Choosing her own time to die

NICOLA MILTZ

In November last year, Goodman, originally from South Africa and now living in Toronto, Canada, opted for medical assistance in dying (MAID). The practice is illegal in South Africa, and many parts of the world.

Her son, David Goodman, 66, who lives in Johannesburg, told the SA Jewish Report this week that his late mother did not want to endure prolonged suffering, and become a burden on her family.

“For as long as I can remember, she made it clear she wanted to die with dignity,” he said.

Now, almost seven months following her passing, Dr David Juurlink, who was with her until her last breath, has shared her final moments and his reflections on her death on Twitter. His posts have since gone viral, being read 6.5 million times, according to an email sent by the doctor to the family.

Juurlink, a Canadian pharmacologist and internal medicine doctor, is head of the clinical pharmacology and toxicology division at Sunnybrook Health Sciences Centre in Toronto, Ontario. This was the hospital where Goodman died.

On 18 May, he tweeted, “She gave me explicit consent to tweet the details of her case about four hours before she died. Her hope was that someone might benefit from her experience.”

According to Juurlink, Goodman experienced a great deal of pain caused by an infected and septic pseudo aneurism as a result of a previous hip replacement. She required further surgery and antibiotics for the rest of her life, something she did not want. She would have been in persistent pain.

“She wanted no more surgery,” Juurlink tweeted. “Her mind was sharp, and she was clear about that. Antibiotics alone weren’t going to cure the infection; they would only supress it.”

An even greater concern, going forward, was her quality of life, or lack thereof. “She foresaw being confined to her apartment, in pain, struggling with her walker. No more walks outside. No trips to the grocery store. No playing bridge with her friends, as she had done for years. She wasn’t interested in living like that.”

She insisted that palliative care was not for her. At that stage, she was already hospitalised and practically bedridden. So, in consultation with her family and a team of dedicated doctors and medical practitioners, Goodman opted for MAID.

“I saw her every day after that. Managed her pain. Listened to her stories … I grew very fond of her, especially her wit, and clear-eyed stoicism,” Juurlink said.

David visited his mother in hospital in November. He spent time with her and his devoted nieces (Sonia’s grandchildren living in Toronto who affectionately called her ‘Yaya’). There had been numerous emails back and forth concerning Goodman’s deteriorating condition. There had also been discussions about MAID. His mother was still being assessed for eligibility by the time he left to return to South Africa.

“My mother and I said our goodbyes. She told me not to come back when she passed away.”

About ten days later, on 30 November, David Goodman had his last FaceTime chat with his mother before the two bade each other farewell. “She seemed upbeat and happy,” he said.

An hour later, she passed away with the help of medical assistance.

Medical assistance in dying occurs when an authorised doctor or nurse provides or administers medication that intentionally brings about a person’s death, at that person’s request.

Goodman slipped away surrounded by loved ones, having had her hair done and wearing a fresh coat of lipstick. She sipped cognac with some Canada Dry Ginger Ale, and enjoyed her choice of music by Johann Christian Bach.

Juurlink tweeted, “There were tears, of course. All around. But mostly the atmosphere in the room was one of serenity and gratitude, and a genuine sense of having done the right thing.

“I’m no MAID expert, and I get that some people are opposed to it for various reasons. But I’ve been a doctor for 25 years, and I’ve seen enough deaths to know a good one from a bad one. This was, without exaggeration, the best death that I have ever witnessed.”

Medical assistance in dying offers patients, who may be experiencing intolerable suffering due to a grievous and incurable medical condition, the option to end their life with the assistance of a medical practitioner. It is provided only to legally eligible patients. There is a strict system of safeguards designed to protect vulnerable people and support all people in making an informed decision.

In June 2016, the Canadian government legalised MAID in Canada for competent adults. The law sets out specific criteria for eligibility.

The practice is legal in some countries under certain circumstances, including Belgium, the Netherlands, Luxembourg, Colombia, Switzerland, Germany, Australia, as well as Washington, Oregon, California, Montana and Vermont in the United States.

Cape Town euthanasia advocate, Professor Sean Davison, is the founder of right-to-die organisation, Dignity SA. Davison was this week sentenced by the Western Cape High Court to an effective three-year house arrest after pleading guilty to the charges of assisting three people who wanted to end their lives.

The legalisation of the right by terminally ill patients to choose when to end their life conjures up intense ethical and moral debate. Archbishop Emeritus Desmond Tutu has been a vocal proponent of assisted death.

In a heartfelt letter to family and friends last month, Sonia’s granddaughter, Sandy Murray, revealed an intimate conversation she’d had with Juurlink shortly before he posted his tweets. He told her that “at least one person will die differently, and better, because of her”.

“That’s what she wanted. I think she would be absolutely thrilled to hear this. I can’t think of a better testament to her and her character,” said Murray.

“I understand there are sensitivities around this. But this was definitely her story to share, and she wanted that to happen. I am so proud of her and her choice, and so glad she got the end she wanted.”