This is Assisted Dying

“There’s something special about reading the story of a person who has found their true vocation—their passion jumps through the page and grabs you. Dr. Stefanie Green is a doctor who was born to help others through her work. In 2016 when the law changed in Canada to allow assisted dying,  Green, a maternity ward doctor, decided to learn more. Assisted is the story of a gentle pioneer. From its earliest pages, it is a book about courage—the courage of Green, and of those she encounters. It is a remarkable reading experience seeing the world through this author’s eyes. We are there with her as she learns how to navigate this emerging area of medicine and as she confronts the opinions of other people, all the while with respect and dignity. Green doesn’t shy from the controversies; she is gracious enough, to be honest about her own moral quandaries. In essence, however, she is a scientist: someone who presents the facts for us to make up our own minds. This is a joyful and important book—and a successful one. Green’s prose is easy, understated, and never preachy. It is also incredibly intimate,  with Green offering a safe pair of hands to help the reader through the murky waters of the controversial topic of assisted dying. Readers who enjoyed Karen Hitchcock’s The Medicine- a doctor’s notes will enjoy  Assisted for its clarity.”

“Physician Green chronicles in this stunning account her work in the assisted dying field after Canada passed its Medical Assistance in Dying bill in 2016. Through stories of her many patients, she reflects on her work “bringing about death” in Vancouver Island, the area in Canada with “the highest percentage of assisted death.” One woman with advanced metastatic breast cancer, for example, had eating and mobility issues as well as progressive pain, made worse by having watched her mother and two sisters die of cancer before her: “I know what’s coming next and I’d rather skip it,” she concluded. Another man declared, “I want to do it my way. I want to have my friends over… maybe even sneak a sip of a beer.” Much like her patients, Green avoids cloying sentimentality and gets straight at the heart of the matter with compassion and force: ‘We’re going to talk about death today, and we’re going to talk about dying… I’m going to talk about these things quite frankly,’ she tells one patient. Green gives a personal voice to a contentious topic, making a memorable case that death is a ‘mark of our humanity.’ Written with sensitivity, grace, and candor, this is not to be missed.”

A Canadian physician recounts a still-evolving practice of allowing people to end their own lives with medical help. 

In 2016, Canada was ahead of the curve in passing a law that allowed for doctors  to assist terminally ill people to choose when and how to die, by which “the fear of  an unknown ending is replaced by a semblance of control.” The law had a few gray areas that were later addressed: At what point can it be determined that death is imminent? Can someone who is beset by incurable depression or some other mental disorder be considered a candidate for medically assisted suicide? Green addresses such questions with case-studies from her own practice. She also investigates the moral and ethical challenges placed on her and her fellow physicians by the sheer task of determining when a patient qualifies for the application of the law. “It turns out all these emotions go somewhere,” she writes,  “and every once in a while, a crack forms in the retaining walls, and the feeling  slips out.” Her allowance that doctors are humans, too, is welcome. With a few years of practice in medically assisted suicide, which in Canada is accomplished through the ingestion of lethal drugs by mouth or intravenously, Green has a notion of trends. For example, the number of people who choose that avenue is growing,  and it is especially prevalent around the holidays. Even so, she recounts, it’s a  small fraction of the number of Canadians who die each year, in part, she suggests,  because medically assisted suicide is not widely advertised. Canada bests its  southern neighbor in favoring science over religion, but, Green also notes,  medically assisted suicide is allowed in several U.S. states, if with somewhat  tighter controls, with states requiring “that the patient be terminally ill with a  prognosis of six months or less.” Green predicts that these controls will be loosened as more people learn about the option. 

A humane, clear-eyed view of how and why one can leave the world by choice.

The assisted dying debate in the UK sometimes seems detached from the very lives of those to whom a law would give the end-of-life choice they seek. Dr. Green’s memoir, sharing her experiences as a pioneering assisted death practitioner in Canada, is therefore welcome in providing insights into the lived experience. 

This informative and often poignant book should be mandatory reading,  whichever side of the debate you support. Dr. Green’s compassion for her clients oozes from the pages, alongside an admirable honesty as she processes the personal and professional challenges thrown up by her work.  

In particular, away from the claims that opponents often make, those with a medical background may be surprised and heartened by the penetrating scrutiny to which Dr. Green and her colleagues subject themselves in assessing individuals for MAiD. Many are refused.

Above all, this is a book that will move you – in my case to both joy and tears – because ultimately it is about the lives of human beings who are terminally ill or intolerably suffering making difficult choices – and one day it could be you or me.  

