Hesitations about MAiD

“We are not here to save lives. We are here to practice medicine.”—George Bernard Shaw, The Doctor’s Dilemma (1906)I promise that my hesitations have nothing to do with any veiled religious background. You need an abortion? I don’t do it myself, but I'll refer you; if you want one, I'll set it up. We just sign the certification, “Maternal Health at Risk”—and it’s done. So, honestly, no hang-ups from any organized faith.It’s just that I hail from a medical family. Our running joke is we have more doctors than patients. For example, just in the immediate circle: mom, me, daughter—and counting. Three just there, dozens more if you tally up all the cousins.But this means the family has a To Serve and Protect mentality. We’ve all shared emergency room stories about saving an eye, saving a limb, reviving a person after a heart attack, getting a newborn to breathe, or preventing an intracranial bleed from going south. We’ve all had instances when we saved a life; or when we couldn’t, how we heroically tried.We consider a cut nerve a tragedy, a partially removed colon a lifelong sentence, or eye surgery gone wrong devastating. That’s how we think. And we’ve spent so much brainwork on learning how to protect your kidneys and blood vessels and bones and liver, that’s our go-to, default position. Our whole medical lives, we’ve only heard about quality of life, not quality of death.Plus our general South Asian view of the elderly: we don’t subscribe to the idea of discarding seniors once their useful productive capacity has been exhausted. The retirement home corporations, who want to capitalize on this market, don’t get it.But the times they are a-changin'. Doctors are now licensed to kill, to offer you “a comfortable and dignified death.” It takes considerable mental gymnastics to incorporate this latest social sanction, but it’s doable. Now the technocrats, who want to legalize everything, will let us do away with an entire person. So we shall learn how to choreograph worthy deaths. Here’s the number for the MAID Care Coordination Service if you don’t believe me: 1-866-286-4023.Read: Dr. Shafiq Qaadri: The quiet appointmentJimmy Jimmy was a workingman in his mid-60s. He was of the grin-and-bear-it school, not seeking healthcare much. His thinking was—if it ain’t bleedin’ or fallin’ off, I’m good. He had the expected conditions: spinal osteoarthritis, chronic shoulder pain, high blood pressure, elevated cholesterol, obesity. Daily homemade wine was a must, cardiac exercise had little place, and there was no life without generous carbs. Of course, he smoked—“Only five a day, doc. That’s not much?”He was a lovely man, worked hard for his family, earned an honest wage, and did right by his union and his buddies. He was proudest when he saw his kids go to college or get good jobs. Like so many, he had been looking forward to “resting my bones,” slowing down, spending time with grandkids, and getting to those long-deferred home projects and hobbies. Maybe a little travel. Fortunately, he followed his own father’s advice, who told him 35 years ago to buy the biggest house he could afford. Jimmy did this and he is a property millionaire. As far as I could see, his one great indulgence was a monstrous, high-powered motorbike. After photos of the grandkids, he would be happy to show bike poses. He even had an ominous leather jacket, which is de rigueur for bikercraft.We will likely never know why he got so ill over the past 16 months. Probably inhaling a lifetime of toxic dust, fibres, mould, asbestos, insulation, and debris at all those construction sites had something to do with it. But we can’t be sure.Sick of waitingJimmy was now waiting for a transplant at the University Health Network, Toronto. His condition had deteriorated: excess pain, fatigue, and general misery. Even the newest medications, the biologics costing thousands of dollars per year, didn’t seem to answer. The brochures his specialists gave him, featuring smiling transplant recipients, belied his day-to-day lived experience.But like so many waitlists in Canada, there was no getting around it. You have to wait for social housing, immigration approvals, autism therapy, hip replacements, MRI tests, school board psych testing for your kid, even getting accepted into a family practice. Of course, indefinite waiting while your lifeforce fades is especially nerve-wracking.A modest proposalI cannot prove this, it’s just my reading; my impression, perhaps mistaken. But Jimmy never once asked about assisted dying; he likely had never heard of it. But certain members of his family did—therein lies the rub. I was slightly appalled and disappointed and hurt when his family brought it up.He was not in a good place, but he was reasonably patient waiting for a potential transplant. A fighter, he was in modest spirits. He never gave you the impression that he wanted to leave this world.So the vibe was just off.Now I had to act as MAID advisor and gatekeeper to his relatives.For sure, his whole family was compassionately