Dying Indignity

Witnessing my father's medically assisted death in Canada

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I share my account of my father’s euthanasia as a reference case study for those watching, studying, campaigning, safeguarding, and legislating around Medical Assistance in Dying (MAiD) in Canada and its equivalents elsewhere. We hear many uncritical claims that there are no problems with MAiD and that suicide, or not-suicide as MAiD is sometimes promoted, is somehow always dignified, a noble “choice”. Such sentiments avoid the complexity of people’s lives and relationships that shape suicidal responses to illness. MAiD, in my experience, at least as currently formulated and legislated, unforgivably misunderstands, mis-approves, and often failingly provides death, and thus misses those infinitely precious, sacred, opportunities for life. To even begin to understand a death, it is necessary to understand a life. And yes, most definitely read between my lines.

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My father was killed, in front of my family and me, by his Medical Assistance in Dying (MAiD) provider, a physician, in some numbered hospital room in Victoria, British Columbia, in the summer of 2021. Though he was mid-way through the 90-day assessment period required for Track 2 MAiD requests (non-foreseeable death), he was quickly moved from Track 2 to Track 1 (foreseeable death), having passed both required assessments.

One week before dying, he had moved into a newly renovated and appointed Assisted Living apartment and said the food was good and he was keen for the in-house barber shop. Two days later, he began refusing meals. Two or three days after that, he fell, during a heat wave that overtaxed local ambulances and paramedics. As a result, he was left on the floor of his apartment for six or seven hours before an ambulance could reach him, and the staff had a ‘no lift’ policy. He was incensed. The first time my family and I heard from his MAiD Provider was at this time – forty-eight hours before death. My father indicated that his assessors could contact the family at any time, so it is unknown why we were not previously notified. We were told simply that Dad had been track-moved, and that we should get flights now if we wanted to attend his death in two days.

The provider told me that he was track-moved because a) he started refusing solid food (or just skipped dining room meals because he found it hard to get to; and not, as we discovered, caloric liquids), and b) that his elevated white blood cell count indicated a possible infection (or, a side-effect of his prednisone - unmentioned) that he did not immediately want to investigate. Apparently, those fugitive choices were the basis for labelling his death as fixed and foreseeable. Yet it was never explained to me how either choice was irremediable or constituted imminent death or loss of capacity.

In terms of physical health, my father had several non-terminal chronic issues, chiefly rheumatoid arthritis, type 2 diabetes that seemed less serious in recent years, and claudication or pain in his legs. He was a lifelong smoker and frequently drank alcohol, sometimes to excess (when his comments shifted to the vulgar and sexual) and, I believe, occasionally smoked pot late in life. During the 1990s, he had a severe alcohol problem, which may have been related to his untreated but diagnosed depression, though he later denied or minimised this. My family never thought his depression went away and felt he may have had other mental illnesses, such as personality disorder, voices, or PTSD.

Personal History

In the 1960s and 1970s, my father served with the police, where he encountered many traumatic cases. Even in his last months of life, he would occasionally voice vivid descriptions of violent or macabre deaths he encountered in his work. He was especially haunted by the death of an Indigenous man who was struck by a train in Ontario, who evidently was alive after the accident, before dying at the scene. He was not permitted to investigate, however, out of concern that it would embarrass the train company, as the train crew had not stopped. He was tasked alone to return the broken body in a box to the family. Before he died, he recounted this experience and said if he could do over again, he would have gone to the media. Dad never received any professional recognition, mental health care or treatment for the psycho-physical shock and disturbances he experienced in his service. After he left the police, for at least ten years, he kept casework photos of mutilated corpses, and personal photographs of dying people he took out of interest. He collected books of dark war imagery, such as those from Don McCullin, and would periodically become obsessive about historical mass deaths such as Wounded Knee  and others. He later became a professional photographer, which brought its own travails of a failed business and depression.

