A patient of his once joked that she expected to see him wearing a black coat and carrying a sickle.
For the past two years, Dr. Eric Haywood-Farmer has provided a unique and necessary medical service — ending the lives of people suffering intolerably from incurable conditions through medically assisted death.
“These are people who have looked death in the face, they know that it’s coming and they’ve decided to take a little bit of control over where and when it happens,” Haywood-Farmer told KTW.
“I think people who have done that have often developed a bit of a sense of gallows humour about the whole thing and it’s a way of lightening the mood and making it more comfortable.”
The local ER doctor has assessed 14 cases and guided about 10 people to a peaceful end since medical assistance in dying (MAiD) became legal in Canada in June of 2016.
He was one of four panelists who spoke on the topic last week during one of a three-part series on health-care decisions hosted by the Royal Inland Hospital Foundation.
Requests for medically assisted death in the Kamloops area have been on the rise, he said.
“If you’d tried to look for information back in 2016, you wouldn’t have found it anywhere, whereas now there’s a co-ordinator, there’s a website, family physicians are starting to know where to refer people,” Haywood-Farmer said.
The physician conducted one assisted death in 2016, was involved in five in 2017 and was part of four this past March alone.
Haywood-Farmer said he turned down a few other cases earlier this year and is currently on a hiatus from providing MAiD services, in part hoping more local doctors will step up to begin offering the service.
“I felt like I was taking on the whole burden, so I felt I had to force the issue a bit,” Haywood-Farmer said.
Two doctors are required to assess a patient’s condition, ensuring they meet all the legal requirements for medically assisted death.
But only one of those physicians needs to administer the medication that ends the person’s life.
The procedure involves injecting a person with a high dosage of a sedative. They can also take the medication orally, but in B.C., a physician must be present the entire time.
Haywood-Farmer is often that attending physician and until this year was the only local doctor conducting the procedure.
“[A patient] can be in the hospital, they can be in their home. It’s up to them to choose when and where,” he said, noting most of his patients have chosen to die at home surrounded by loved ones.
“I’ve had people curled up in bed with their spouse. I’ve had up to 30 people in the same room,” Haywood-Farmer said.
Following a procedure, he said, there’s a palpable, almost magical feeling of relief in the room amongst family members who have had to watch a loved one struggle for so long.
“The feeling in the room when someone dies is a lot like the feeling when a baby is born … it’s something that only happens to you once, and being able to facilitate that and coach families through it so that it’s a more positive experience for them has been really rewarding,” Haywood-Farmer told those gathered in the Ken Lepin Lecture Theatre at RIH.
He told KTW he feels it’s important people have access to this type of service.
“I think it’s important for people to have the choice,” he said. “There’s a large number of palliative care tools and I see MAiD as being one of those tools.”
To be eligible for medically assisted death, a number of conditions must be met.
In order to receive MAiD, a patient must have an irremediable condition, must be at least 18 years old, must be at the point where a natural death is reasonably foreseeable, must request the assistance in writing without pressure or influence from others and must give informed consent throughout the process.
Those who are eligible to choose this route must be informed by their doctor or nurse practitioner of all alternative options, such as palliative or hospice care, though they are not required to accept them.
MAiD can only be provided to those who can give consent. Consent by a representative of the patient is prohibited, as is the patient giving their consent in advance of an illness.
Patients always have an opportunity to back out of the procedure, even in their final moments.
“You always have a discussion with the patient just before they die to say, ‘Do you really want to go through with this? Do you want to go through with it now? Are you sure you don’t want to put it off?’” Haywood-Farmer said.
When evaluating a patient’s eligibility, some cases are cut and dry. The person has a terminal condition such as cancer, no further options for treatment are available and they’re in constant pain, he said.
In some cases, more research is needed to determine a person’s prognosis.
“I cannot tell you the tens of hours I have spent in my basement trying to decide whether someone’s death is in fact reasonably foreseeable,” he told the forum.
“That is by far the most difficult part of the process from a decision-making point of view.”
As a practitioner, the experience of helping someone end their life feels like having run an emotional marathon, Haywood-Farmer said.
“It’s extremely emotionally depleting,” he said.
“You do one MAiD case in a day and it’s very difficult to do anything else that day. It’s exhausting.”
Decisions could impact law
Fellow forum speaker and Thompson Rivers University faculty of law professor Margaret Hall said the current state of the legislation surrounding medically assisted dying in Canada is fluid.
This is due to an ongoing constitutional challenge to the federal legislation and three independent reports addressing issues not outlined in the law that are still pending.
“Stay tuned, it seems that further developments may be imminent,” Hall said at the forum.
The legislation was amended following a 2015 Supreme Court of Canada decision in the case of Carter vs. Canada.
In that case, the plaintiff was living with ALS and approaching a point where she would be unable to take her own life.
“She said this forced her to make a cruel choice, between the intolerable suffering that awaited her and taking her life prematurely at a time when she could still physically do it,” Hall said.
Being forced to take her own life before she had or wanted to violated her right to life as outlined in section seven of the Constitution of Canada, Hall said. The Supreme Court of Canada agreed, thus leading to the change in law.
But the subsequent legislation only allows for people with terminal conditions where death is “reasonably foreseeable” to access medically assisted death, which sparked the constitutional challenge from the BC Civil Liberties Association on behalf of Chilliwack resident Julia Lamb, a young woman with spinal muscular atrophy who has been in a wheelchair since age six.
Lamb argues her condition could deteriorate to the point of suffering intolerably for years without being able to take advantage of medically assisted dying if her death is not considered to be reasonably foreseeable.
Whereas Carter vs. Canada argued a violation of a person’s right to life, Lamb’s case claims the new legislation violates a person’s right to liberty to make fundamental decisions about their body, Hall said.
The current legislation doesn’t address certain issues, such as requests from mature minors, advance requests and conditions in which mental illness is the main medical condition, but the federal government has commissioned the Council of Canadian Academies to review those issues.
“Their reports are due this fall, so it’ll be very interesting to [hear] what they have to say about it that may have a future impact on the legislation,” Hall said.