This Is Assisted Dying: A Doctor's Story of Empowering Patients at the End of Life

by Stefanie Green M.D. M.D.

A transformative and compassionate memoir by a leading pioneer in medically assisted dying who began her career in the maternity ward and now helps patients who are suffering explore and then fulfill their end of life choices.

Dr. Stefanie Green has been forging new paths in the field of medical assistance in dying since 2016. In her landmark memoir, Dr. Green reveals the reasons a patient might seek an assisted death, how the process works, what the event itself can look like, the reactions of those involved, and what it feels like to oversee proceedings and administer medications that hasten death. She describes the extraordinary people she meets and the unusual circumstances she encounters as she navigates the intricacy, intensity, and utter humanity of these powerful interactions.

Deeply authentic and powerfully emotional, This Is Assisted Dying contextualizes the myriad personal, professional, and practical issues surrounding assisted dying by bringing readers into the room with Dr. Green, sharing the voices of her patients, her colleagues, and her own narrative. As our population confronts issues of wellness, integrity, agency and community, and how to live a connected, meaningful life, this progressive and compassionate book by a physician at the forefront of medically assisted dying offers comfort and potential relief.

This Is Assisted Dying will change the way people think about their choices at the end of life, and show that assisted dying is less about death than about how we wish to live.

Genres: Nonfiction, Death, Memoir, Medicine, Medical, Audiobook, Canada

Audible Audio

First published March 1, 2022

Reviews

[Petra X]

RTC. 5 stars, but the more I think of it, maybe 10. This book is going round and round my head, it left me much to think on. Oh to live in a country where the right to self-determination including the end of life, is respected and aided.
__________

The author went from Obstetrics to Assisted Death, delivering new lives to ending sick ones. One end of life to the other! The correct title of the book should be This is Assisted Dying: A Doctor's Story. The book is as much about the author and her life as it is about being one of the first doctor's practicing euthanasia under the new laws in Canada. It's very interesting.

[Sharon Orlopp · Rating 4 out of 5]

This Is Assisted Dying: A Doctor's Story of Empowering Patients at the End of Life is a powerful, poignant memoir by Dr. Stefanie Green. Green began her medical career in maternity/ob gyn. After several decades, she switched to medically assisting with death, known as MAiD in Canada.

The book opens with a very memorable and heartwarming story about a terminally ill man and his wishes on how he wanted to die. He definitely went out on his own terms and with style.

Canada approved MAiD in June 2016; their approach to medical assistance with dying is very patient-centric while the US's approach has been voter-centric (what will voters approve in each state). In Canada, patients can choose to take the final medication via an IV or a drink. Very few choose to drink the medication. In the US, the only choice in some states is via a drink.

Canada's MAiD legislation requires patients to be a resident, over 18, capable of making their own healthcare decisions, and suffering from a grievous and irremediable condition. The wording has had some adjustments in recent years. Canadian healthcare pays the costs of MAiD prescriptions.

Assisted dying is also legal in Netherlands, Belgium, Luxembourg, Switzerland, Spain, New Zealand, and some states in Australia.

The primary storyline of Green's memoir is the transition from helping deliver babies to helping deliver people from an agonizing ending. Her stories about her patients and the unique ways they chose to celebrate their life with loved ones and friends is a wonderful tapestry about humanity.

Green shares that she is a witness to little slivers of beauty, humor, and tragedy. She focuses on beneficence, doing what is in the best interest of the patient.

I highly recommend This Is Assisted Dying: A Doctor's Story of Empowering Patients at the End of Life. Two books that I recommend with a US focus are In Love: A Memoir of Love and Loss and When My Time Comes: Conversations About Whether Those Who Are Dying Should Have the Right to Determine When Life Should End.

At the end of her book, Green recommends the following books which I have added to my TBR:
Being Mortal: Medicine and What Matters in the End
Knocking on Heaven's Door: The Path to a Better Way of Death
The Inevitable: Dispatches on the Right to Die
A Good Death: Making the Most of Our Final Choices
Physician-Assisted Death: What Everyone Needs to Know®

[Krista · Rating 4 out of 5]

I empower my patients by letting them know they are eligible for an assisted death. This doesn’t mean they have to do it, and it doesn’t mean they will. It means they can proceed if they ever feel the need to, and the result is a reduction in suffering. How do I feel when I do this work? As if I have been a part of something profound. As if I have had the privilege of helping someone in need.

