Introduction  

I am writing the story of my Track Two MAID assessment journey in the hopes that it can help those who want to apply, as well as family members of applicants, and anyone else who does not know how the Track Two MAID assessment process sometimes works – and would like to know.  

Background  

I am a 65-year-old divorced mother of an adult child. I have coped with a chronic, incurable medical condition for decades. My symptoms have worsened as I have aged, despite many efforts to stabilize them. Sometime in my early 20’s, I realized that something was wrong with my body. It simply did not perform the way that other people’s bodies did. I sought medical help and received both a diagnosis and guidance regarding how to manage my symptoms.  

I then coped as well as I could for as long as I could.  

Fast forward several decades. 

My condition worsens significantly and my concerted efforts to help myself are ineffective, resulting in never-ending pain, daily dysfunction, and frightening weight loss. I reach out for medical help once again, suspecting that there is likely little that can be done, given my diagnosis, medical history, and age. Preliminary tests are conducted, specialist referrals are made, and appointments are booked. As I wait for help, pain and dysfunction rule my long days and nights. I lose more weight, become weak, exhausted, and emotionally drained. Eventually, I reach my limit. 

I pick up the phone and call a 1-800 number to apply for medical assistance in dying (MAID). I am sure that I am ready. A referral to a MAID assessor is put through by a Registered Nurse on my behalf. I am told it could take up to eight weeks before I am contacted.  

The MAID Process Begins  

Since my natural death is not “reasonably foreseeable,” I am considered a “Track Two” MAID patient. I am advised by my primary MAID assessor to “continue to pursue all treatment” as he contacts my physicians. “This is going to take some time,” he tells me. It turns out, if you want a medically assisted death, you must have a well-documented medically assisted life.  

My two independent MAID assessors require current medical evidence confirming both my diagnosis (which I received decades ago), my current status, and my prognosis. As well, they must witness me consistently express over time (not just during a crisis period) that my illness is causing me physical or psychological suffering that is intolerable to me and which cannot be relieved under conditions I find acceptable.  

By law, I must be offered all means of medically recognized relief – and I must thoughtfully consider each and every one of them. However, ultimately, I have the right, like all patients in Canada, to refuse or to discontinue treatment. This is the first pillar of medical ethics: patient autonomy – and something I wish I had been educated about before seeking medical guidance.  

The Diagnostic and Treatment Process 

I begin navigating a world of long hospital corridors, brick medical buildings, crowded labs, crammed elevators, bustling waiting rooms, public washrooms, and – at one point – an emergency department in the dead of winter while most of the city slept.  

I am weighed and measured, poked and prodded, scanned and tested. I am put under anesthetic and my organs are biopsied. I am also questioned multiple times – even lectured once or twice. I receive medical report after medical report after medical report. I forward them all to my MAID assessors. Are we there yet?  

Nope.

Each doctor I see suggests another medication trial, or another test, or another assessment by another doctor to rule out any potential missed diagnosis or to find a way to relieve my suffering. Ultimately, they are trying to save my life, as they know I have applied for MAID.  

Months go by. The assessment journey, the medication trials, and my worsening condition cause me much distress. I experience fear, frustration, anger, anxiety, sadness, desperation. As well, I am aware – and deeply regret – that I am causing my loved ones much grief and worry.  

Each morning, I wake up wondering how I will get through the day – each one feeling like an eternal hell. And each night I tell myself: “You did it. Good for you. Stay strong. Stay focused.” I take a deep breath, cross off one more day on my calendar, and count down to the next medical appointment, like a prisoner etching lines into a brick wall to mark time passing.  

After what feels like an eternity, I finally see a critical specialist (waiting lists are long) and I am given a diagnosis and a prognosis: this condition is serious, chronic, incurable, and the relief available will be minimally effective. Lastly, it is confirmed that I have been on a downward trajectory for a while now.  

Sitting at home, alone, I close the report and mouth the words: “I tried to tell you so.”  

The Decision  

A few weeks after that critical assessment by a kind, thoughtful, senior specialist – and after a beloved and brilliant family physician/psychotherapist whom I have been treated by for over 30 years generously steps out of retirement to speak to both me and my MAID assessors – I get the phone call: Both of my assessors have independently determined, after reviewing all of my medical file, that I am legally eligible for MAID. I cry tears of relief.  

What happens next is – finally – up to me.  

There is no timeline or deadline for the provision of medically assisted death after approval, but Track Two procedures must be preceded by a minimum 90 clear day assessment period (another safeguard) which, in my case, has passed. The road is open for me, at long last.  

