The perverse “Human Connection”
Part I:
MAiD is the Canadian acronym for “Medical Assistance in Dying.”
Medical Assistance in Dying / MAiD in Canada spans both legalized voluntary euthanasia and assisted suicide [AS]. In practicality, MAiD here it is provided almost 100% by direct euthanasia. These terms are now being used in other jurisdictions because they are delightfully euphemistic — as if the ‘maid’ is just cleaning the room.
Rosanne Beuthin and Anne Bruce’s article “MAiD as human connection: Stories and metaphors of physician providers’ existential lived experience” was published December 2023 in the online journal, Death Studies. The article is based on interviews taken in 2020 from 8 frequent providers of MAiD. In Canada, providers can be either a doctor or Nurse Practitioner, but these were all doctors. [Dr. Beuthin’s ‘bio’ from University of Victoria is in the Appendix.]
This paper came to my attention through reading Christopher Lyons detailed response, “Human misconnection? A response to Beuthin and Bruce on medical assistance in dying providers’ lived experience” which was published in Death Studies, January 2025. Lyons paper is a remarkable dissection of the original article and I highly recommend it.
I hesitate to call the original article “research.” What stood out for me was: A. The personal emotional justifications, the logical fallacies, moral turpitude and self-absorption of the participants and B. The authors patent bias in favour of the providers.
This article deals with the former. A follow-up article [Part II] will show the authors position — also in their own words.
Rather than provide a third-hand review from Lyons article, I went back to B&B’s original piece to read the phrases used by the 8 providers of euthanasia. It was quickly evident that Beuthin & Bruce’s presents the testimony in the best possible light and that they had only used a tiny fraction of the interviews.
To note: these doctors admitted to “experience as a direct provider of MAiD ranged from 12 to 113 assisted deaths” in 2020. (Note that as the PROVIDER of euthanasia, they directly killed the patient rather than being a secondary assessor.) That was 4 years after legalization of euthanasia in Canada, 2016. Another 4 years has passed [pun intended] so one can only guess at the numbers of lives these doctors have taken in toto.
We can see that selective editing occurred because the authors noted “Some spoke of feelings of love and joy” but B&B did not provide the direct quotations. As I suspect that less favourable comments were excluded, I contacted Dr. Beuthin PhD in the (faint) hope of reviewing the original recordings myself. The interviews are documented as being 40-70 minutes for each of the 8 participants: so there is something in the region of 8 to 9 hours of interviews.
Dr. Beuthin responded:
We are unable to share this data outside of the parameters of consent provided by the participants. In order to further analyze the data by others would require a full ethical review. Since I am now retired, this is not an option.
No surprise.
As the original recordings are not available the comments below are taken from the original Beuthin & Bruce article. I removed some obviously repeat comments. Remember, the smattering of comments below is taken from ~8 to 9 hours of interviews. Clearly, much was not reported. We can only guess as to what has been omitted.
Physician provider comments:
“extraordinarily rewarding”
“deep empathy”
“I hadn’t expected this”
“It’s amazing. It blows my mind still.”
“Loving;”
“a solitary practice;”
“intimate contact;”
“heartwarming,”
“the most important medicine I do;”
“satisfying medicine;”
“rewarding.”
“an ultimate act of compassion;”
“an honor;”
“incredible gift;”
“liberating;”
“unlike anything I’ve ever…”
“extraordinary work.”
“social justice;”
“a crusade;”
“empowering people;”
“the right thing in the right circumstance.”
“Like trying to sing and play the piano at the same time.”
“A release.”
“One patient said to me just before I had to inject him, he said, “thank you for saving my life.” And he looked at me and he said, “Do you understand what I mean?” ”
“I surprised myself with how comfortable I am about talking about dying, really. And I don’t know, when people die, surprised about how little it upsets me, because it doesn’t upset me at all. I thought it would and it doesn’t. It’s like a fruition of their wishes, so no, not upsetting at all. In fact, uplifting. The complete opposite. The complete opposite to what I expected. I cant say it’s like something…. It’s completely unlike anything I’ve ever…I can’t compare it to anything…. It’s like a mixture of empowering people and setting them free…”
“You’ve gotta leave a piece of yourself behind every time, emotionally. I think there is an element of loss.”
“There’s the part of it that you, in order to understand the patient’s rationale for requesting this and delve into the questions of suffering you have to get to know the person, knowing that the end result is going to be that they’re going to die. And you get to engage with the family. So I don’t know if you’d call it an element of grief, I think there’s an element of loss. I suppose offsetting that is a sense of satisfaction. The patients are very appreciative that we’re providing this and they do express that. I think that it’s, if you could say this is a rewarding aspect of medicine I would say yes, it’s very rewarding.”
“I’m using more of an emotional side of myself.”
“There’s often a home visit involved and there’s, I don’t know, there’s that sort of mutuality about it. It’s different than general practice. Very different. Very different work. There is – I find that I invest emotionally more but that doesn’t mean that I’m upset it just means that I’m using more of an emotional side of myself than I often do in an ordinary general practice consult.”
“This is emotionally charged medicine.”
“Boundaries and role clarity are important especially since this is emotionally charged medicine so you need to be drawn in but it’s not like you have to do everything. You learn by doing. It’s not the most emotional – honestly most of these cases are not emotionally charged, most of them are relatively easy actually but some of them are incredibly hard.”