I found This Is Assisted Dying to be quite surprising: After the Canadian Parliament legalised what it called “medical assistance in dying,” or MAiD, in June of 2016, it was up to Canadian medical professionals (doctors and nurse practitioners) to come up with the protocols and processes for offering the procedure, without precise pharmacological, legal, or bureaucratic guidance from the government. As one of the first doctors to begin a MAiD practice, Dr Stefanie Green was instrumental in setting the standards for termination of life care, and the story that she tells of her first year in this practice is fascinating and moving. Filled with stories of MAiD in action, Green brings us into the rooms of those terminal patients who insist on controlling their final moments — most often surrounded by loving friends and family, sometimes proceeding despite angry opposition — and the picture she paints is of peaceful passings; the end of suffering; the “good death” we all want for ourselves and the ones we love. Eye-opening and provocative, this is the kind of book you really want to talk to people about; totally recommended. (Note: I read an ARC through NetGalley and passages quoted may not be in their final forms.)

A birth plan, a death plan. It struck a deep chord. This was the first time I made the connection between my skills in maternity care and the skills required to provide a good death. Both situations involved intense emotional experiences and carried a strong sense of the event’s significance. Both called up complex family dynamics and required a patient-centered approach to care. Perhaps my expertise would be transferable after all. Perhaps I was not as inexperienced as I felt.

After over a decade in a maternity/neonatal practice — with long and unpredictable hours, middle-of-the-night deliveries, and the colleagues in her practise beginning to retire — Dr Green started thinking about changing her focus. And when the Canadian Supreme Court struck down its blanket prohibition of assisted dying, Green began to wonder what providing medically assisted death might look like. She attended a conference in Amsterdam — where she was shocked to see only a handful of other Canadian physicians in attendance — and recognising the urgency and importance of what they could learn there, this small group went to every seminar, shared notes on what other jurisdictions had settled on as best practises, and brought that learning back to Canada in order to start offering MAiD to those patients who were already clamouring for it. This was the part that I found most surprising: That this small group of doctors would have happened upon the knowledge they needed (the necessary pharmaceutical cocktails, proven delivery methods, what to expect at every step of the process), and without a lot of direction from the government — Parliamentary language states that a patient must be suffering from a “grievous and irremediable condition”, that suffering had to be intolerable, their decline irreversible, and their natural death “reasonably foreseeable” — these doctors began to provide MAiD, often to the distaste of other medical (and particularly palliative) professionals, and wary of complying with laws that weren’t exactly clear. Also surprising: When they began, the service was so new that these doctors didn’t even have proper billing codes to get paid for their work through the various Provincial Health plans. It’s amazing to think of all of those people who were suffering through painful, lingering deaths — people who must have thought, “MAiD is now legal, so I just have to ask for it” — but there were still just a few practitioners, and most of them were on Vancouver Island, like Green herself. (She writes of Vancouver Island that it’s “a region that has turned out to have the highest percentage of assisted death, not just in the province or in the country but worldwide.” WHAT?) As that first year proceeded and more Canadian practitioners began offering the service, they would discuss their experiences on an online forum and this eventually grew into the professional group known as the Canadian Association of MAiD Assessors and Providers — CAMAP — and Dr Green was chosen to be their first president. And again, it was surprising to me that all of this grew from the ground up instead of the government somehow imposing structure from the top, but as Green says, these sorts of decisions are more properly made in the clinic than in the boardroom (and while that totally makes sense, it's still surprising that the government didn't want to get involved and mess things up.)

All of this information about how MAiD first became available, and how those doctors discovered their own protocols and created CAMAP, was totally fascinating to me. But This Is Assisted Dying is marketed as a memoir, and despite my appreciation for how Green shares her personal reactions to all of the events she describes — and despite the fact that I do read and like memoir — I don’t know if descriptions of her childhood and family life added much to this topic for me, but others' reactions might vary:

In my mother, I saw the seed of my own emotional fortitude. I’d had a turbulent childhood at times, and I’d learned at an early age to protect myself by building some emotional armor, some emotional walls to help keep the intensity at bay. Although this coping mechanism had not always been helpful in my personal relationships — making me more cautious about becoming vulnerable — it was perhaps due to this inner toughness modeled on my mother, and the lessons in protecting myself from difficult feelings, that I was able to compartmentalize my life, such that I could do my MAiD work and not be wrecked or overwhelmed by it.

