Kelley Korbin, left, poses with her father David, on Hawaii's Big Island in 2015.
Kelley Korbin is a palliative care and MAID Family Support Society volunteer. She holds a bachelor’s degree in cultural anthropology and a master’s in journalism, and is writing a reported memoir of her father’s last days titled Exit Stage Rite: Lessons for a Brand-New Way of Dying.
My father’s assisted death was anything but routine.
The night before he died, perched in a hospital bed that had been wheeled to the head of our table, he presided over his final Friday night dinner. He didn’t eat much, but he savoured the attention of his wife, children and beloved grandkids. Then he let me beat him in an arm wrestle – the first time he let me win at anything. These were just two of the moments we celebrated in the ticking days and hours between Dad’s terminal diagnosis and his final breath.
And yet, reading the news about medical assistance in dying in Canada might lead you to believe the country’s permissive legislation and high uptake have led to a medical conveyor belt that performs the procedure like a factory assembly line.
Undoubtedly such coverage will be exacerbated by Quebec’s announcement that it will allow people who have serious and incurable illnesses such as Alzheimer’s disease (but still have capacity) to make advance requests to access MAID at a later date. The Quebec government has said that it will no longer wait for the federal government to amend the Criminal Code, and is now granting such requests.
It is true that Canada has some of the most progressive assisted-dying laws in the world. It’s also true that since MAID was legalized in 2016, Canadians have adopted the practice on a trajectory so steep that at least two provinces now record more assisted deaths per capita than any jurisdiction in the world; in 2022, the last year for which federal figures are available, MAID accounted for 6.6 per cent of all deaths in Quebec, while in British Columbia, the rate was 5.5 per cent. (A recent provincial report pegs the second-quarter rate in B.C. at more than 8 per cent.)
Given the patchwork of rules and regulations across the globe, it is virtually impossible to make jurisdiction-to-jurisdiction comparisons. Nevertheless, for perspective, in the Netherlands, where MAID has been legal for more than two decades, a little more than 5 per cent of deaths are medically assisted. Meanwhile, California – a state with a population similar to Canada and that also legalized assisted dying in 2016 – recorded 15 times fewer assisted deaths than its northern neighbour in 2022 (853 versus 13,241).
But the stories of the nearly 50,000 Canadians who have made considered and thoughtful decisions about how to end their lives – including my father – are buried when we focus on these cold statistics and contentious legal and ethical narratives. They distract from the way that MAID can be made meaningful, and how that can actually lead to better outcomes for grieving loved ones.
David Korbin and his daughter Kelley pose for a photo in Penticton, B.C., in September, 2022 – just a few months before David passed away.
It is estimated that nine people are bereaved for every death; in my father’s case, that number was 11. We joined the nearly half a million Canadians who have been touched by this new way of dying. And, like many of those families, we were not prepared for the surreal experience of knowing in advance precisely the number of days and hours we had left with our person.
MAID is performed by doctors and nurse practitioners. But a small but growing body of research suggests that, by adding ritual and ceremony – what University of Victoria researcher Rosanne Beuthin calls “enacting MAID as a ceremony” – it can be much more than a medical procedure. Celebrating a “parade of lasts” seems to slow time and help mourners digest grief and loss, and can improve bereavement outcomes for family and friends.
Applying for MAID can be a laborious process for family members, involving complicated logistics. When my father decided on MAID we had to source and complete forms, find a witness and schedule appointments with two medical professionals who would independently assess his eligibility. Then came the most daunting logistical and existential hurdle of all: helping Dad choose a date and time.
Through all these practicalities, we never really stopped to consider what the moment of his death would – or, more to the point, could – look like.
Fortuitously, our MAID process landed my mother and me in our rabbi’s office – ostensibly to purchase a plot, but with an ulterior motive: to pre-emptively gauge the rabbi’s thoughts on assisted death. The rabbi met our disclosure with kindness and offered to “be there” with us. Although we have never been a particularly religious family, we took him up on his offer. What we couldn’t have known then was that his prescriptive liturgy and careful choreography would give each of us the space to be fully present. The medical procedure became a sacred rite of passage.
Rites of passage are ceremonies that transition us from one social role to another: Children become teenagers; students become graduates; daughters become orphans. However, unlike births, weddings or even funerals, we don’t have centuries of history to guide us in how to mark MAID events.
Thanks to our rabbi’s presence, I was able to suspend my roles as mother, sister, wife and general family-dance-step caller to be the one and only thing I needed to be in that moment: a daughter telling her father I love you, thank you, goodbye.
When the compassionate and professional nurse practitioner who provided MAID encouraged us to “come closer” at the moment of his death, each of us put a hand on Dad. With our free hands, we supported one another. We were a Celtic knot of love, holding on and letting go for the eight slow minutes it took my father to become an ancestor.
I don’t know what my grief might have been like if we hadn’t added ritual to his last hours. What I do know is that although I miss and mourn my father, when I think about the way he died, I am overcome with gratitude and a sense of grace.
Adding ceremony to MAID can be as simple and secular as lighting a candle or playing a favourite song. Alternatively, it can be as elaborate as a full-scale celebration of life while the person is alive, complete with champagne, caviar and a slide show. Through my role as a volunteer with the MAID Family Support Society, a non-profit that provides peer support for people helping a loved one through MAID, I have heard the most magnificent stories: One family painted a pine casket together, while in another family, a dying woman asked her daughter-in-law to post the news of her demise on Facebook 12 hours early, just to be able to revel in what people said in response to her passing, while she was still here.
I’ve also spoken to people who were unprepared for their person’s MAID death. Some continue to experience lingering, complicated grief. Many tell me they weren’t ready; they say, “It happened so fast.” If we hadn’t considered the ceremonial aspect of my father’s MAID death, I may have found myself in a similar situation.
Yes, the numbers say it all: In Canada, MAID is not rare or exceptional, and it is no longer, as The Wall Street Journal recently described it, “an experiment.” It is a legitimate health care option and part of the fabric of Canada’s end-of-life care. So let’s try to look beyond the numbers and at the stories instead – stories of how assisted death has been a gift for sick and suffering people who want to control their exit. It’s time to give family members the tools to help them usher their loved ones to peaceful deaths, while simultaneously easing their grief and preparing themselves for their new roles.