P.E.I. doctor calls his role in medically assisted death a 'profound experience'

Dr. Matt Kutcher calls his role in the medically assisted death of his patient a "profound experience" that has forever changed him as a physician.

"To be in a situation where you were about to end someone's life and have them look you in the eye, and hold your hand and say, 'Thank you so much,'" said Kutcher.

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Helping Paul Couvrette on May 10, 2017 was the first time Kutcher had been involved in a medical assistance in dying (MAID) procedure.

"It did feel pretty profound. You were able to really provide somebody with the means to realize a decision that is probably as momentous as a decision can be," said Kutcher.

Reflecting now, close to a year later, Kutcher says it is a totally new role for him as a physician in one sense, but also completely in line with everything physicians do, including alleviating suffering and providing "some measure of happiness in difficult circumstances."

"I don't want this to be something that's whispered about, that's hidden behind doors," said Kutcher.

"We have a law that governs it. It's regulated carefully. It's done with great care by the people involved in it." 

12 medically assisted death requests in 2017

Couvrette was 72 when he died — one of six Islanders who had a MAID procedure last year and one of 12 who requested a medically assisted death.

For privacy reasons, health officials won't provide many details, but say most of the six procedures involved men, aged 59 to 74, with cancer being the most common underlying condition. Some were performed at home; others in institutions.

The procedure became legal in Canada in June 2016, but there were no MAIDs provided in P.E.I. that year.

Some of those who requested a MAID passed away without using the procedure, while a few were denied because their health problems were not considered serious and irreversible as required by law, according to Dr. Andre Celliers, chief of family and community medicine with Health PEI.

A person must be also be assessed by two medical professionals (physicians or nurse practitioners) as mentally competent when they request a MAID and again on the day of their death.

• More than 2,000 Canadians have died with medical assistance since legalization

Celliers said he's not aware of any problems accessing professionals to do the assessments or procedures. 

However, if a patient's family doctor isn't comfortable taking part, Health PEI has a small pool of professionals patients can access through the province's 811 health services line, he said.

'They know what they want'

"There are many circumstances when people want to have control over the manner of death, and this is what the choice entails — that they have the ability to decide how this is going to play out," said Celliers.

Once approval is given there is a mandatory 10-day period of reflection.

"As a rule people are very thoughtful when they apply for this," said Celliers. "They know what they want. They know how they want this done and we try to be respectful of their choices."

If the procedure is performed in a hospital or other institution Celliers says it's arranged in a private area and only staff who are comfortable with the process are involved.

Sharing their story

Couvrette's widow, Liana Brittain, says he urged her and Kutcher to share his story to help demystify the process and make people feel more comfortable talking about it as one of their end of life options. 

It was a message Couvrette reinforced on the day he died, she said.

"He said, 'I want everybody to know that they can die with dignity and they do have choices. Make my death have meaning. Tell our story,'" said Brittain. "In his very last moments of life he was thinking of others and how he could best help them."

Couvrette had advanced stage cancer and lived at home for months under the palliative care program.

Kutcher met with Couvrette several times to assess his competency, and had no doubts about his commitment to his decision.

Once Couvrette's MAID was approved, "it was like the weight of the world had been lifted off his shoulders. It gave him a sense of control, a sense of well-being," said Brittain, adding her husband didn't want to suffer or for others to watch him suffer.

"It really gave him a lot of peace for quite a few months," added Kutcher, "knowing that when he was ready that he could avail himself of this."

Normalizing the discussion

Since Couvrette's death Brittain and Kutcher have shared his story several times: at a medical conference on end of life issues in Halifax, to staff at the Prince County Hospital, and at a teaching session for P.E.I. family medicine residents.  

Kutcher says their collaboration has developed into a friendship that has made him a better doctor. "She has helped me learn better ways to speak to families. She's helped me develop materials to give to families."

He now includes MAID in a "basket of medical services" available to those facing end of life options, that also includes palliative care and hospice. "I do so in an attempt to sort of normalize the discussion."

Hearing a family member is thinking of MAID has the potential to leave families, shocked, angry and upset, however Kutcher said the families he's talked to have been supportive. 

"Certainly over a good number of days and open discussion, most often everybody rallies around their loved one and supports the decision, even if they themselves feel that it may not have been the appropriate choice."

Getting approval

Brittain says she would like to see advance directives allowed so people don't feel rushed to have a medically assisted death before they become incapacitated. She says her husband might have chosen a later date for his MAID if an advance directive had been available.

Kutcher also worries that the requirement to be competent at the time of the procedure "may have the unintended consequence of pushing some patients or nudging some patients" to choose an earlier date for their procedure. 

As more people become aware of the procedure and with an aging population, Kutcher also wonders whether there will be enough people to provide the service. He said most of the physician's work is done after hours, including several lengthy meetings for the assessments. "You're being asked as a physician and as a care provider to make some pretty serious judgments you don't want to be rash about."

A number of issues being debated now about the law, include whether mature minors should be offered the procedures, and patients in the early stages of Alzheimers. 

Since her husband's death Brittain has been busy writing material for doctors and patients to help them through the process and working with Dying with Dignity Canada to share the stories of those families that have experienced MAID.

She's also writing a book about MAIDs that she hopes to publish by the end of the year. 

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