Medical help in dying | The Trial of the Remaining

Seven years after the introduction of medical euthanasia in Quebec, the experience of nurses remains an important issue in the application of this intervention. Two witnesses confided The press about how they experienced the loss of a loved one.

Posted at 5:00 am

Vincent Marcellin

Vincent Marcellin
The press

“Like a Shot”

Diane Marquis’ spouse, Pierre Camirand, received Medical Assisted Dying (MAD) at Maisonneuve-Rosemont Hospital last February. At age 65, with “aggressive and sclerotic” multiple sclerosis, he had lost the use of one leg and one eye and had great difficulty eating and bowel movements. “He was a workaholic, he worked all the time. Being locked up, lying down without being able to do anything, had become repulsive for him,” explains Mme Marquis.

Her husband had initially considered receiving euthanasia in Switzerland before learning that in March 2021 Canada had expanded access to MAID to patients with neurodegenerative diseases with no hope of a cure. “He had three plans: Switzerland, Quebec, otherwise it was the Rivière des Prairies. She and her children were actually afraid of suicide.

Despite this, Pierre Camirand’s decision to seek medical attention when dying was very difficult for his family, who were informed only late. “I was in shock,” admits M.me Marquis remembers the moment when his wife informed him that he had already chosen the date of his death. “I saw life change because it was saying goodbye to someone with whom I had shared several years of my life. »

She calls the timing of the injections “traumatizing”. “It’s like a shot. He was there, smiling, talking, and then suddenly it was over. After the death, Diane Marquis said she felt guilty and suffered from adjustment disorders for several weeks. Despite the support available, she did not want health professionals to accompany her in her grief.


PHOTO ALAIN ROBERGE, THE PRESS

Diana Marquis

I couldn’t imagine meeting a psychologist or meeting people I didn’t know at all to tell them about my pain.

Diane Marquis, whose spouse used MAID

Writing and sports helped her come to terms with the loss of her husband. “The pain is there, it keeps coming back, but I’ve learned to tame it,” she testifies, adding that she has had a lot of support from her family and work colleagues. Mme Finally, Marquis would like to acknowledge the work and commitment of the caregivers. “It’s demanding and very generous work,” she says. Sometimes people lose their own lives there. It takes a lot of love. »

“A moment of joy and liberation”

Réjean Morin saw his adoptive father Claude Vachon dying medically in February 2021. He battled a serious lung disease for ten years and had become very dependent during the pandemic. Admitted to the hospital, informed by the doctors that he could no longer live alone, he experienced this loss of autonomy very badly. “He found it difficult to take care of him. He blamed himself for being a burden to us, but he never was,” explains Réjean Morin in a moved voice.

After a few months in hospital, it was Claude Vachon himself who decided to resort to MAID. Despite initial reluctance, her son quickly understood why he wanted to put an end to his suffering.

If anyone had thought of us, we would have said, “No, we’ll take care of you.” But he explained to us that he had suffered so much emotionally from this condition that he had become increasingly so that he no longer saw any meaning in his life.

Réjean Morin, whose adoptive father used MAID

Mr. Morin’s adoptive father was then transferred to a palliative care center where he and his three sons could share valuable moments of conviviality. “We watched hockey, we had dinner with him. And my father said day after day: ‘It’s okay, I’m fine’”, says Réjean Morin, specifying that the patient who receives medical attention while dying has the right to change his mind up to the last moment.

On D-Day, the whole family gathered to say goodbye to Mr Vachon. “It was a moment of joy and liberation,” his son recalls. All the mental pain that appeared on his face suddenly disappeared. So his father’s relief helped him overcome his pain, as did a psychologist friend and the center’s staff, “Angels,” according to Mr. Morin.

Having already experienced severe grief following the death of his parents, AMM remains an extremely positive experience for him. “If I could do it again, I would. I would advise that to anyone who is unfortunately in this irreversible state. »

What is the grieving experience for loved ones?


PHOTO OLIVIER JEAN, LA PRESSE ARCHIVE

A recent study examined the grieving process in family members of people who sought medical help while dying.

Medical end-of-life care (MAID) does not necessarily facilitate the grief of loved ones, a recent study reports. A finding that questions the community support practiced in Québec since 2015 for people using MAID.

Is grief more or less difficult to experience in medical euthanasia? That’s the question Philippe Laperle, a doctoral student in psychology at the University of Montreal, explores in a study published last month in the Diary of Death and Dying. The researcher surveyed 60 people who had lost a loved one for at least six months using a questionnaire: 25 for medical euthanasia, 35 for natural causes in palliative care. He then conducted guided interviews with eight participants from each group to compare how they experienced their grief.

The results of his research have been mixed, to say the least. “On a quantitative level, by comparing the results of the two questionnaires with data on other types of death, particularly accidents or suicide, medical euthanasia appears to facilitate grieving,” explains Mr. Laperle in an interview with The press. However, he sees no significant difference in experience between the grief after a natural death and that after medical euthanasia: “The results are quite similar [pour ces deux situations]. »

However, the qualitative data highlighted by the study show a wide variety of experiences in MA.

There are participants who have found medical euthanasia very difficult, feeling that something has been rushed. Some people felt that they were not at the same point as their loved one who would receive help, and it is this discrepancy that makes grieving more difficult.

Philippe Laperle, PhD student in psychology at the University of Montreal

For others, however, the AMM allows a positive memory of the loved one until the last moment. Philippe Laperle then speaks of a “metaphor of the hero”, the deceased embodying “values ​​of freedom, control and courage”. “We even touched on the issue of immortality,” explains Mr. Laperle. The grieving process can sometimes go through these two stages one after the other in the same person.

Aftercare for loved ones

These results prompted the doctoral student to question the relevance of specific bereavement care in the case of medical euthanasia. “Overall, I don’t think we need to develop specialized programs just for these people because the majority of them are still fine,” he says.

An opinion that Jean-Marc Barreau, holder of the Jean Monbourquette Chair in Social Support for Bereaved Families, who is currently supervising a research project related to MAID, does not share much.

“For grief to take place, the grieving process must have a linear aspect. Medical euthanasia benefits that aspect because loved ones don’t have as much time to prepare for a natural death,” says the professor, who is also a professor at Montreal University’s Institute of Religious Studies.

The feeling of guilt is particularly present in survivors after medical euthanasia and therefore requires a different approach than in the case of a natural death in order to anticipate the difficulties in accepting the decision.

This need for expectation relieves loved ones of that burden of guilt. So you will know that the decision of the person who is going to engage MAID is really a free act that is not laced with too many affects.

Jean-Marc Barreau, holder of the Jean Monbourquette Chair

He also sees the “lack of social acceptance of this question as a particular difficulty, which means that the social support required to cope with grief is no longer the same as it is in the case of a natural death. In light of this situation, Mr. Barreau advocates the establishment of a genuine “culture of support” for people seeking medical assistance from the dying, bereaved and carers.

Nevertheless, the two researchers agree that individual support for the relatives is essential in order to facilitate the grieving experience, regardless of the type of death. This support is provided in particular by medical euthanasia palliative centers, which accompany the bereaved before, during and after death. “When natural death is accompanied by palliative care, it has a positive impact on grief,” explains Philippe Laperle. So, in both cases, if we can expand our range of palliative care, we can imagine that the bereaved will be better off. »

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