Medical Assistance in Dying

Last Wednesday (March 7) it came to my attention that there is a heated debate in my area regarding the provision of Medical Assistance in Dying (MAiD) within a hospice/palliative care setting.  My local newspaper posted this article. 

In response to this article I have written the following letter to our local Hospice Society (and subsequently also to the Hospice itself which is run independently) which I also submitted to my local paper as an open letter to the editor.  It is my hopes that it will be printed in tomorrow’s publication.  I share it with you all here.  I welcome you to share it with whomever you desire.

In writing this letter I have uncovered that it is the Fraser Health Authority which is in the process of mandating ALL Fraser Health facilities, inclusive of palliative care, offer MAiD (another article about what’s going on here).  This alarms and concerns me.  Things move slowly in my life, but my next step is to write a similar letter directed towards Fraser Health.  Furthermore, the Canadian Society of Palliative Care Physicians is advocating for exclusion of MAiD from Palliative facilities and provides assistance to Canadians in advocacy and advice.  As such, I plan to enlist their help.

Thank you for taking time to read my concerns.

Dear Sue,

I write in response to the recent article in The Chilliwack Progress informing Chilliwackresidents of the Chilliwack Hospice Society’s pending decision regarding allowing Medical Assistance in Dying (MAiD) “in house”.

This matter is of utmost concern to me as I am a Chilliwackresident and was diagnosed with terminal brain cancer in October 2016.  I have already lived past the average survival of individuals with my diagnosis.  It comforts me greatly to know that my community has comprehensive palliative services.  However, it alarms me that the society providing these services is considering allowing MAiD.  I strongly petition you to NOT support MAiD within your programs and services.

I firmly believe that the vulnerable process of dying naturally is beautiful and allows a special bond of love to flow between the person breathing their last breaths and the loved one bearing witness to it.  This is a beneficial and shaping experience and is what I desire for my own death.  I make this decision with my personal experience of encountering the beauty and value of being present in the tender moments of my grandmothers’ last days. 

 As I see my own death approaching I’ve already begun to experience the beauty and vulnerability of dying.  Until recently I was a pharmacist and a depended upon health care provider in our community.  I am now the patient trusting my health care team.  Additionally, as a mother I was accustomed to caring for my 3 young children.  Now I am the fragile, dependent, and needy one.  I’ve had to ask for and accept a great deal of help.  Yet in receiving this help I’ve gained much more than the practical support I’ve needed.  These beautiful acts of humanity have been life-giving gifts for both the givers and myself. 

At the same time, my diagnosis is precipitating raw and vulnerable conversations.  While rewarding these are difficult waters to tread.  This journey requires courage; in my frailty I rest on the shoulders of those supporting me to garner this courage.  Meaningful and safe relationships are of utmost importance.  I need to know that those supporting me are fully invested so I can lay bare my aches, disappointments, heart, and hopes to continue on this courageous journey.   I need to ensure that my care will continually foster this unguarded openness.  This is a vulnerable state requiring utmost trust in those I surround myself with.  I am exposed.  Because I am exposed I need to ensure that my circle of trust is not broken.  As palliative care physician Dr. L. Herx states, “The foundations of our work in palliative care are trust and relationship.” She continues, “Is trust really engendered when we reach out with one hand inviting patients to engage in the hard and intense work of addressing their suffering, while in the other hand we hold the needle to end life?” ¹ To ensure vital trust is protected at such a vulnerable time in life it is important to clearly segregate palliative and hospice care from any provision of MAiD.

Furthermore, I long for my care to be focused on living well while at the same time be fully committed to the arduous process of dying.  Indeed, the World Health Organization defines palliative care as affirming life and intending to neither hasten or post-pone death².  I believe the Hospice Society has championed this definition by supporting the palliative patient through providing holistic care and comfort as a patient lives their last days.  I am tremendously grateful a compassionate local environment like this exists where independence, as much as possible, is valued.  This will enable me to live as fully as possible, while I’m alive. To provide MAiD in this setting would be utterly off-focus and contrary to the purpose of a hospice and palliative care.  I plan to LIVE until I succumb to my disease.  This is an entirely different mind-set than choosing to die prematurely.  These 2 mind-sets cannot co-exist, certainly not housed under the same roof.  As Lincolnsaid, “A house divided against itself cannot stand.”

To continue providing this city, including myself, my husband and my 3 young children, with vital and life-bolstering care I sincerely urge the Chilliwack Hospice Society to safe-guard an environment of vulnerability, openness and whole-hearted support by NOT supporting MAiD within your programs and services.

Best Regards,

Cheryl Rostek

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