All About Estates

My First Experience with Medical Assistance in Dying (MAID)

After approval of the legislation, it did not take long for one of my patients (identity disguised) to request access to MAID.  I knew that this was a possibility because of previous discussions regarding the eventual outcome of her debilitating and progressive medical condition.  However, it had been couched in terms of a sense of security just to know that the option was available.  In recent months, her condition deteriorated and her quality of life drastically declined from the productive, satisfying and enjoyable career and family life she had previously enjoyed.  It was painful to watch.  This was indeed “intolerable suffering from an irremediable condition”.

My somewhat peripheral role was related to a co-morbid psychiatric disorder which was in remission and did not influence her decision to access MAID. This was of course critical in the assessment of her capacity to make this decision.  In the end, an interdisciplinary team of physicians ensured that this case met all the legal and ethical criteria.  The team worked closely with a supportive and loving family to ensure that her wishes with respect to MAID were consistent over time. After the requisite waiting period when she signed off on the request, a humane and painless death ensued at her home exactly as was requested.

What was not anticipated was the intensity and nature of the mixed emotional response of the physician team. There was admiration for the bravery and determination of the patient and her family, profound sadness at the loss and yet in the end, a feeling of satisfaction that suffering had been relieved and that proper care and the right decision had been taken. Lesson learned is that until we move from the theoretical to real world experience, it is difficult to anticipate all of the consequences. All the more reason to proceed with caution.

About Dr. Ken Shulman
Dr. Shulman graduated from the Faculty of Medicine, University of Toronto in 1973 and did postgraduate training in Psychiatry at the University of Toronto. He then went on to do specialty training in Geriatric Psychiatry in London, England. Since 1978, he has been based at Sunnybrook Health Sciences Centre, University of Toronto. He is the inaugural recipient of the Richard Lewar Chair in Geriatric Psychiatry at Sunnybrook Health Sciences Centre, University of Toronto. Currently, he is the Chief of the Brain Sciences Program at Sunnybrook. Dr. Shulman has had a longstanding interest in the issue of testamentary capacity and vulnerability to undue influence and has been qualified as an expert witness in Estate matters in Ontario and Alberta. Together with colleagues he has published several papers in the area of testamentary capacity in international journals and is a frequent presenter at legal continuing education conferences on Estates and Trusts. Email: