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âTheyâre going to say that all suicides are way down.â 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 patientâs condition has to be âgrievous and irremediableâ, and death âreasonably foreseeableâ, for them to qualify for euthanasia. But the law appears to allow loose interpretations of these conditions.
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: âHe was being treated for absolutely nothing, no illness.â But Alanâs mental health was volatile. âHe would go through stages where life was good and then heâd hit a stage for a while, for a month or two, where he didnât feel like living.â He was prone to paranoia and reacted badly to change: if Gary was getting ready to leave, Alan might say: âAre you going to leave me home with all these knives?â And Gary would have to say: âAlan, I trust you. If thatâs what you want to do, I canât guard you 24/7.â
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 isnât unusual: of the 31,664 assisted deaths in Canada, 17% of the patients cited âisolation or lonelinessâ 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 âwas fighting not to go into the ambulanceâ. Gary rushed to the hospital to see his brother, who said to him: âIf youâre not here to bust me out, you might as well leave.â Gary didnât 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 Alanâs condition, the staff were optimistic: âThe hospital would say, âOh, heâs doing fine. Heâs okay. Yeah, heâs eating.ââ It made Gary think Alan was âgetting back on track.â What the hospital didnât 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: âWe 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 â nay, I demand it!â His family describe the process as cathartic: âAs he requested, Deep Purpleâs âChild in Timeâ was cranked up in the background. His death was completely on his own terms, just as he wished.â
But what happens when there is no terminal diagnosis? What if your family donât 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 didnât have to inform them about Alanâs application for assisted dying. The people who loved him didnât 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. âThe last two weeks, they were treating him for nothing. They were giving him room and board.â He could have gone home. When, later, Gary asked the hospital, âWhy did you keep him there?â, they said: âAlan didnât think he should go home because you guys would try to convince him otherwise.â
Gary did, indeed, spend the last day of his brotherâs life trying to change Alanâs mind. He winces at the memory: âI think we came really, really close to convincing him not to do this.â Aware that his brother felt isolated, Gary told him: âAlan, Iâm contemplating retiring this year, and possibly coming back to Chilliwack. To give you a little more support and a little more family close byâ: âHe just looks at me and says, âGeez, I wish Iâd known that.ââ In Alanâs 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. Itâs common knowledge in psychiatry that most previously suicidal people do. One Harvard study shows that ânine out of ten people who attempt suicide and survive will not go on to die by suicide at a later dateâ. Gary says he feels utterly betrayed by the hospital, the Canadian government, the whole system that undid all his familyâs 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 âunbearable sufferingâ 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 Belgiumâs or Switzerlandâs. In March 2021, adults with âincurable diseasesâ but no foreseeable death were made eligible. Now, the âSpecial Joint Committee on MAiDâ is considering whether to expand the law to âmature minorsâ (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 Weissâs Common Sense, on an epileptic woman called Victoria, who was only 21 when she considered applying for MAiD to alleviate her familyâs dire financial situation. Subramanya also told the story of 23-year-old Kiano Vafaeian, who is seeking MAiD for depression, and his distraught family. Alanâs MAiD form, which I have seen, only listed âHearing Lossâ 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 Nicholsâs case, the nurse who approved his application was also the âpractitionerâ giving him the fatal injection. âItâs like youâre writing your own paycheck,â Gary says.
Gary suspects Trudeau will allow the laws to go even further. âWhy donât you just set up a walk-in clinic for it? Because thatâs whatâs going to happen: once the government opens the door, these physicians and medical teams are just going to open it wider.â
As we say our goodbyes, Gary remembers something:
âIn 2008, my mum called me and said: âAlan didnât show up for dinner last night.â So I said: âOkay, Iâll go check on him.â
So, I went over to see him, and his door was locked and wasnât 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: âI knew eventually somebody would come to see me.ââ
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You can call Samaritans for free on 116 123, email them at [email protected], or visit www.samaritans.org to find your nearest branch.
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