concerned about his current status. No doubt they didn’t want him to live in pain, getting weaker and frailer than they had ever seen. Seeing Jimmy deteriorate affected the family too. But was that the whole motivation?The vibe was just off. Was this the Law of Unintended Consequences?I couldn’t help but think that immediate money distribution and property inheritance played some role in some of the family’s newfound exploration of assisted suicide. Jimmy wanted to do right by his family: so over the span of a few weeks, they convinced him to register for MAID.How to die in 9 minutesWhen you learn about the process of therapeutically ending a life, it’s quite startling. It’s faster than Uber Eats, watching your 11-year-old finish a math assignment, or baking cookies.Of course, there’s paperwork. You have to get all of two—two of the 100,000 available!—MDs or nurse practitioners to sign off on a MAID request. They are to verify that your request is genuine, taking 90 days to do so. Various consents, waivers, and legal releases have to be signed and witnessed. (You can even get anonymous folks, “Find an Independent Witness for MAiD” to witness your forms by Zoom; for a fee, of course.).Then it comes down to drugs. Essentially, three separate intravenous infusions are given. By iv push, 10 milligrams of Midazolam ($2.80), a sedative and distant cousin of Valium. That relaxes you. Then 1000 milligrams of Propofol ($30), which is an anesthetic that puts you into a coma. (It’s also called milk of amnesia. That’s what Michael Jackson was using at home for a good night’s rest but ended up with eternal sleep.) And then 200 milligrams of Rocuronium ($80), which blocks nerve signals to your breathing muscles. Of course, the medications are covered by the government; patients don’t pay. I just list the prices to show how cheap death is. So no more inspiration, only expiration, nine minutes end to end. For $112.80, about the price of a four-slice toaster, you can humanely take a life. The pharmaceutical industry is currently busy developing intravenous drugs that will speed this up. So far, the record for death by iv drug administration is one minute. The ones that instantly killed the patient were considered too painful.Oh, yes: the family streamed the death live on Zoom from Jimmy’s home for well-wishers to watch. Cake, candles, a celebration of life, he was surrounded by loved ones—they called it “Goodbye Day.” You’re that sad you wanna die?At least Jimmy had physical ailments, which severely affected his quality of life and survival prospects. Doctors might agree (?) that patients with devastating physical sickness--such as metastatic cancer or degenerative diseases like ALS—might not want to go on living. But now the technocrats want to authorize MAID for mood disorders, and governments across the country are once again considering options.One of the key symptoms of depression is not wanting to live: either the idea of suicide or an actual attempt is part of the architecture of emotional disorders. What’s more, a person who is chronically sad and down and withdrawn, that may be a proxy for so much more. Poor parenting, abusive relationships, malnutrition, poor housing, disability, lack of supports, addiction, chronic unemployment, and so on. So you can be 18-years-old or over, come from a bad situation, be diagnosed with depression, and then legally seek death?That will take a lot for MDs to accept. And yet there are strong voices from informed stakeholders on either side. Some patients are even suing the government for the constitutional right to die by psychiatric MAID. One mother spoke about her daughter to Maclean’s, “(Claire) is so continually, excruciatingly ill that MAID for mental illness is the only way that she is going to get peace. It’s taken me a while to get there as a mother, but I know that at this point.”But will death then be considered a general remedy? We’re going to address socioeconomic determinants of health with lethal intravenous drugs?Criss-crossing both sides, the lawyers are fighting the doctors who are fighting the ethicists who are fighting the professors. So no one knows where this will land. For now the official decision on psychiatric MAID has been punted to 2027.AdieuJimmy’s funeral was sweet, a memorial of his life and legacy. Some of the grandkids gave speeches. Of course, there was no mention of MAID, but some knew.Listen, I will adjust with the times. If this is what folks want, I guess I can accommodate. But I have to say, I’m still glad that of the 60,000+ Canadians who have died with for medical assistance, so far I haven’t had many. And unlike learning most medical procedures, unlike other therapies, this one requires a whole lot of psychosocial management--not just for the patient and their families, but for us mere mortal doctors and society too.As the Hippocratic Oath says:Primum non nocere.Above all else, do no harm.Dr. Shafiq Qaadri is a Toronto physician.

Hesitations about MAiD

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