Also: I was moved by all of the stories Green shares about her patients; specific cases are, naturally, more affecting than general debate. So, while it wasn’t totally unexpected, it was a little disappointing to read in the Author’s Note, “other than where I have obtained express consent to describe real events, characters and cases have been purposefully altered — including name, age, gender, ethnicity, profession, familial relationship, place of residence, and diagnosis — and in some instances reflect fictional composites.” On a more positive note: It was very interesting to read the other information Green adds at the end — how Canadian termination of life care compares to other countries (I had no idea how few countries have legalised the procedure or how comparatively liberal our rules are), what legal issues are still being debated (whether MAiD should be offered to mature minors, if it should be offered to those suffering debilitating mental illness, whether it can be asked for in advance for dementia patients), and how COVID protocols affected the delivery of service.

Fascinating and surprising, This Is Assisted Dying makes for a compelling, necessary, read. Rounded up to four stars.

[Eileen Mackintosh · Rating 5 out of 5]

This book confirms for me what I already thought…..that assisted death should be a legal option. The many variety of situations and reactions by friends and family are well presented. Even though the subject matter can be difficult, the writing made this a very easy read. I particularly made note of an explanation of the difference between pain and suffering. Although my interest in this book may be partially encouraged by my age, I do think it should be read by all ages. Information is power. #indigoemployee

[jenny✨ · Rating 4 out of 5]

insightful, informative, and beautifully, fluidly written - this was a wonderful book.

i especially appreciated how accessible and cogent dr. green's writing was, and also the seamless and engaging way she interwove medical and legal information with personal anecdotes, emotional vulnerability, and humour.

thank you sheena for recommending and buddy reading this with me!

[☘Misericordia☘ ⚡ϟ⚡⛈⚡☁ ❇️❤❣]

So. This year started out for me reading decidedly morbid stuff.
I think I'll be back w/something more cheerful. At some point. Probably. Hopefully.

How do relatives deal with the aftermath? I can't imagine.

Q:
He was a true believer in reincarnation, he told me, and was eager to move on to his next life. (c)

I dunno what I think about this subject right now. Probably one of the first times in my life when I'm at a loss as to what to think and what to say other that that there's always more than meets the eye.

Do color me depressed.

[Sabina Sohail · Rating 5 out of 5]

This is not a book I’d pick up at a bookstore so when it arrived at my doorstep, I thought, why not give it a try. And I’m so glad I did. I cried A LOT, obviously. But it wasn’t a book I had a hard time getting through. It was a simple read, and Dr. Green’s writing is comforting, which helps with a subject as difficult as this. I wasn’t aware assisted dying was even legal in Canada before reading this book, and it has definitely opened my eyes about the end of life.

[CanadianReader · Rating 3 out of 5]

This is a useful and accessible book for Canadians interested in learning about the issues, procedures, and early days of “MAiD” (Medical Assistance in Dying), which came into effect in 2016. An “accessible” book, however, is not equivalent to an easily read one. There are innumerable descriptions of human suffering and the doctor-author’s experiences providing MAiD. I could handle the book only in small doses.

Green is a former family physician who for many years worked long hospital shifts as a focused-practice maternity-and-neonatal-care clinician in Victoria, British Columbia. Gradually worn down by the hours and missing time with her family, she decided to transition—you guessed it—to a focused practice in euthanasia. No one actually wants to call the human version of this medical procedure “euthanasia” because of its association with eugenics, but euthanasia is precisely what it is. Green is one of the earliest providers of MAiD in Canada. Along with a small group of colleagues, most of them family medicine physicians, she was instrumental in developing protocols and procedures. Green talks about a somewhat surprising overlap between maternity care and medically assisted death—saying both provide the intensity and drama that she is drawn to—but I admit to finding her selection of a practice exclusively dedicated to helping people die questionable. I am doubtful about anyone’s ability to remain mentally well balanced long-term while performing only this work. I base this observation on a lot of personal experience being present for veterinary euthanasia, which is performed routinely. Few domesticated animals die a natural death. I’ve observed the toll euthanasia takes on veterinarians. It hardens many of them, sometimes alarmingly so.

As well as providing case studies and an exploration of ethical, psychosocial, and legal issues around MaiD, Green tells stories about her own upbringing and family, so this is a combo memoir/expository piece. I can hardly say I enjoyed the book. Indeed, I suspect anyone who has been involved in the care of a terminally ill friend or family member (even a nonhuman one) will find THIS IS ASSISTED DYING bordering on (if not fully) harrowing at times. It is valuable, certainly, but any recommendation of it should be accompanied by the caveat that the content is intense..

