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Medically assisted death allows couple married almost 73 years to die together

George and Shirley Brickenden in their Toronto retirement home on March 22, 2018.

Fred Lum/The Globe and Mail

When George and Shirley Brickenden tell the story of how they met, it’s like watching a charming little play unfold – one the couple might have workshopped for seven decades.

It was Christmas in Halifax, 1944. He was in the Navy and she was in the Air Force. Mr. Brickenden’s mother had tried to set them up earlier, but the timing didn’t pan out.

Mr. Brickenden, 95, grinned as he explained why.

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“I said, ‘I haven’t got time for her for a few days because I’ve got a few dates.’”

Three of the couple’s four children, sitting nearby, groaned and laughed. They had heard this before.

Mrs. Brickenden, 94, interjected. “I was engaged to somebody else!”

George and Shirley at their wedding.

Fred Lum/The Globe and Mail

“He’s always saying that he had to break his dates and he never mentions that I already had a ring.”

The Brickendens were reminiscing in a recent interview with The Globe and Mail about their first date – a fairy-tale evening that led Mr. Brickenden to propose marriage six days later – knowing that less than a week after the interview, they would be dead.

On March 27, George and Shirley died holding hands in their own bed in a Toronto retirement home.

Their children, who watched from the foot of the bed, say the couple drew their last breaths at almost the same moment.

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They had been married for just shy of 73 years.

The Brickendens are one of the few couples in Canada to receive a doctor-assisted death together, and the first to speak about it publicly.

They wanted to explain what it meant to them to die at a time and place of their choosing, as at least 2,149 Canadians and likely hundreds more have done since assisted dying became legal in this country.

The Brickendens are at the vanguard of patients and families who are creating new rituals around dying in Canada – the kind of rituals that are only possible when death comes at a previously appointed hour.

But cases like theirs also raise uncomfortable questions about whether the vague eligibility criteria in Canada’s assisted-dying law are sometimes being interpreted more broadly than the government intended.

One of the most controversial stipulations in the law is that a patient’s natural death must be “reasonably foreseeable,” – something that could plausibly be said of every nonagenarian. The law dictates other requirements, including intolerable suffering and irreversible decline, but those concepts can be elastic, too.

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George and Shirley had to wait several years for doctors to agree to their plan to die together.

Fred Lum/The Globe and Mail

When I met the Brickendens on March 22, the plans for their predeath parties were already in full swing. Their conversations were full of gratitude, gentle teasing and gallows humour, much of it provided by Pamela, 71, Saxe, 60 and Angela, 54, three of the couple’s four children.

The couple’s other son, Dal, 69, was on his way to Toronto from Vancouver. Grandchildren and other relatives were coming home from as far away as Vietnam, Norway, Switzerland and Scotland to say goodbye.

A family reunion was taking shape in anticipation of the Brickendens “flying away,” as they had always put it, when they told their children that they did not want to linger if their health eventually failed.

“We witnessed, many years ago, someone we loved very much, a family member, who lived for several years and turned from being a magnificent human being into somebody you couldn’t recognize, that lay in bed and made noises,” Mrs. Brickenden said.

“We thought then, ‘Well, I don’t care what happens when we get to zero. When we know it’s the end, we’re not going to do that.’”

When the federal government, in response to a Supreme Court of Canada decision, passed a law in June, 2016, that permitted medically assisted dying for people who were suffering intolerably from a grievous and irremediable condition and whose deaths were reasonably foreseeable, the Brickendens decided to find out if they qualified.

Mrs. Brickenden’s body was wracked by rheumatoid arthritis, an inflammatory condition that turned her hands into swollen purple claws.

Her heart was failing. She nearly died during an operation after she suffered a heart attack in 2016.

Of course, I would not go without him.

— Shirley Brickenden

That was enough for two doctors – as required by the law – to conclude in early 2017 that Mrs. Brickenden was eligible for an assisted death.

Around the same time, two different physicians assessed Mr. Brickenden. The first felt that Mr. Brickenden’s advanced age and frailty made him a candidate for an assisted death, but the second disagreed because Mr. Brickenden did not have a specific underlying illness that made his death reasonably foreseeable, the standard set out in the legislation.

