> Zed Book Club / This Is Assisted Dying

Photo: © Jacob C. Green

> Bookshelf

This Is Assisted Dying

In a Q&A about her candid memoir, Victoria doctor Stefanie Green talks about her decision to pivot from delivering babies to helping people die, and what a good death looks like / BY Kim Hughes / March 25th, 2022


If Dr. Stefanie Green has her way, family members will discuss death and dying with the same mundane purposefulness as post-secondary education and investing in RRSPs. One of her greatest hopes is that her candid, readable memoir, This Is Assisted Dying: A Doctor’s Story of Empowering Patients at the End of Life, will inspire readers to consider what death could — or should — look like.

In 2016, after two decades as a family physician specializing in maternity and newborn care, the B.C. doctor changed focus to provide medical assistance in dying (MAID) after the Supreme Court of Canada struck down a ban on physician-assisted death and the Canadian government legalized it on June 17, 2016.

The idea for her career pivot began in 2014, when ­— at the age of 46 and with two children at home — she “was beginning to wonder if it was time for a change,” Green writes. “ I adored the work … but there were drawbacks,” namely the long and exhausting shifts that were keeping her from home.

Stefanie Green

 

The watershed moment came at a May 2016 conference in Amsterdam, where hundreds of international delegates reviewed protocols, best practices and the legality of providing assisted death to terminally ill patients who qualify for the procedure. In Canada, informed consent and clarity of mind are paramount among a long list of qualifying criteria.

The conference convinced Green that end-of-life care — and the calmer work pace it afforded — was the path she wanted to follow. In Amsterdam, she made essential connections that helped her, and her Canadian colleagues, put the newly minted, detailed legislation into practice.

This Is Assisted Dying chronicles Green’s first year as a MAID practitioner on and around Vancouver Island, and introduces the reader to terminally ill patients who elect to die through an IV injection of lethal drugs, typically surrounded by family and friends, after their parting words are spoken.

She threads her own story throughout the book as she examines how other countries are managing (or not managing) end-of-life care, and covers the pragmatic and moral aspects of medically assisted death, although her position is clear: coherent but very sick patients should have agency over their deaths, and their government should support them.

“Time and again, I’ve witnessed the power that having the right to choose the time and manner of death affords people,” she writes in the prologue. “Instead of feeling helpless, people feel empowered, something their illness may have denied them for months or even years. [MAID is a way to] fully reclaim the time they have left, to live their final days with a startling amount of purpose.”

In addition to caring for patients, Green is the co-founder and current president of the Canadian Association of MAID Assessors and Providers (CAMAP), medical advisor to the B.C. Ministry of Health MAID oversight committee, moderator of CAMAP’s national online forum, and has hosted three national conferences on the topic.

Green spoke with Zed about This Is Assisted Dying, which comes out March 29, from her home in Victoria.

Was this book always in the back of your mind when you started this work?

I’ve always shared stories about my work, going back to maternity. When I started doing this work there were some extraordinary moments, so I made notes. I hadn’t seriously thought about writing until I received a cold call from a literary agent in New York. She had seen my name in the New York Times [in a May 2017 story about one of her patients]. It went from there.

Did writing require you to circle back and get permission from the families of the patients whose deaths you assisted?

At first, I just wrote. Once it became obvious the stories I wanted to use, I sought permission from the families of the patients who had inspired these stories. But I’ve changed names, genders [and] locations to protect privacy.

You’re very candid about your own life, notably your experience handling your father’s passing, which was a classic case of someone not articulating their wishes, leaving the family to guess. Was this a way of humanizing yourself?

Yes. Having that personal thread wasn’t my original intention. But I was convinced that the real way into this topic, which could be scary for some people, was to make it more relatable and to recognize we are all human and have all been through similar experiences. I think it’s only fair that if I’m going to be talking about my patients and their intimate moments, I should open myself up to the reader as well. We are all just trying to do the best we can.

Did you have a specific reader in mind for this book?

I really think this is a topic for everyone to consider. It is about assisted dying and debunking myths about it, but it’s also about recognizing the fact that death is a part of life and it’s something we should be talking about at every stage. No matter what people think about assisted dying, if I can encourage and facilitate those conversations, then my book has done its job.

