Sunday, 2 October 2016

Thoughts On Death

Yesterday I went to the Medical Assistance In Dying seminar put on by the ALS Society of Alberta. Besides being very interested in the content, I have come away with some very strong opinions about the process for me, and several feelings of uncertainty around whether or not I even want medical assistance in dying. I am, after all, a kind of do-it-yourself guy.

The first thing, the strongest feeling I left that meeting with, is that I, in no way, want to die; not right now, not in the near future, not ever. I love being alive, although there are plenty of times when it is a massive struggle. I have said a couple of times lately that ALS is a humiliating and terrible way to die.

Secondly, given that I have ALS, I know for a fact that I am going to die. My timing might be a little off. I may be like everyone else, not knowing the date of my demise. What I can say, however, is that the combination of certainty of death and progression of ALS means I have some planning to do, or at least some thinking to do. I may not choose MAID. I may not even choose a DIY death. I just know that I have to have some idea of what and when, under what conditions, and who will be there.

I am still uncertain about how I want my death to "happen". I am certain I want to die at home, or on the foredeck of a sailboat. Since I no longer have a sailboat, my home seems like the best option. I want to go quietly, peacefully. My ideal scenario would be to go to sleep one night and not wake up the next morning.

Unfortunately with MAID, this scenario is impossible. For medical assistance, the medical professional must be there to assist in the process. That's just how it works. I can die at home, but I have to have the doctor there. I can take the drugs orally, and just drift off to sleep, something I like the idea of, but the doctor has to be there to see me take the drugs. So once again, I can't just decide when I want to go and do the deed. There has to be some planning, some clinical approach, even an appointment.

On the other hand, the DIY approach has its own problems. First of all, there is always some uncertainty in the process with the drugs. It is possible I might screw it up. Secondly, under Canadian law, even with a MAID supplied drug cocktail, if there is no medical professional present then my death becomes "suspicious", and a police matter. It is also labeled "suicide" instead of a medically assisted death. While the distinction may be fine, I really don't want someone saying I was a coward and committed suicide.

Then there is the whole "day of the event" problem. For me, death is really a very private affair. I have come to learn that I want to die alone in my bed. I don't want a crowd gathered round, their grief palpable as I make this most fateful decision of my life. I want a peaceful, quiet exit. At least that is what I think right now; I make no claims to permanence in decisions like this. With MAID, the date is well planned and I am not sure I can keep that secret. I am such a blabbermouth.

The one thing I did learn from the seminar, the most comforting thing, is that the process here in Alberta is very "patient-centric". I simply make a call to the AHS Care Coordinator, and that person looks after the process with and for me. It takes a few weeks, giving time if I change my mind. Even when I am approved for MAID, I don't have to "pull the trigger" right away. I can wait until I am ready, then call for the appointment. The only proviso is that I must be mentally competent to make my decision, based on a determination by the administering medical professional.

I still have lots to think about. Do I want MAID? Do I want to a DIY death? Do I really care if my Death Certificate says "Suicide"? What will people say to my children and grandchildren? Do I want this as my legacy? Do I want to throw that last big party, then go that night, or do I want to go quietly, no notice to others? Do I want to use the very fast IV process, or the slower oral process for the drugs?

It's a lot to think about.

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