SASKATOON, Sask. — For two decades, Ari Avivi watched as his mother’s condition deteriorated while battling cancer. He saw his mom battle the disease bravely, but despite receiving extensive treatment, she dealt with its effects and her health suffered.
Avivi said his mother had initially fought cancer and beaten it, only for the disease to return. Although treatment again helped, its effects eventually caused serious problems with her kidneys and quality of life.
His mom, despite her declining physical condition, remained mentally sharp and finally decided how she wanted her life to end, opting to access medical assistance in dying (MAiD) before losing the capacity to make the decision herself.
“She knew the cancer was going to win. Basically, she made the decision. She said, ‘Yeah, it's going to win, but it's going to win on my terms.’ She had a 25-year running battle with cancer. And she had fought it and beaten it, and then it returned, and she fought it again and beat it,” said Avivi.
Avivi added that his mom’s faculties were 100 per cent intact and that she was sharper than a tack. She appeared at the ceremony when she received the Order of Saskatchewan while managing the medical equipment she needed to stay alive.
But Avivi said people who encountered his mother in public would not necessarily have understood what she was dealing with privately. Her medical condition increasingly restricted her quality of life and the amount of time she could spend away from home.
Under MAiD, Avivi said his mother could not simply provide advance instructions authorizing someone else to make the final decision if she later lost the capacity to consent. That became a major factor in when she chose to proceed.
“She couldn't say, ‘If my condition gets to this part where this is my checklist, this happens, this happens, I authorize my power of attorney to do the process.’ Her fear was she would lose the capacity to make the decision,” Avivi said.
When the time came, Avivi and his brother were by their mother's side in the hospital. He said the experience was peaceful and bore little resemblance to some of the frightening descriptions of MAiD he had previously heard.
Avivi recalled that on the day of the procedure, they chatted with their mom, who explained and talked them through the whole process. Then she closed her eyes, like someone who fell asleep mid-conversation.
MAiD became legal in Canada in June 2016 after Bill C-14 received royal assent, according to Health Canada. In Saskatchewan, eligibility is governed by federal law and assessed through the provincial MAiD program, according to SHA. Eligible adults must meet several requirements, including having decision-making capacity, making a voluntary request, giving informed consent and having a grievous and irremediable medical condition, says Health Canada. A person’s natural death does not have to be reasonably foreseeable, although different safeguards apply depending on whether it is, Health Canada notes.
Under the guidelines, health-care providers may administer intravenous medications to a patient in sequence to cause a peaceful death, according to SHA.
SHA says, four medications are given over approximately five minutes, and most people fall asleep and lose alertness quickly.
Avivi said his mother’s death reinforced his belief that MAiD should be available as an option for people facing debilitating illness and declining quality of life. He said the decision should ultimately belong to the individual, not to someone else’s beliefs.
“I am an advocate for it as an option for people to consider. I think it's something that is a very personal choice. I think it is very much something that is a case-by-case basis, where a person should be able to choose how they want to end their life,” said Avivi.
He added that support for MAiD should not mean overlooking what is lacking in Canada’s palliative and seniors’ care systems, as he believes more resources are needed, but improving those services should not eliminate an individual’s right to make an informed choice.
Centralized process
The provincial Health Ministry said it acknowledges that MAiD is a deeply personal matter for many people and that it balances the complex issue with proper safeguards for individuals while respecting the wishes and personal convictions of patients, families, health-care providers and health facilities.
The Health Ministry said Saskatchewan differs from other jurisdictions in the country because it has a centralized provincial MAiD program that approves all health-care workers — doctors or nurses — who will participate in administering the process.
“This centralization ensures consistency in formal and informal processes and adherence to federal legislation, including having two separate assessors complete the MAiD assessment and informing the patient of other means available to relieve their suffering,” the Health Ministry said.
“Individuals contact the Saskatchewan MAiD program directly to begin the process. Physicians and/or nurse practitioners connected with the MAiD program complete eligibility assessments, which can take days, weeks, or months depending on patient-specific circumstances.”
Saskatchewan’s provincial MAiD program co-ordinates patients seeking end-of-life care and connects them with appropriate health-care professionals, co-ordinates the assessment process and oversees the physicians and nurse practitioners who administer it. The Saskatchewan Health Authority says patients, families or health-care providers can contact the program directly.
However, the provincial MAiD program does not independently determine whether every patient is eligible for MAiD. Eligibility remains subject to federal law requirements and must be established through required clinical assessments by qualified health-care professionals.
Patients in Saskatchewan also do not need a family doctor or a referral from a primary-care provider to begin the MAiD process. This allows people to access the provincial program directly rather than making access dependent on an existing relationship with a family physician.
However, the absence of a referral requirement does not mean a patient automatically qualifies for MAiD. People must still meet the applicable eligibility criteria and complete the required assessments and safeguards before MAiD can be provided.
