It’s been nearly three years since Ken Armitage of Miniota made the last decision of his 72-year-old life. That choice was to ask for and receive, Medical Assistance in Dying (MAiD).
It was a decision that he made almost immediately after receiving the diagnosis of glioblastoma (brain cancer) early in 2021, a condition with a poor prognosis.
Ken’s whole family was supportive of his decision. However, had they known then what they know now, it would have enabled them to navigate the process with a little less stress and a lot less worry, making Ken’s last days on earth a deliberate choice instead of a race against the clock.
Their message to others facing a similar dilemma and considering MAiD as an option?
“Don’t wait until it’s too late,” said Trevor Armitage of Miniota on his father’s decision, the process, and what they went through as a family. “Plan ahead, do your homework, talk to the MAiD people so when it’s time to execute it, everything is lined up and you’re not fighting against time.”
What he means is that even though his dad had made his wishes known right from the time of his diagnosis and his medical team was well aware, MAiD wasn’t something that automatically kicked in once all other avenues had been exhausted. They didn’t realize then, all the steps involved with accessing MAiD.
Armitage advised that the onus is on the patient and their family to initiate contact with the MAiD team or ensure that their medical team has, well in advance of a potential request for services.
“MAiD is not an emergency service. The process takes time to go through,” cautioned Jason Permanand, senior media relations and communications specialist for Shared Health. “The MAiD team aims to return calls within one week, and the assessment process usually takes two to four weeks or longer to complete.
And sometimes, time, clarity and patience are things that folks don’t have a lot of near the end. At the very least, those precious moments might be better spent enjoying each other’s company while lucid and pain-free if a well-laid plan is initiated in advance.
Many safeguards are in place for obvious reasons. A strict screening process is required for individuals requesting MAID. An intake and triage process is administered by a centralized intake service located in Winnipeg. To be eligible, a person must have a “grievous and irremediable medical condition,” be over 18 years and be mentally competent. The patient must make the application themselves and be able to give consent.
A grievous and irremediable medical condition is not necessarily a terminal one. However, candidates for the procedure must meet all of the criteria: a serious illness (not a mental illness), be in an advanced state of decline that is irreversible, and experience unbearable physical and/or mental suffering as a result of the condition which cannot be relieved.
Those requesting MAiD must be assessed by two independent physicians through the program and deemed competent of making their end-of-life decision. In addition, the recipient of MAiD must be able to give verbal consent immediately prior to the service being carried out or sign a Waiver of Final Consent shortly before, granting the family the ability to act on the individual’s behalf should they become incapacitated.
The patient is asked throughout the process if they still wish to proceed and, in some cases, individuals decide not to go through with it. However, in some situations, like Ken’s, health status can decline very rapidly and if those steps have not already been completed, it can be the determining factor in whether a candidate is approved for and can ultimately receive MAiD, or not.
“I consider them angels,” said Armitage, of the MAiD team and the accommodating, compassionate and organized approach with which they assisted Ken’s family with the process and ultimately, his provision.
“Dad had his interview on a Monday morning,” said Armitage, vividly recalling the whole ordeal. Due to Ken’s rapidly declining health, Trevor said, “They were able to have two doctors meet him at the same time via Telehealth and conduct a combined interview. He wasn’t in good shape at all; he had been unable to sleep or relax, was restless, had involuntary finger tapping and couldn’t open his eyes really. But Dad wanted this so bad that he was able to answer all of their questions really well – he literally hit it out of the park.”
“‘There’s nothing for me anymore, I’ll never be myself again,’ he told the doctors during that Monday morning interview,” recalled Armitage. “Then, when they asked him when he’d like to schedule the provision, without hesitation Dad asked, ‘What are you doing tomorrow?’.”
Although MAiD wasn’t able to be coordinated quite that quickly, the provision was scheduled for Thursday. However, by early Thursday morning, Ken had lost consciousness. But he had signed a waiver of final consent on Monday, the day of his interview, allowing his family to act on his behalf. Deciding his own fate was the last gift he gave to his family. He was finally at peace knowing everything was in order. The MAiD team was dispatched from Winnipeg and the provision took place, taking less than an hour from start to finish.
