by Green, Stefanie, M.D.
Scribner (March 29, 2022)
Dr. Stefanie Green, president of the Canadian Association of MAID Assessors and Providers (CAMAP) opens her book with the question, “What if you could decide, at the end of your life, exactly when and where your death would happen? What if, instead of dying alone, in the middle of the night, in a hospital bed, you could be at home at a time of your choosing?”
She begins her book with this question because she wants us to know how it can be possible to die as we wish. Canada has a Federal medical aid in dying law that makes it available to any qualifying Canadian resident or citizen. Most of the requirements are similar to those in the United States, including being over the age of eighteen, suffering from “a grievous and irremediable condition” and making the request voluntarily and under no sense of coercion. A major difference, however, is that the medication does not need to be self-administered. Patients have a choice of two methods: a self-administered drink with a health care practitioner standing by to make sure all goes smoothly, or, much more commonly, medication that is delivered by the clinician through an IV. It is the delivery by an IV that is the subject of Green’s book. It is chosen by the overwhelming majority of her patients and she makes a strong case for it.
The IV process involves four medications: an anti-anxiety medication called midazolam that makes the patient feel relaxed and sleepy; a local anesthetic called lidocaine that numbs the vein and is not always necessary, but is used to be 100% certain; a dose of propofol that creates a much deeper sleep, and rocuronium to ensure there is no muscular movement in the body.
The entire process takes eight to ten minutes.
Green , who began her career in general practice and maternity and newborn care, tells the reader what she does, how it works, what she’s seen, and what she’s learned. She introduces us to patients and takes us to their bedside while they die. She chronicles the conversations she hears. In one moving chapter she describes how a husband was ready to die and how his wife disrobed, lay naked beside his naked body, and held him closely as he fell asleep.
Green admits to being challenged by finding the right words to tell people what she “does.” In the beginning, she called medical aid in dying a medical procedure. She shifted to calling each event a “delivery,” comparing it to her maternity background. “At one end, I was helping deliver a baby, usually into life. At the other end, I was helping deliver a person out of intolerable suffering and through to their death. I liked the symmetry the term evoked, the poetry of it. Turned out, my patients like it too.”
There is a lot covered in this well written book, including summaries of where medical aid in dying stands in other parts of the world. She tells the history of getting MAID passed in Canada and of the need to write a clear law. In Canada, she says, “politics, unclear law and fear all played a role.” She writes that we must redefine the word “euthanasia” or else find a substitute. It comes from the Greek eu meaning good or well, and thanos meaning death. The modern understanding in Canada and parts of Europe is that it means the administration of a lethal medication by a health care professional at the request of a competent adult, with the goal of relieving suffering. Canada consciously chose to use the term MAID to avoid the negative connotation.
Green’s book offers a comprehensive view of how the practice of MAID in Canada helps to alleviate suffering, even for patients such as Parkinson’s and ALS patients who typically cannot administer the medication themselves, a requirement that is universal in the US. She has no answer for dementia. She has, however, written a sound book that will inform everyone who wants to understand better what medical aid in dying is.
Review by Susan Gillotti, PCV Board Member