It is not unusual for married couples to die within a few days, weeks, or months of one another. It has become more common in recent years for couples, especially those who have been together for many years and are in poor health, to plan their deaths together by taking barbiturates or some other drug that is deadly when taken in sufficient quantity. Recently, through Canada’s assisted-dying law, a Canadian couple, married for almost 73 years, arranged their joint deaths in the same bed, while holding hands.
From the Toronto Globe and Mail:
Shortly before 7 p.m., Mrs. Brickenden turned to her husband. “Are you ready?”
“Ready when you are,” he replied.
They walked into their bedroom and lay down together, holding hands. The two doctors, one for each patient, inserted intravenous lines into their arms.
Angela rubbed her mom’s feet. [Pamela] rubbed her dad’s. “They smiled, they looked at each other,” Pamela said. Then Mr. Brickenden looked at his children, standing at the end of the bed. “I love you all,” he said.
The circumstances of the planned, intentional deaths of George and Shirley Brickenden, who lived in a retirement facility in Toronto, are worth reviewing, both to understand Canada’s law and to understand their decision.
The Brickendens were in their mid-90s when they died on March 27. Both had several health problems and were experiencing significant physical suffering. Mrs. Brickenden’s body was described as “wracked by rheumatoid arthritis, an inflammatory condition that turned her hands into swollen purple claws.” She also had a failing heart after a heart attack two years ago.
The Brickendens sought to die together a year ago, but one of the doctors who evaluated Mr. Brickenden under Canada’s law did not believe that he satisfied the criteria for intolerable suffering from a grievous and irremediable condition that made his death reasonably foreseeable, because he did not have an underlying illness that satisfied the reasonably foreseeable standard. He was, however, frail, of advanced age, but with the cognitive capacity necessary to make an informed decision that he wanted to hasten his death.
The couple was determined to die together, so they decided to wait. Over the next few months, Mr. Brickenden developed other health problems. He began fainting repeatedly. His heart began to fail. He contracted infections that required hospitalizations,. He came close to dying of influenza. And Mrs. Brickenden developed other health problems, breaking a hip in two places. Shortly before their tandem deaths, she described herself as feeling miserable.
More than a year after their first attempt to use Canada’s assisted-dying law to synchronize their deaths, they applied again. This time, the two doctors who evaluated Mr. Brickenden both determined that he met the criteria for assisted dying. The other pair of doctors who evaluated Mrs. Brickenden arrived at the same conclusion that had been reached a year earlier–she was eligible to use the assisted-dying law.
Because four independent doctors were involved with the evaluations of the Brickendens, there was little chance of undue influence on either of them, a concern by many bioethicists when looking at joint deaths. But it is also an issue raised by opponents of assisted dying in every individual case. However, it seems self-evident that if each doctor works independently and professionally, there should be little chance of undue influence.
The acronym MAID (medical assistance in dying) is frequently used in Canada to refer to what the 2016 law, known as Bill C-14, allows. Its general criteria are these:
• Two independent health care professionals need to evaluate an individual in order to determine whether he/she qualifies for MAID
• Patients must be must be 18 years or older and be able to provide informed consent at the time that MAID is provided, not be subject to external pressure in requesting MAID, and be informed of other assistance to relieve their suffering (including palliative care)
• They must be eligible (not counting any waiting period) for health services funded by a government in Canada
• Generally, there is a 10-day waiting period after qualifying for MAID before MAID can be provided (if maintaining competency becomes an issue, the waiting period can be shortened)
To qualify, an individual must meet these specific health criteria:
1. Have a serious (grievous) and incurable (irremediable) illness, disease, or disability
2. Be in an advanced state of irreversible decline in capability
3. Endure physical and psychological suffering that is intolerable to them
4. Face a reasonably foreseeable natural death
Unlike all DWDA (Death With Dignity Act) laws in United States jurisdictions, Canada allows two types of MAID:
1. A physician or nurse practitioner can directly administer a substance that causes the death of the person who has requested it, or
2. A physician or nurse practitioner can give or prescribe to a patient a substance that can be self-administered to cause death.
All the US laws require self-administration of lethal substances prescribed by a physician, which sometimes leads to regurgitation of the substance after ingestion and limits use of these laws to patients who can swallow and who have the dexterity to manage the process.
Portions of the Preamble to the Canadian law express well the differences between Canadian and American views of MAID:
Whereas the Parliament of Canada recognizes the autonomy of persons who have a grievous and irremediable medical condition that causes them enduring and intolerable suffering and who wish to seek medical assistance in dying;
Whereas robust safeguards, reflecting the irrevocable nature of ending a life, are essential to prevent errors and abuse in the provision of medical assistance in dying;
Whereas it is important to affirm the inherent and equal value of every person’s life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled;
Whereas vulnerable persons must be protected from being induced, in moments of weakness, to end their lives;
Whereas suicide is a significant public health issue that can have lasting and harmful effects on individuals, families and communities;
Whereas, in light of the above considerations, permitting access to medical assistance in dying for competent adults whose deaths are reasonably foreseeable strikes the most appropriate balance between the autonomy of persons who seek medical assistance in dying, on one hand, and the interests of vulnerable persons in need of protection and those of society, on the other;
Whereas it is desirable to have a consistent approach to medical assistance in dying across Canada, while recognizing the provinces’ jurisdiction over various matters related to medical assistance in dying, including the delivery of health care services . . .;
Whereas persons who avail themselves of medical assistance in dying should be able to do so without adverse legal consequences for their families—including the loss of eligibility for benefits—that would result from their death;
Whereas the Government of Canada has committed to uphold the principles set out in the Canada Health Act—public administration, comprehensiveness, universality, portability and accessibility — with respect to medical assistance in dying;
Whereas everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms; . . .
The Brickendens successfully used Canada’s MAID law to have the kind of deaths they both wanted. The closeness and quality of their relationship has been commented on by several writers, including Hemant Mehta and Kelly Grant.
While dying together is not the decision of most couples, the importance of the Brickenden’s story to the mission of the Final Exit Network is that the Brickendens were able to exercise the autonomy that each of them had to have their individual end-of-life choices honored by their health care system and by their government. While we have made progress in achieving such goals for US residents, we have a long way to go to have a system as humane as Canada’s, and Canada is continuing to work to improve its system so that all its people will enjoy the autonomy and choices that were available to the Brickendens.