In the book, you outline some negativity your colleagues have experienced because of this work. Is this putting a bull’s eye on your back?

Honestly, I have been happily surprised by the tremendous amount of support I get when I tell people what I do. I went into this work open-eyed and knowing I would do it purposefully and publicly, and when I did that, I knew I’d be more open to targeting. When I walk into a cocktail party, and someone asks me what I do, I tell them I’m a physician. If they ask me, “What kind of physician?” I am upfront. About 90 per cent of the time, I am immediately hearing a personal story about death that was negative. People tell me this work is important and they’re grateful someone is doing it. That support has given me more confidence to go out and speak publicly. The essential role of the physician is to help people in whatever way they need help. I don’t see this role as any different.

It’s fascinating how you connect the dots between maternity care and end-of-life care, as both come so freighted with tradition and expectation.

It really is a full circle, and from an aerial view, the two events are quite similar. The skill set I need to do those jobs as a clinician — navigating the intensity, the emotion, the family dynamics, the life-changing event that’s happening — are similar. My previous skill set was useful in transitioning to end-of-life care. I am very lucky, and my job has been profoundly meaningful to me at every stage of my career.

Your book presents Canada, and Canadians, as beacons of progressiveness with respect to end-of-life care via medically assisted death.

Especially considering how moderate we can be about so many things. The truth is, we got to learn from those who went before us and set up models in other places, like Oregon and Belgium. [Oregon’s Death with Dignity Act was enacted in 1997; Belgium legalized “active euthanasia” in 2002]. There are benefits to not being first. Having said that, the unique thing about Canada is the way we approached this issue.

It wasn’t because voters demanded it, but because patients demanded it and challenged the prohibition of assisted dying based on their Charter rights. By seeing it as a rights issue and arguing it that way, this became rights-based care.

That’s unique in the world. As such, our language, structure, and approach is patient-centred, which creates a whole language that’s patient-centred and that breeds success in health care. I think it will be a model. Countries currently grappling with the issue, like Germany and Portugal, have sought advice from Canada.

What will success look like for you with this book?

I want it to be widely read and to inspire conversations about death and dying, so people aren’t left to make guesses in emergent moments when someone is sick. I saw it all the time in the ICU, and you just know it can be better. Embracing death is part of life, and we need to clarify our wishes and make sure others do, too. Even me. My mother was in a long-term care home, and I found it hard to talk about her wishes. I know it’s easy to say and hard to do, but we need to have those conversations and prepare well for end of life. Inspiring those conversations would make this book a success to me.

What’s the most important takeaway from This Is Assisted Dying?

I experience a lot of gratitude from patients. And the clinicians doing this work are incredibly compassionate individuals. We take this work seriously and we do it cautiously and carefully and within a rigorous system. This is not easily stepped into and there are no cowboys among us. I simply cannot overemphasize how careful and cautious we are. I want people to know that.

The transcript has been edited for length and clarity.

THE SCROLL

Canadian Writers Among Literary Luminaries Named on the New York Times’ “Top 100 Books of the 21st Century” ListThe New York Times Book Review ultimately featured two Canadian authors – and three Canadian books – on their list of the 100 best books of the 21st century.


Alice Munro, One of Canada’s Literary Masters, Dies at 92Alice Munro's career spanned over four decades, during which time she earned a multitude of literary awards, including a Nobel Prize nearing the end of her writing career. 


American writer V. V. Ganeshananthan wins the US$150,000 Carol Shields Prize for FictionHer novel, 'Brotherless Night,' was chosen over the work of four finalists, including 'Birnam Wood' by Eleanor Catton


2024 Amazon Canada First Novel Award Shortlist AnnouncedThe award, which was founded in 1976, offers a $60,000 prize for the winner.


Three Canadian Authors Shortlisted for the US$150,000 Carol Shields Prize for FictionClaudia Dey, Eleanor Catton and Janika Oza are finalists for the largest cash prize celebrating American and Canadian women writers


Donald Sutherland, 88, to Detail His Journey to Hollywood Fame in Long-Awaited MemoirThe Canuck screen legend's first-ever autobiography will hit Canadian bookshelves on Nov. 12.


