B.C. man is one of the first Canadians with dementia to die with medical assistance

When Canada's medical assistance in dying law was passed in 2016, the widespread assumption — among doctors, lawyers, patients and even MAID providers — was that it excluded those with a dementia diagnosis.

Gayle Garlock decided to challenge that assumption. On Aug. 26, the Victoria man became one of the first Canadians with a dementia diagnosis publicly reported to have received MAID.

His case is a sign of a growing consensus that a dementia diagnosis does not necessarily preclude eligibility. 

"In my opinion, the majority of providers in this country have come to the conclusion that patients with dementia can be assessed for an assisted death, that some of them may be eligible in certain circumstances, and if that is the case, they'd be willing to help them," said Dr. Stefanie Green, the head of the Canadian Association of MAID Assessors and Providers (CAMAP).

If someone with dementia meets the criteria for MAID — mental capacity for informed consent, intolerable suffering, and a foreseeable death — they should be eligible, she said. 

This is not an expansion of our law … This is a maturing of the understanding of what we're doing.— Dr. Stefanie Green

Green, who provided MAID to Garlock, was initially hesitant to speak publicly about the case, but decided these assisted deaths should not take place "in secret."

Barbara Garlock, Gayle's widow, said he wanted his story told.

"It was hugely important to Gayle that some good come out of this. Many people don't want this option … but for those who want the option, I hope, he hoped … it would open the door for them," she told The Sunday Edition's documentary producer Alisa Siegel. 

Losing the ability to read

From the beginning of their marriage in 1968, Barbara knew Gayle's "need to read" was integral to who he was. 

Then one day, the retired university librarian and scholar found that he couldn't read a map. In 2014, when he was 70, he was diagnosed with Lewy body dementia, the second most common form of progressive dementia after Alzheimer's disease. The condition also involves physical symptoms similar to Parkinson's disease. 

"That was one of the losses that he would define as intolerable suffering: being unable to read," said Barbara. 

He wasn't ready to die yet, but wanted to know if MAID would be an eventual option. 

When he first met with Green in 2018, the doctor turned him down. She wasn't sure he met the criteria, and she wasn't sure she would be willing to help him even if he did. 

His case "seemed very much on the edge. ... The risk of not meeting the eligibility criteria, or not being found to have done so properly, is a criminal offence, which leaves me liable to go to jail for up to 14 years," Green said. 

"I promised my husband when I first started doing this work that I would do it openly and honestly and publicly, but that I would not go to jail."

Reconsidering the request

Green stayed in touch with Gayle and continued to think about his request.

In 2017, she had received an application for MAID from Mary Wilson, a Victoria woman with Alzheimer's. Green considered helping her, but withdrew from the case because of the risks involved. 

"I don't think that was a very courageous choice of mine ... I remember thinking that if I was ever placed in the same position, I would look very seriously at helping someone," Green said.

Wilson died with medical assistance on Oct. 29, 2017. In February 2018, the College of Physicians and Surgeons of British Columbia opened an investigation into the three doctors involved, as reported in the Globe and Mail.

At the same time, Green's colleagues at CAMAP were assembling a new guidance document that outlined the circumstances under which people with dementia might be eligible to receive MAID. 

Ten months after the Wilson investigation began, the college cleared the doctors involved of any wrongdoing. 

In the spring of 2019, after extensive conversations with colleagues and legal scholars, Green decided she was ready to reconsider helping Gayle. She did a second assessment.

The more we talk about this topic ... the better our deaths will be, however we want to shape them.— Dr. Stefanie Green

By then, Gayle's condition had deteriorated. His mental processing had slowed, and he struggled in conversation. 

"I was able to determine that Gayle still knew what was going on around him and with him. He understood that he had dementia, that it had progressed," Green said. 

"At that point I really believed that Gayle had both capacity and was suffering intolerably."

On May 9, she approved his MAID application. 

Capacity for informed consent 

But in July, Gayle woke from a nap and, for the first time, didn't recognize his wife. Barbara worried he had lost capacity and would no longer be eligible for MAID. 

Green said capacity is more complicated than people realize. "Capacity is ... not a flick of a switch. It can fluctuate. It can come and go," she said. 

Green said the case may still spark concerns about whether the law is being expanded, but she argued it does not represent a "so-called slippery slope."

"This is not an expansion of our law … This is a maturing of the understanding of what we're doing," she said. 

Pauline Tardif, the CEO of the Alzheimer Society of Canada, said the case "brings to light the diverse interpretations of MAID by the medical community and underscores the ongoing debate of the law as it relates to Canadians living with dementia. 

"The Alzheimer Society supports Canadians with dementia by providing them with information and honouring the decisions they make about their personal and health care, including at end of life."

'This can be done well'

On the day of his death, Green first met with Gayle alone. 

"Gayle knew who I was ... He knew that I'd be giving him some medication that would cause his death. He knew he very much wanted that to happen," Green said. 

Barbara lay down next to Gayle and held him. Their sons, seated at the foot of the bed, told him what a wonderful father he had been.

"I was just lying next to him, saying, 'I love you.' Just whispering in his ear repeatedly," Barbara said. 

Green began administering the medication. Gayle died peacefully a few minutes later. 

Green hopes this case shows "that this is possible, that this is legal, that carefully done, this can be done well."   

"The more we talk about this topic, the more comfortable we'll be, the better our deaths will be, however we want to shape them," she said. 

Click 'listen' above to hear Alisa Siegel's documentary, Ten Minutes to Midnight.