Dying on Your Own Terms

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Video Transcript

Stefanie Green, MD
When I first meet people, I tell them right away. The first two things I tell them actually are that I'm pretty direct. I talk pretty directly about what we're going to talk about.

I don't use metaphors. I don't talk about passing over meadows. I talk about death. And I call it that.

And I find that patients are incredibly relieved at the ability to have an open and honest conversation, especially with the physician, about their end-of-life options.

WILL PEGG
[GROANING] Yeah, I think so. Okie-dokie. There there's a tendency maybe to see death as kind of a finish line. But I remember one time hearing Joseph Campbell speak. And he said that, if you went on the prairie and looked at the entire horizon, the horizon was not, in fact, a straight line in the distance somewhere but was a circle.

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I asked the nurse who was doing the blood work if those words in Latin meant that I had bone cancer on my spine. And she said it did. And I started to cry. And she started to cry.

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As I drove home that night, it was as if all of my dreams, hopes, wishes just started unspooling off the spools, falling on the floor like an editing room in an old black-and-white movie. It all just fell apart.

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In spite of the fact that I seem to talk all the time, I'm an introvert by nature. And I discovered that being out of doors was a place that I felt calm, peaceful, centered, grounded.

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There's something about the seed, the earth, the process of growing. I think that restores us to that sense of beauty.

LOUISE TAKEDA
That very first time that I saw Will, he just went right into my heart. For about three years, we really were just friends. One day, I got an email from Will where he basically told me about this terminal diagnosis he had. And I felt very sad that we'd known each other for three years. And yet, I hadn't taken the time to really get to know him.

And then suddenly, it occurred to me, actually there still is time. And it was really during that time that a love blossomed between us.

INTERVIEWER
Do you have anything to add?

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WILL PEGG: Clearly, remarkable and rare, probably, because I was very ill and not looking and feeling my best.

[CHUCKLING]

Not professionally shaved like Sinatra, I can tell you that.

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STEFANIE GREEN, MD
I got to know Will, because his family physician sent me a consult letter. I believe it was after he'd heard me speak about this work. And Will had approached him about end-of-life issues. And his family physician sent me a referral letter to meet Will and to start this process with him.

He recently had a downturn in his illness. And he was quite fearful about what was coming up. I think Will has found a lot of inner strength that he probably knew he always had but didn't expect to really find.

WILL PEGG
The cancer started in my prostate. And at some point, it figured out how to change its cellular structure so that it could escape into my lymph nodes. And once it's in the lymph system, it can travel elsewhere in the body. And so, by the time they shot those initial scans, it was in about 200 different places in my bony structure. And I knew enough to know that that meant that I was going to die.

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I've had to honor all the different voices that have come up for me, including being afraid. My father died of the same cancer. If one imagines the main neural trunk of the whole body, our spine, with cancer boring into the nerve channel, apparently the pain level is beyond imaginable. It meant that I started having tremendous, searing pain.

So it would be in my leg. Then by that afternoon, it would be up in my chest, so I couldn't sit down. Or maybe by nighttime, it would be in both sides of my chest, so I couldn't breathe. I walked as if I was injected with concrete.

Sitting, laying, standing, and sleeping had become impossible. You could really say my life fell apart in about a 10-day period. I was in great despair.

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And I remember laying on the bed unable to convince my body to move even 1 inch. Some people had propped a book up firmly on a pillow in front of me. And I could read a couple lines of that at a time, and then close my eyes on the pillow, and lay there, and wish that I was dead.

LOUISE TAKEDA
I think, in our culture, we're not used to talking about dying. We're afraid of dying. It's a very death-denying culture. I think it's really quite harmful not to see death as a natural part of life.

We're all going to die, right? So I think, if we can come to that place of accepting death as a natural part of life, we don't have to prolong life at any degree of suffering. You can live a long time with bone cancer. And you know that the suffering will begin becoming more intense as time goes on. When that becomes intolerable, it's nice to know that he has a way out.

