Canada's MAiD law does not require the person requesting death to inform their family and the euthanasia assessor is also not required to speak to family, making it difficult to accurately assess a person who is asking to be killed.

Hertgers feels at a loss.

“You feel like you’re taken for granted, like the relationship you’ve built over all these years is superseded by someone who has known her a few months, that your care has been for naught,” says Mr. Hertgers. “At the end of the day, did all that time and effort mean anything?”

I have published several articles on the grief related to death by euthanasia. In October 2018 I received a call from a grieving woman after her grand-father died by euthanasia (Link).

Anderssen reports that some experts say that the role of families needs to be clarified before MAID extends to patients with mental illness. 

In December, responding to concerns raised by doctors and health care organizations, the federal government announced it would ask Parliament to delay the MAID expansion, to allow more time to establish clear safeguards. Toronto’s Centre for Addiction and Mental Health, the country’s largest psychiatric teaching hospital, has suggested that should include more consultation with patients and their families.

Anderssen shares the story of an Ontario woman who was approved for euthanasia in British Columbia without her family knowing.

In Ontario, for instance, a father learned this fall that his adult daughter was being assessed for MAID when she forwarded an e-mail from a B.C. doctor proposing that she travel west to complete the process. By then a plane ticket had already been booked for November. Her parents, who had been caring for her since she was diagnosed with schizophrenia as a young woman, were distraught.

The father, whom The Globe and Mail is not identifying to protect his daughter’s privacy and his relationship with her, says he’d watched, over many months, as MAID consumed his daughter’s day; she pored over how-to information online.

His daughter’s life is not easy, he conceded in an interview. Her mental illness causes fearsome bouts of anger, she spends most of her time alone, and she is plagued by delusions that she is rotting inside from a terminal physical illness.

But certainly, he didn’t think she’d be eligible for an assisted death. While she has some physical health issues, he could not imagine they were serious enough to qualify for MAID....

So it was unfathomable, he says, that a physician was counselling his daughter, who suffers from psychosis, to travel alone halfway across the country. Or that two MAID assessors might approve her without insisting on input from her treating psychiatrist or family doctor. Yet the e-mail suggested an expeditious outcome: If she could get to B.C. – where ostensibly a physical illness might make her eligible – she could qualify within weeks.

The father doesn’t know what illness his daughter used to apply, and was not privy to all the discussions with the MAID clinician. But in the end, the parents managed to persuade their daughter to cancel the plane ticket.

It was likely the euthanasia clinic in Vancouver that was involved with this case. Dr Wiebe is reported to have approved euthanasia by Zoom and was willing to pick people up at the airport for being killed. 

Christopher Lyon

Anderssen then told the story of Dr Christopher Lyon father, who died by euthanasia in Victoria.

Before his father died, Dr. Lyon, an environmental social scientist, says his family tried to share what they consider to be important context for the MAID providers and assessors. When his father was first assessed for MAID, the family wrote up a detailed history of his physical ailments and mental health struggles, his alcohol use and personality quirks – and sent it to the office of the MAID co-ordinator. Dr. Lyon knew his father experienced bouts of depression, especially around negative events. Hospitalized after a fall, he now faced moving into an assisted-living apartment. He had been openly talking about suicide for months. The family expressed their opinion, however, that with time, social support and mental health care, their father would improve.

Even today, Dr. Lyon is not sure who read it. He doesn’t know the content of his father’s assessments, or what information was collected. He says the health authority has declined to release the full records, deeming it not to be in the “patient’s best interest.” A late-stage psychiatrist report that he has seen contained so many errors and omissions that he worries about what else was overlooked.

When the MAID provider phoned to give him 48 hours’ notice, it was the first time they had spoken. By then, Dr. Lyon and his family had been trying for weeks to find a solution to keep his 77-year-old father alive. They thought they had time; his chronic health conditions had qualified him for MAID as a non-terminal patient, which required a 90-day waiting period, and there was still a month to go. But his dad stopped eating a few days after moving, reluctantly, into the new apartment. He was admitted to hospital after another fall, and fast-tracked to receive an assisted death.

Dr. Lyon rushed to Victoria from Montreal, and on a sunny afternoon, he gathered at his father’s hospital bed with his two siblings, and his mother. He remembers that the MAID provider was running late. “We were just watching the clock tick down until someone was going to come and kill him, which is, you know, an excruciating, unbearable thing to experience.” Arriving, Dr. Lyon recalls, she said, “I hear it’s someone’s birthday,” as if joining a party; by awful chance, the procedure had been scheduled on a family member’s birthday. “Get me the hell out of here,” his father declared, giving his consent. He was dead 20 minutes later. His son still has nightmares about it.

“It was like some sick, dystopian Black Mirror or Squid Game,” Dr. Lyon says. “You, family member, have 90 days to convince a doctor, whose name you don’t know and cannot directly contact, to save your father’s life.” To pass on important information the patient might conceal. To scramble when the date is unexpectedly moved up. To make sure, before the lethal injection, that all options have been fully explored. It felt, he said, that “if we want to save our loved one’s life, we are actually in competition with the assessors and providers.

Duncan sisters

The article then tells the story of Donna Duncan who died by euthanasia in October 2021 after having a head injury from a car accident in 2020, that she didn't receive treatment for, due to Covid restrictions. The article states:

Christie Duncan, and her sister, Alicia, learned their mother, Donna, who lived near Abbotsford, B.C., was starting the MAID process when their mom’s husband texted them a link to a support group in October, 2021.

Their mom’s decline began after a car accident in early 2020, Christie says, and she was losing weight, without a clear diagnosis. But her daughters worried that the pandemic had made it hard to get treatment, and lockdowns had affected their mom’s mental health.

When they found out a MAID date had been set, the sisters successfully appealed to the courts for a delay. A few days later, Donna was admitted to hospital after cutting her wrist – an event her daughters hoped would postpone their mom’s assisted death indefinitely.

In the hospital, on Oct. 29, Christie says, “I hugged her goodbye, and I went home, thinking I will talk to my mom in the morning.” Donna was released a few hours later, and that night, her daughters received a text from her husband that their mom had received MAID, “as per her wishes.” (A police investigation, prompted after her daughters filed a complaint, did not find any evidence of criminality.)

The police investigation did not find evidence of criminality because Canada's euthanasia law makes it nearly impossible to prosecute any doctor or nurse practitioner for their role in a death. The law states that the doctor or nurse practitioner only need to be "of the opinion" that the person fits the criteria of the law. In all of these cases, the assessor was "of the opinion" that the person fit the criteria of the law.

Euthanasia is not a revocable decision once you are dead.

The grief associated with family members who have lost a loved one to euthanasia, is rarely discussed, but it is real. There have been many controversial euthanasia deaths in Canada that may have led to complicated grief. A study needs to be done concerning the grief associated with deaths by euthanasia.