Stefanie Green - Assisted: A doctors story of assisting death and embracing life

Dr Stefanie Green spent over twenty years working in maternity and newborn care before changing her focus to medical assistance in dying. She pioneered physician-administered assisted dying in Canada, and is the co-founder and president of the Canadian Association of MAiD Assessors and Providers. Dr Green is a medical advisor to the British Columbia Ministry of Health MAiD oversight committee, and clinical faculty with the University of British Columbia and the University of Victoria.

A tender and truthful look at the idea whose time has come: assisted dying.

Andrew Denton, television presenter, founder of Go Gentle Australia

This compelling book describes the journey of a compassionate doctor as she provides end-of-life control to her suffering patients.

Dr Rodney Syme, Urologist, former president of Dying with Dignity, Victoria

I felt as though I was in the room with her and her patient at this most intimate time. It is my hope that many of my nursing and medical colleagues will read this book to help guide their own practice.

Susie Byrne, Convenor, South Australian Nurses Supporting Choices in Dying

Stefanie is what a doctor should be, compassionate, fierce and articulate.

David Seymour MP, New Zealand Parliament

After 40 years as a clinician, I dont cry easily, but this beautiful book brought tears to my eyes.

Dr Nick Carr, MA MMed MB BChir DCH MRCGP FRACGP, St Kilda Medical Group, Board member, Dying with Dignity Victoria

This exceptional book recounts the bravery of a doctor who chose to pioneer a controversial assisted dying practice in Canada, and the bravery of the patients who sought her help in the first months of legislation. It is a gripping read that challenges the readers preconceptions about what it means to live and die well.

Matt Vickers, author of Lecretias Choice

A humane, clear-eyed view of how and why one can leave the world by choice.

Kirkus

Stefanie Greens courageous account inspires compassion, joy, and deep understanding. Essential reading for patients with serious illness, their families, and all of those who care for them.

Ronald Epstein MD, author of Attending: Medicine, Mindfulness, and Humanity

First published in Australia and New Zealand by Allen & Unwin in 2022 First published in the United States as This Is Assisted Dying in 2022 by Scribner, an imprint of Simon & Schuster, Inc.

Copyright Stefanie Green 2022

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without prior permission in writing from the publisher. The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10 per cent of this book, whichever is the greater, to be photocopied by any educational institution for its educational purposes provided that the educational institution (or body that administers it) has given a remuneration notice to the Copyright Agency (Australia) under the Act.

Allen & Unwin

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Crows Nest NSW 2065

Australia

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ISBN 978 1 76052 915 4

eISBN 978 1 76106 355 8

Interior design by Wendy Blum

Cover photograph: borchee/ 925475360

Cover design: Megan van Staden

For my patients, who have each left an indelible mark

And for all the members of CAMAP, upon whose shoulders I stand

WHAT IF YOU COULD DECIDE, at the end of your life, exactly when and where your death would happen? What if, instead of dying alone, in the middle of the night, in a hospital bed, you could be at home at a time of your choosing? You could decide who would be in the room with you, holding your hand or embracing you as you left this Earth. And what if a doctor could help ensure that your death was comfortable, peaceful, and dignified? What if you could plan a final conversation with everyone you love? You might never look at death the same way again.

I knew from the first moment I met him that Ed was an eccentric man. When he opened the door to his apartment, I was struck by the variety of handmade jewelry on his body: a row of bracelets, several necklaces, and multiple earrings. A small statue of the Buddha surrounded by various colored crystals sat on the floor behind him, and a strong smell of incense wafted out of the completely unfurnished space. I had been offering assisted deathsproviding medication and helping people to end their livesfor several months by then, and I had met some fascinating individuals, the courageous pioneers and the truly desperate, but still, Ed stood out.

I got to know Ed and his story over several months while visiting him in various residences, or sometimes in the hospital, in Victoria, British Columbia, Canada. At sixty-eight, Ed was proud to say he had never held a job and had lived the life of a free spirit. He told me he had seen the world, chased his dreams, and had few, if any, regrets.

Like more than 65 percent of the people I work with, Ed had terminal metastatic cancer. His cancer had developed over four years, and never once had he consented to active medical treatment, avoiding chemotherapy, surgery, and radiation. His disease had progressed as expected and now was causing symptoms he couldnt avoid. Eds pain was reasonably controlled, but his increasing need for narcotics, his deep fatigue, and his frequent, urgent trips to the restroom were severely limiting his ability to move around independently, which made it all but impossible for him to venture outside. Life confined within four walls was not a life for Ed. He was articulate in his explanation of the loss of meaning in his everyday experience, the dwindling of sand in his hourglass. He was a true believer in reincarnation, he told me, and was eager to move on to his next life.

Ed was also the first person to tell me he wanted to die alone.

When I arrived on the day of his scheduled death, he was in a small private hospital room, a surprising choice for where he wanted to die, and we chatted for a while first. He seemed ready, eager to proceed, tired of waiting. After a few minutes, he excused himself to go to the washroom and returned wearing a full clown suit: tie-dyed pants and T-shirt, a colorful clown wig, and a red nose. He told me he hadnt been sure if he was going to use the nose or not, but in the end, hed decided to go for it. Despite all our previous conversations, Id never realized Ed was an amateur clown. I asked him why hed chosen to wear the clown suit on this day, and he told me he wanted to go out laughing. He figured this was his best bet.

I called for the nurse, and as Ed was having his IV started, I excused myself to go see his friend Maggie, who he had asked to wait in the quiet sitting area nearby. About ten years his junior, she was sad but coping. I wanted to explain to her what would be happening even though she wasnt going to be in the room with us, but before I got started, I mentioned that Ed had put on his clown suit.