“They’re going to say that all suicides are way down.” Gary Nichols is speaking to me from his home in Edmonton, Canada. In 2019, his younger brother Alan was hospitalised for threatening to kill himself. Within a month, he was dead. He had ended his own life at Chilliwack General Hospital, aged 61, and doctors and nurses had helped him do it.
Last year, assisted suicide accounted for 3.3% of all deaths in Canada, a third more than the previous year. At the same time, deaths officially recorded as suicides fell to the lowest rate in two decades. The Medical Assistance in Dying, or MAiD, Act was passed in 2016, requiring that a patient’s condition has to be “grievous and irremediable”, and death “reasonably foreseeable”, for them to qualify for euthanasia. But the law appears to allow loose interpretations of these conditions.
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As a child, Alan Nichols had suffered complications from surgery which affected his mobility on one side and left him with hearing loss. Still, he was living independently before his death. Physically, Gary says, his brother had been doing much better: “He was being treated for absolutely nothing, no illness.” But Alan’s mental health was volatile. “He would go through stages where life was good and then he’d hit a stage for a while, for a month or two, where he didn’t feel like living.” He was prone to paranoia and reacted badly to change: if Gary was getting ready to leave, Alan might say: “Are you going to leave me home with all these knives?” And Gary would have to say: “Alan, I trust you. If that’s what you want to do, I can’t guard you 24/7.”
He did guard Alan, as well as he could. After their parents died, Gary and his other brother Wayne took turns in helping Alan to do tasks that overwhelmed him, such as banking. But they both had their own lives, and Alan struggled to accept help from friends. In the months before his death, he had begun to feel increasingly isolated. His local network was coming apart: Wayne had decided to take a trip across Canada; a trusted neighbour was planning to relocate; his favourite shop had closed. His story isn’t unusual: of the 31,664 assisted deaths in Canada, 17% of the patients cited “isolation or loneliness” as a reason for wanting to end their lives.
The week before Wayne was due to leave, Alan was found by paramedics on the floor of his apartment. The neighbour he trusted had raised the alarm after not seeing him for days. He was malnourished and clearly suffering a major depressive episode. He was taken to Chilliwack General Hospital.
Alan did try to resist being sectioned. Gary was told that his brother “was fighting not to go into the ambulance”. Gary rushed to the hospital to see his brother, who said to him: “If you’re not here to bust me out, you might as well leave.” Gary didn’t bust him out, a decision he now says he regrets. He trusted the hospital to look after Alan. When he called to get updates on Alan’s condition, the staff were optimistic: “The hospital would say, ‘Oh, he’s doing fine. He’s okay. Yeah, he’s eating.’” It made Gary think Alan was “getting back on track.” What the hospital didn’t tell Gary was that his brother had actually signed his own death warrant.
For some Canadians, assisted suicide is a peaceful alternative to an unpleasant death. Patients with terminal illnesses often point out that end-of-life care can be highly undignified, and appreciate the power to choose something else. Don Kent was assisted to die in Ottawa after being diagnosed with terminal cancer. In a blog post written before his death, he declared: “We euthanise our pets humanely, but it is only recently that we have started applying humane dying to our own species. I want medical assistance to ease my way out of this life — nay, I demand it!” His family describe the process as cathartic: “As he requested, Deep Purple’s ‘Child in Time’ was cranked up in the background. His death was completely on his own terms, just as he wished.”
But what happens when there is no terminal diagnosis? What if your family don’t support your wish to die? In the days and weeks following his hospitalisation, Alan refused to take visits from his brothers. Gary tells me that patient confidentiality meant that the doctors didn’t have to inform them about Alan’s application for assisted dying. The people who loved him didn’t find out about it until a couple of days before the procedure was scheduled. Gary sees the hospital as partly responsible for keeping Alan from his family. “The last two weeks, they were treating him for nothing. They were giving him room and board.” He could have gone home. When, later, Gary asked the hospital, “Why did you keep him there?”, they said: “Alan didn’t think he should go home because you guys would try to convince him otherwise.”
Gary did, indeed, spend the last day of his brother’s life trying to change Alan’s mind. He winces at the memory: “I think we came really, really close to convincing him not to do this.” Aware that his brother felt isolated, Gary told him: “Alan, I’m contemplating retiring this year, and possibly coming back to Chilliwack. To give you a little more support and a little more family close by”: “He just looks at me and says, ‘Geez, I wish I’d known that.’” In Alan’s view, it was already too late to alter his decision.
Now, Gary wonders if his brother would have regretted his attempt to end his life, had it not succeeded. It’s common knowledge in psychiatry that most previously suicidal people do. One Harvard study shows that “nine out of ten people who attempt suicide and survive will not go on to die by suicide at a later date”. Gary says he feels utterly betrayed by the hospital, the Canadian government, the whole system that undid all his family’s hard work to keep Alan alive.
Other countries are taking tentative steps towards a debate on legalised euthanasia. Last year, Spain passed legislation stating that a person can qualify for euthanasia if both incurable illness and “unbearable suffering” are proven. In the UK, both euthanasia and assisted suicide are currently illegal. But in 2021 an Assisted Dying Bill was proposed to the House of Lords and in the same year YouGov polls showed 73% of citizens supported legalising euthanasia for terminal patients. Only 35% of MPs agreed at the time, but since then the violent suicide of a grandfather with debilitating prostate cancer revived the debate, which remains preliminary and cautious.
Justin Trudeau, meanwhile, is barreling at breakneck speed towards near total liberalisation. The Canadian system is set to become similar to Belgium’s or Switzerland’s. In March 2021, adults with “incurable diseases” but no foreseeable death were made eligible. Now, the “Special Joint Committee on MAiD” is considering whether to expand the law to “mature minors” (no further clarification given) and offering assisted dying to those with solely mental health conditions. Both tweaks to the law could come into effect in Canada as early as 2023.
Evidence suggests that there is demand for these services. Rupa Subramanya recently reported, for Bari Weiss’s Common Sense, on an epileptic woman called Victoria, who was only 21 when she considered applying for MAiD to alleviate her family’s dire financial situation. Subramanya also told the story of 23-year-old Kiano Vafaeian, who is seeking MAiD for depression, and his distraught family. Alan’s MAiD form, which I have seen, only listed “Hearing Loss” as his reason for requesting to die.
The conflicts of interest here are troubling. A 2020 preparatory analysis of MAiD predicted that it could save $66 million in healthcare costs. And facilities that carry out assisted suicides are given government support. In Alan Nichols’s case, the nurse who approved his application was also the “practitioner” giving him the fatal injection. “It’s like you’re writing your own paycheck,” Gary says.
Gary suspects Trudeau will allow the laws to go even further. “Why don’t you just set up a walk-in clinic for it? Because that’s what’s going to happen: once the government opens the door, these physicians and medical teams are just going to open it wider.”
As we say our goodbyes, Gary remembers something:
“In 2008, my mum called me and said: ‘Alan didn’t show up for dinner last night.’ So I said: ‘Okay, I’ll go check on him.’
So, I went over to see him, and his door was locked and wasn’t opening. I called a locksmith who came and opened up the door, and we went in there and he was laying in his bed.
And he says: ‘I knew eventually somebody would come to see me.’”