STEFANIE GREEN, MD
In Canada, whether it's an assisted suicide or a voluntary euthanasia, it is under the umbrella of what we call medical assistance in dying. And we're only one of four jurisdictions in the world that allow that combination to happen.

LOUISE TAKEDA
One time, when we were out at the beach and there were these otters coming up-- there was actually a couple. And they'd come, and scooch up on the beach, and kind of look behind. Is my partner coming? And they'd eat their fish, and then slip into the water again.

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And this actually became a new metaphor for us, that he wanted to be able to slip in the water like that.

STEFANIE GREEN, MD: So in Canada, if you want to access an assisted death, you need to ask for it on a written form. It's actually a legal document. And that form needs to actually be witnessed by two independent witnesses. The witnesses cannot be anybody who would benefit from the death of the patient.

They can't be people who provide medical care to the patient. And they can't be anyone who provides personal care to the patient. Often, people need to go to good friends, neighbors, or friendly strangers.

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The law says that the patient needs to have what's considered a grievous and irremediable condition. And it has gone on further to describe what that is. And it actually requires five other criteria to be met-- a serious illness that puts them in an advanced state of decline and capability, that's irreversible, suffering in a way that they deem intolerable, and because of their illness, they are now on a trajectory that is putting them towards death.

I think you can see that there's a lot of safeguards built into that. It's a very rigorous process. And it's not a simple matter.

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Any patient who's making this request can change their mind, even at the moment of the event.

LOUISE TAKEDA
It's still a difficult journey. Will didn't have any choice how the illness is going to progress.

WILL PEGG
My body is passing away naturally from natural causes. What MAID allows is some assistance to speed that process up when it's reached a point where it's undo-able for me. How one prepares for it-- one minute at a time, I think.

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STEFANIE GREEN, MD
One of the really most striking things I've learned right from the beginning is, that when I tell someone, when I get to the place in the process where I can actually tell someone that they're eligible for care, that they've done all the paperwork, and everything's fine, there's an immediate sense of relief. And I think it's a documentable, therapeutic effect, actually. I see people literally relax. The focus goes from dying to living almost in an instant.

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WILL PEGG
I can feel the carpet under my toes. It's soft today. There was so many months where I never felt comfortable for even one second. What an incredible option to leave with my loved ones in a place where we can say goodbye to each other in a clearer conscious way, maybe, and on a beautiful day.

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STEFANIE GREEN, MD
I went into medicine to help people. And people are asking for my help. And that's what I'm doing. I want to see anybody who is capable and competent to make this choice to have the ability to do so.

I call them deliveries at both ends. I actually no longer deliver babies. I now focus on the other end of life. But I found both events to be very emotional--

[BABY CRYING]

--two of the most important days in someone's life. It's a huge privilege to be invited into that very, very special space of someone on those very special days. The end, I know, will be the same. But how we get there is very individualized.

It doesn't happen often, but sometimes there is a moment of just such great intimacy that I'm witnessing, or beautiful words, or goodbyes that it's impossible not to be captured into the moment. And if a tear falls, a tear falls. I'm human. I don't hide that from anyone. But I try to stay focused on what I'm there for. And I can debrief, and digest, and work on my own issues afterwards.

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WILL PEGG
In terms of the prognosis, they gave me-- at the time, they thought I might be able to live about 18 months. We're now at 19 months. So I'm meeting you in overtime.

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LOUISE TAKEDA
Last spring, he decided we were going to make this large garden here. On the one hand, we're watching this illness slowly dissolving Will's body. And on the other hand, just outside of our window, we have this incredibly creative, life affirming garden that we spend our time in.

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We don't know how it's going to end. And it might end on a Friday night in emergency in a crowded room full of people. But if we could make it that beautiful as those otters that just slipped quietly back in the water, I think this would be a really preferable way of doing it.

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WILL PEGG
I'm just the gardener. And I don't feel like I have anything else to add to that dialogue that would be very edifying. I think that I'm just participating in the ways of nature.