When Rolf Heer’s doctor walked into the examination room and closed the door, Mr. Heer got right to the point.

“You know why I’m coming to see you? I want a medical-assistance death as soon as possible,” he said. “I’ve been in so much pain it’s unbelievable.”

While his doctor empathized with Mr. Heer’s pain and offered medication, he said: “My opinion is really to try and dissuade you from this line of thinking, the main reason being that you’ve responded to treatment… MAiD (Medical Assistance in Dying) is probably not in your best interest essentially.”

Mr. Heer disagreed. “I’m so sick I can’t even do anything,” he said. “Laying in bed is not the future for me.”

With Mr. Heer’s prostate cancer in remission, his doctor said he doesn’t have a medical explanation for Mr. Heer’s pain, why it comes and goes and why it’s so severe that he is requesting MAiD. Their conversation went back and forth with the doctor advocating for more testing and pain management and Mr. Heer wiping away tears while trying to get his doctor to reconsider.

What follows is condensed from their discussion:

Mr. Heer: “You won’t give me the medical-assistance death. Is that basically what you’re telling me? You want me to suffer a lot longer it sounds like.”

Doctor: “No, I definitely don’t want you to suffer.”

Mr. Heer: “I can go to Switzerland and get it done.”

Doctor: “Rolf, what I’m saying again is that your terminal illness is under control.”

Mr. Heer: “Why am I so bloody sick?… It’s been going downhill. Since the house burned down and everything it’s just been going downhill every day. I feel that every day I’m getting worse and worse and worse and there’s no way out.”

Doctor: “My biggest concern is that you’re making an irreversible decision on the basis of possibly other things.”

Mr. Heer: “It sounds like only costing the government a lot of money for nothing.”

At Mr. Heer’s 65th birthday party a few days earlier, the man who is known for his wild parties and frivolity didn’t want to exchange pleasantries with the Pioneer. Instead he said he was feeling terrible and invited the paper to another milestone life event – his appointment to ask for MAiD.

When his doctor asked how he enjoyed his birthday, Mr. Heer said: “It was a good party. But you know how many pills I had to drop until I could make it to the party? This is no fun for me living like this anymore.”

The doctor acknowledged Mr. Heer’s pain, and implored him to have a colonoscopy and gastroscopy.

“One issue that people have with Medical Assistance in Dying is that we maybe are not treating people,” he said. “It’s legal in Canada, but I really think that we need to do these other tests to give you a better answer.”

Mr. Heer reluctantly agreed to the additional testing his doctor recommended. How reluctantly? He said he feels like he’s being forced to stay alive.

Clutching his new pain-management prescription, he struggled with shaking hands to light a cigarette as he stood outside the clinic.

Dr. Doug Smith, Interior Health’s executive medical director for end of life care and medical assistance in dying, said conversations – like the one Mr. Heer had with his doctor – are crucial when it comes to making end-of-life decisions.

“From my point of view (MAiD) comes down to respect for a person’s autonomy and self determination and really understanding that we don’t have an understanding of anyone’s suffering unless we’re in their shoes,” he said. “What the legislation describes is that the patient is experiencing intolerable suffering that is not able to be relieved according to their own experience. So that allows the patient voice in this… At the end of the day it’s the person who’s asking for the assessment who would like to go through this, it’s their determination, their experience, their decision to make.”

That said, in order to have a medically-assisted death, there are stringent criteria a patient needs to meet, criteria Mr. Heer’s doctor isn’t sure that he meets.

Among other conditions, the patient must have a “grievous and irremediable condition which is an illness, disease or disability that causes the person enduring suffering that is intolerable to them and cannot be relieved in a manner that they consider acceptable” and be “in a state of irreversible decline where death is reasonably foreseeable,” Dr. Smith said.

As for what makes a person’s death ‘reasonably foreseeable,’ he said it’s not always easy to define.

“It really is complicated. Like everything there’s some black and white and then there’s some grey,” he said.

While someone – like Mr. Heer – who is “having a fair amount of suffering” whose death is not imminent could initially be declined for MAiD, that person could arrange to meet with their doctor again as their illness progresses.

After his appointment, Mr. Heer got a call from his doctor, who offered to meet with him again the following week.

“He said to me it’s actually your decision if you want to go for medical-assistance death,” Mr. Heer said.

In order to have assistance in dying, a patient needs to first request MAiD, obtain approval from two doctors, wait for a period of at least 10 days to allow time for somber reflection, and consent again at the time of the procedure.

Now that he might have his doctor’s support, Mr. Heer is having second thoughts.

“The people I’m living with here, they don’t quite agree with me either that I would go for the medical-assistance death. But I have lots of other friends that say: ‘well in the pain you’re in, go for it.’ So I got a little bit on both sides, you know, so at the moment I’m not sure,” he said.

More on MAiD

Since medical assistance in dying became an option in 2016, four patients have chosen to meet their ends through the service provided by doctors at the Invermere & District Hospital. By the end of February 2019, 344 medically assisted deaths had taken place across the Interior Health region.

Dr. Smith said approximately half of the people who have requested and are approved for MAiD choose to proceed. The other half opt out for a variety of reasons which could include changing their minds, passing away in the meantime or becoming incapacitated and incapable of providing consent before the procedure.

“The patient and their families will arrange with the prescriber (the doctor who administers the life-ending treatment) all the details of the medically assisted death: when it would occur, where it would occur” and how it would occur, whether the patient would prefer a “patient-administered oral medication route or an intravenous route,” he said. “It’s supposed to be very person-and-family centred, and we work very hard to ensure that that’s the case.”