Growing awareness of medically assisted dying leading to rising numbers, advocate says

Eight months after his brother ended his life on the date of his choosing, Jeffrey Keep still wishes he could give him a call. 

"He and I were the jokesters with the family," said Keep. "I used to phone him up on a bad day and just joke for a while, just to sort of make things better." 

As much as he misses his brother, whom CBC is not naming at the request of family, Keep is grateful his brother was able to choose when to die. At 67 years old, Keep's brother had multiple sclerosis and had lost the use of his arms and legs and required constant home care.

"He had been suffering greatly for the last six or eight years to the point where he couldn't do anything for himself," said Keep.

This June marked three years since the federal legislation on medical assistance in dying (MAID) came into effect. Keep's brother is one of 284 people in Manitoba who have received MAID, as of May 31, 2019.

Cheri Frazer, a founding member of the Winnipeg chapter of the advocacy group Dying With Dignity, attributes the increase to growing awareness about the program. Data provided by Shared Health shows an increase in the numbers of people requesting and receiving MAID in the first few years of the program. Midway through the year, 2019 appears on pace to match or exceed the number of people who received MAID in 2018.

"Judging from the sheer number of people who say to me, 'I didn't know this was legal,' I would say a good proportion of those reasons is that education, word is spreading," said Frazer.

Cancer No. 1 reason for MAID in Manitoba

In April, Health Canada released its fourth and final interim report, monitoring the progress of MAID across Canada. According to the report, which covers the period from Jan. 1, 2018 to Oct. 31, 2018, the average age of people who received MAID in Manitoba was 72. 

The most common underlying medical condition for people who received MAID in Manitoba was cancer (72 per cent), followed by cardiovascular disease (12 per cent), neurodegenerative diseases (8 per cent), respiratory illness (3 per cent), and other illnesses (6 per cent).

One aspect of Manitoba's MAID program that distinguishes it from other jurisdictions is the fact that Manitoba has a single, centralized team that assesses requests before applicants submit their written requests. This means there are fewer declined requests in Manitoba compared to other provinces, Health Canada said in its report.

Keep praised the work of the MAID team in helping his brother through the process.

"I think that it's an amazing program. Those people are amazing," he said. "They were patient even when he got mad and blustered at them, because, of course, he was in a lot of pain. They were always calm and cool and very sympathetic, and always put their arms around him and stuff like that, which is what you need."

Death being reasonably foreseeable doesn't have anything to do with the misery of your existence until your body decides to die.- Cheri Frazer, Dying With Dignity

Initially, Keep's brother didn't qualify for MAID because, although his multiple sclerosis caused him great suffering and would certainly kill him eventually, doctors couldn't say when that would be. Only after seeking help of lawyers from the B.C. Civil Liberties Association was Keep's brother able to qualify. 

Frazer, of the Winnipeg chapter of Dying With Dignity, would like to see the clause in the federal legislation requiring a patient's death to be "reasonably foreseeable" to be changed.

"I think that's really deeply unfair," she said, adding that it "violates the spirit" of the Supreme Court's decision striking down the ban on medically assisted death.

"Death being reasonably foreseeable doesn't have anything to do with the misery of your existence until your body decides to die. And that was the whole purpose of giving Canadians the ability to die with dignity."

MAID opponents 

The implementation of MAID has not come without controversy. Many faith-based health institutions such as St. Boniface Hospital, which is governed by the Catholic Health Corporation of Manitoba, refuse to allow medically assisted death to be performed on their premises. Patients wishing to receive MAID can be assessed on-site, but must be moved elsewhere to receive it, a practice Frazer wants to see changed. 

Advocates for people with disabilities worried that people would be pressured to end their lives prematurely, but Frazer said she has not heard of any cases of that happening.

She would also like to see changes to the law preventing patients from including MAID as part of their advance care plans, which spell out what medical services they want to receive should they lose the capacity to consent.

Having watched his brother go through the MAID process, Keep wishes it could have been available to his mother when she was nearing the end of her life, or for friends of his dying of AIDS in the 1990s. 

"I think [MAID is] the best thing that's ever happened," he said.