January 23, 2019
“I feel that all people should be able to have a good death however they perceive it to be, and to have access to that where they live,” says Dr. Dionne Walsh, Physician Lead for Medical Assistance in Dying (MAID) for South Zone of Alberta Health Services.
Story & Photo by Sherri Gallant
Dr. Dionne Walsh had always wanted to be a family doctor, but her Lethbridge practice took an unexpected turn after about seven years. She loved family medicine, as she knew she would, especially the opportunity to get to know her patients well over long periods of their lives.
“But I found that I really enjoyed caring for patients with incurable illness, and those near end of life,” says Walsh. “Providing palliative care, following people I knew and journeying with them and their families through that time in their life.
“People say that must be such a hard thing to do, but it’s just such a lovely thing to do, and such a special time to be a part of people’s lives. I can spend a lot of time talking with my patients about fishing, or cooking or their losses, their family and the things that are important to them. They teach me so many things. It’s been very special.”
When she learned that Medical Assistance in Dying (MAID) would become legal in 2016, Walsh felt compelled to get involved. She believed strongly that MAID should be available to terminally ill people as an option — and that it should be available in their home community.
“It wasn’t because I’d seen bad deaths. In fact, I had seen that palliative care can help alleviate much suffering, but it was just because I feel that all people should be able to have a good death however they perceive it to be, and to have access to that where they live. We know that a person contemplating MAID is suffering so deeply. Palliative care is about alleviating physical and emotional suffering — but some individuals still desire MAID.”
At the same time, she was mindful of all there was to think about.
“I was uncertain if I could be the person to provide MAID. I certainly support the patient’s wish; but to be the person giving the medication made me feel anxious and made me wonder how I would feel or how I would react. It’s not something that any of us have been involved with prior to this. But I did join the South Zone MAID working group a few months before the law came into place in 2016.”
Walsh was out of town when the first call came, but when the second call came, she was available.
“It’s not an emergency when a patient inquires about MAID,” she says, “but it is very urgent to the patient and the family because they’re suffering greatly. It’s of a timely nature. When I was going to the patient’s home I was feeling very anxious and preparing myself. I had read her chart. I knew that I would most likely find her eligible by the criteria of the law. As I was driving there, the tailgate of a truck in front of me opened, and large pieces of wood dumped out right in front of me and I had to stop very quickly. Everything was fine; I pulled around and I waited and no one was hurt. But at the next stop it really made me pause and think — am I really meant to continue on this journey? I needed to be very intentional then that I wanted to continue.
“When I met the patient and her husband it was just almost relaxing. My anxiety was gone because they were so forthcoming in sharing their story of how they got there, and all the time they spent thinking of all this, and the suffering she had. Her husband was very supportive of her wish. Very sad, but supportive. After finding her eligible, I felt comfortable to also be the providing physician for her, and the experience cemented my feeling that this is a very peaceful and honourable way to die if a person chooses it, and to continue following on that path.
“Now that I’ve had the opportunity to be the physician lead for MAID, it means I don’t necessarily get the same intensity of a relationship with the patient, because now I sometimes talk with them on the phone, but I generally don’t meet them because I’m doing oversight and co-ordination. I spend a lot of my time with physicians, talking with them on the phone or in person to provide them education so that as a family physician they can feel confident to support their own patient, and especially if it’s their first time providing, I go there to be with them. I remember how uncertain I felt, and I had another physician with me and that was a very grounding force. Other physicians have let me know that this is a good support, it makes us more resilient, so none of us will become burned out, because we’re all sharing this great joy and also this burden on our hearts.”
It didn’t take long before helping the dying began to trump healing the living, and two years ago Walsh made the decision to close her practice.
“Now I’m a palliative care consultant and no longer have my own patients. I see patients in their homes, in the hospital, at St. Michael’s Health Centre in the palliative care unit. I do some rural work. I think I just love being with people and hearing their stories. During the time that we have in palliative care with our patients — we take the time to hear those stories. I think that’s where I get my joy from.
“Many families avoid talking about aging and dying to their children, but mine wasn’t like that. I loved visiting my great grandmother for tea as a child, and journeyed with my family as she lived into her 90s, blind and frail before she finally gave up her own home, moved in with my grandparents, and eventually died in a nursing home. To me, it was all just part of life.”
No one knew quite what to expect in terms of demand after MAID became legal. Walsh expected an initial flurry of requests from people who might have been waiting, followed by a settling down of demand.
“We can look at a place like Oregon to try and predict what the experience might be here, but their law is quite different than ours in terms of who is eligible. In the Netherlands four- to five-per-cent of deaths are by MAID and they have a similar law, but they have a different culture and have had this type of death occurring for many years.
“What we’ve actually seen, when I look at six-month intervals, is that it continues to increase — the number of people who are inquiring, who are requesting, and who are going forward.”
In Alberta in 2017, one per cent of deaths occurred by MAID. In South Zone, there have been 66 MAID deaths since the law was passed in June 2016.
With growing demand, there’s a need for more physician providers in order for the MAID team to continue to see patients promptly and honour individual preferences for place and time.
“We have a limited number of physicians and we’ve needed them to travel around the zone. They are highly committed, but we don’t want them to burn out. I want physicians to know that we all face this new experience with uncertainty, but as a team we are available to provide education, logistical and emotional support, and that it is an incredibly humbling and rewarding part of medicine.”
Interested in becoming involved in MAID? Please email Dionne.Walsh@ahs.ca.
