Green, who has begun to see both experiences as childbirth, says that for more than two decades as a maternity doctor she prepared her well for her new career by providing medical assistance in death. “I really find them very, very similar moments,” said Green, who has helped with more than 1,500 births and now more than 300 deaths. “In both traditions, as I call them, I am called to a more intimate moment in people’s lives.” Green made his first medically assisted death on Vancouver Island a few days after the service was legalized in Canada in June 2016. She has now recorded the first year of these bittersweet stories in her memoir This is Assisted Dying: A Doctor’s Story of Empowering Patients at the End of Life, published by Scribner, part of Simon and Schuster, and on the shelves this week. “Something deep is happening,” says Green. “I guide it, I direct it. I make sure the right people are in the right place. “And as soon as I tell someone that my heartbeat has stopped, I leave gently and quietly and leave the room.” “Something deep is happening,” says Green. “I guide it, I direct it. I make sure the right people are in the right place. “And as soon as I tell someone that my heartbeat has stopped, I leave gently and quietly and leave the room.” She then gathers her thoughts while walking on her favorite Oak Bay beach with her dog, hiking on the island or rowing with her kayak. “I imagine Meg carrying Richard in their bed and I think I have learned what love can look like,” wrote Green, 53, who is married to an astrophysicist who became a businessman and is the mother of two grown children. Today, Green, who started out as a family doctor, is in the waiting room of the same Fort Street office in Victoria, where she has been advising expectant mothers for much of her 22-year career. The walls are decorated with snapshots of infants, many of which he can even name. Those who now come to the same office to be evaluated for medical assistance in case of death say that they like the lively air that the photos of the baby bring to the examination rooms. The average MAID patient is 75 years old, although Green says he has helped people between the ages of 27 and 105, referring to the latter patient as “quite a character”. He has helped members and even leaders of all religions. More than 65 percent of those she helps have advanced cancer. Green’s work has gained international attention following an article in the New York Times about the assisted death of 78-year-old former president of the BC Government and Employees Service, John Shields. The Oak Bay resident died in March 2017 at Victoria Hospice after being diagnosed with a rare and incurable inherited form of amyloidosis two years earlier, a painful and disabling disease that would eventually see him lose the use of his arms and legs and closes his heart. A political rights activist and former Catholic priest who became a social worker, then president of a union that negotiated landmark pay agreements, Shields decided in the days before his planned death to make an Irish awakening – full of drink and Swiss sausage. Following the New York Times article, a literary agent in New York approached Green to write a book about the early days of assisted death. In the book, Green tells the story of the “free spirit” Ed, 68, who on the day of his death chose to wear a clown costume, a red nose and a colorful wig. Despite their many conversations, Green did not know he was an amateur clown. She rolled with him and alone with him in the room, he forced her by telling his favorite joke. “I heard him laugh,” Green wrote. “Then he closed his eyes and fell asleep.” In the early days of evaluating people for medical assistance in the event of death, Green was tormented by the thought of risking up to 14 years in prison if she did something wrong – a mistake in evaluating a person for MAID, a complaint from an angry family member who opposed the patient’s choice, a mistake in the procedure. Writing about her first assisted death, Green says: “Harvey is not just my first assisted death. It is the first MAID death on Vancouver Island and one of the first in Canada. “I know I have to do it right – for myself, for the MAID program, but most importantly, for Harvey.” At the time, Green was one of three providers in Victoria and five on the island. Green went on ferries, helicopters, highways and water taxis to help patients across the island and county. In the first four months of MAID, Island Heath had an average of six assisted deaths per month. In the first year, the island provided three times the national average. People would look for Green on their own because their GP “did not want to be confused” at MAID. Green describes the “noticeable” sigh of relief most clients expressed when they were told they were eligible for MAID and struggling to get away with unbearable pain because the law restricted the process to people whose natural deaths were “Reasonably predictable”. Few who are considered eligible for MAID change their minds, he says. “Once my patients were no longer afraid of how they might die, they focused on life and allowed themselves to embrace the rest of their lives more fully,” he writes. Green triples its bureaucracy, ensures that patients are aware of their options for palliative care, travels to each procedure early to start exactly as expected, reviews the plan with the patient and gets their final agreement to proceed and takes with her a spare set of medicines. Most patients choose MAID with a series of injections given by a doctor – the first drug is an antidepressant drug that puts the patient to a light sleep, followed by a local anesthetic and then a third drug, propofol, which puts the patient on a coma and finally a paralytic. The patient is seduced to sleep and usually during the third medication, breathing and heart stop slowly. Patients also have the option of getting a formulated drink, but few choose this option. Green says that most people want to die the way they lived – some choose rock music to be heard, some prefer classical music that lullabies them, while others live in the silence of silence. Many people use the intervening time to sort out their home and relationships. Sometimes there is drama. In her book, Green tells the story of a grandmother who eventually tells her grandson to “clean up your mess” before driving him out of the room, and that of an adult daughter who, just seconds after the first anesthetic is injected. mother, conveys words that have not been said for decades. Green describes the ossified hand of an 88-year-old mother on the “pale, smooth, steroid-induced cheeks” of her 67-year-old child with end-stage cancer, saying her last goodbyes. After more than 40 assisted deaths, “it was the first time I felt tears I just could not hold back,” Green wrote. “It’s impossible not to project myself in some situations,” Green said in an interview. “Some of them are torturous. I mean, the meaning of saying goodbye to your child is something… that takes my breath away… it’s a lot – we all have a limit. ” Green also helped a 40-year-old woman he knew. The woman was diagnosed with end-stage melanoma that had metastasized to her lungs, liver and brain. “I love you mom” were the last words of the woman’s daughter, as Green was about to give the first needle. Green usually asks the patient to think of a favorite memory before falling asleep. This woman said, “There is so much to choose from.” Shortly before he died, Ray, who was in excruciating pain, told Green: “I understand this may sound ridiculous, but I feel you saved my life.” There are more moving stories than sad ones – like the family singing “Who could ask for more?” from I Got Rhythm. Woven through This is Assisted Dying is the story of Green himself – what shaped the person who would choose to lead MAID, lead the Canadian Association of MAID Assessors and Providers, and advise governments on how to improve legislation on medical assistance in death. Green talks about how her parents’ less friendly divorce and subsequent marriages forced her to be independent and take care of herself. She explains how Judaism gave her a sense of belonging and a moral compass and in detail how her role as a mother and husband required her to set boundaries in her new profession. Green hopes the book will spark discussion and reduce the stigma surrounding making end-of-life decisions. It would take her four years in the practice of assisted death to express her last wishes with her husband. It took about the same time for her mother to make her wishes for her death known. The government, meanwhile, is still considering eligibility for assisted death. The law that allowed it came into force on June 17, 2016, but the government’s eligibility criteria said that the natural death of the beneficiary must be “reasonably predictable”. In the years that followed, the criteria of “reasonably predictable death” proved problematic for evaluators and service providers. It was challenged in 2017 and 2019. As of March 17, 2021, the law no longer requires a person’s death to be “reasonably predictable.” On the contrary, those who wish to receive a MAID must “be in an advanced state of irreversible reduction of capacity and have a permanent and unbearable …
