End of life choices

Old age is not for the weak of heart. I realize that 65 is the new 45, or something like that, and that I am not supposed to think of myself as old yet. But, if we are being honest, most of us who have hit 60 would admit that many things are more difficult than they used to be. We have little memory lapses (have you found yourself getting out of bed to make sure you turned the oven off?). Our joints are stiff if we sit still for too long. We plan our trips up and down the stairs to make as much use of one trip as we can. Night-time sleep has become a much beloved but elusive friend. We have minor and mysterious aches and pains in parts of our bodies we did not know were there until they started to hurt.

Of course, it’s not all bad, especially for those of us fortunate enough to know where the next meal is coming from and with decent health (and access to good publicly funded health care).

Elder orphans

What is good about our lives as we age is often because we have friends and family, but not everyone has someone with whom they can share a meal, a laugh, some tears or a good or bad day.

According to a recent article in Maclean’s magazine, 25% of “seniors” live alone, and a subset of those live in acute isolation. Known in some circles as elder orphans, these folks can go days or even weeks without seeing another person. It’s a cyclical situation: when someone does not actively socialize, they often become less mobile, which in turn increases their isolation and loneliness.

As Grace Park, the program medical director of home health at Fraser Health in British Columbia notes:

“They may not even open their door or walk down to get the mail.”

Looking for company

It is well known that older folks sometimes resort to calling 911 just for the social contact it provides.

Beginning in 2013, paramedics in Winnipeg developed a specialized team to respond to frequent callers, many of whom are elderly. If there is no obvious urgent medical issue, the paramedics assess the caller’s social and medical needs before making a decision about whether or not they need to be taken to the hospital.

This team has an at-risk referral program, through which anyone – a mail carrier, meter reader, neighbour – can contact the team to refer an older person if they have concerns that person is isolated. The team will then connect the person with a social worker, home care worker and other services.

There are informal solutions, too. For example, a friend of mine, whose 93-year-old aunt lives alone and is starting to lose her memory, sends her 15-year-old son over once a week to assist the aunt with her technological communication, which has helped her to stay connected with friends. Bonus: the contact between the teenager and the aunt has proven to be something they both enjoy. He earns some money for his technological expertise, and she muses whether to call him her tech consultant or her social secretary.

When there is no pleasure left

Fraser Health’s Grace Park worked with a woman who requested a medically assisted death because she no longer had pleasure in her life.

While MAID (medical assistance in dying) is slowly becoming accepted across the country – 6,749 people in Canada accessed MAID between 2015 and April of this year; 1,593 Ontarians have done so in the past 12 months – it is not available to someone who is simply tired of being alive. The requirements to qualify for MAID include, among other things, both the mental capacity to consent at the time of the medically assisted death and a foreseeable death.

This rules out a lot of people, not just those who are old and have had enough of being alive.

Jacques Campeau, for instance, had lived with multiple sclerosis for many years, over which time his physical capacity diminished significantly. He requested MAID three times and was rejected each time because he was not considered to be at the end of his life. Instead of being able to involve his family in a planned death, he killed himself, alone, thus depriving both him and them of a real goodbye. As his daughter, Catherine Campeau-Tremblay said:

“We would have liked to talk to him before he did this.”

Michele Cadette was found guilty of manslaughter after killing his wife, Jocelyne Lizotte, in 2017. Lizotte had Alzheimer’s and lived in a long-term care facility. Cadette’s request for MAID was rejected in part because Lizotte was not capable of consenting, but also because her death was not imminent.

While it is important to guard against the misuse of MAID by someone who may not have the older or ill person’s best interests at heart, it is also important to allow people who have decided they have lived as long as they wish to a dignified death that does not require them to keep their plans secret from family members and friends and then to die alone.

Michael Micallef, who had a medically assisted death earlier this summer at the age of 69, after living with Huntington’s for many years, had a party with friends and family and then died, comfortably, with those he cared about surrounding him in a friend’s backyard. Shortly before he died, he said:

“Being able to have choices is extremely important to me.”

I want those choices, too, for myself, my family and my friends, even if I lack capacity to consent at the time or if my death is not imminent.

3 thoughts on “End of life choices

  1. I enjoyed reading your post, as always, and I find myself increasingly challenged around this exact end of life issue. As a family advisor to older adults and their children/caregivers, end of life discussions are ones rarely held and fraught with much complexity. Despite competing agendas of the various stakeholders, I guide folks toward the importance of choice of the older adult at the centre of it all.
    You close your post with hope that you can one day exercise choice, albeit without capacity. Does this mean that you would do some pre-incapacity planning or do you envision choice at the time of incapacity?
    Your thoughts are most welcome!

    • Thank you for your comment, Debra. I have done a lot of pre-incapacity planning: discussions with my family, including my adult children, as well as with my lawyer. I have prepared what I jokingly call the world’s longest power of attorney for personal care, setting out the many situations in which I do not want medical intervention, so both those making these decisions and the medical professionals who may be caring for me will know my wishes.

      I also prepared an Advance Directive stating that, even if I am incompetent later, I want my wish for MAID, consented to, now, when I am competent, to be respected. Of course, the law has to change before this Advance Directive could be acted on, but I wanted to put it all in writing now, while I am fully competent.

      In all of this, I have found the materials and resources produced by Dying with Dignity (https://www.dyingwithdignity.ca/) to be extremely helpful.

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