Assisted death raised with Nova Scotia woman awaiting mastectomy

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The Nova Scotia woman was steeling herself for major surgery, a mastectomy for breast cancer, when an unfamiliar doctor ran through a series of pre-operative questions: What was her medical history? What medications does she regularly take? Any allergies? Was she aware of medical assistance in dying?

Fifteen months later, before a second mastectomy, “it happened again,” the woman said. Different doctor, same inquiry. “In the list of questions about your life and your past and how are you treating these things was, ‘Hey, (MAID) is a thing that exists,’” she said.

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“It was upsetting. Not because I thought they were trying to kill me. I was shocked that it happens. I was like, ‘Again? This happened again?’”

The woman, 51, requested anonymity because she lives in a small area with a limited number of doctors. She believes euthanasia was raised as “I was literally on my way into surgery” not because of breast cancer but because of her long history with autoimmune and other disorders that, theoretically, would make her eligible for MAID.

Her experience is drawing fresh concerns about doctors in Canada raising euthanasia before their patients do, a practice that is prohibited or strongly discouraged in most jurisdictions in the world with legalized assisted death.

The Nova Scotia woman, whose story was first reported by The Telegraph, worked, raised children and volunteered. She has never wanted to be pitied. “I’m nobody’s teachable moment.” She wasn’t offered MAID, she said. But the blunt question over whether she was aware of it “threw me. It came up in completely inappropriate places and completely inappropriate times.”

“I am a very lucky woman. I have a large and supportive family. I have all the love,” she said. “But I felt small and lonely and alone in that hallway before going into surgery.

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“There are people who have lists of conditions like mine who don’t have a big, happy loving family, or financial or emotional support, and if those words are said to them when they’re lonely and alone…. If my life were like that, I may not have had the strength or courage to either pretend that that question didn’t exist or just say, ‘No, I don’t want to talk about it. Let’s move on.’”

Dr. Gus Grant, registrar and chief executive officer of the College of Physicians and Surgeons of Nova Scotia, said it was “clearly inappropriate and insensitive” for a doctor to raise MAID as a person is being rolled into a surgical suite. “I can understand why the patient was upset,” Grant said.

However, he said, “there’s a difference between raising the topic of discussing awareness about MAID and possible eligibility, from offering MAID. They are wildly different things that need to be disambiguated.”

“The issue is the sensitivity or appropriateness of raising the question of an awareness of MAID at the time, and I can certainly understand the patient being put off by that.”

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Grant said the college’s policies don’t impose a duty on doctors to initiate a discussion about eligibility for MAID, including on doctors who have a conscientious objection.

But a group of Christian doctors said the college’s new policy on conscientious objection has sown confusion and that a “strict reading” implies they do have a duty to raise MAID with their patients.

“I’m not sure that any physicians in Nova Scotia are clear on where we are on this,” said Dr. Jeanne Ferguson, a geriatric psychiatrist. “Certainly, what we’re seeing in hospital is that physicians are initiating the conversation with patients.”

Nationally, the organization representing Canada’s MAID assessors and providers argues doctors have a professional obligation to raise MAID as a “clinical care option” if a person might be eligible, provided the intent is not to induce, persuade or convince the person to request an assisted death.

But some ethicists have argued people could be unduly influenced to choose to have their lives ended, given the power dynamics of the doctor-patient relationship.

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Writing on X, Calgary palliative medicine specialist Dr. Leonie Herx said patients have reported feeling “badgered and harassed” to consider MAID.

The Nova Scotia doctors’ policy reads, in part, that doctors “must discuss all available treatment options” relevant to the patient’s condition and that doctors must not “withhold information regarding a procedure or treatment” even if providing such information conflicts with the doctor’s conscience. (The policy covers not just MAID but other areas where conflicts of conscience can exist, such as reproductive care.)

“Every patient I see in my office who is suffering with a chronic medical condition — anyone I see could potentially be eligible for MAID,” said Dr. Amy Hendricks, an internal medicine specialist in Antigonish. Most of her practice is cardiology. “Is the intention that I am supposed to be bringing this up with every person that I see in the context of our relationship? Is it intended to be part of a ‘goals of care’ conversation?”

“If this ended up on a checklist, how did it get there? Did it get there because people think they have an obligation to raise this with every single patient that crosses their path?

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“And even if it sounded like it was off a checklist, what she heard was, ‘Does your life really have any value to you? Because we can end it for you.’”

Suffering is “so personal, and it looks different for everybody,” Hendricks said. “If you don’t know the patient very well, if all that you have is a list of their medical issues and their external appearance, how can you, as a physician or a nurse, speak to their experiences and decide in an instant, ‘Oh, they must be suffering so much that maybe we should offer to help them end their lives?

“I don’t understand how that could be coming from anywhere but a place of bias.”

There’s a difference between raising the topic of discussing awareness about MAID and possible eligibility, from offering MAID

Grant said the thrust of the college’s approach to MAID and conscientious objection “is to make clear that the patient’s rights are paramount” and to ensure that “the care available and provided to patients does not vary according to the belief structure of the physician providing the care.”

Assisted death is “increasingly becoming part of the dialogue between patients and physicians, particularly when the patients have grievous and irremediable conditions,” he said.

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The Nova Scotia woman isn’t opposed to MAID. “I’m not a ‘right wing nut job’ with a ‘Christo-fascist agenda,’” she said in response to some of the comments posted on social media following the Telegraph story. “I have no religious or political agendas to push.” The U.K. parliament is considering a bill that would legalize assisted dying in Britain for the terminally ill.

But she worries the criteria for those who aren’t dying, whose deaths are not “reasonably foreseeable” are too broad, and that the expanded eligibility hasn’t come with the supports the federal government promised “so that nobody was choosing medically assisted deaths because they did not have the ability to lead a dignified life on subsistence benefits.”

She developed mononucleosis as a child after it “ripped through my classroom,” and, shortly after, was diagnosed with Epstein-Barr virus. She has been diagnosed with fibromyalgia, lupus and numerous other conditions. “Deep down, I’m not even sure I’ve ever had a day in my life without pain.”

After she discovered a lump in her breast over the 2022 Labour Day weekend, “everything moved quickly.” Mammogram, biopsy and then surgery. “It was a lot to take in, and processing it was a herculean task…. It was a lot and it was fast and it culminated in that really casual, clinical question: ‘Do you know about assisted dying?’”

The mastectomy was followed by numerous rounds of radiation. “But it’s not spreading; it’s not back,” she said.

“We’re considering this a victory.”

National Post

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