‘The Last Doctor: Lessons in Living from the Front Lines of Medical Assistance in Dying’ by Dr. Jean Marmoreo, Johanna Schneller

In this 274-page memoir co-authored by journalist Johanna Schneller, Dr. Jean Marmoreo recounts her experiences of providing medical assistance in dying (MAID). Marmoreo had been a family physician for 45 years when the Carter decision decriminalized assisted dying in Canada. She writes that she knew immediately that she would become a provider, having seen too many of her patients take ‘matters into their own hands’ and withdraw from her care at the end of their lives. Structured by the stories of seven patients, her narrative recounts how she learned to provide MAID in the early days of Canadian legalization.

While Marmoreo is a strong advocate of MAID, in her memoir she wrestles with cases that left her feeling uncertain. She highlights the stories of patients who requested MAID who were socially isolated or had inadequate community supports, and two cases in particular leave Marmoreo wondering if she, or the health care system generally, have done enough for the patient in question. She writes, ‘I had to learn to accept that sometimes I was doing MAID because the chain of care had failed.’ In comparison to This is Assisted Dying, published the same year by Dr. Stefanie Green, another high-profile Canadian MAID provider, Marmoreo’s account presents a more critical picture of MAID. At the same time, Marmoreo writes eloquently of the power of MAID to give dignity and control back to patients, and to provide them with a peaceful death. She further emphasizes that MAID has led to an expansion of palliative care services in the five years since legalization and that MAID data reporting creates an opportunity to identify and improve gaps in services to neglected populations. Moreover, in the epilogue to her book, she applauds the changes made to Canada’s MAID legislation in Bill C-7 in 2021. The major change in the law was the creation of a second track of MAID eligibility for patients whose natural death is not reasonably foreseeable. In her words, the changes to the law, ‘answer many of the concerns that plagued me in my first five years of provisions.’ Despite some of the conflicted feelings Marmoreo describes towards MAID, she nonetheless closes her book with a plea to her fellow family doctors to consider providing MAID, as part of a ‘cradle-to-grave’ model of care. Marmoreo is a member of Dying with Dignity Canada’s Clinicians Advisory Council. She is a regular columnist for the Globe and Mail, the National Post, and Zoomer. The Last Doctor was a finalist for the 2022 Balsillie Prize for Public Policy, which recognizes nonfiction books that contribute to Canadian policy. In 2023, Marmoreo was inducted into the Order of Canada.