British Columbia·A Good Goodbye

B.C. has highest rate of medically assisted death in Canada

British Columbia has almost double the rate of medically assisted deaths compared to the rest of the country. That makes the province a testing ground for the practices and controversies surrounding assisted dying.

Doctors, not judges, decide what constitutes foreseeable death, court says

Storm Miller received an assisted death in her home in August of 2016 and is seen here hugging a friend on the morning of her death. (Dave Miller)

They stop thinking about dying.

That is how Dr. Stefanie Green describes patients' reaction to being approved for medical assistance in dying (MAiD). 

Green, the president and co-founder of the Canadian Association of MAiD Assessors and Providers or CAMAP, is also a MAiD provider on Vancouver Island, the region with the highest rate of assisted deaths in the country.

In fact, in the first 11 months of 2017, nearly half of all medically assisted deaths in British Columbia happened in areas covered by Island Health.

In this region, which includes Vancouver Island and the Gulf Islands, 3.5 per cent of all deaths were medically assisted, compared to just 1.7 per cent for the whole province.

Although B.C has the highest rate of assisted deaths, one of the most recent influential court cases unfolded in Ontario.

It pertained to the requirement in the legislation a patient's natural death must be reasonably foreseeable. 

The court case involved a woman, referred to as A.B., who had a severe case of osteoarthritis.

According to Green, the woman struggled to find two doctors who would agree her death was reasonably foreseeable, partially over fears of prosecution. 

Green says the judge found in favour of A.B..

"He spoke very strongly in favour of the fact that it is the physician and the clinician themselves who determine what is reasonably foreseeable," Green said."That it should not be decided by lawyers and by the courts. 

B.C. has nearly double the national rate

"I know that that decision has made a difference to the community of providers and assessors in the country." 

With nearly double the national rate of assisted deaths for the first six months of 2017, Green says there are many reasons why B.C. and Vancouver Island, specifically, are at the forefront of assisted dying. 

"Here on Vancouver Island, we have the demographics: a little more elderly, [people that are] a little more capable of making this decision," Green said. 

Green also credits the local health authority with moving quickly to create infrastructure for assisted death once it became legal. 

Even though B.C. has the highest rate of MAiD in the country, there are concerns about patients being able to access the procedure in faith-based institutions. 

The Denominational Health Association (DHA) includes 44 health-care facilities in B.C., and their members do not allow MAiD to be performed on their premises. Most facilities do, however, support patients being transferred to another facility to have an assisted death.

Dr. Stefanie Green is a MAiD provider and she says Island Health had assisted death infrastructure ready as soon as it became legal in Canada. (Jacob Green)

Recently Dr. Ellen Wiebe provided MAiD to 83 year-old Barry Hyman who lived in The Louis Brier Nursing Home in Vancouver. The Jewish facility does not allow assisted dying on the premises. 

"That care home is a home. It was the only home for Barry Hyman and he chose to die in his home and he had the right to make that choice," Wiebe said. 

The nursing home has now issued a complaint against Wiebe with the B.C. College of Physicians and Surgeons.

Struggled to get information

While getting access to MAiD in faith-based facilities today is still a challenge for some patients, in the early days, just getting information about the procedure was challenging. 

​Dave Miller of Comox, B.C., says he struggled to get answers about MAiD when his wife, Storm, decided to pursue an assisted death in the summer of 2016.

"We couldn't find anyone to educate us on how to get into the program," Miller said.

"We talked to the GP and they said, 'it's too soon for that.'"

Dave Miller says he is grateful that his wife was finally able to have an assisted death in their home surrounded by family and friends. 

As an assessor and provider of MAiD, Green has no doubts about the relief felt by patients who are approved for an assisted death.  

"We notice a visible, a real, documentable, therapeutic benefit. People feel better. There is a relief. There is a sense of control that is back in their hands for the first time, usually in a very long time." 

To listen to the full interview, click on the audio link below:

 A Good Goodbye is a radio and digital series exploring medically assisted death in B.C. Tune into your local CBC Radio One morning show Jan. 29 to Feb. 1

About the Author

Jean Paetkau

Associate producer, CBC Victoria

Jean Paetkau is an award-winning writer who works as an associate producer for CBC Victoria. Her work includes writing for digital, TV, radio and print.