My Loved Ones  

The hardest part of my decision to begin the MAID assessment process was knowing the hurt that it would cause my precious loved ones, some of whom are (or were) opposed to MAID. Many difficult conversations have taken place. Anger has been expressed (“Why can’t they help you?!”). Many tears have been shed – and continue to fall.  

And yet, the length and rigour of the Track Two process seems to have allowed time to work in the way that only time can: by helping my loved ones come to terms with my choice, at least in part. How did they edge somewhat closer to acceptance? By witnessing first-hand, often at my side, the medical community trying to find a way to relieve my suffering. It was clear that no one wanted me to die. No one was negligent. 

My loved ones also learned that my MAID assessors did not base their decision on their personal opinions of me or my condition. They needed medical evidence from appropriate specialists, and they refused to approve my request until all avenues to relieve my suffering had been explored and offered to me – as dictated by law – despite the toll the process was taking on me, of which they were aware.  

My family also saw me trying my best to improve my symptoms: to hurt less, to function better, to maintain my dignity. Since I knew that my request for MAID might be declined – based on the statistics – as my death was “not reasonably foreseeable,” I worked simultaneously on two fronts:  

1) What if my application is approved?  

2) What if my request is denied? 

I needed plans for two diametrically opposed outcomes: I needed to get my affairs in order, and yet I needed to keep trying to somehow get better. 

Ultimately, the hard truth that not all medical conditions are “fixable” was revealed. And not all existing treatments are effective – or acceptable – to all patients. For me, to continue to live is to continue to suffer both severe pain and debilitating dysfunction – intolerably – with no end in sight.  

Conclusion  

The journey to MAID if you are categorized as a “Track Two” patient can be long, and it can be difficult, as I think my story shows. Please do not give up hope. There are people who will help you navigate this journey, such as the kind professionals at Dying With Dignity Canada or MAiDHouse. Reach out to them, even though it is difficult to ask for help. 

If your sole condition is a mental illness, the journey to MAID is currently impossible. In Canada, you cannot even apply. This is because safeguards have purposely been put in place by governments to protect the vulnerable.  

I think it is arguable that these well-intentioned safeguards have their origins in medical paternalism and can be seen as discriminatory and stigmatizing barriers, not “safeguards.” Many people living with mental illness make competent decisions about their lives every single day, including medical decisions. At least let people apply to be carefully assessed over time by experts, with proper safeguards built into the assessment process itself – as they already are for everyone else.  

Carter v. Canada  

“The prohibition on physician-assisted dying infringes the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice.” – Supreme Court of Canada, Carter v. Canada, 2015  

Many grievously ill patients, along with their legal and other allies, paved the way for everyone’s constitutional right to have the option to apply for MAID. No one has to exercise this right and MAID applicants are asked many times if any pressure has been put on them by anyone or anything (trust me, I’ve been asked).  

No doctor or nurse practitioner has to perform MAID.  

In my opinion, the right of access should be available to everyone, if needed and wanted. 

The decades-long history of the struggle for the legalization of MAID in Canada is fascinating. It is comprised of a legal fight between the powerless individuals who advocated for it, and an army of government lawyers and interest groups who opposed it.  

The landmark Supreme Court decision in Carter v. Canada in 2015 was unanimous: criminalizing the medically assisted death of competent adults was ruled as unconstitutional and the federal Criminal Code had to be revised. The Court gave the government one year to do so. New legislation had to then be created, with safeguards.  

MAID became legal in Canada on June 17, 2016, for those whose death has become “reasonably foreseeable.” An amendment to this legislation pertaining to those who suffer a grievous and irremediable medical condition whose death has not become reasonably foreseeable (Track Two), came into force on March 17, 2021, with additional safeguards. 

You can learn about these historic legal decisions via books, internet articles, videos, and non-profit and legal websites. Check out the book “A Good Death” by Sandra Martin, and “This Ruling Changes Everything – The Story of Carter v. Canada” a very moving short film on YouTube. 

Thank You  

I want to express my deep gratitude to the MAID physicians who do this critical, difficult work, as well as to the specialists who assessed me and who were not afraid to call it as they saw it – knowing that what happened if I was approved for MAID would be my decision, not theirs.  

I would also like to thank the non-profit organizations that support patients and MAID providers. From the bottom of my heart: thank you. 

Most importantly: thank you to my loved ones for your support, understanding, and unconditional love.  

Thank you for reading my story.