“So you asked why I went into this and I’m not particularly sure it’s causative but when I think back to when I was 10 and my grandmother was dying – she was dying of congestive heart failure and it was an awful death, she was in terrible agony, she was in and out of the emergency room even though it was clear that she only had weeks left to live because nobody – palliative care was not well done in her town and her experience at the end of life was poor but for the families’ it was terrible. And so my mom and I lived with those memories for the rest of our lives. My grandfather lived with that for the rest of his life which was a long time after that. And MAiD was the only thing that could have made that better. She probably wouldn’t have chosen it but to be able to give people grace and dignity and comfort at the end of the of life and a memory for families to see that ending is an incredible gift that we give patients and it’s an honor to be a part of that part of their life. But yes, it’s emotionally charged.”
“invest emotionally.”
“I don’t think you can go in and do this without feeling emotional attachment.”
“I’m a little surprised at two things emotionally for me. One is I found myself – a year into it, I found myself helping a woman I really liked. A situation had come up and we had to change her date, make it earlier, like I’d gotten to know her, I really liked her and her family, I was happy to help them, everything was cooking along in a very positive way. There were some changes and we accommodated for that and I was still able to help her and it was still a beautiful, beautiful death. Very moving at the end. And I felt really good about the job I had done and received all that gratitude and so that was all very good.”
“And then I found myself driving home feeling a familiar feeling I hadn’t felt in a long time and it was the feeling I had after doing a birth, after a delivery. It’s almost an adrenaline rush. And I was surprised at how good I felt. It was a little bit weird. I was really, really –I don’t know what the word is. I’d say happy but that’s not that word. You get a – there’s a certain rush when you deliver a baby. It’s like an adrenaline rush. And I felt that after her experience and I thought wow, that’s weird. So I was quite surprised at that and I thought, wow, I shouldn’t feel that way. And then I thought, no. I should. I just did a really great job and I really helped someone so it’s ok. Like I wasn’t sure, I had to give myself permission to be ok with that. So that was a bit surprising. Lovely, I mean it was a great feeling but weird in the context. But you kind of question – I mean I questioned myself in that kind of, can I feel that way, is that ok? Can I be so, can I be so up after having done this? You kind of question yourself.”
“I don’t find it emotionally difficult. I don’t find it heavy.”
“No, I don’t do anything (to prepare) because I guess for me I don’t find it emotionally difficult. I don’t find it heavy. In fact I find it kind of, like it puts me –it seems strange maybe but it puts me in a good mood. I feel like I’m doing something good for someone. It feels like I’m helping people, I’m doing what I signed up for when I became a doctor, right? So I don’t have, I don’t do anything because I don’t feel like I need to do anything. I feel like I’m doing my job but in a really awesome way if that makes sense?”
“In a weird way, natural”
“Certainly the first death and the first 10 deaths were difficult because I wasn’t sure how to anticipate how the drugs would work. I wasn’t sure where to put myself. So I think it’s taken a little while to just orchestrate how to be a pebble and not a rock. How to be slightly invisible in the process and let the person who’s dying take the lead, sort of center stage. So that has taken a little while. So now it feels totally fine. Saturday I was out in a big orchard on one of the islands, lying on rugs with a whole bunch of people, and it was fine, it just feels completely, in a weird way, natural.”
“it felt great… but weird”
“in a weird way, (it’s) natural”.
“I think you have to have balance. I think you have to debrief. We debrief afterwards with whoever else was involved, the others, friends or family without obviously compromising the patient’s privacy, but you need to talk about it. And I try not to talk about it with people too much in case they find it stressful. I don’t want to burden anybody with it but I think in your head you have to work it though a lot. Before a case you can get butterflies in your stomach or lose sleep for a few days so it’s really important to take good care of yourself and to make sure that you keep your focus and to not focus too much on death and dying but to hold your kids a little tighter and just to keep your head in the right place. (I: and how do you do that?)”
“Immediately I make sure to get chocolate – which sounds a bit bad but you need something. I think it comes from the Harry Potter books. It’s interesting – I don’t know how familiar you are with it –but if they see a Dementor which is a soul-sucking creature, they get chocolate afterwards just to revive their strength. There’s something bizarre about it but it feels like that, right? You sort of break the negativity with having a bit of chocolate. And then you have to make sure that you’ve got quiet time. I try to not go home too quickly because otherwise it leaves a bit of a shadow over me that my family will notice. For a day or so things are not quite 100%, you just won’t be quite as chirpy, or maybe a bit more distracted in conversation.”
“Allow for digestion of the emotion.”
“I’m doing lots of procedures in the same week or even sometimes two procedures on the same day. I find after a couple of weeks of that I just feel like I need a break. That’s just too much and I don’t think that’s smart, that kind of work all the time consistently. I think it doesn’t give time to allow for digestion of the emotion, or working through…. It’s not like I need a ton of that but I do need some. Everybody’s human.”
Preliminary Comments
Part II will present the authors comments showing their partisan approach; their support of the euthanasia providers; and their support of MAiD in general.
My main commentary will be in Part II.
The quotations above give a sense of the ethical abrogation and moral turpitude prevalent in these euthanasia providers.
Kevin Hay
Appendix:
Dr. Rosanne Beuthin’s bio from the University of Victoria web site.
Role:
Care Coordinator Medical Assistance in Dying & Nurse Researcher, Vancouver Island Health Authority.
Credentials:
PhD Nursing (2014)
Rosanne is currently involved in research projects about the experience of living with advanced illness and nurses' experience with assisted dying. In the Care Coordinator role for assisted dying, she focuses on ensuring access and promoting understanding about this new end of life care option in Canada. Rosanne is passionate about kindness and compassion in nursing, health care, and in life. Her PhD honed her skills as a narrative researcher where she has focused on persons aging with HIV, with an emphasis on metaphor and language, spirituality, and death and dying.