The couple had no intention of dying separately. “Of course I wouldn’t go without him and they knew I wouldn’t. We had to wait and wait,” Mrs. Brickenden said.

“Then, miraculously, he started to go downhill,” she added, laughing.

Mr. Brickenden began fainting. He passed out repeatedly; his daughter found him unconscious in the bathroom on the day of his 95th birthday. His heart was faltering. In the meantime, Mrs. Brickenden broke her hip in two places, and Mr. Brickenden was also in and out of the hospital with infections and a life-threatening bout of the flu.

How often, during this period, did they worry one would die before the other?

“It’s every day,” Mrs. Brickenden said. Then she paused. “Oh, this is going to sound so mournful. I’m glad I’m not going to be here to read it.”

“I’m dying to read it,” Mr. Brickenden deadpanned.

Making light of things is a natural coping mechanism for the Brickenden family, they all agree.

Pamela, Saxe and Angela all remember raucous laughter floating upstairs from their parents’ parties at the family’s townhouse in Westmount, the posh Anglo section of Montreal where the Brickendens moved after spending the first years of their marriage in London, Ont.

They lived in Montreal for 21 years, through the excitement of Expo 67 and the terror of the FLQ crisis, before joining the Anglophone exodus to Toronto in the early 1980s.

Mr. Brickenden was the co-founder of an insurance company and an accomplished show jumper whose family bred horses. Mrs. Brickenden was a renowned artist whose water colours and acrylics were sold through Montreal galleries and the Art Gallery of Ontario.

Above all else, George and Shirley were romantic partners, deeply in love. “They’ve done everything together,” Saxe said. “If Mom goes shopping for stockings, Dad’s with her. Being that they’re kind of one entity and they support each other so thoroughly, [dying together] seems only fitting.”

As certain as they are about their choice, the Brickendens decided not to tell most of their friends or their neighbours at the retirement home, people they cherish.

“Many of our friends have flown away already,” Mrs. Brickenden said, “and the ones that are left are very precious. It’s very, very hard not to tell them. But you have to make a rule. You’re either going to tell quite a few people or you can’t tell.”

How does it feel to know they only have five days left on Earth?

“Well, I’m startled,” Mrs. Brickenden said, turning to her husband. “How does it feel to you, darling?”

“Good,” he said, provoking another burst of laughter from his children.

“What I’m surprised at is there’s no fear involved at all,” Mrs. Brickenden said.

As I left my interview with the Brickendens I couldn’t help feeling slightly perplexed by their decision to die now.

They still appeared sharp, vibrant and elegant. He wore a dress shirt and tie with a sweater knotted over his shoulders like a prep-school student. She wore a simple black turtleneck and lipstick, her nails freshly manicured.

Holding hands until the end, George and Shirley died in March, 2018, after describing their plans to The Globe and Mail.

Fred Lum/The Globe and Mail

They seemed so happy in the company of their children, who were taking full advantage of the time they had left to thank their parents for a lifetime of joy. (”I’ve never heard so many kind words,” Mrs. Brickenden joked. “Perhaps we should stay.”)

Two days later, Mrs. Brickenden called me at home. She had been up all night, unable to sleep through rheumatoid arthritis pain that was like “some kind of awful animal” gnawing at her joints.

“As I was awake, I was thinking, ‘Oh gosh’ I’m so miserable,” she told me. “And I guess we really didn’t put that across to the paper because we tried to pull ourselves together, stupidly. In our family, we always protect ourselves, unfortunately, by trying to make a joke of things. And I just felt it was an unfair picture of what we’re dealing with. I don’t like being quoted nagging and complaining. It’s just totally against how I was brought up. I thought I would like to check in and tell you we did sort of gloss over the situation and it was a stupid thing to do.”

The doctor who first assessed Mr. Brickenden for his eligibility in January, 2017 – the same doctor who would ultimately inject the lethal medications on the evening of his death – said that kind of stoicism and the fact that Mr. Brickenden still looked good at the time of his appointment may have played a role in his being turned down for an assisted death the first time.

More than a year later, after Mr. Brickenden’s fainting and heart problems surfaced, a different, second doctor assessed Mr. Brickenden and found him eligible.

The first doctor, who asked that his name not be used because his family is religious and does not know he provides medical aid in dying, read me a few lines from the new second assessor’s conclusion about Mr. Brickenden: “The patient has a serious and incurable illness, which is age-related frailty. It is end stage.”

