Following on from the End of Life Choice Bill passing its final reading, we revisit a first-hand account from June of a doctor's experience in carrying out assisted dying once it becomes legal.
Stefanie Green didn't enter the medical field thinking she would end up helping Canadians end their lives. In fact, she spent much of the earlier part of her career on the other end of the lifecycle, in the maternity ward, helping mothers give birth.
Speaking at the medical campus of the University of Auckland on Thursday, Green told a gathering of students and clinicians that she had been directly involved in 150 assisted deaths since Canada first passed euthanasia legislation three years ago.
Green's visit coincides with the successful second reading of the End of Life Choice bill and her experiences provide a glimpse at what life might be like for the doctors who will have to carry out the tough job of helping people choose when they'd prefer to die.
While few among us would willingly put up their hands for the job of pushing down the plunger time and time again, Green told the audience this has been "the most rewarding work of her life".
"I've never left a death and felt anything but good about what I've done," she said.
"I've never helped anyone I didn't think qualified. And I don't have to do it, even if they do qualify. I only do it if I'm comfortable doing it."
A common concern about this line of work lies in the guilt the doctor may feel in being the one to administer death to another person, but she says her conscience is clear.
"These are people who are suffering intolerably by definition," she said.
"Otherwise, they wouldn't be in the room. When I give medication to these people, and they fall asleep at the first medication, you hear a light snore going on. It's immediately apparent that they are no longer suffering. The gratitude of their family and friends is enormous. And it doesn't stop."
She says there have even been times where family members of the deceased have approached her after the death and again expressed their gratitude for what she has done.
"I've run into people in the grocery store. And yes, it can be weird. It's a different kind of 'how are you?' It's actually happened to me three times. And each time there were no words exchanged. I was just standing there looking at the fruit. And someone comes over and just hugs me long and hard. That's what I get from doing this work. It is incredible. It is incredible work."
This was something she didn't expect after making the transition from the maternity ward to her current occupation. But there have been other similarities that also caught her off-guard.
"Helping mothers give birth gave me a skillset that I found incredibly transferable to death," she said.
"One of the skills you have to learn [during a birth] is to be in a room where it's very intense. There is a lot of emotion going on, it's one of the most important days of someone's life and there are a lot of family dynamics happening. Also, it's never lost on me that I was not the most important person in the room, even though I was in charge of making sure everything went well. There's something more important going on."
While the vast majority of patients prefer to die at home, Green said some people were a little more creative and made it an event.
One particularly compelling story involved a fiercely independent woman suffering from an aggressive form of oral cancer who booked a hotel room 72 hours before the actual event and then had her family and friends visit her at various intervals. She was essentially attending her own wake.
"On the day of the actual death, the person who is dying is the calmest in the room. They are settled, satisfied, adamant and ready to go. It's the people around them that are way more nervous and don't know what to expect."
Green says the vast majority of people she's worked with to end their lives were white Canadians with an upper-socioeconomic background, even though the service is included under Canada's public healthcare system.
But they aren't the only ones choosing this treatment.
She's worked with a monk of 22 years, priests, a Jewish rabbi and a man reading the Quran on his deathbed.
Cancer is often listed as the main reason people choose to end their lives, but, interestingly, pain isn't the main motivation for taking the step. Green said international research shows the top three reasons people want the treatment is because they are no longer able to do activities that bring meaning to their lives, that they feel they've lost autonomy and that they feel they weren't in control.
"Pain is in there, but it's usually fourth or fifth on the list," she said.
Green may talk frankly and unapologetically about this issue, but she never belittles the weight of what she does for a living. She said that none of the doctors involved in this space ever take a decision lightly. And her statement is backed by stats.
A recent Canadian study showed that 37 per cent of the people who come forward to ask for end-of-life treatment never receive it. In some instances, this comes down to the patients not meeting the strict requirements of the legislation, but in others, it's because they don't live long enough to receive it.
Green said a possible contributing factor to people dying before being given the treatment is simply because there aren't enough medical practitioners who have signed up to do the work in Canada.
This reluctance is also apparent locally, with 1000 doctors recently signing a petition opposing euthanasia legislation in New Zealand.
She says the stigma has led to the few Canadian doctors available doing high volumes of treatment when it could be far less. She points to the Netherlands as an alternative, saying that medically assisted dying has been incorporated into general practice – spreading the workload and ensuring that a single doctor is only required to administer the treatment a few times a year.
The problem with this is that the work is taxing, given the legislation provides such strict guidelines for when the treatment can be administered.
This means that busy doctors end up working even longer hours and more weekends to help people in often desperate situations.
There are also concerns about training, given that most medical schools don't yet cover the procedural side of this treatment. This is something Green has been working hard to rectify, engaging with universities and ensuring that it is added to the curriculum.
These issues among others will be particularly important for New Zealand to address as it moves to bring its bill into effect.
Because, as Green reiterated time and again, having the legislation enacted is only the first step in what is a very long process.
Where to get help:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
Or if you need to talk to someone else:
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youthline: 0800 376 633
• Need to talk? Free call or text 1737 (available 24/7)
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
• Rainbow Youth: (09) 376 4155
• Samaritans 0800 726 666
• Rural Support Trust: 0800 787 254.
• For others, visit: https://www.mentalhealth.org.nz/get-help/in-crisis/helplines/