Watch: Dr. Ronald Bayne reflects on his pioneering work in Canadian long-term care and how it informed his choice about medically assisted death, which he received at his Victoria home this past Friday.
The Globe and Mail
Photography and video by Chad Hipolito/The Globe and Mail
As Ronald Bayne watched what happened inside Canada’s nursing homes during the coronavirus pandemic, the retired geriatrician experienced a blend of anger and déjà vu.
When it comes to providing dignified care for the elderly, he said, “It’s always the same question. Can we afford it?”
Dr. Bayne, one of the first physicians in Canada to specialize in geriatric medicine, saw for himself how that question was answered in the negative time and again over decades. Although he fought to improve care for chronically ill seniors and enjoyed some successes in that battle, the horrors of the pandemic made it plain that governments still aren’t willing to spend the money necessary to give Canadians the golden years they deserve, Dr. Bayne said in an interview two days before he died.
On Friday, Dr. Bayne received a medically assisted death at the home he shared with his daughter and son-in-law in Victoria. He was 98, exhausted and in pain from bladder cancer that had spread to his spine. He urged Canada’s seniors to speak up for themselves, to demand better care and more autonomy in their twilight years.
He also wanted to emphasize that, when death is near, today’s generation of seniors have the option to choose the time and circumstances of their exit if they’re mentally competent, as he did with his own death by MAID, the acronym for Canada’s medical assistance in dying program.
“If you don’t use MAID, you’re simply prolonging pain, agony and distress,” he said in an interview over Zoom, with his daughter, Lillian, close by.
“Who are [opponents of MAID] to intervene and tell somebody else, ‘No, you can’t end your life. You’ve got to suffer more. You’ve got to suffer to the end.’”
Dr. Bayne’s death came one day after the Superior Court of Quebec agreed to delay by another month the implementation of a September, 2019, ruling that struck down a portion of the federal MAID law that reserved the procedure for people whose natural deaths are “reasonably foreseeable.”
Rather than appeal the Quebec decision, the Trudeau government opted to rewrite the federal law, touching off a prolonged fight in Parliament over how to broaden it without putting vulnerable people at risk, including those with advanced dementia, mental illness or physical disabilities. Responding to a pandemic that disproportionately killed people from some of the same vulnerable categories also delayed the effort to amend the law.
One of the most consequential changes likely to come from the current tussle in Parliament is the opening of the door to assisted dying for people whose sole underlying illness is mental. Justice Minister David Lametti has said his government will back the spirit of a proposed Senate amendment that would lift the ban on MAID in cases of mental illness in two years, after an expert panel has devised protocols and safeguards. (The Senate wanted 18 months.)
Dr. Bayne knew a lot about taking care of the vulnerable, and not just from his long career as a geriatrician and professor of medicine at McMaster University in Hamilton. His personal experiences cemented his view that MAID should be more widely available, so long as legal guardrails are in place.
One of his five daughters took her own life in 1988, at the age of 29. His wife of 63 years, Barbara, died in 2017, after developing dementia and spending more than a year in a long-term care home. Dr. Bayne was also a grandfather to a profoundly disabled grandson and father to a daughter with Williams syndrome, a rare neurodevelopmental disorder. Dr. Bayne lived with and cared for her until he was 97.
Born in Sherbrooke in 1923 to a country doctor and his wife, Dr. Bayne felt a kinship with the chronically ill after growing up with asthma and suffering a bout of tuberculosis while in medical school.
But in the middle of the 20th century, the medical profession had little interest in improving the lives of elderly people with chronic diseases. Geriatrics didn’t become a recognized medical specialty in Canada until 1977. “You can’t imagine it,” he said. “When I was a student, death was regarded as normal. You just waited for it to happen. You didn’t do anything [for old patients]. You didn’t treat them. You didn’t waste any money on [old] people, because death was going to happen anyhow and they made no contribution to society.”
Early in his career he moved to Britain, where he worked with Marjory Warren, considered the mother of geriatric medicine. He brought her philosophy to his teaching at McMaster and his practice in Hamilton, helping to revamp programming for the elderly at St. Peter’s Hospital, and creating programs that matched seniors with community activities and homecare services.
Seeing the kinds of patients he spent his life advocating for suffer and die during the pandemic has been devastating, but not surprising to Dr. Bayne. Quality elder care is expensive, and politicians have always been reluctant to pay its full price, he said. His advice is for seniors to demand better. “Seniors in the long-term care centres should be the ones who are speaking up and running the place,” Dr. Bayne said. “Some of them are not competent, that’s true. But many of them are. And they could take on the challenge.”
When Dr. Bayne died on Friday, he joined the ranks of thousands of Canadians who have died by MAID since the pandemic began.
In B.C., where Dr. Bayne lived, MAID provisions accounted for 4.2 per cent of all deaths in 2020, up from 3.4 per cent in 2019, according to Jeffrey Brooks, a MAID data analyst and educator in Victoria. The share in each of Alberta, Saskatchewan, Manitoba and Ontario was around 2 per cent in 2020, an increase over 2019 in all four provinces.
Stefanie Green, the Victoria doctor who helped Dr. Bayne to die, said that when COVID-19 first hit, MAID providers scrambled just like other physicians to offer their services without risking transmission of the coronavirus. Virtual eligibility assessments and remote witnessing of documents took off.
Assisted deaths in hospitals became rare because of the pandemic rules, according to David Price, chair of the Department of Family Medicine at McMaster University, where Dr. Bayne was a professor emeritus.
“If you were going to have [MAID] in the hospital, you’re having it with maybe one other support person because the visiting restrictions have been so severe,” Dr. Price said.
Even at home, assisted deaths have changed, added Dr. Green, the president of a national organization of MAID providers. The pandemic has led her to wear masks, goggles and gloves while she helps patients to die. Families have been forced to keep their farewell gatherings small. “It does feel different to me on a personal level,” Dr. Green said of providing medical aid-in-dying during the pandemic.
For Dr. Bayne, the final year of his life has been “quite tedious” – more because of his cancer than the pandemic. “I wake up in the morning and my mind is alert, acute, ready,” he said. By the time he’s dressed, he’s too sore and fatigued to do much more than return to bed.
Had Dr. Bayne hung on until the pandemic subsided, his family could have held a proper funeral for him, one that might have been as large as his life and personality. But Dr. Bayne said he didn’t mind.
“I like to enjoy a person’s life while they’re alive.”