Quebec doctor pulls back the curtain on medically assisted dying

In his 30 years as a palliative care physician, many patients have asked Dr. Alain Naud for his help to die. But until Quebec's law came into effect last year, he could do nothing but make their last days as comfortable as possible.

Physician Alain Naud hopes to demystify the process of hastening death for those who choose it

Physician Alain Naud explains the process from a doctor's perspective. 1:38

In his 30 years as a palliative care physician, many patients have asked Alain Naud for his help to die. But until Quebec's law came into effect last year, he could do nothing but make their last days as comfortable as possible.

Naud is the first doctor involved in medically assisted dying to speak publicly about the procedure.

"Honestly, medically assisted death is new, not just for the population or patients or family, but also for caregivers, including doctors. It's something that has never been done here. The first time, you prepare accordingly," he said.

Quebec became the first province in Canada to make it legal for terminally ill patients to choose to die with medical help. The law went into effect on Dec.10, 2015. 

Bill C-14, the proposed federal legislation to legalize medical aid in dying, was tabled in the House of Commons today.

The issue has been the focus of political debate, but Naud wants to lift the veil on the realm of actual patient care and relief from suffering.

He said he's heard enough from the critics.

"We've left a lot of space [in the public discourse] for those who are against it," Naud said.

He said he accepts and understands that doctors who are opposed to the procedure will not take part in it. But he hopes to demystify the process and prevent terminally ill patients from believing they cannot get access to the procedure.

"Some people want to believe that medical assistance to die is dangerous, that it's complicated, and no one should have the right to do so," he said. "But it's not the case."

'It happens very calmly'

The procedure consists of three injections: one to relax the system; one to induce a coma; and a third that stops the vital organs.

What doctors have learned since performing the procedure is that the patient often dies during the second injection.

"The patient simply closes their eyes gently, stops breathing," Naud said. "There isn't a single sound, there's no movement, there's no reaction."

"It happens very calmly, in the space of a few minutes, not hours."

For many, it's a peaceful end to painful final days.

But getting to that point isn't as simple as a patient expressing a wish to end his or her life.

According to Quebec's end-of-life care legislation, patients must be legal adults, capable of giving consent. They must suffer from a serious and incurable illness and already be near the end of their natural lives.

Patients also must be in an advanced state of "irreversible decline in capability" and must be experiencing constant and unbearable physical or psychological pain.

From there, Naud explains, there are procedures the physician must attend to.

Quebec was the first province in Canada to allow terminally-ill patients who meet certain criteria to choose to end their lives. (Radio-Canada)

Patients have chance to reconsider

Naud recently helped a terminally ill man in a Quebec City hospital end his life.

He ensured the patient met all the legal criteria, had filled out all the paperwork and expressed his wishes to two different doctors.

That process gives people time to contact members of their family and ensure their affairs are in order.

"It allows everyone to give their final goodbyes … to say one last time the thing that hasn't been said and to live that moment there, as a family," Naud said. 

Gently holding the man's hand, Naud asked him about his pain and sleep before again confirming he wanted to proceed.

Patients can change their minds at any time, he said.

On his second visit, Naud said, the patient was too drowsy from medication, and he decided to return later. 

A week and several visits after their initial meeting, the patient remained steadfast in his wishes. 

He died in hospital with the doctor at his side.

"We are really at the essence of a human being in his final living days, and [he] is asking us to use science and our humanity to end his suffering," Naud said. 

With files from Radio-Canada's Davide Gentile

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