Camilla Leads Miniature Book Initiative to Celebrate 100th Anniversary of the Queen’s Dolls’ HouseThe miniature book collection includes handwritten tomes by Sir Tom Stoppard, Dame Jacqueline Wilson, Sir Ben Okri and other well-known authors


2024 Giller Prize: Noah Richler, Kevin Chong and Molly Johnson Among Jury MembersAuthor Noah Richler is chairing the jury for this year's Giller Prize, an award's body his father literary icon Mordecai Richler helped launch in 1994.


Queen Camilla to Offer Weekly Reading Recommendations in New Queen’s Reading Room PodcastThe Queen's Reading Room Podcast will feature Her Majesty's book picks as well as literary discussions with authors and celebrities every week.


2023 Booker Prize: Irish Writer Paul Lynch Wins For Dystopian ‘Prophet Song’Canadian Booker Prize jury chair Esi Edugyan called the novel a "a triumph of emotional storytelling, bracing and brave."


Sarah Bernstein’s ‘Study for Obedience’ Wins 2023 Scotiabank Giller PrizeThe author, who gave birth to a daughter 10 days ago, accepted the award remotely from her home in the Scottish Highlands


Governor General’s Literary Awards: Anuja Varghese’s ‘Chrysalis’ Among This Year’s WinnersEach of the 14 writers, illustrators and translators will receive a prize of $25,000


Giller Prize Winner Suzette Mayr Among Finalists Shortlisted for 2023 Governor General’s Literary AwardsThe 14 winners, who will each receive a prize of $25,000, will be announced Nov. 8


Five Authors Shortlisted for This Year’s $100,000 Scotiabank Giller PrizeDionne Irving and Kevin Chong are among the finalists who "probe what it means to be human, to survive, and to be who we are"


Norway’s Jon Fosse Wins Nobel Literature Prize for Giving “Voice to the Unsayable”The author's work has been translated into more than 40 languages, and there have been more than 1,000 different productions of his plays.


Scotiabank Giller Prize Longlist Recognizes 12 Authors Who Demonstrate “the Power of Human Imagination”The 2023 longlist includes the prize's 2005 winner David Bergen and debut novelist Deborah Willis. 


Duke and Duchess of Sussex Buy Film Rights to Canadian Author Carley Fortune’s ‘Meet Me at the Lake’Prince Harry and his wife Meghan have purchased the movie rights to the bestselling romantic novel, which was published in May this year.


Booker Prize Longlist ‘Defined by its Freshness’ as Nominees RevealedEsi Edugyan, chair of the 2023 judges, said each of the 13 novels "cast new light on what it means to exist in our time."


Barack Obama Releases His 2023 Summer Reading ListThe list includes the latest novel by Canadian-born New Zealand author Eleanor Catton.


David Suzuki Takes Inspiration From His Own Grandchildren for New Kid’s Book ‘Bompa’s Insect Expedition’The book features Suzuki and two of his grandchildren exploring the insect population in their own backyard.


Milan Kundera, Author of ‘The Unbearable Lightness of Being’, Dies at 94Kundera won global accolades for the way he depicted themes and characters that floated between the mundane reality of everyday life and the lofty world of ideas.


Cormac McCarthy, Pulitzer Prize-Winning Dark Genius of American Literature, Dead at 89McCarthy won the Pulitzer Prize for his 2006 novel 'The Road.'


Remembering the Life and Loves of Literary Bad Boy Martin AmisThe legendary British author has died at 73. His absence will be keenly felt, but Amis leaves behind a book shelf’s worth of novels, including 'London Fields', 'Money' and 'Success', filled with shambolic anti-heroes raising a finger at society. 


Sophie Grégoire Trudeau to Publish Two Books Related to Mental Health and Wellness With Penguin Random House CanadaThe upcoming releases include a wellness book for adults and a picture book for children, which will roll out over the next two years.


Queen Camilla Celebrated Her Love of Books by Having Some Embroidered on Her Coronation GownThe Queen's coronation gown also featured tributes to her children, grandchildren and rescue dogs embroidered into it.


