P.E.I. doctor calls his role in medically assisted death a 'profound experience'

Dr. Matt Kutchercalls his role in the medically assisted death of his patient a "profound experience" that has forever changed him as a physician.

"To be in a situation where you were about to end someone's life and have them look you in the eye, and hold your hand and say, 'Thank you so much,'"saidKutcher.

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Helping Paul Couvretteon May 10, 2017 was the first timeKutcherhad been involved in a medical assistance in dying (MAID) procedure.

"Itdid feel pretty profound. You were able to really provide somebody withthe means to realize a decision that is probably as momentous as a decision can be," said Kutcher.

Reflecting now, close to a year later, Kutcher says it is a totally new role for him as a physician in one sense, but also completely in line with everythingphysicians do, including alleviating suffering and providing "some measure of happiness in difficult circumstances."

"I don't want this to be something that's whispered about, that's hidden behind doors," saidKutcher.

"Wehave a law that governs it. It's regulated carefully. It's done with great care by the people involved in it."

12 medically assisted deathrequestsin 2017

Couvrettewas 72 when he died one ofsix Islanders who had a MAID procedure last year and one of12 who requesteda medically assisted death.

For privacy reasons, health officials won't providemany details, but say most of the six procedures involvedmen, aged 59 to 74, withcancer beingthe most common underlying condition. Some were performed at home;others in institutions.

The procedure became legal in Canada in June 2016, but there were noMAIDsprovided in P.E.I. that year.

Some of those who requested a MAIDpassed away without using the procedure, while a fewwere denied because their health problems were not considered serious and irreversibleas required by law, according to Dr. AndreCelliers, chief of family and community medicine with Health PEI.

Aperson must be also be assessed by two medical professionals (physicians or nurse practitioners) as mentally competent when they request a MAID and again on the day of theirdeath.

• More than 2,000 Canadians have died with medical assistance since legalization

Cellierssaid he's not aware of any problems accessing professionalsto do theassessments or procedures.

However, if a patient's family doctor isn't comfortable taking part,Health PEI has a small pool of professionals patients can access through the province's 811 health services line, he said.

'They know what they want'

"There are many circumstances when people want to have control over the manner of death, and this is what the choice entails that they have the ability to decide how this is going to play out," saidCelliers.

Once approval is given there is a mandatory 10-day period of reflection.

"As a rule people are very thoughtful when they apply for this," saidCelliers. "They know what they want. They know how they want this done and we try to be respectful of their choices."

If the procedure is performed ina hospital or otherinstitutionCellierssays it's arranged in a private areaand only staff who are comfortable with the process are involved.

Sharing their story

Couvrette'swidow, Liana Brittain, says he urged her and Kutcher to share his story to help demystify the process and makepeople feel more comfortable talking about itas one of their end of life options.

It was a message Couvrettereinforced on the day he died, she said.

"He said, 'Iwant everybody to know that they can die with dignity and they do have choices. Make my death have meaning. Tell our story,'" saidBrittain."In his very last moments of lifehe was thinking of others and how he could best help them."

Couvrettehad advanced stage cancer andlived at home for months under the palliative care program.

Kutchermet withCouvretteseveral times to assess his competency,and had nodoubts about hiscommitmentto hisdecision.

Once Couvrette'sMAIDwas approved,"it was like the weight of the world had been lifted off his shoulders. It gave him a sense of control,a sense of well-being,"saidBrittain, addingher husband didn't want to suffer or for others to watch him suffer.

"It really gave him a lot of peace for quite a few months," added Kutcher, "knowing that when he was ready that he could avail himself of this."

Normalizing the discussion

SinceCouvrette's deathBrittainand Kutcherhave shared his story several times: at a medical conference on end of life issues in Halifax, to staff at the Prince County Hospital, and at a teaching session for P.E.I. family medicine residents.

Kutcher says their collaborationhas developed into a friendship that has made him a better doctor. "She has helped me learn better ways to speak to families. She's helped me develop materials to give to families."

He now includes MAID in a "basket of medical services" available to those facing end of life options, that also includes palliative care and hospice."I do so in an attempt to sort of normalize the discussion."

Hearing a family member is thinking ofMAIDhas the potential to leave families, shocked,angry and upset, howeverKutchersaid the families he's talked to have been supportive.

"Certainly over a good number of days and open discussion, most often everybody rallies around their loved one and supports the decision, even if they themselves feel that it may not have been the appropriate choice."

Getting approval

Brittainsays she would like to see advance directives allowed so people don't feel rushed to have a medically assisted death before they become incapacitated. She says her husband might have chosen a later date for his MAID if an advance directive had been available.

Kutcheralso worries that the requirement to be competentat the time of the procedure "may have the unintended consequence of pushing some patients or nudging some patients" to choose an earlier date for their procedure.

As more people become aware of the procedure and with an aging population, Kutcheralso wonders whether there will be enough people toprovide the service.He said most of the physician's work is done after hours, including several lengthy meetings for the assessments. "You're being asked as a physician and as a care provider to make some pretty serious judgments you don't want to be rash about."

Anumber of issues being debated now about the law, include whether mature minors should be offered the procedures, and patients in the early stages of Alzheimers.

Since her husband's death Brittain has been busywritingmaterial for doctors and patients to help them through the process and working with Dying with Dignity Canada to share the stories of those families that have experienced MAID.

She's also writing a book about MAIDs that she hopes to publishby the end of the year.

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