Introduction

Webcast archive: Family of British Columbia man contests his eligibility for euthanasia

This week, we discuss the story of a man who was euthanized before the circumstances underlying his suicidality were addressed.

Webcast archive: Family of British Columbia man contests his eligibility for euthanasia

In this episode of Euthanasia & Disability, Amy Hasbrouck  Christian Debray, and Taylor Hyatt discuss:

  • Family of British Columbia man contests his eligibility for euthanasia

Please note that this text is only a script and that our webcast contains additional commentary.

THE FAMILY OF A BRITISH COLUMBIA MAN CONTESTS HIS ELIGIBILITY FOR EUTHANASIA

  • This week, we’re looking at the events surrounding the death of a British Columbia man who was euthanized in July.  According to the man’s family, healthcare professionals failed to identify the Medical Assistance in Dying (MAiD) request as arising from a history of mental illness, and wrongly determined that his death was “reasonably foreseeable.” We received his family’s testimony from the Euthanasia Prevention Coalition, which is now assisting in their call for a formal investigation into his death.
  • Alan Nichols had mobility, hearing and visual impairments, as well as a brain injury from childhood cancer that caused some cognitive and psychiatric limitations. He had been living independently, with some informal support from his brother Wayne (who took him shopping every week) and Gary (who helped him to manage finances). He retired after a long career working for a local school district and a plant nursery, receiving financial support from his family as well as a pension. In his free time, Mr. Nichols enjoyed traveling, fishing, and hiking.
  • Mr. Nichols’ decision to stop taking antidepressants and other medications caused instability and according to his brothers, led him to make poor choices for himself. Mr. Nichols would sometimes threaten to harm himself by not eating (though Wayne noticed the groceries he bought each week were all eaten and Alan never lost weight). He was reluctant to use a walker or mobility scooter, and refused to use assistive devices to improve his vision and hearing. He did not live with pain.
  • In June of 2019 Mr. Nichols was struggling to adapt to some significant life changes:
    • His brother Wayne was planning to travel across Canada and so wouldn’t be available to take Alan shopping for several weeks;
    • A favourite neighbour was preparing to move away; and
    • The grocery store where he shopped had recently closed.
  • The events leading up to his death began on June 16, when Alan’s neighbour realized she had not seen him for a few days. She informed Wayne, and called the RCMP to check on him. The officers found Alan “weakened…from not eating or drinking” and contacted Wayne to tell him that Alan was being admitted to the local hospital “for his own health and safety.” When Gary visited from Edmonton, Alan asked to be “busted out” of the hospital. Alan was transferred to the psychiatric unit on June 17, but refused visits from his brother.
  • During his hospital stay, Mr. Nichols said his hearing aid didn’t work properly, so staff used a whiteboard and marker to communicate with him.
  • After multiple calls and emails asking for an update, Gary was informed on June 27th that Alan had been transferred a week earlier to the Patient Assessment and Transition to Home (PATH) unit.  Gary emailed and phoned the PATH unit looking for information on his brother’s condition, but was told Alan’s doctor was away on vacation. He was able to speak to a social worker who said Alan “was eating, walking, talking, visiting with others on the ward. He was doing well.” There was no mention of an application for MAiD.
  • Alan’s physician called Gary on July 22 and told him of the MAiD request, four days before the euthanasia was scheduled.
    • Gary’s wife, Trish, spoke to the doctor that same afternoon. She explained that Alan’s desire to die probably stemmed from unaddressed depression and anger. The doctor stated that although Alan’s health had improved since being admitted to the hospital, he had a “legal right” to MAiD. The doctor “had asked Alan several times if ending his life [was] what he really wanted to do, and was met with a yes response each time.”
    • Although the doctor did not believe death was the best course of action, she gave him the application forms. Once the request for euthanasia was approved, no one but Alan could stop it. The Nichols brothers later learned that his doctor was not part of the team that determined him eligible.
    • Hospital staff were able to convince Alan to see his family before he died.
  • Alan celebrated his 62nd birthday on July 23; his aunt sent flowers, staff provided a cake and his brothers called to wish him a happy birthday.