He often also referenced the deaths of his brother and parents. In 1978, his father died of a ruptured abdominal aortic aneurysm. He sometimes regarded that passing as merciful, saying things like, “he went to bed and bled out in ten minutes quick and painless,” though when he later suffered the same condition, he chose to have it repaired and survived, which he sometimes regretted. Ten years later, his mother died in his arms, following the DNR withdrawal of life-support. The cause of death was heart failure compounded by severe emphysema. When he was forty, he lost his brother to cancer. He seemed fond of a pet theory that his sister-in-law, a nurse, had euthanised his brother with stolen medicines. Though he was for many years married with children in our family home, these losses exacerbated his unease, as did subsequent losses related to his marriage, business, and moves.

As a boy in the 1940s and 1950s, his relatives and family’s friends were veterans. His grandfather, from the Boer and First World War, saw men burn on ships and rotted corpses in the mud. His uncle, in the Second war, Mentioned in Dispatches and “thrice wounded in Italy”, was later killed at a battle school with a bullet-stitch to the side from a mis-sighted Bren and buried near London. Another who won a DSO and shot a German from his bed, left his wife to visit Geisha in Japan. He would repeat such stories.

Despite Dad’s challenges, in his last years, he got out in the community and frequently went about town. He often busked with his flutes, which especially brought him joy, visited the pub, and kept in touch with family and friends. He would glow red-faced and beam when he saw my siblings and me, and his calls would often end with, “love ya”. He was quick to hug, and fretted in his way over each of us, as any parent does, in the ups and downs of our lives.

The year before his death, however, was the first year of the Covid-19 pandemic. Covid risk confined him to his small sailboat, where he did little but browse the internet, drink, and visit friends on neighbouring moored boats. While he had pre-existing mobility issues due to claudication, his legs worsened due to lack of movement and muscle wastage. His living conditions therefore also suffered, and he resided in filth, amid the clutter of rotting refuse, piles of clothing, droppings and shoe-dirt where he fed songbirds and gulls in his cooking area and entrance, and bottles of urine.

Over that pandemic year, and up until the week of his death, my family shared Sunday group video calls as a means of staying connected and lifting lockdown spirits. My father was present for nearly all the calls, and while we lived far apart, we frequently phoned and texted each other in between.

Before MAiD, he had his Covid vaccines when they became available, dental repairs, and dentures, and was looking forward to a procedure to help increase dexterity in his arthritically crippled hands.

Falls, hospitals, and residence move

He was hospitalised three times, following falls, in the months before his death. The first fall was due to septicaemia from living on his cramped, moored, 28 ft. sailboat in those squalid and isolated conditions. He was hospitalised for a short time, one or two weeks, and then released to his boat. My family, and possibly his GP, were concerned that he might have been prematurely released and should not have been allowed to return to his septic craft. Though, by that time, we had arranged visits from social services.

The second fall occurred just before he was due to visit his assisted living facility, for an assessment, to see if he was able to manage there. I regard that fall as potentially self-inflicted, as he wanted to remain in the hospital and demanded palliative care. My impression from speaking with both him and his ward doctor is that he was malingering. He could not go back to his boat after the second fall, as it was clear that the boat was uninhabitable, and the clinicians were keen to move him to assisted living. During this stay, he acquired three 30 milligram morphine tablets from another patient with addiction issues with whom he shared a room. When he told me this on a call, I immediately informed his ward staff. A nurse called back to say they the tablets could not be found, and he probably could not have gotten them. However, he offered them to my sibling just before he died. 

My family used his hospitalisations as an opportunity to convince social services to intervene and accelerate him into either assisted living or safe and sanitary accommodation. He had been very resistant to moving for several years and had a long history of suicidal expression that peaked during periods of change. Social services worked their wonders and managed to find him an urgent placement in a local assisted living residential facility. 

He often appeared anxious about his move to assisted living and was fixated on the seventy percent deduction to his low, mostly Canada Pension Plan income ($1400/month as I recall) it would cost to reside there. He was never very skilled with money and would be left with barely enough to cover his mobile phone bill and living costs. Family help was always available. We offered to supplement his costs and had planned to buy him a mobility scooter before he was killed.