In “This is Assisted Dying” Dr Stefanie Green takes the reader along on her personal road of development regarding the practice of Medical Aid in Dying (MAiD) after it became legal in Canada. Using patient stories she recounts her growth as a MAiD provider, from one of the first cases in Canada after law C14 was passed, through the first year of her experience, up till the establishment of CAMAP, the professional organisation supporting providers (and assessors) in which she plays a major role. It is impressive to read the way she writes how step by step a new law is being implemented into a daily practice, in which professionals can execute the newly acquired legal possibility of assisting a patient in dying, at the same time – as the subtitle says – empowering patients at the end of life.  In this first year described you’ll read about her natural growth of expertise,  based on personal experiences and professional exchanges with colleagues; based also on a seemingly natural attitude to want help patients in existential situations. Like many others in the field Stefanie compares  her new job with her former position as maternity doctor: “in both ‘deliveries’ as I call them, I am invited into a most intimate moment in peoples lives”. Stefanie Green’s book shows that careful procedures, humane interest and personal dedication make so called right-to-die laws feasible and safely implementable. A lesson to others, public and professional, to assess the prospects of legislation and practice of MAiD in other jurisdictions. As she herself says ” … when there is nothing more “to do”. I sit with my patients and try to journey with them, stay present, provide a listening ear, and answer their questions and answer their questions as best as I can. this what a doctors does. ‘To cure sometimes, to relieve often, to comfort always'”. Her book demonstrates that MAiD is about comforting patients. A must read.

“I first met Dr. Stefanie Green via email in 2018, when I was advocating for a  small group of people with lived experience – loved ones of those who had received assisted deaths – to attend the Canadian Association of MAiD  Assessors and Providers (CAMAP) conference in Vancouver the following year. Looking back at that email thread now I have to laugh, as at first I  didn’t realize I was communicating with the president of the organization.  As a healthcare advocate, one of my strongest beliefs is in the relationship between a patient and physician. Dr. Green’s voice in that email exchange speaks to a similar view; she is involved. 

It was an honour to receive an advance copy of This is Assisted Dying: A  Doctor’s Story of Empowering Patients at the End of Life. Stefanie – she writes of the compliment, when patients use her first name – infuses the book with the personal stories of those for whom she has provided an assisted death, as well as those of their friends and families. While she has fictionalized these stories you would never know, as their value and meaning is rooted. The stories alone make This is Assisted Dying worth reading. The history of assisted death in Canada – both pre and post legislation – is also well presented for those who are not familiar with the development of this personal right. 

For me – as the wife of a man who chose MAiD (Medical Assistance in  Dying) in 2017 and a related advocate – the value of Stefanie Green’s new book is the insight into who she is as a human being, and how choosing to be a MAiD assessor and provider has deepened her humanity. Each story leaves you with a specific gleaning, how that individual changed the author’s perception of death and/or how she could better support those looking for assistance in this regard. Of particular note is Stefanie’s emphasis on the similarities between birth and death, having had a  maternity focus for years before she shifted to MAiD. Emphasizing this circle reminds us that death is just as much a part of life as is birth, a truth we have very much forgotten.  

‘Both maternity care and MAiD were intense, intimate, emotional experiences that called upon family dynamics and required me to respect personal choices. Both challenged me to be at once fully present and then,  fairly quickly, to graciously withdraw . . . . Not unlike my role in maternity care, my job in MAiD is to stay focused on what patients need, listen for their intentions, understand their goals, and help steer them and their loved ones through what I hope can be a slightly more empowered transformation from partner to caregiver, from person to patient, from life to death. My role also goes through transition during these events – as I  place a baby on mom’s chest or as I pronounce out loud that a loved one  has finally died – and I am immediately aware that my role has shifted from  a helpful guide to a respectful witness.’ 

I attended the CAMAP conference in 2019, and consider it an honour to continue supporting Stefanie Green’s vision as she spearheads the development of a national curriculum for MAiD assessors and providers.  She is a change-maker with a clear voice and you would do well to take time with her book. One day assisted death may step close to you, but regardless, we will all die and have the opportunity to make that experience a fulsome one by considering it in advance through words such as you will find in this book.”

“I have recently finished reading an advance copy of Stefanie Green’s book This is Assisted Dying. The book is really, really good and I am happy to strongly recommend it. For those of us who are assessors and providers of this care, it gives voice to those feelings and inner conversations that we have had since starting our MAiD work and by doing so enables us to feel pride whilst at the same time encouraging useful introspection. For people supporting our work (patients, friends, family) it helps those of us who do not share Stefanie’s eloquence explain to them what being involved in MAiD means. I have passed my copy to my wife and recommended the book to my daughter and son. It’s not that I haven’t talked to them about MAiD – I do, a lot. It’s just that Stefanie’s stories and self-analysis add significantly to what I have said to them before.”