WATERtea May 2024

Follow-up to WATERtea

“Exploring Medical Assistance in Dying”

with Bina Feldman and Mary Anne Cecutti of DWDC

Tuesday, May 14, 2024 at 2:00 pm EDT

Medical assistance in dying has been legalized nationwide in Canada. Eligibility requirements are stringent and the cooperation of the medical system is assumed, but MAID is now one end of life option in Canada.

WATER thanks Dying with Dignity Canada, the “the national human-rights charity committed to improving quality of dying, protecting end-of-life rights, and helping people across Canada avoid unwanted suffering.”

https://www.dyingwithdignity.ca/

We are indebted to adult educator Bina Feldman and health care consultant Mary Anne Cecutti for an excellent presentation and discussion that helped many of us think about this important issue.

The video of this event, which includes the DWDC informative slides, can be found at: https://www.youtube.com/watch?v=AsQy–Nbbts&t=7s&ab_channel=WATERwomensalliance

Introduction by Mary E. Hunt

I was thinking about our topic when I read a May 7, 2024 New York Times obituary by Penelope Green entitled: “Lesley Hazleton, Writer Who Tackled Religion and Fast Cars, Dies at 78” (https://www.nytimes.com/2024/05/07/books/lesley-hazleton-dead.html?searchResultPosition=1).

It captures what I want to say.

The obit begins: “Lesley Hazleton, a British-born, secular Jewish psychologist turned journalist and author, whose curiosity about faith and religion led her to write biographies of Muhammad, Mary and Jezebel and examine her own passions in books about agnosticism and automobiles, died on April 29 at her home, a houseboat in Seattle. She was 78.”

I had never heard about her but I had to know more.

The obituary continues: “Ms. Hazleton announced her death herself, in an email that she scheduled to be sent to friends after she died. She had been diagnosed with terminal kidney cancer and chose to take her own life, as Washington State’s Death with Dignity Act allowed her to do legally, with the assistance of hospice volunteers.

“Yes, this is a goodbye letter,” she wrote, “which is difficult for me, because as many of you know, I’m lousy at saying goodbye.”

“I’ve been a pro-choice feminist for over six decades, so it should come as no surprise that I’ll be exercising choice in this, too,” she said, adding, “I’m experiencing an unexpected but wonderfully bearable lightness of being. Not a sad feeling of saying goodbye to life, but one of joy and amazement at how great it’s been. And of immense gratitude. I truly have had the time of my life. In fact, it sometimes feels like I’ve managed to live several lives in this one.”

I liked her better and better.

Penelope Green goes on to write:

[…]“What’s wrong with dying?” Ms. Hazleton asked in a 2016 TEDx talk in Seattle. She had met a Silicon Valley type who was working on his immortality. (Many, many supplements were involved.) What could be more awful, more boring, she thought, than immortality? The exchange led her to develop the talk, which was her last.

“We need endings,” she said in that talk, “because the most basic ending of all is built into us.”

“Our ability to die, our mortality, is a defining part of what it is to be human,” she added. “We are finite beings within infinity. And if we are alive to this, it sharpens our appreciation of the fact that we exist. Gives new depth to the idea of life as a journey. So my mortality does not negate meaning; it creates meaning.”

“Because it’s not how long I live that matters — it’s how I live,” she concluded. “And I intend to do it well, to the end.”

I think Leslie Hazleton offers a wonderful perspective on death and dying. I offer it to set the tone for our conversation today.

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The presentation, conducted by Bina Feldman, can be found on the video. We urge you to watch it to get the full, rich details. Especially salient were materials on End of Life options, eligibility requirements for MAID, and the evolving nature of the Canadian law as more and more real time cases are considered, for example, the mental health complexities. It is a presentation to rewatch as there is so much data and so many aspects to consider.

Small group discussion followed so that everyone could share something that surprised, comforted, or excited them about the presentation.

