A nurses story: Euthanasia (MAiD) death was not dignified.

This story was sent to the Euthanasia Prevention Coalition by a nurse who wanted to remain anonymous. The nurse changed all names to ensure the privacy rights of those involved. -Alex Schadenberg.

They say euthanasia is a compassionate, dignified way to die. They say everyone should have the option, and that a life with suffering is not a life worth living. But that's not what I've seen. I know Medical Aid in Dying (MAID) to be messier and more distressing than anyone cares to talk about. I have seen the ripple effects of euthanasia, and the complexity it adds to grief. I want people to know the impact MAID has on healthcare professionals. I am a palliative care nurse, and this is my side of the story.

One shift I worked with a patient named Laura who was scheduled to be euthanized later that day. Laura had a terminal metastatic breast cancer diagnosis, but with no exceptionally challenging symptoms that I could observe. However, she told me she was tired of living, and the thought of living longer scared her more than dying. Laura had picked out music to play in the background while she died, and had chosen which loved ones she wanted by her side. It was planned for 6 pm. She was alert and oriented, and had signed a waiver saying that if for whatever reason she was no longer judged to be of sound mind at the time of the MAID provision, she could be euthanized anyways. She thought she had complete control. Just a few hours before 6 pm Laura had a completely unexpected grand mal seizure. She wouldn't stop seizing and required large doses of a sedating anticonvulsant. The time of the provision came, and she was confused and groggy from the sedating medication, and unable to properly confirm she wanted the euthanasia, or say goodbye to her family members. She tried to speak but no one could understand what she was saying. Laura was euthanized at 6 pm, according to the waiver she had signed. This was what she had requested, but the family came out of her room shaking, with eyes wide. They cried, and kept saying it should have never happened that way. They had no closure. There was no dignified, peaceful ending. Just their loved one, killed in the middle of trying to say something.

This was a horrible death. If Laura had chosen to die naturally, maybe she would have lived two more weeks. Maybe she would've needed more sedatives, and spent more time sleeping. But we would've kept her comfortable. Her family could've been by her side and treasured any awake moments and words she had to give. As her nurse I would've battled any restlessness, worked to prevent any seizures, noticed a furrowed brow and given pain medication. I could've explained the dying process to Laura's family, spoken about the changes we were seeing in breathing, in circulation, and slowly walked alongside them in their grief as she grew closer to death. Instead her death was sudden, and traumatic, and the family went home right after without anyone to support them through the process.

It wasn't just the family traumatized by this death. For every MAID provision, a nurse is in the room, along with the MAID provider injecting the lethal medication. As a conscientious objector to euthanasia, I did not have to be in the room as it happened. Instead, my coworker volunteered. After Laura's life was ended, this coworker sped out of the room shaking and crying, distressed in a way no natural death of a patient has ever affected her. I know multiple other nurses who have been through the same experience. Although they had no religious or moral objections to MAID, after witnessing it first hand they swore to never be in the room again while it happened. They were deeply unsettled, and their conscience told them what they couldn't admit to themselves: the intentional ending of a life is wrong, no matter the circumstances.

The ripple effects of Laura being euthanized carried on, beyond her family, beyond the staff, to other patients on the palliative unit. Mark, who had the unfortunate position of a bed in the hallway, expressed to me, "I saw something today that I am not okay with, and I just have to bring it up". Mark carried on to tell me he saw Laura go by in her wheelchair, talking with a visitor as she went into her room. Later, Mark observed staff and family members going in, and then witnessed the family coming out weeping. He reported seeing a stretcher leave the room, with a black cover overtop, and realized Laura had died. Mark watched her family crying, and it brought up memories of his own wife dying. He was horrified that one moment Laura was up and talking, and the next she had died. He admitted to feeling scared he would die suddenly, too. I hadn't said a word about Laura due to confidentiality, but as a patient in the hallway Mark was able to observe and hear a lot of things. He and Laura were both mobile, and over the past few days they had spoken in the patient lounge on occasion. Her death brought up many complex emotions and distress for Mark, and I felt torn on how to support him.

For myself, Laura's death was exceptionally hard to deal with. Before she died, it was difficult to interact with her in a normal way. I kept watching the clock, and counting down the days, hours and minutes till her scheduled death. I had an awkward moment of bringing in the scheduled laxative she got each morning along with her other medications, to which she responded, "really? I'm dying today, does it matter if I'm constipated?". Every interaction I had with her I felt the weight of her impending death, I wanted to scream out "don't do it! Your life has value!". But instead I bit my tongue and supported her, and then went home morally distressed, wondering if I had spoken my mind, would it have made a difference? I wanted to rip up the waiver she had signed, and plead with the doctor injecting her lethal dose not to do it. After she died and my shift was over, I went home feeling profoundly sad, and helpless at how the situation played out.

The goal of palliative care is to alleviate suffering and support patients and families until natural death, neither hastening nor prolonging death. I am upset that in Laura’s case, we had to betray our own philosophy. When euthanasia was first legalized in Canada, palliative units and hospices were exempt from having to provide MAID on site, for good reason. The whole unit feels the impact when death is chosen before it’s time. Perhaps for staff who see natural death on a regular basis, we feel the impact even more than others. We see the contrast, we know a natural death doesn’t have to be scary or painful. If a patient like Laura has a grand mal seizure, we are skilled at adapting to changing circumstances to keep her comfortable. Letting death happen at its natural hour gives families the chance to bond, and soak in every last moment loved ones have to give. Patients may think that choosing MAID relieves their family of the burden of waiting for their death, or seeing suffering. But in reality it steals time and closure, and replaces a natural process with an unsettling ending. From what I have seen, loved ones of euthanized patients appear to struggle more in their grief than loved ones of patients who die naturally.

A story like Laura’s showcases a reality of euthanasia not often spoken about. And even though this was just one example, it is not an isolated incident. There are many more stories I could’ve shared, and the impacts of euthanasia are felt far and wide with each and every case - even the ones that go as planned. My hope in telling this story is that eyes will be opened to the horrifying reality of euthanasia, and perhaps hearts and minds will be changed as well. I am a palliative care nurse, and this is my side of the story.