A British Columbia man who struggled with depression and showed no signs of facing an imminent demise was given a medically-assisted death despite desperate pleas from his loved ones, family members say.
Alan Nichols was admitted to Chilliwack General Hospital in June, at age 61, after he was found dehydrated and malnourished. One month later, he died by injection.
Days before his death, family members begged Nichols, a former school janitor who lived alone and struggled with depression, not to go through with the procedure. They still don鈥檛 know why doctors approved the life-ending procedure and insist that Nichols did not fit the government criteria of facing an 鈥渋mminent death.鈥�
鈥淗e didn't have a life-threatening disease. He was capable of getting around. He was capable of doing almost anything that you had to do to survive,鈥� his brother, Gary Nichols, told 麻豆影视. 鈥淚 didn鈥檛 think he had a sound mind at all.鈥�
The family has asked the RCMP to investigate the case.
This story is based on accounts from Nichols鈥� family and a neighbour. The family has hired a lawyer in hopes of accessing Nichols鈥� medical records to understand what happened.
鈥淚n light of the potential RCMP investigation, and out of respect for the patient鈥檚 privacy, we will not be able to provide any further information,鈥� the regional authority that oversees the hospital, Fraser Health, said in a statement to 麻豆影视.
Alan Nichols was 12 when he first underwent brain surgery for a non-malignant tumour. Over time he lost his hearing in both ears and had a cochlear implant.
But he finished school and worked much of his life. He developed depression but his family said he was doing well on medications.
Nichols relied on his father to manage his day-to-day life. But when his father died in 2004, Nichols鈥� life went into a tailspin. He stopped taking the antidepressant and often became angry, said his family.
Nichols wanted to live on his own, so his brother Wayne would visit him once a week, for groceries and banking. A neighbour would help out as well.
But family members and the neighbour say Nichols would isolate himself. He got rid of all his furniture except for a chair and a bed. Family members said if something upset him, he would stop eating. Yet he refused to see a doctor or take his medications.
鈥淗e would have maybe a period, a year, he would be very easy to deal with and make some decent changes. But then he would fall back into a very depressed state,鈥� said his brother Gary Nichols. 鈥淣ot going out in public, not seeing anybody, not eating properly.鈥�
The family requested guardianship in 2015 to provide care for him, but was unable to get permission. They say they were doing what they could, given Nichols鈥� reticence for help.
Then, on June 16, a concerned neighbour called police after she noticed that Nichols had stopped opening his curtains. When officers entered Nichols鈥� apartment with the neighbour鈥檚 spare key, they found Nichols weak, dehydrated and confused.
He was rushed to the emergency department. Police called Nichols鈥� brother Wayne to tell him what happened.
鈥楢LAN DID NOT FIT THE CRITERIA鈥�
As soon as Nichols鈥� family found out that he was in hospital, brothers Wayne and Gary went to see him. They say that, at first, Nichols wanted to leave hospital, but that family agreed with police that he needed medical help.
鈥淲e thought this would be the best place for him to get back on track,鈥� Gary said. 鈥淲e would never have allowed this to happen if we knew the outcome.鈥�
From there, the family says, things became difficult. They say the hospital did not give them much information on Nichols鈥� case. Staff told the family that he was doing well but he did not want to speak with family.
鈥淚 was always led on to believe that he was doing good,鈥� Gary said. 鈥淭hey never informed me of any (medical assistance in dying) application.鈥�
On July 22, they received a shocking phone call from a doctor who said that, in four days鈥� time, Nichols was scheduled for an assisted death. According to the family, the doctor said they couldn鈥檛 provide any other information, including the medical reason for the procedure.
鈥淚 started crying,鈥� Gary said. 鈥淚 was at work and never thought it would get to that. Just never thought he would ever be approved even if he applied for it.鈥�
Nichols鈥� sister-in-law, Trish Nichols, called the doctor to get more information.
鈥淚 was appalled by all of it and I said we want this stopped, this can鈥檛 happen. Our family doesn鈥檛 agree with this,鈥� she said.
鈥�(The doctor) said, 鈥榃ell, you can鈥檛 stop this. Alan is the only person who can stop this.鈥�
At the hospital, the family was told that two doctors had approved Nichols鈥� application for a medically assisted death, and that a psychologist and psychiatrist were there to assess Nichols鈥� competence.
The family was not given access to those medical records. They still don鈥檛 know what grounds doctors used to approve the application.
Nichols鈥� death certificate lists MAID, or medically assisted death, as his immediate cause of death. Officials also listed three 鈥渁ntecedent causes鈥� connected to his death including a stroke, seizure disorder and 鈥渇railty.鈥�
Other 鈥渟ignificant conditions鈥� not directly contributing to his death include the tumour he suffered as a child and a shunt to help relieve pressure on his brain.
Under Canadian law, assisted death can only be offered to patients who are considered as having 鈥渁 grievous and irremediable medical condition.鈥� , a patient must meet four criteria:
Have a serious illness, disease or disability
Be in an advanced state of decline that cannot be reversed
Experience unbearable physical or mental suffering from an illness, disease, disability or state of decline that cannot be relieved under conditions considered acceptable
Be at a point where a natural death has become reasonably foreseeable
They also must be of sound mind to provide informed consent. According to the law, families do not get a say in the process.