The first doctor, who is a committed supporter of assisted dying, said he and other providers talk often about the conundrum of whether extremely elderly patients who want to hasten their deaths can qualify by virtue of their age alone.

“I think there is a significant disagreement about that,” the doctor said. But in Mr. Brickenden’s case, he clarified, “it’s not just age-related. A lot of these [health problems] do come as we get older, but you don’t necessarily develop his heart rhythm problems when you’re 95.”

Trudo Lemmens, a professor of law and bioethics at the University of Toronto, said that even though he doesn’t know if this is the case here, he is generally concerned about the fragility associated with old age becoming a reason for people to legally end their lives with the help of a doctor.

“From a societal perspective, this would be problematic,” he said by e-mail. “Both the [Supreme Court of Canada] decision and the legislation treat active life-ending measures by physicians as an exceptional procedure, an exception to a still existing criminal law prohibition. We should be very careful not to normalize it as if it is the solution to all end-of-life planning, even when we may have sympathy for the idea that a couple prefers not to leave each other behind.”​

The other question that arose in the Brickendens’ case was whether George and Shirley could die at the same time without running afoul of the legislation.

In January, 2017, a long-married British Columbia couple was forced to have their assisted deaths four days apart, despite their wish to die together, because of concerns expressed by the Canadian Medical Protective Association, the legal advisory group for physicians.

The doctor in that case decided to follow the advice of the lawyers, who feared a joint death would raise questions about whether one spouse had unduly influenced the other, which could violate the requirement that requests for assisted death be entirely voluntarily.

The Brickendens’ doctors elected not to consult the CMPA.

“They met all the criteria,” said Chantal Perrot, who was the first doctor to assess Mrs. Brickenden and the one to preside over her death. “They were so clear and so consistent, independently, over an extended period of time that I just don’t see any of evidence or suggestion of coercion at all.”

Shanaaz Gokool, the chief executive officer of the advocacy group Dying with Dignity, which helped guide the Brickendens through the process of qualifying for an assisted death, said she is aware of only one other instance in which a couple in Canada has received an assisted death together.

Qualifying for a joint assisted death is not automatic and it shouldn’t be, Ms. Gokool said. “The safeguards are there for a reason. The thing that’s most important here is that the clinicians who are doing this work are doing their job correctly. Each case has to be assessed on its own, individual merits.”

In the Brickendens’ case, she added, dying together, “is the final articulation of the love that they’ve had for each other for nearly 73 years.”

Two nights before their death, the Brickendens went out for one last date at Opus, their favourite restaurant in Toronto’s Yorkville neighbourhood.

George and Shirley Brickenden died together with their family gathered around them.

Fred Lum/The Globe and Mail

The next night, they bid farewell to more than 20 members of their immediate family at a bon voyage dinner at their daughter Pamela’s apartment.

The evening of their deaths was more intimate, Pamela, Angela and Saxe told me two days later.

“It couldn’t have been a better way to go. Totally peaceful,” Angela said. “It allowed them to bow out gracefully together, as they lived.”

Present were Pamela, Saxe and Angela, their spouses, the two doctors and Andrew Asbil, the Dean of Toronto’s St. James Cathedral, who later told me he had “without hesitation” supported the couple’s wish for their funeral to be held at the Anglican church.

Mr. and Mrs. Brickenden, dressed in caftans, drank champagne and nibbled on a last supper of hors d’oeuvre of lobster, salmon and filet.

Shortly before 7 p.m., Mrs. Brickenden turned to her husband. “Are you ready?”

“Ready when you are,” he replied.

They walked into their bedroom and lay down together, holding hands. The two doctors, one for each patient, inserted intravenous lines into their arms.

Dean Asbil prayed, while Mozart, Bach and Scottish folk songs wafted through the room. Saxe, at his mother’s request, had assembled a playlist. He called it “fly away music.”

Angela rubbed her mom’s feet. Pamela’s rubbed her dad’s. “They smiled, they looked at each other,” Pamela said. Then Mr. Brickenden looked at his children, standing at the end of the bed.

“I love you all,” he said.

A note from Queen Elizabeth.

Fred Lum/The Globe and Mail

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