Photo: © Jacob C. Green
This Is Assisted Dying
In a Q&A about her candid memoir, Victoria doctor Stefanie Green talks about her decision to pivot from delivering babies to helping people die, and what a good death looks like / BY Kim Hughes / March 25th, 2022
If Dr. Stefanie Green has her way, family members will discuss death and dying with the same mundane purposefulness as post-secondary education and investing in RRSPs. One of her greatest hopes is that her candid, readable memoir, This Is Assisted Dying: A Doctor’s Story of Empowering Patients at the End of Life, will inspire readers to consider what death could — or should — look like.
In 2016, after two decades as a family physician specializing in maternity and newborn care, the B.C. doctor changed focus to provide medical assistance in dying (MAID) after the Supreme Court of Canada struck down a ban on physician-assisted death and the Canadian government legalized it on June 17, 2016.
The idea for her career pivot began in 2014, when — at the age of 46 and with two children at home — she “was beginning to wonder if it was time for a change,” Green writes. “ I adored the work … but there were drawbacks,” namely the long and exhausting shifts that were keeping her from home.
The watershed moment came at a May 2016 conference in Amsterdam, where hundreds of international delegates reviewed protocols, best practices and the legality of providing assisted death to terminally ill patients who qualify for the procedure. In Canada, informed consent and clarity of mind are paramount among a long list of qualifying criteria.
The conference convinced Green that end-of-life care — and the calmer work pace it afforded — was the path she wanted to follow. In Amsterdam, she made essential connections that helped her, and her Canadian colleagues, put the newly minted, detailed legislation into practice.
This Is Assisted Dying chronicles Green’s first year as a MAID practitioner on and around Vancouver Island, and introduces the reader to terminally ill patients who elect to die through an IV injection of lethal drugs, typically surrounded by family and friends, after their parting words are spoken.
She threads her own story throughout the book as she examines how other countries are managing (or not managing) end-of-life care, and covers the pragmatic and moral aspects of medically assisted death, although her position is clear: coherent but very sick patients should have agency over their deaths, and their government should support them.
“Time and again, I’ve witnessed the power that having the right to choose the time and manner of death affords people,” she writes in the prologue. “Instead of feeling helpless, people feel empowered, something their illness may have denied them for months or even years. [MAID is a way to] fully reclaim the time they have left, to live their final days with a startling amount of purpose.”
In addition to caring for patients, Green is the co-founder and current president of the Canadian Association of MAID Assessors and Providers (CAMAP), medical advisor to the B.C. Ministry of Health MAID oversight committee, moderator of CAMAP’s national online forum, and has hosted three national conferences on the topic.
Green spoke with Zed about This Is Assisted Dying, which comes out March 29, from her home in Victoria.
Was this book always in the back of your mind when you started this work?
I’ve always shared stories about my work, going back to maternity. When I started doing this work there were some extraordinary moments, so I made notes. I hadn’t seriously thought about writing until I received a cold call from a literary agent in New York. She had seen my name in the New York Times [in a May 2017 story about one of her patients]. It went from there.
Did writing require you to circle back and get permission from the families of the patients whose deaths you assisted?
At first, I just wrote. Once it became obvious the stories I wanted to use, I sought permission from the families of the patients who had inspired these stories. But I’ve changed names, genders [and] locations to protect privacy.
You’re very candid about your own life, notably your experience handling your father’s passing, which was a classic case of someone not articulating their wishes, leaving the family to guess. Was this a way of humanizing yourself?
Yes. Having that personal thread wasn’t my original intention. But I was convinced that the real way into this topic, which could be scary for some people, was to make it more relatable and to recognize we are all human and have all been through similar experiences. I think it’s only fair that if I’m going to be talking about my patients and their intimate moments, I should open myself up to the reader as well. We are all just trying to do the best we can.
Did you have a specific reader in mind for this book?
I really think this is a topic for everyone to consider. It is about assisted dying and debunking myths about it, but it’s also about recognizing the fact that death is a part of life and it’s something we should be talking about at every stage. No matter what people think about assisted dying, if I can encourage and facilitate those conversations, then my book has done its job.
In the book, you outline some negativity your colleagues have experienced because of this work. Is this putting a bull’s eye on your back?
Honestly, I have been happily surprised by the tremendous amount of support I get when I tell people what I do. I went into this work open-eyed and knowing I would do it purposefully and publicly, and when I did that, I knew I’d be more open to targeting. When I walk into a cocktail party, and someone asks me what I do, I tell them I’m a physician. If they ask me, “What kind of physician?” I am upfront. About 90 per cent of the time, I am immediately hearing a personal story about death that was negative. People tell me this work is important and they’re grateful someone is doing it. That support has given me more confidence to go out and speak publicly. The essential role of the physician is to help people in whatever way they need help. I don’t see this role as any different.
It’s fascinating how you connect the dots between maternity care and end-of-life care, as both come so freighted with tradition and expectation.
It really is a full circle, and from an aerial view, the two events are quite similar. The skill set I need to do those jobs as a clinician — navigating the intensity, the emotion, the family dynamics, the life-changing event that’s happening — are similar. My previous skill set was useful in transitioning to end-of-life care. I am very lucky, and my job has been profoundly meaningful to me at every stage of my career.
Your book presents Canada, and Canadians, as beacons of progressiveness with respect to end-of-life care via medically assisted death.
Especially considering how moderate we can be about so many things. The truth is, we got to learn from those who went before us and set up models in other places, like Oregon and Belgium. [Oregon’s Death with Dignity Act was enacted in 1997; Belgium legalized “active euthanasia” in 2002]. There are benefits to not being first. Having said that, the unique thing about Canada is the way we approached this issue.
It wasn’t because voters demanded it, but because patients demanded it and challenged the prohibition of assisted dying based on their Charter rights. By seeing it as a rights issue and arguing it that way, this became rights-based care.
That’s unique in the world. As such, our language, structure, and approach is patient-centred, which creates a whole language that’s patient-centred and that breeds success in health care. I think it will be a model. Countries currently grappling with the issue, like Germany and Portugal, have sought advice from Canada.
What will success look like for you with this book?
I want it to be widely read and to inspire conversations about death and dying, so people aren’t left to make guesses in emergent moments when someone is sick. I saw it all the time in the ICU, and you just know it can be better. Embracing death is part of life, and we need to clarify our wishes and make sure others do, too. Even me. My mother was in a long-term care home, and I found it hard to talk about her wishes. I know it’s easy to say and hard to do, but we need to have those conversations and prepare well for end of life. Inspiring those conversations would make this book a success to me.
What’s the most important takeaway from This Is Assisted Dying?
I experience a lot of gratitude from patients. And the clinicians doing this work are incredibly compassionate individuals. We take this work seriously and we do it cautiously and carefully and within a rigorous system. This is not easily stepped into and there are no cowboys among us. I simply cannot overemphasize how careful and cautious we are. I want people to know that.
The transcript has been edited for length and clarity.