‘This is Assisted Dying: A Doctor's Story of Empowering Patients at the End of Life’ by Stefanie Green, MD

In this memoir published in 2022, Dr. Stefanie Green chronicles her first year providing medical assistance in dying (MAID) on Vancouver Island, British Columbia. Green describes how she transitioned her practice from family medicine, where she specialized in maternity and newborn care, to providing MAID in June 2016, as soon as the procedure was legalized. Green had been looking for a career shift away from obstetrics, because of its demanding schedule, but had not found another speciality that she found meaningful until she began exploring MAID. When she began providing MAID, the procedure was so new that there were no provincial billing codes or best practices for physicians. Green writes that there was nobody to teach her the ‘art’ of assisted dying. Before she provided MAID for the first time, she had never seen the procedure performed, which is contrary to the usual method of medical training. She finds that she is unprepared for the intimacy that comes with providing MAID and the outpouring of gratitude that she receives from patients and their families. Green draws parallels between birth and death, saying that they are both types of ‘deliveries,’ that evoke a strong sense of significance for patients and that are often tied to complex family dynamics. She describes her surprise that she does not face negative responses from the public, but does experience pushback from other medical professionals. Many of the stories that Green shares are touching and poignant, but she does not shy away from moments of discomfort, like when she assesses a patient with suicidal ideation. Consistent throughout the year is her worry that she may face criminal charges or regulatory complaints if she makes a mistake in her MAID assessments. She struggles with interpreting the language used in the legislation, particularly the requirement that a patient’s death be ‘reasonably foreseeable.’ These challenges lead Green to incorporate the Canadian Association of MAID Assessors and Providers (CAMAP), a national organization to support professionals providing MAID across the country. She becomes the founding president of CAMAP, which later takes on an advisory role to Health Canada on issues in the practice of MAID.

Green’s book paints an intimate portrait of a doctor’s experience of MAID. Rather than directly outlining critiques of MAID, Green humanizes the procedure by revealing how she developed her practice and how she has been affected by the work. In so doing, she responds to many arguments used by those who oppose MAID. She emphasizes that her patients generally have excellent palliative care, and notes that it is not inadequate care that leads them to pursue MAID but diminishing quality of life and an inability to do things that they once found meaningful. She equally notes that her patients are mostly white, well-educated, elderly, and of a higher socioeconomic class, rather than more vulnerable populations. She reflects that many of her patients delay MAID after their approval and live well past the point that they thought would be intolerable. For many people, this is because needing help, like assistance to get dressed and use the bathroom, is not as terrible as they thought it would be. She further describes the positive effect that being approved for MAID can have on patients, writing “[o]nce my patients were no longer fearful of how they might die, they focused intently on living and allowed themselves to more fully embrace the life they had left.” Green shares that watching her patients experience their final moments has led her to contemplate her own mortality and to more fully embrace her life. Green comes across as the picture of a competent and compassionate physician and her book functions as an affecting defence of MAID. Green is currently a member of Dying with Dignity Canada’s Clinician’s Advisory Council and medical advisor to the BC Ministry of Health’s MAID oversight committee. Since 2016, she has become one of Canada’s most well-known physicians advocating for MAID.