Answering the call for an assisted death has 'taught me more about living my life than dying': MAID manager

Talking about death is a big part of Michelle Fisher's job.

When a person decides to enquire about a medically assisted death, she's the one who answers the phone. If that person is eligible for the procedure, Fisher could be in the room when it happens.

She enters their world at a time when it is filled with emotion — if not for the patient, then for their family members.

But she said she and her colleagues in the Saskatchewan medical assistance in dying, or MAID, program draw strength from each other — and from their patients.

"We talk a lot about 'how long can we do this work?'" said Fisher.

"And I know all of us in the program, we've all had this conversation. And people across Canada have had this conversation, I think, because the [MAID] program is so new we don't know what our longevity is.

"But I can tell you right now [the patients] bring such strength, and they have taught me more about living my life than dying."

It's not a secret, you know — we're not in a back room hurting people or harming anyone.- Michelle Fisher, Sask. MAID program manager

Fisher is the provincial manager of the new Saskatchewan MAID program, which came into effect on Nov. 1, 2018.

Prior to working with the MAID program, Fisher built some of the first HIV and AIDS programs in Victoria, B.C. She said for the past 20 years she has worked in cancer care, managing chemotherapy and pediatric care.

The launch of the new program coincided with a new service that can connect the people to information about MAID through the provincial 811 health line. Fisher is the person who answers those calls.

Prior to the health line becoming a central access point for MAID information, there were reports of seriously ill patients missing out on the procedure because of delays.

Dr. Lilian Thorpe, a member of the MAID team in Saskatoon, said last October that reasons for the delays included patients not knowing who to contact about registering for MAID, and physicians not having the knowledge to help them proceed quickly.

Thorpe said that in some cases, the person can lose the mental capacity — sometimes due to heavy medication — to give the approval that's legally required for doctors to go ahead with the procedure.

Fisher believes that funneling access to information about MAID through the health line has helped alleviate those delays.

"We needed to be able to get that number out to people so that people could easily access it," she said.  

"I think we still have some work to do. You know, it's very difficult to advertise a phone number about a program that not everybody may agree with."

A 'patient-driven' process

Many people who do inquire about MAID decide not to go through with the procedure. Others take the information and wait to do the required assessments until a later date.

If they decide to receive MAID, there is a 10-day waiting period, and Fisher said most people will want the procedure within a month.

Fisher emphasizes that the program is "patient-driven." Once the assessments are done, her office will not call to inquire about a date or "solicit" to the patient.

Not everyone who calls the MAID health line is eligible, says Fisher, but most are.

Under federal law, a person must have an irremediable or grievous condition that cannot be cured with today's medical treatments, and a "foreseeable" death.

"Everybody thinks you have to have a terminal illness," said Fisher.

"You don't have to have a terminal illness but you have to have a disease that at some point is going to cause your death."

There are other barriers to access, though. Fisher said she still hears that some people who might have wanted MAID do not know about it, or don't find out about it until it is too late.

As well, she said access to MAID in southern parts of the province has also been hampered by difficulties recruiting medical professionals to the program.

MAID is occurring more frequently in Saskatoon than Regina, and hiring difficulties have also affected the Estevan and Weyburn areas in southern Saskatchewan.

It's not easy work, and practitioners who administer MAID always work or travel in pairs to support each other if need be, Fisher says.

There are also employee-assistance supports that can be accessed through the health authority if a MAID practitioner is struggling.

New nurses to improve rural access

Two new nurse practitioners qualified to deliver MAID — one in the north and one in the south — have recently been hired into new roles to travel to communities and improve access to MAID.

Prior to the creation of the new program, Fisher said patients had to travel to MAID providers to access the services.

Now, she says, taking MAID to the patients is a priority.

Fisher said she understands that not everyone agrees with MAID, but hopes people will support their family members if they choose to receive it.

For Fisher, the work has brought her full circle, to a position where she is often present for a person's death. 

"It's not a secret, you know — we're not in a back room hurting people or harming anyone," said Fisher.

"We are just simply trying to provide good end of life care that patients have requested and that they have the legal right to."