During one of our weekly calls, following his second-last hospitalisation, he claimed that he was bedridden and immobile and therefore needed MAiD. However, he was seated in a chair, got up to use the toilet, and was able to move about the room on his own. When we confronted him about this and other claims and inconsistencies, he would either become enraged and threaten to kill himself or, without explaining his decision, demand that we not question it.

My father was very intelligent and charismatic and would use these traits to manipulate people or conceal his intentions. One could not always be sure of his sincerity, and he could feign interest in things only to reject them later. He could be extremely oppositional-defiant when challenged or corrected by others, and passive-aggressive to family members. He only took advice that agreed with his views and deferred responsibility to others for his poor choices, including MAiD. He was also self-absorbed and found it difficult to recognise the impact of his choices on others, to the point where I suspected pathology. A family friend once said he had an “inverted personality”. He could be demeaning, especially when drinking, and his derogatory comments were often related to genitals, including some made the morning before he died where he had consumed wine.

Suicidality

In the months before he applied for MAiD, Dad was acutely suicidal. He cited the suicides of people like Robin Williams and Ernest Hemingway as inspirations – men who “just knew when it was their time to go”. He said he looked up ways to kill himself, online, such as starvation. Other times, he would say things like “ashes to ashes” and “we are dust in the wind,” as in previous bouts. When he said this, I arranged for the BC suicide hotline to phone him, and he had a conversation with them where he noted these deaths and claimed that he was not depressed.

His typical suicide narrative, recurrent since least since the 1990s, followed a depressive and darkly romantic idealism, with fantasies about drifting off into the middle Georgian Bay to drown. His suicidality became acute during involuntary upheavals in his life, such as the loss of his business, marital separation, and residential moves in ways that adversely impacted every member of my family. In my younger years, he threatened my mother with his suicide, an event in which I physically intervened. He also said he picked his MAiD provider because of her attractiveness to him, and declared her a second spouse or love, again suggestive of his romantic view of self-annihilation.

In his darkest moments, he used suicide to manipulate family members. In the weeks before MAiD, he said that when his family asked for an explanation or called him out on his inconsistencies or apparent dishonesty, it made him “want to do it more”. He threatened suicide if he was denied MAiD. While in the hospital, a family member asked him about his ideation, and he replied with a surly, “I’ll find a bit of cord”. He would back down from his threats when a family member very patiently walked him through how much of a burden and problem a suicide on their watch would create for the hospital staff doing their best to look after him. I believe the hospital staff was aware that he was suicidal.

Application for MAiD

During the period of his falls and hospitals, Bill C-7 passed and MAiD for Track 2, non-reasonably foreseeable natural death, became newly available. When he first told me he was looking at MAiD, weeks before he applied, he said that “a doctor” he spoke to in the hospital “told me I should have it”.  I did not believe him due to his tendency for selective hearing and deferring responsibility. Yet I now have doubts, after learning that Vancouver Island hosts some of Canada’s most prolific and ideological MAiD assessors and providers, who favour vivisectional ideas of amputated autonomy and eligibility expansion, as well as the highest medically assisted death rate in the world. It is sickening to ponder.

His 90-day assessment period would have ended on his deceased mother’s birthday, and he took this as a ‘sign’ that he should proceed with MAiD. This echoed his later reaction when his assessment period was halved with his track-move and fell on the earliest day his chosen provider was available, also another family member’s birthday for whom he had often expressed a simmering resentment.

Learning from a friend from another province who witnessed a terminally ill loved one’s intensive MAiD assessments and engaged with the assessors, I believed they would be rigorous. I thought given time to get used to assisted living, and with appropriate environments, medical care, mental health support, and greater family and community engagement, he might remember he could enjoy life. My role then, on behalf of my family, was to ensure that his assessments were robust in accounting for his history of mental illness and suicidality, as I suspected he would likely try to conceal these issues. Though I thought he would fail his assessments, I knew the law was new and that he could perhaps qualify for MAiD for some reason that I could not immediately see. Even so, I recognised that more peace of mind would come if his history and personality were fully accounted for so that all opportunities to save his life could be afforded to him.