  • The day before his death, Alan’s brother Gary and sister-in-law Trish visited him, and met his social worker. Gary said he planned to move closer to Alan after retiring next year. Alan’s family noticed that he often looked to his social worker for reassurance when answering questions, and for confirmation that nothing would get in the way of the euthanasia. They wondered if this meant that the decision to die was not truly his.
  • On the day of Mr. Nichols’ euthanasia, he didn’t seem to care that his family was present; he didn’t talk and only shrugged when the nurse said it would be necessary to try again to find a vein for the injection. He wouldn’t look at messages his family wrote on the white board begging him to change his mind, then he became agitated and shouted “It’s too late! This is my moment!”
  • When the doctor arrived, the family expressed their concerns about the lack of support Alan had received for his psychological condition.  The doctor said “we cannot legally stop people from making bad choices and we should not judge Alan for this.”
  • Alan’s family asked to spend as much time with him as possible to explore alternative living arrangements, and even opportunities available in the cities where his relatives lived. When his doctor told Alan his family “would like to try to rebuild their relationship with you” Alan again became angry, saying his doctor was no longer ‘on his side’ and that his brothers were not blood relatives.  Even after calming down, Alan continued to demand that the euthanasia be done immediately. He received a lethal injection around 10 a.m. on July 26, 2019.
  • The primary cause of death listed on Mr. Nichols’ Medical certification of Death was “MAiD,” with the “underlying” conditions listed including:
    • a stroke he had years before, from which he had recovered;
    • a seizure disorder for which he had not needed medication for nearly 15 years. He had reported no seizures for a decade, and;
    • two brain tumours which were surgically removed 50 years ago.
  • The Nichols brothers discovered that Alan’s euthanasia had initially been scheduled for July 19. According to the family, the nurse practitioner who was to perform the injection stopped the procedure at the last minute, because she was concerned about the lack of contact with Alan’s family, the absence of his doctor (who was on vacation at the time), and a lack of documentation of his final wishes in a will.
  • Alan did not have a will, an advance directive, a power of attorney naming a substitute decision-maker or other document outlining his wishes before he applied for MAiD. According to the family, the organization that managed the hospital insisted that a will was necessary in order to access MAID. It was drawn up in the hospital on July 12, in the presence of the hospital social worker, and a local notary was made the executor. The brothers were only able to meet with the notary after Alan’s death. Though the notary also found it strange that none of Alan’s loved ones were contacted beforehand or listed as executors, he told Gary that nothing could be done.
  • Mr. Nichols’ family is now seeking the assistance of a lawyer to obtain the documents related to his case, especially the doctor’s review of the euthanasia procedure. They believe Alan Nichols was ineligible for MAiD for several reasons:
    • he was incapable of making a decision due to his psychiatric condition, external stressors, anger and suicidal feelings;
    • he did not experience pain or discomfort that rose to the level of “intolerable suffering;”
    • his condition was not in an advanced state of irreversible decline;
    • his natural death was not reasonably foreseeable.
  • Our society’s emphasis on institutional care may also have  contributed to Alan Nichols’ death.
    • He would have been an ideal candidate for a legally-recognized supported decision-making arrangement. But his brothers’ efforts to become his guardian had failed, and the resulting informal arrangement, while workable in the normal course of things, failed under stress.  The result was that medical staff did not consult with the people who helped him to maintain his stable and independent lifestyle when making a life-and-death decision.
    • Both Alan’s family and his doctors encouraged him to try living in a residential facility as the “obvious” solution to his isolation and difficulty in caring for himself. He resisted, preferring to hang onto the autonomy and spontaneity he had in his own home.  Other supported independent living models should replace institutional care as the “default” option.
  • It’s tragic when a person kills themselves, for whatever reason. We continue to believe that society should not step in and facilitate that irrevocable, final act.