Rating: 3.5 rounded down

[Cari · Rating 5 out of 5]

An absolutely fascinating book about how we approach the end of life and how medical assistance in death can benefit people. Green is a physician in Canada, where MAiD is legal. She tracks the story of how she became a MAiD practitioner and how she helped to form the first association for doctors who provide it. The chronological nature of the story reads like a novel, with Green narrating the different deaths she's assisted, from the very first death to deaths that affected her in different and profound ways. I could not put this book down and found myself thinking critically about how I might approach my own death when it comes around. My grandmother recently died, and the book made me wonder how an assisted death might have alleviated her and our family's suffering (although I don't think she would have gone for it). I know some people are vehemently opposed to this practice, and Green touches on that, but the nice thing about this is that Canadian citizens can choose their own paths, and palliative care is another way to go. Green's relationship with palliative caregivers is respectful and kind. I can only hope that people who don't pursue assisted death are able to die with dignity through palliative care.

[Haley Alexander · Rating 3 out of 5]

I think this book is actually quite good, it just requires my full brain and wasn’t for me. I loved the anecdotes about situations around assisted dying but personally wasn’t invested in the sections in between. Interesting to watch how it came about and how things find a guideline and adapt

[midori]

(removing my rating from this bc I thought this was super well done but this doc keeps saying really questionable things on twt that have been making me rethink a lot of things)

this was absolutely incredible, and I’m not just saying this as someone who studies the policy and ethics of assisted dying

many tears have been shed tonight

[Denise · Rating 5 out of 5]

An important book about an important subject that should be talked about more. I have the utmost respect for the work Dr. Green is doing, and the empathy she does it with. While at this stage of my life I have no way of knowing whether Assisted Dying is the way I'd want to go approaching the inevitable end that awaits us all, I absolutely would want to have the option to make this choice.

[Kelly Hurley · Rating 5 out of 5]

I wish I could give this more stars. A talented physician and author, Dr. Green offers insight into the rewards and challenges of providing MAiD. Everybody, especially healthcare providers, should read this. ⭐️⭐️⭐️⭐️⭐️

[Rama · Rating 4 out of 5]

“ Although my job is to assist in death and dying, I believe that through this work, I have been privileged to see the best of life and living.”

4/5- strong re-telling of the history of Medical Assistance in Dying and it’s development in Canada, specifically focused on BC, and expressed anecdotally. This empowering work left me with a deeper understanding and newfound curiosity about MAiD, and aided in providing a more accurate definition of “dying with dignity”.

The author does not skim over difficult subjects, and the pacing is clearly thought out, with a thread of seasonal metaphors running through the book. It was a good mix of heavy and informative, and it is clear that considerations from all aspects were taken into account prior to writing.

I was most touched by the few stories where the emotional connection and sense of loss is felt by the writer, as it humanised the procedure in my mind. Greene compares MAiD to her previous maternity work, and I believe this analogy introduced both nuance and depth, and helped her get the overall point across.

She expertly addresses misconceptions, calls to current legislative decisions, and clarifies that decisions are not made haphazardly, and that various safeguards are in place to protect the safety and well-being of potential patients. She draws on the palliative care system, and her challenging journey navigating the novel procedure. It is at once deeply personal and technical, which is no easy feat.

Great way to introduce yourself to one of the POVs in this context, and well-written especially as a layperson. Would recommend reading this if you enjoyed “Being Mortal”.

[Madeline Nixon · Rating 5 out of 5]

I finished this a few days ago and sat on it until I knew what to say for a review. I still have few words. This book was beautiful. Dr. Stefanie Green wrote with such grace about people at the end of their lives. I read this book through tears at times and smiles at others. I learned a lot and didn’t feel like I was reading a textbook, instead I felt like I was having a chat with my new friend Stefanie. I wasn’t sure how I would feel reading a book about death less than a month after my grandma died, but ultimately this called to me and I think this book helped me work some things out and understand more about death and grieving. I’m beyond glad to have had the pleasure of reading this.

Thanks to Simon & Schuster Canada and Netgalley for an ARC of this book.

[Steven Hepburn · Rating 5 out of 5]

"This Is Assisted Dying" is a must-read for anyone interested in the topic of Medical Assistance in Dying (MAiD) in Canada.

The author uses her intimate experiences with providing MAiD to individuals in British Columbia to explain the history, jurisprudence, legislation, societal views, and the medical considerations.