鈥淎lan did not fit the criteria. Alan was capable of talking, he was sitting up, he was eating, he was going to the bathroom, we were laughing, he was out of bed,鈥� Trish said.
鈥淚 knew by looking at him that he still had living to do. He was not near the end of his life.鈥�
Family members pressured the hospital to postpone the procedure. They argued that, at one time, Nichols had agreed to look at moving into an assisted-living facility.
But Nichols became angry, the family says, and at one point accused them of not being his 鈥渂lood family.鈥�
They also say that Nichols told them, 鈥淚t鈥檚 done. It鈥檚 going to happen.鈥�
Hospital staff said that the decision was up to Nichols.
鈥淲e were told we couldn't stop it,鈥� Trish said.
鈥淚 said, listen, I want to see Alan's signature that he wants this procedure. I want to see the doctors that have signed for this. We have a right to see this information. (The doctor) said the only person that could release that information was Alan. At that point, to me, I knew things were way out of whack 鈥� How can you allow this with Alan, knowing his background of mental anguish and depression?鈥�
On July 26 at 10 a.m., the family watched as medical staff at the hospital delivered three injections that ended Nichols鈥� life.
鈥淚 thought I was in a dream. I couldn't believe this was happening. I really thought it was a dream,鈥� Trish said.
His brother said the whole process was disorienting.
鈥淚t was hard to believe that you were in Canada, going through this process,鈥� Gary said.
HIGHER RATES IN B.C.
It wasn鈥檛 until after Nichols鈥� death that the family was told that an assisted death had been scheduled even earlier, on July 19.
Ten days before he died, the hospital had already started the process of an assisted death. However, before the injection, the medical professional who administers the assisted death intervened. The family was not notified and was given few details of what happened.
鈥淗e would鈥檝e died that day if this gal hadn鈥檛 stopped it. We would never have known about it,鈥� Trish said. 鈥淲e would鈥檝e never had a chance to say goodbye.鈥�
That trepidation only heightens their concerns that Nichols was not fit for a medically assisted suicide. They feel that he was vulnerable and mentally not competent.
Their question is: how can family members and a neighbour see a man with questionable decision making, but he is then given the clearance to make a decision about medically assisted death by two doctors who didn鈥檛 know the whole picture of his life?
The family is now sharing their story out of concern for other families who may be put in a similar situation.
鈥淲e spent 50 years helping Alan live, and in one month they signed his death warrant,鈥� Trish said. 鈥淗ow can that happen in that period of time? Where's the legislation to protect us?鈥�
Since legislation was enacted in 2016 some 7,949 medically assisted deaths have been administered in Canada as of December 31 last year. Statistics also show that B.C. has almost double the rate of medically assisted deaths per 100,000 residents compared to Ontario -- a high rate that puzzles some experts.
Trudo Lemmens, a bioethics experts and law professor at the University of Toronto, said the circumstances of Nichols鈥� death underscore the importance of having clear criteria on assisted deaths.
鈥淣ow here we see already a case where seemingly the interpretation of foreseeable (death) has been made in a very open-ended, very broad way,鈥� he said, commenting on notes shared by the family.
鈥淲e鈥檙e dealing with a vulnerable person. We鈥檙e dealing with questions about what the basis was of the decision-making by this particular person. Was the person fully appreciating the options that he had?鈥�
Lemmens also voiced concerns about how quickly Nichols鈥� assisted death was approved.
鈥淚 think all of these raise red flags about how the decision was made,鈥� he said.
Michael Bach, managing director of the Institutes for Research and Development on Inclusion and Society, reviewed the family鈥檚 report and said it raises many questions 鈥� particularly when it comes to what constitutes an 鈥渋mminent death.鈥�
"It's clear that the medical profession, in some cases, and healthcare facilities are interpreting the reasonable foreseeability of natural death in a much, much wider way than was ever intended,鈥� Bach said.
鈥淭he fact that, within the law as it exists, a man with a mental health condition can have his life terminated -- effectively by the sounds of it on that basis -- is alarming.鈥�
Catherine Frazee, a professor of disability studies at Ryerson University, said that of all the medically assisted deaths in Canada so far, 鈥渨e have no way of knowing how many might have been in situations similar to Alan.鈥�
The family says the RCMP told them they must take up their request for answers with the BC Ministry of Health. They want answers.
鈥淲hy did they allow Alan to die? Why did they give him permission?鈥� Trish said.
Bach added that there was a need for "much clarification on the guideline" for healthcare professionals.
"This case exposes concerns that a number of legal experts and assisted health professionals have had since the legislation was introduced," Bach told CTV's Your Morning.
There were 773 medically assisted deaths in B.C. from January 1 to October 31, 2018, compared to 1,211 in Ontario for the same time period.
Bach referred to a B.C.-based advocacy group made up of doctors and lawyers who suggest "the reasonable forseeabiliy of natural death requirement doesn't mean that you actually have to be at the end of life."
"And so we're in a situation where we have a number of health professionals and lawyers which have been advocating for wide-open access with no clarification from the government of Canada," Bach said.
"All of us should be concerned about this."