Afterwards, Mary Anne Cecutti of DWDC led a plenary discussion. Among the many questions/issues raised were:

An Irish woman reported that many elderly people in Ireland died during the early time of Covid and how that relates to a society’s care for the vulnerable.

She raised other relevant issues to which Mary Ann provided these answers:

–only YOU can request MAID for yourself

–an independent witness is requires for certification of eligibility

–MAID is paid for under the nationwide health care system in Canada

A US participant asked how long it took for the MAID law to evolve to where it is now.

Mary Anne mentioned DWD’s 40^th anniversary and the last 20 years of intensive legislative work indicating that there is no quick fix. She also mentioned that the incorporation of eligibility for those with mental disorders, though passed by legislation, has had implementation pushed off until 2027. Additionally, the Canadian Constitution affirms the right to make decisions about one’s own body, something that US people (especially women) do not experience.

The question of a waiting period between approval and implementation was raised by a Canadian person. There is no wait time now for those who meet eligibility requirements, including “foreseeable death,” though there had been a waiting period under earlier legislation.

A Canadian colleague spoke of her country’s dual focus on the individual and the common good. Decisions about end of life are not simply for those who choose to complete their lives, but also have implications for the whole society, something that in the US, by contrast, is sadly absent. She then spoke of her local situation where MAID deaths are not uncommon but also not by any means routine.

Mary Ann reported that many public hospitals have a MAID Navigator to help people through the process. Increasing numbers of people are exploring the process, but exploring does not mean that anyone will or must choose MAID among other end of life options.

A minister raised the question of whether counselling resources are made available to families of people who choose MAID.

Mary Ann replied that such resources are made available at the discretion of the patient with respect for doctor-patient confidentiality. Many people who choose MAID involve their families, social workers, and religious professionals. There is a group called C14 that works with families during and after the process. Important: no one can interfere with the process which is in the control of the person requesting MAID and not anyone else.

Another question was raised about training for religious professionals with government funding so they can study outside of their religious traditions, especially for those whose traditions oppose MAID.

Mary Anne replied that there is no such training offered to religious or psychological counselling professionals in Canada.

Another question that Mary Anne said she hears often was whether MAID deaths were considered suicide for purposes of life insurance. All Canadian life insurance companies have agreed that MAID will not be considered suicide so MAID deaths are eligible for life insurance coverage.

Since a high percentage of MAID deaths in some parts of Canada are in hospital, a question was raised about hospice care and other ways the end is facilitated.
Mary Ann talked about the many ways people choose to end their lives—with a party, a beer bash, or a family dinner (as in the case of a couple who ended their lives afterwards). Many people get the deaths they want.

WATER staff spoke of 2 women in our extended community who completed their lives with some involvement from WATER. One wanted liturgical resources to have a celebration before her death, resources we were able to provide. The other person made us aware of her situation after the fact, but on reflection we could see her deliberate preparation.

Future issues:

–AI and ghostbots when thinking about the meaning of immortality when people are available to the family by these means

–religion and populist politics in a consumer-driven world

–deaths that were secrets in families and elsewhere which can now be brought to public attention for discussion

WATER thanks our colleagues at DWDC and all who participated in the conversation. While many issues remain to be discussed, it was a privilege to hear from people who have worked for decades on death with dignity in relation to individuals and the common good.

We are already hearing how WATER people are extending the conversation in our circles, whether in communities, families, or even in our intern’s group house where young people took up the topic. There is much work to be done, especially in the US which has only 12-13 states where MAID is permitted. We all learned a lot.

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DWDC kindly provided the following resources:

Medical Assistance in Dying Supplemental Resources & Readings

Information & Support

Ontario Ministry of Health Care Coordination Service – MAID/End of Life Decisions

OR Toll free: 1-866-286-4023

Dying With Dignity Canada (DWDC)

Support OR Call: 416-486-3998 Toll free: 1-800-495-6156

Navigating a Request for MAID in Ontario (video)

MAID Assessment Guide

Patient Rights Guide

Palliative Care Resources