Trudo Lemmens: Medical Aid in Dying in Canada: A Case Raises Questions About Its Use in Patients with Disability and Mental Illness


Barry Blackwell’s Comment


        I read this informative comment on the novel Medical Assistance in Dying (MAiD) legislation brewing and beginning to be implemented in Canada and its application to the particular case of Alan Nichols ending in his death by lethal injection.

        Contrasted to assisted suicide this procedure was designed to accommodate adults with a “grievous and irremediable medical condition causing unbearable suffering leading to a reasonably foreseeable death.”

        In the case of this 62-year-old single male the picture is blurred by the presence of both significant medical and psychological disorders, the nature and significance of which remain unclear due to lack of detailed contemporary medical and psychiatric workups as well as the failure to involve family members in a meaningful manner that the case details will clarify.

        Alan lived alone but with significant family support provided by two brothers, Gary and Wayne, as well as a sister-in-law, Trish. They were separated by a five-hour car drive, but care was also provided by a neighbor and by brother Wayne who visited Alan weekly to do grocery shopping and visit the local bank.

        The details of exactly how and when the MAiD process was initiated also remains unclear. Alan was committed to its goal and the application was facilitated by a local psychiatrist Dr.Y who staffed a psychiatric unit at the local hospital where Alan had been a patient. The timing and details of their interaction is not given but resulted in a formal application, approved by Dr Y and forwarded for evaluation by a panel of four psychiatrists who supported the application. It remained for Dr. Y to initiate the timing and location of the lethal injection.

        Fate now played a hand in the planning and Alan’s precise role remains murky. The watchdog neighbor became involved and requested a “wellness visit” by the local police who in turn arranged for an ambulance and Emergency Room evaluation. After some delay of a day or more, Alan was admitted to the psychiatric unit and came under the care of Dr. Y who was about to take a several weeks long vacation. Before leaving she scheduled the MAiD process for July 26, several days after she returned.

        Fate now played a part. Alan’s brother Wayne and his major family support was also on vacation in a remote spot, out of reach of a phone call. The other family members, aware of Alan’s admission to the unit, tried but were unable to contact Dr. Y and did not become aware of MAiD until their return four days before the procedure was scheduled.

        No offer or suggestion was made of a possible delay and Alan made it clear he had forbidden Dr. Y to contact the family or negotiate with them. Any talk of cancelling the procedure led to irascible complaints that the family was intruding on his plans and “his day.” The day before he was to die was Alan’s 62nd birthday. He shared a birthday cake with the staff who reported he was cheerful, in a good mood.

        Both the family and Dr. Y were present when the designated representative of MAiD administered the lethal injection.

        The family submitted a formal complaint to the MAiD commission to which they responded sympathetically and expressed their goal to “continuously learn from the experience of patients and families so that we can improve our systems and the quality of services we provide.”

        I am grateful for this opportunity to comment on this sad and intriguing posting without arriving at any constructive conclusions other that only two people were fully informed of its details and outcome. One is dead and the other sworn to silence.


November 4, 2021