Quebec doctor pulls back the curtain on medically assisted dying

In his 30 years as a palliative care physician, many patients have asked Alain Naud for his help to die. But until Quebec's law came into effect last year, he could do nothing but make their last days as comfortable as possible.

Naud is the first doctor involved in medicallyassisted dying to speak publicly about the procedure.

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"Honestly, medicallyassisted death is new, not just for the population or patients or family,but also for caregivers, including doctors. It's something that has never been done here. The first time, you prepare accordingly," he said.

Quebec became the first province in Canada to make it legalfor terminally ill patients tochoose to die with medical help. The law went into effect on Dec.10, 2015.

Bill C-14, theproposed federal legislation to legalize medical aid in dying,was tabled in the House of Commons today.

The issue has been the focus of political debate, butNaud wants to lift the veil on the realm of actual patient care and relief from suffering.

He saidhe's heard enough from the critics.

"We've left a lot of space [in the public discourse] for those who are against it," Naud said.

• The fight for the right to die

He said he accepts and understands that doctors who are opposed to the procedurewill not take part in it.Buthe hopes to demystify the process andprevent terminally illpatients from believing they cannot get access to the procedure.

"Some people want to believe that medical assistance to die is dangerous, that it's complicated, and no one should have the right to do so," he said. "But it's not the case."

'It happens very calmly'

The procedure consists of three injections:one to relax the system;one toinducea coma; and a third that stops the vital organs.

What doctors have learned since performing the procedure is that the patient often dies during the second injection.

"The patient simply closes their eyes gently, stops breathing," Naud said. "There isn't a single sound, there's no movement, there's no reaction."

"It happens very calmly,in the space of a few minutes, not hours."

For many, it's a peaceful end to painful final days.

But getting to that point isn't as simple as a patient expressing a wish to end his or herlife.

According to Quebec's end-of-life carelegislation, patients mustbelegal adults,capable of giving consent.They must suffer from a serious and incurable illness and already be near the end of their natural lives.

• Act Respecting End-of-Life Care

Patientsalso must be in an advanced state of "irreversible decline in capability" and must be experiencing constant and unbearable physical or psychological pain.

From there, Naud explains, there are proceduresthe physician must attend to.

Patients have chance to reconsider

Naudrecently helped a terminallyill man in a QuebecCity hospital end his life.

He ensured the patient met all the legal criteria, had filled out all the paperwork and expressed his wishes to two different doctors.

That process gives people time to contact members of their family and ensure their affairs are in order.

"It allows everyone to give their final goodbyes to say one last time the thing that hasn't been said and to live that moment there, as a family," Naud said.

Gently holding the man's hand, Naudasked him about his pain and sleep before again confirming he wanted to proceed.

Patients can changetheir minds at any time, he said.

On his second visit, Naud said, the patient wastoo drowsy from medication, and hedecidedto return later.

A week and several visits after their initial meeting, the patient remained steadfast in his wishes.

He died in hospital with the doctor at his side.

"We are really at the essence of a human being in his final living days, and [he] is asking us to use science and our humanity to end his suffering," Naud said.