This book deserves 5+ stars for the authors ability to take chomplicated legal and medical concepts and explain them in terms every Canadian might understand. The author also does an incredible job of explaining her emotions and perspectives while ensuring her stories retain the thoughts, feelings, and rationales of the the patients she was working with.

This book was an emotional rollercoaster, a thought-provoking, and enlightening read. 10/10 would recommend.

[emily gielshire · Rating 4 out of 5]

illuminating and frank and despite being medical in nature, is written in every day language that makes it comprehensible and even enjoyable to read. it’s so obvious how deeply Dr. Green cares about her patients’ whole personhood & right to choose how they spend the last days of their lives. dying with dignity should be an option for everyone everywhere. very much appreciated this book and the work that Dr. Green is able to do.

[Sean Young · Rating 5 out of 5]

The only book that made me tear up this year (and did I ever tear up). Dr. Green writes with such beauty but also simplicity. You’ll get carried naturally through her story, and the stories of all her deliveries. Truly a gorgeous, affecting read that is equal parts process and art, much like Dr. Green’s MAiD work.

[Whitney Lehman · Rating 5 out of 5]

This book was so beautifully written. Had me in tears on multiple occasions.

[Sherry Dhillon · Rating 5 out of 5]

Easily one of the best non-fiction books I’ve read this year. Left me with lots to think about.

[Samantha M · Rating 5 out of 5]

Dr. Green, I don’t know if you read these, but you are inspiring. From a fellow Haligonian. 5/5

[Tanya · Rating 5 out of 5]

Stefanie Green, MD writes about her experiences with beginning the Maid program, Canada’s program for assisted dying. Dr. Green does a thorough job of explaining the differences between Canada’s program and programs available in other countries. She provokes so much thought and emotion with each client she discusses in the book. I felt as though I were a witness to their decision to choose an assisted death. I was emotionally invested in each of their stories. While I know this book can bring about strong emotional reactions from each side, whether it be religious or political, it is a necessary conversation to be had. We need to soften the edges of stigma and look at the center of these decisions, which is with the patient. Dr. Green has such a compassionate and gracious approach to such a controversial subject material. I came away with a much vaster knowledge base from reading this book and I am looking forward to seeking out more reading material related to assisted dying. I’m so grateful that Dr. Green took the step and wrote this profound book!

[Jennifer · Rating 5 out of 5]

As a nurse, as someone who has known patients to ask for MAiD, or be an advocate for those who do I'm glad this book exists. It was touching to read about all these stories and I've teared up a few times, but in the end I would vouch for any of them, their decision to request MAiD is a strong one and I'm glad that here in Canada people have that choice to die with dignity. I hope more people read this book.

[Bernie · Rating 4 out of 5]

A comprehensive and compassionate look at those that choose a voluntary end to life and a physician who helps them through the process. It had a good mix of logical explanation of the laws and process to compliment her personal experience and stories. Would recommend it to anyone interested in health writing!



*Reviewed this for a family member who read it and doesn’t have Goodreads.

[Courtney · Rating 5 out of 5]

Incredible, thought-provoking, and IMPORTANT book. This was so heavy, but also so inspiring: it made me think about how life should be lived and what it means to die with dignity. Expect to shed many tears.

[Elena · Rating 3 out of 5]

This book is a compelling look at medical assistance in dying (MAID) in Canada through the lens of Dr. Stefanie Green’s personal experiences as a practitioner. I appreciated her storytelling style and the insight she provides into the ethical and emotional complexities of helping patients at the end of life.

That said, I went into this book expecting a more journalistic approach—one that covered the broader history of assisted dying, the evolution of legislation, and overall a variety of perspectives beyond the Canadian system. While Dr. Green’s firsthand account is valuable, I would have loved a deeper dive into the legal and philosophical debates across different countries and policymakers. I also imagine that the practice of assisted dying in the US looks quite different, especially given how health insurance plays a role.

Overall, a worthwhile read for those interested in personal narratives of MAID. But if you're looking for a historical perspective or a US practitioner's take, this book isn't that.

[Hopksiazka · Rating 5 out of 5]

Ciekawy temat, myślę, że warto się z nim zapoznać. Książka dobrze napisana, chociaż robiła z autorki prawie ideał

[Evan Potts · Rating 5 out of 5]

Amazing read! Beautiful, insightful, and poignant.

[Alspancakeworld · Rating 5 out of 5]

Heartbreaking but beautiful. Gives u a new perspective towards death

[Katie · Rating 4 out of 5]

Kaelen reminded me we read this book last year and it was really good so u know I had to pop it on my Goodreads (for stats purposes)