Better Late Than Never: Gabriel Garcia Márquez’s Unpublished Novel Set for Release in 2024'En Agosto Nos Vemos' or 'We'll See Each Other in August' was deemed by the late author's family to be too important to stay hidden


End of an Era: Eleanor Wachtel leaves CBC Radio’s ‘Writers & Company’ After More Than Three Decades on the AirAfter a career interviewing what she describes as the "finest minds in the world," the long-time radio host says she's ready to begin a new chapter.


Canadian Independent Bookstore Day Features Deals, Contests and ReadingsOn Saturday, every book purchased at an indie store qualifies you to enter the Book Lovers Contest, with a chance to win gift cards worth up to $1,000


Translation Project Will Bring Literature From the South Asian Continent to English-Speaking AudiencesThe SALT project aims to translate and publish 40 works by authors from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka


The Book Thief: An Italian Man’s Guilty Plea Ends a Caper That Puzzled the Literary World for YearsFilippo Bernardini’s elaborate phishing scam netted 1,000 unpublished manuscripts by prominent authors including Margaret Atwood and Ian McEwan


The Late Nobel Laureate Toni Morrison Is Honoured with an American StampThe Obamas and Oprah Winfrey pay tribute to the writer whose poetic interpretations of the African American experience gained a world-wide audience


Five Canadian Writers Make the Long List for the Inaugural Carol Shields Prize for FictionThe US$150,000 English-language literary award for female and nonbinary writers redresses the inequality of women in the publishing world


The Furry Green Grump is Back in a Sequel to “How the Grinch Stole Christmas!”Dr. Seuss Enterprises will publish “How the Grinch Lost Christmas!” in September


Chris Hadfield to Publish a Sequel to His Blockbuster Debut, “The Apollo Murders,” on Oct. 10"The Defector” brings the Cold War intrigue from space to Earth as the Soviets and Americans race to develop fighter jets


Prince Harry’s ‘Spare’ Continues to Break Worldwide RecordsThe book also seems to have put a dent in the popularity of members of the Royal Family — including the Prince and Princess of Wales.


Prince Harry’s Memoir Breaks U.K. Sales Record On First Day of ReleaseThe publisher of the new memoir, 'Spare", says it had sold 400,000 copies so far across hardback, e-book and audio formats.


Barack Obama’s Favourite Books of 2022The former U.S. president’s 13 titles include Canadians Emily St. John Mandel and Kate Beaton, as well as tomes from Michelle Obama, George Saunders and Jennifer Egan


Here are the 5 Books on Bill Gates’ Holiday Reading ListThe billionaire philanthropist is giving hundreds of copies to little libraries around the world


Sheila Heti and Eli Baxter Among 2022 Governor General’s Literary Award WinnersToronto writer Sheila Heti took home the fiction award for 'Pure Colour,' a novel the GG peer assessment committee called "a work of genius."


Suzette Mayr Wins $100,000 Scotiabank Giller Prize for ‘The Sleeping Car Porter’The 2022 Giller Prize jury called Mayr's novel "alive and immediate — and eerily contemporary."


Writers’ Trust of Canada Awards: Authors Nicholas Herring, Dan Werb Nab Top PrizesThe Writers' Trust of Canada awards amounted to a combined monetary prize value of $270,000.


Bob Dylan Releases ‘The Philosophy of Modern Song,’ a Book of Essays Dissecting 66 Influential SongsIn his new book, Bob Dylan offers up both critique and historical insight into various musical recordings of the last century by a variety of popular artists.


Prince Harry’s Memoir ‘Spare’ Will Be Published in January 2023The long-awaited memoir will tell with "raw unflinching honesty" Prince Harry's journey from "trauma to healing", his publisher said on Thursday.


Sri Lankan Author Shehan Karunatilaka Wins 2022 Booker PrizeKarunatilaka won the prestigious prize on Monday for his second novel ‘The Seven Moons of Maali Almeida’, about a dead war photographer on a mission in the afterlife.


Canadian Council for the Arts Reveals Governor General’s Literary Awards FinalistsThe finalists for the Governor General's Literary Awards spotlight books in both the English and French language, as well as translated works.