The ability for individuals to choose MAiD as an end-of-life health care option is relatively new legislation for Canada, with changes to the Criminal Code of Canada originally passed in June of 2016. However, assisted death is not a new concept.
It is a contentious issue to say the least. So much so in fact, that many doctors and nurses may not even suggest it let alone endorse it, and some hospitals in the province may not support patients wishing to pursue the MAiD option. It is still new and doctors, by virtue of the Hippocratic Oath, pledge to save lives, not end them.
In 2023, Manitoba recorded 236 MAiD deaths, up from only 24 in 2016. The number one reason people report seeking MAiD services is terminal cancer, resulting in the loss of ability to engage in meaningful life activities and perform activities of daily living independently.
“Like the rest of Canada, Manitoba has generally seen a steady increase in demand for MAiD since the service became legal in Canada,” reported Permanand. “On average there are approximately five MAiD deaths per week in the province. There are more MAiD approvals each year than there are MAiD deaths, mainly due to voluntarily withdrawn requests or individuals dying prior to receiving MAiD.
Choosing a MAiD option does not disqualify any pension or insurance benefits for survivors.
In Canada, there are two MAiD options although only one is available to Manitoba residents, clinically-administered medical assistance in dying. The other, self-administered MAiD or assisted suicide is not an option. MAiD can be performed outside of a hospital setting, although in-hospital is generally the most common. It cannot be made by advanced request (non-imminent death) or directive. It is not allowed via Power of Attorney or substitute decision-maker.
“The patient is the only person who can consent to MAiD, and they must meet all the eligibility criteria at the time of their request. Patients wanting MAiD for dementia can only receive MAiD while they can still provide consent,” said Permanand on the strict adherence to policy to safeguard against misuse. “The new 2021 legislation allows for a waiver of final consent under strict circumstances. The waiver cannot be used as an advance directive or by a substitute decision-maker.”
What he is referring to is Audrey’s Amendment, a change to the legislation in 2021 initiated by the late Audrey Parker of Nova Scotia, who was diagnosed with Stage 4 breast cancer. Of course, no one fights harder for change than those who are personally affected, and she could see that this was an important piece. She was instrumental in lobbying for the waiver of final consent to be included.
For the Armitage family, this amendment came into effect on March 17, 2021, just a few short months before they would ultimately need it, allowing Ken to be granted his final wish.
Death is part of the spectrum of life and education about incurable conditions, irreversible degradation of health and about this service is key to making informed decisions regarding one’s end-of-life care.
“People need to know about their options for all types of care, which may include MAiD. Making decisions requires clarity, energy, and commitment and all of those things are compromised in the 11th hour,” said Christine Cross, who has helped countless people make informed choices when faced with a serious illness or declining health. “MAiD gives people the opportunity to live until they are ready to die.”
Both she, and Cathy Coulter, also an advocate for people’s right to make their own choices surrounding death and dying, say the feeling of helping people fulfill their last wishes in making it happen is indescribable. But, they caution, people need to get informed sooner, rather than later. They encourage families to have open, honest conversations about death and dying, and ask and answer the really hard questions that seem to be taboo in today’s society.
Coulter said, “Education, communication and documentation are vital. When those who will look after you at the end of life see your wishes and plan in writing, it reduces the stress and pressure during one of your most difficult life experiences.”
So why choose MAiD if you’re going to die anyways?
“To me, that service was invaluable,” said Armitage, the memory of his father tormented by the final stages of an illness still a vivid recollection. “My father’s life for the next one day or three weeks... he could have laid like that in pain. We don’t put an animal through that, so why would we do that to our people?”
“People think they know, but they don’t understand what is required, with regard to legalities, signed documentation and how much time each process consumes,” said Coulter. “To ensure that services, resources and options are in place when needed, people need to engage in difficult conversations about dying and learning what their loved one’s wishes are.”
