She's authentic. She's thoughtful. She's articulate.
An 82-year-old cancer patient recently discussed with Dr. Gary Rodin, Head of Supportive Care at Princess Margaret Cancer Centre, her decision to receive Medical Assistance in Dying (MAID).
"It's a personal decision," the woman, who preferred her name not be used, says in the interview.
Four days after the interview was filmed, she received MAID surrounded by close friends.
With the permission of the patient, the interview was filmed by the Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC) to further public discourse on an important and controversial end-of-life issue.
In addition to the edited video above, you can watch the full, unedited version here.
Patient: Well, thank you very much for talking with me today. Before we start, I would like to warn you that the last two chemo I had badly affected my eyes. So it may look like I'm crying, but I’m not necessarily.
Dr. Rodin: Can we actually start off by you just telling me a little bit about yourself?
Patient: Yeah, I'm 82 years old, and I was teaching 350 Symbolic Logic students at U of T as recently as last April.
Dr. Rodin: What is your personal situation?
Patient: I'm unmarried. I was in the convent for many years, so that when I came to do my PhD here. It was the time when the church was in great upheaval. A lot of my friends from my group in the convent were leaving. I realized that I had a little different value than they did, so I left the order and devoted myself to study and teaching, which proved to be… I taught till 82, so it proved to be a very rewarding career.
I'm in philosophy department with so we have bioethics classes. So I knew my options right away. If I had a family member I would defer to their wishes. I know sometimes it's hard for a family to let someone go, but I have no family at all. My parents died. I'm 82 and…
Dr. Rodin: So you feel as a personal decision
It's a personal decision. I hope you understand what I'm going to say. The options that are available don't fit me. I could have long term palliative care, where the end would be the same - I would die. I could have sedation and sleep, but the one thing that I so value about MAID is I can leave with my cognitive faculties. And that matters a great deal to me. I find them slipping out. You know, my friend said, oh everyone forgets. But there are things I saw with much more clarity, and so MAID seems the perfect option. I’m not depressed. I'm not anxious I feel lucky, Doctor.
Dr. Rodin: Your cognitive abilities might be one of the things you value most about yourself.
Patient: The part of me that I had spent most time trying to develop is of course my mind. And it’s really…I want to say with full consent. But you know, going into palliative care, every morning little increments of my person are gone. I've been, I mean I won’t rattle off the side effects, but, you know, things that are important for daily living, I can no longer do. I can't control my tears, you know. People walk in, and I think I know that person. But I… I'm losing it in small increment, and it seems to me since the end is the same, you know, this is the perfect opportunity.
Dr. Rodin: When you look back, I have a sense of some things you are proud of. Your work particularly stands out. Are there regrets?
Patient: Yes, there are. The last time my mother visited me in Toronto… I was a grad student. She would help me financially. I never got the opportunity. It was always there as a subtext that everything I did. But I never got the opportunity to really openly not just leave it as a tacitly understood thing - how deeply I appreciated her and that was the last time I saw her.
Dr. Rodin: I have an impression that you're somewhat of a private, independent person.
Patient: I am and these six months were not just taxing on my friends, but on me. I had to ask for things. That was a new humbling experience, but it made me really aware the human condition. We need each other badly. And, you know, asking was most difficult.
Dr. Rodin: How did the idea for MAID come out?
Patient: When the law passed, I wasn't ready. But I thought, I remember Dr. Lowe, remember from the SARS condition. I remember him saying they do it for animals, and not for humans. He made a tremendous contribution. I'm so honoured to think that one of the doctors involved in giving MAID was a friend of his. Really, you know, he was a remarkable man.
Dr. Rodin: Did you have any reservations about MAID?
Patient: No.
Dr. Rodin: What about the religious...
Patient: Oh well, you know, I'm not sure. I think I'm agnostic. It would be lovely if I could flutter around and take care of my friends. But, you know, doing philosophy as I said, current theories of mind and cognition are all materialistic. I think it's probably the end of me, but how many 82 year-olds had such a good life, doctor?
Dr. Rodin: You feel satisfied with your life?
Patient: Absolutely, I feel fortunate.
Dr. Rodin: For someone else who is in your situation, who hadn’t made such a decision, would you have any advice for them?
Patient: Absolutely, absolutely not. I would absolutely not. I think it's a highly personal choice, and no, this is a professor who will give no advice on that at all. You know, I would let them talk, but I would…
Dr. Rodin: Each person’s situation is so different, do you mean?
Patient: I do, I (have) no family, no ties
Dr. Rodin: This is being contemplated, as I understand in about 5 or 6 days or something like that?
Patient: Yes, I believe it's going to happen the day after Thanksgiving.
Dr. Rodin: Do you have any wishes between now and then?
Patient: Well, you know, the doctors involved in it said I can have any music I want, anything I want, you know, what kind of clothes do I want to wear. It might be a reflection on my temperament. I want it as simple and as small possible, so I'm going to have it, I hope they’ll lend me a hospital gown, and I'm going to have that close network of friends.
Dr. Rodin: They will be here at the time?
Patient: They will be here. I've invited my GP who has always supported my decision to come to Princess Margaret, has carefully laid out my options, and everything.
Dr. Rodin: Is there anything you want to mention to me that we haven't talked about, anything that might be important?
Patient: I want to reiterate something. It's really a pleasure to meet you, and I am so lucky with the compassion and intelligence that I've met among the staff. I think it takes a special temperament to deal with palliative care, and they're all ages here. One of the volunteers who comes in to do grunt jobs said to me her nine-year-old son died here and she wants to be here. You know some of these are young women who could do anything. I think it takes a special temperament, and I feel really privileged.
Dr. Rodin: It has been a privilege to talk to you actually.
Patient: And to you and to finally meet you, doctor. Thank you so much for coming.