New Penguin Random House Award Named After Michelle Obama Will Honour High School WritersMichelle Obama Award for Memoir will provide a $10,000 college scholarship to a graduating public school senior based on their autobiographical submission.


French Author Annie Ernaux, 82, Becomes First French Woman to Win Nobel Prize for LiteratureThe author said, of winning, that "I was very surprised ... I never thought it would be on my landscape as a writer."


Hilary Mantel, Award-Winning British Author of ‘Wolf Hall’ Trilogy, Dies at 70Wolf Hall, published in 2009, and its sequel Bring Up the Bodies, released three years later, both won the Booker Prize, an unprecedented win for two books in the same trilogy and making Mantel the first woman to win the award twice.


Prince William “Cannot Forgive” Prince Harry, According to ‘The New Royals’ Author Katie NichollPrince William “just cannot forgive his brother,” according to Katie Nicholl, author of 'The New Royals: Queen Elizabeth’s Legacy and the Future of the Crown.'


Five Finalists Announced for Hilary Weston Writers’ Trust Prize for NonfictionThe winner — to be announced on November 2 — will take home the annual $60,000 prize.


Peter Straub, Bestselling American Horror Writer, Dies at 79Friend and co-author Stephen King has said the author's 1979 book, "Ghost Story," is his favourite horror novel.


Rawi Hage, Billy-Ray Belcourt and Sheila Heti Make the 2022 Scotiabank Giller Prize Long ListThe jury read 138 books to choose 14 titles for the long list, one of which will win the $100,000 prize, one of the richest in Canadian literature


Salman Rushdie, Novelist Who Drew Death Threats, Is Stabbed at New York LectureThe Indian-born novelist who was ordered killed by Iran in 1989 because of his writing, was attacked before giving a talk on artistic freedom.


Raymond Briggs, Creator of Beloved Children’s Tale ‘The Snowman’, Dies at 88First published in 1978, the pencil crayon-illustrated wordless picture book sold more than 5.5 million copies around the world while a television adaption became a Christmas favourite in Britain and was nominated for an Oscar.


Canadian Author Emily St. John Mandel Makes Barack Obama’s 2022 Summer Reading ListObama's list includes everything from fiction to books on politics, cultural exploration and basketball.


Canadian Author Rebecca Eckler to Launch RE:books Publishing House Focused on Female Authors and Fun ReadsThe former National Post columnist says her tagline is ‘What’s read is good, and what’s good is read.’”


Brian Thomas Isaac’s “All the Quiet Places” wins $5,000 Indigenous Voices AwardThe B.C. author, a retired bricklayer, drew on his childhood growing up on the Okanagan Indian reserve for his coming-of-age story set in 1956


Canadian-American Author Ruth Ozeki Wins Women’s Book Prize for “The Book of Form and Emptiness”The UK judges said her fourth novel, inspired in part by the Vancouver Public Library, contained "sparkling writing, warmth, intelligence, humour and poignancy."


The Bill Gates Summer Reading List Includes a Sci-Fi Novel On Gender Inequality Suggested by His DaughterBill Gates' summer reading list includes fiction and non-fiction titles that cover gender equality, political polarization and climate change.


American novelist Joshua Cohen wins the Pulitzer Prize for fiction for “The Netanyahus”The 2022 Pulitzer prizes include this satirical look at identity politics, focused on the father of former Israeli Prime Minister Benjamin Netanyahu, at a crucial time in the Jewish state’s history


Margaret Atwood, Alice Munro Among Canadian Authors Recognized in Commemorative Reading List Marking Queen’s Platinum JubileeThe authors are among six Canadian scribes included on the The Big Jubilee Read list.


Queen Elizabeth II’s Aide Reveals Details of Life in Royal Pandemic Lockdown in New Addition to BookAngela Kelly, who's worked for the Queen for 20 years, discusses everything from cutting the Queen's hair to "the light and laughter that was shared ... even in the darkest moments."


New Leonard Cohen Story Collection, ‘A Ballet of Lepers,’ Set for October ReleaseThe collection features a novel, short stories and a radio play written between 1956 and 1961.


Archived Letters Reveal How Toni Morrison Helped MacKenzie Scott Meet Future Husband Jeff BezosBezos hired Scott at the hedge fund where he worked after receiving a recommendation from Morrison. Shortly thereafter, the pair married and Scott helped Bezos launch Amazon.