Within days of his application, I looked up and contacted a leading MAiD psychiatrist and expressed my concerns. I was advised to make a list of my family’s knowledge and worries about mental illness, suicide, and personality issues and to push hard to get it to his assessors to arrange a psychiatric evaluation. Unable to get the assessors' contact details, my family and I put together this information. I sent it to the local MAiD coordinator who said they would pass it on to his assessors.

After he applied, my father seemed to move away from idealized suicide and, adopting the language of MAiD, claimed only vague “suffering” as well as “autonomy” as reasons, citing a changing series of minor complaints about leg pain, constipation, and how he felt that morning. He became elusive and angry when we queried him about remedies that doctors had offered for his ailments, including physiotherapy. He made no effort to locate or create his will, despite our efforts, and we were later very lucky to find an old one among his things that he’d lost or forgotten. He avoided the responsibility of putting his affairs in order; an indication, perhaps, of hesitancy or non-commitment to finality, or a lack of interest in the technicalities and impact of his death, caught as he was in its romantic fantasy.

When, at last, I heard from Provider before his death, I asked if she had received our list of concerns and received an evasive response. The provider seemed to want to hurry off the phone and appeared to be in a busy place, like a hospital corridor, as I could hear voices in the background. I therefore only had a few seconds to describe my father’s complex history. Provider also appeared to regard my father’s suicidal history and previous depression diagnosis as news. During that call, I also relayed, as had my other family members, that I had spoken to a MAiD psychiatrist who had advised me to push hard for a psychiatric assessment. Upon learning this, Provider reluctantly agreed to try to get a last-minute psychiatric evaluation but was unsure if a psychiatrist could be found so close to scheduled death. 

A psychiatrist was found. Provider bluntly told me before my father’s evaluation that the psychiatrist would “just agree” and “provide cover” for her, yet also said he would be ineligible for MAiD if mental illness was found. However, “finding” mental illness would only be a comorbidity and not a sole diagnosis, given the approval and track move rationales, so this comment does not make sense to me. Despite my advisement that Dad had previously been diagnosed, the provider said she did not think he was depressed. I was very disturbed by Provider’s presumption of the outcome of the psychiatric assessment, which suggested to me the evaluation would lack independence and rigour.

My father’s Executor/Next-of-Kin and I later submitted a request for his MAiD records. The records officer denied us access to all records, except for the psychiatric evaluation report because it was not on the deceased patient’s “behalf” to release them to us and enclosed a printout of the relevant legislation. However, we discovered that the psychiatric evaluation report is limited solely to ruling out depression, and no other mental illness. The report mostly claims the opposite of his medical history, stating: no suicidality, occasional drinker, and non-smoker (despite his lifelong tobacco use). It also records him as dwelling in assisted living for about a month, though he was there a mere five days before he fell and was hospitalised – a week before MAiD and death. Appropriately, no chronic clinical illnesses (mainly arthritis, diabetes, claudication) are listed as terminal. Yet the report does not mention any of the allegedly terminal conditions cited by Provider for the track move; rather, it only states that he had been moved. The information in this report is therefore largely wrong and inaccurate, indicating to me a gross failure of this final safeguard.

Some of the information Provider and the psychiatrist dismissed or got wrong would likely have been available in his normal GP medical records. It was in the material I had passed on to the regional MAiD coordinator and told the provider before my father was killed. Because the Vancouver Island Health Authority did not release his full MAiD records, I do not know what information was accessed or used to approve his death.

I protested this in a text message (much contact with Provider was by text), stating that I was astounded that nothing was found, and reiterated my concerns. I asked if anyone in the process had tried to save his life. In response, the provider told me that due diligence had been done, and not to contact her again, as it was her private number and speaking on it was inappropriate. I read this as an implicit threat that I would be barred from the hospital if I kept pushing for answers. Provider had, however, initiated contact with me on her personal phone, which was the only means she used to contact my family and me.

His provider at one point told me that “he’d probably try to kill himself” without MAiD, and that his suicide was “more plausible” now. Provider also told me that she had “never lost sleep” over any of her deaths, as evidence somehow of her skill in approval, and that “families are messy” as if we were too much bother to contact in advance. My father said he had not once barred his assessors from contacting us.

Suicide was a fascination and fantasy for my father. It held a strange and compelling power for him, recalling Gollum and the Ring. It fit his depressive narrative and evoked his worst qualities, especially around a period of adversity and change in his life. Still, he had dealt with such issues for many years, long before his death was deemed unavoidable, and ultimately never proceeded with death until he found someone to do it for him.

Drinks, alcohol, and confusion

In his last days, under medical supervision, Dad drank juice, coffee, and wine with no reservations. He had hospital meals delivered, at which he poked, but disliked the food. He was drinking wine the evening and morning before he was killed. He may not have been sober for his final consent.

When my family arrived, my father or a clinical staff member informed us that he had “special permission” to drink alcohol. The evening before he died, he drank wine (about ½ bottle) after several days without solid food. At this point, my family managed to convince him to postpone his death so we could spend more time with him. The next morning, however, he appeared to have forgotten this conversation. He seemed confused and thought that day might also have been another assessment. I warned Provider about this, but she said only that she would “start from the beginning” and disappeared into his room alone. The provider later cancelled an early afternoon meeting with the family. My father drank coffee and wine that morning and fell asleep from about noon to two pm. I believe that this sleep could have been alcohol induced. 

He also appeared confused during the previous weeks of his assessment period. He could not seem to differentiate between assessors and other clinicians who saw him. He was listed as being on a morphine painkiller and an antidepressant. I recall him being offered, and possibly accepting pain medicine, by nursing staff before he died. In his earlier hospital stays he had demanded higher doses so that he could “feel” them, suggesting to me that he may have wanted their narcotic effect more than pain relief.

The day of his death was a family member’s birthday (not mine), and he declared this was his “special gift” after initially apologising that he had forgotten, but then decided otherwise. This family member witnessed the death and considered his choice a final act of malice or resentment. To my great distress, the Provider also knew about the birthday and made comments to that effect. In a moment alone together, I tried to deter my father, and explain why it was wrong, but he only reacted aggressively and dismissively.

No capacity assessment was done immediately before final consent was taken. 

Death

John Patrick Tylor Lyon, once a little boy who ran naked down the street to greet his daddy home from a war, was killed on a sunny summer afternoon sometime after four. Someone with a licence in medicine injected him with a lethal combination of medical substances employed beyond their designed and approved limits. Much like the enemy in his father’s war.

Some of his last words, proudly uttered to Provider like a child seeking approval, were, “I’ve thought a lot about my autonomy!” 

A little before that, I explained for the umpteenth and last time that I had returned to Canada, and that we all wanted him to move into assisted living, so it would be easier to spend time with him. He then very quietly, almost shamefully said, “I didn’t know that.” 

And for that instant near the end, all the noise stopped, and his storm lulled, exposing a deeply troubled, frightened, frail, and lonely old man who never quite learned to see or hear himself, let alone others, in his distress. But there was no time left. Events then moved very quickly. Death had arrived in a physician’s disguise and all his sound and fury returned to echo for a final time.

Provider was meant to arrive between three-thirty and four, but turned-up late, at about five past four, and voiced, callous and cheery, “I hear it’s someone’s birthday!” before proceeding to ‘obtain final consent’ for the suicide-homicide. My father declared his consent with a belligerent “Get me the hell out of here!” and Provider became Death.

Death tried one arm and then the other for an injection site, settling on his right side, and sat body-warm beside me on the small, smooth, clinical sofa. Death then delivered her long poison-parade of prepared syringes, fished out in order from a plastic toolbox - the chemicals, like the box, repurposed for something their makers did not intend. Adrift somewhere on the slow white river of propofol, flowing into him from three or four milk-bottle syringes, Dad disappeared. His warm face blanched and his head lolled where he was left propped upon the bed. It took him twenty minutes to die.  

Death’s last words to me, just as she left a short time later, were a demand not to bring the concerns or issues I had raised “forward”.

He was 77.