Prince Harry’s Memoir is Set to Rock the MonarchyFriends say the California-based royal got a million-pound book deal to write "an intimate take on his feeling about the family."


European Jewish Congress Asks Publisher to Pull Anne Frank BookThe Congress says 'The Betrayal of Anne Frank' has "deeply hurt the memory of Anne Frank, as well as the dignity of the survivors and the victims of the Holocaust."


Canadian Author Details Anne Frank Cold-Case Investigation That Named Surprise Suspect in Her Family’s Betrayal in New BookAhead of the 75th anniversary of the publication of Frank's 'The Diary of a Young Girl' in June, a team that included a retired FBI agent and around 20 historians, criminologists and data specialists identified a relatively unknown figure as a leading suspect in revealing her family's hideout.


Man Who Tricked Authors Into Handing Over Unpublished Manuscripts Arrested by FBI in New YorkFilippo Bernardini, an employee of a well known publication house, has been arrested for stealing hundreds of unpublished manuscripts.


Hollywood Legend Betty White Has a Last Laugh in New Biographic Comic BookThe creators of the biographical comic book have released similar books about Hollywood legends like Carrie Fisher, Lucille Ball, David Bowie and Elizabeth Taylor.


Barack Obama Reveals His List of Books That Left “A Lasting Impression” in 2021Obama's favourite 2021 reads include two-time Pulitzer Prize-winning author Colson Whitehead's 'Harlem Shuffle' and 'Klara and the Sun,' by Nobel Prize-winning author Kazuo Ishiguro


“Interview With the Vampire” Author Anne Rice Dies at 80 — Tributes Pour in From Stuart Townsend and OthersThe author, who was best known for her work in gothic fiction, died on Saturday evening as a result of complications from a stroke.


Norma Dunning wins $25,000 Governor General’s English fiction prize for ‘Tainna’The Edmonton-based Inuk writer explores themes of displacement, loneliness and spirituality in six short stories


Omar El Akkad wins $100,000 Giller prize for “What Strange Paradise”The former Globe and Mail reporter, who published "American War" to acclaim in 2017, tackles the global migrant refugee crisis in his second novel


South African Author Damon Galgut Wins the Booker Prize For ‘The Promise’Galgut received nominations for his 2003 and 2010 works before finally taking home the prize this year. 


Hollywood Legend Paul Newman Discusses Life, Acting and Aging Gracefully in Newly Discovered MemoirPublishers of the newly discovered memoir say the Hollywood legend wrote the book in the 1980s in response to the relentless media attention he received during that time.


Here’s What You Need to Know About the Toronto International Festival of AuthorsDirector Roland Gulliver lands in Toronto to open his second, much-expanded virtual festival with more than 200 events


Tanzanian Novelist Gurnah Wins 2021 Nobel Prize in Literature for Depicting the Impact of Colonialism and Refugee StoriesGurnah, 72, is only the second writer from sub-Saharan Africa to win one of the world's most prestigious literary awards


Miriam Toews Garners Third Giller Prize Nomination for “Fight Night” after Shortlist AnnouncedSophomore efforts from novelists Omar El Akkad and Jordan Tannahill join debut books from Cheluchi Onyemelukwe-Onuobia and Angélique Lalonde


Tina Brown’s New Book, ‘The Palace Papers’, Covers the Royal Family’s Reinvention After Diana’s Tragic DeathTina Brown's sequel to her 2007 release 'The Diana Chronicles' is set to hit shelves April 12, 2022. 


Audible.ca Releases Andrew Pyper’s Exclusive Audiobook “Oracle” For New Plus Catalogue LaunchThe thriller about a psychic FBI detective is one of 12,000 titles now available for free to members


Barack Obama and Bruce Springsteen to Release Book Based On Their “Renegades” PodcastThe new book will feature a collection of candid, intimate and entertaining conversations


Prince Harry Will Publish a Memoir in Late 2022Harry says he's writing the book "not as the prince I was born but as the man I have become."


> STAY UP TO DATE

Sign Up for the Weekly Book Club Newsletter