Family says B.C. man with history of depression wasn't fit for assisted death

CTV National News: Demands for clarifications There are many questions about safeguards surrounding medically assisted dying laws with vulnerable patients. Avis Favaro reports.

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’t know why doctors approved the life-ending procedure and insist that Nichols did not fit the government criteria of facing an “imminent death.”

“He 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,” his brother, Gary Nichols, told CTV News. “I didn’t think he had a sound mind at all.”

The family has asked the RCMP to investigate the case.

This story is based on accounts from Nichols’ family and a neighbour. The family has hired a lawyer in hopes of accessing Nichols’ medical records to understand what happened.

“In light of the potential RCMP investigation, and out of respect for the patient’s privacy, we will not be able to provide any further information,” the regional authority that oversees the hospital, Fraser Health, said in a statement to CTV News.

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’ 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.

“He 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,” said his brother Gary Nichols.  “Not going out in public, not seeing anybody, not eating properly.”

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’ 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’ apartment with the neighbour’s spare key, they found Nichols weak, dehydrated and confused.

He was rushed to the emergency department. Police called Nichols’ brother Wayne to tell him what happened.

‘ALAN DID NOT FIT THE CRITERIA’

As soon as Nichols’ 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.

“We thought this would be the best place for him to get back on track,” Gary said. “We would never have allowed this to happen if we knew the outcome.”

From there, the family says, things became difficult. They say the hospital did not give them much information on Nichols’ case.  Staff told the family that he was doing well but he did not want to speak with family.

“I was always led on to believe that he was doing good,” Gary said. “They never informed me of any (medical assistance in dying) application.”

On July 22, they received a shocking phone call from a doctor who said that, in four days’ time, Nichols was scheduled for an assisted death. According to the family, the doctor said they couldn’t provide any other information, including the medical reason for the procedure.

“I started crying,” Gary said. “I 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.”

Nichols’ sister-in-law, Trish Nichols, called the doctor to get more information.

“I was appalled by all of it and I said we want this stopped, this can’t happen. Our family doesn’t agree with this,” she said.

“(The doctor) said, ‘Well, you can’t stop this. Alan is the only person who can stop this.”

At the hospital, the family was told that two doctors had approved Nichols’ application for a medically assisted death, and that a psychologist and psychiatrist were there to assess Nichols’ competence.

The family was not given access to those medical records. They still don’t know what grounds doctors used to approve the application.

Nichols’ death certificate lists MAID, or medically assisted death, as his immediate cause of death. Officials also listed three “antecedent causes” connected to his death including a stroke, seizure disorder and “frailty.”

Other “significant conditions” 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 “a grievous and irremediable medical condition.” According to federal guidelines, 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.

“Alan 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,” Trish said.

“I knew by looking at him that he still had living to do. He was not near the end of his life.”

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 “blood family.”

They also say that Nichols told them, “It’s done. It’s going to happen.”

Hospital staff said that the decision was up to Nichols.

“We were told we couldn't stop it,” Trish said.

“I 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 … How can you allow this with Alan, knowing his background of mental anguish and depression?”

On July 26 at 10 a.m., the family watched as medical staff at the hospital delivered three injections that ended Nichols’ life.

“I thought I was in a dream. I couldn't believe this was happening.  I really thought it was a dream,” Trish said.

His brother said the whole process was disorienting.

“It was hard to believe that you were in Canada, going through this process,” Gary said.

HIGHER RATES IN B.C.

It wasn’t until after Nichols’ 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.

“He would’ve died that day if this gal hadn’t stopped it. We would never have known about it,” Trish said. “We would’ve never had a chance to say goodbye.”

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’t 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.

“We spent 50 years helping Alan live, and in one month they signed his death warrant,” Trish said. “How can that happen in that period of time? Where's the legislation to protect us?”

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’ death underscore the importance of having clear criteria on assisted deaths.

“Now here we see already a case where seemingly the interpretation of foreseeable (death) has been made in a very open-ended, very broad way,” he said, commenting on notes shared by the family.

“We’re dealing with a vulnerable person. We’re 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?”

Lemmens also voiced concerns about how quickly Nichols’ assisted death was approved.

“I think all of these raise red flags about how the decision was made,” he said.

Michael Bach, managing director of the Institutes for Research and Development on Inclusion and Society, reviewed the family’s report and said it raises many questions – particularly when it comes to what constitutes an “imminent death.”

"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,” Bach said.

“The 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.”

Catherine Frazee, a professor of disability studies at Ryerson University, said that of all the medically assisted deaths in Canada so far, “we have no way of knowing how many might have been in situations similar to Alan.”

The family says the RCMP told them they must take up their request for answers with the BC Ministry of Health.  They want answers.

“Why did they allow Alan to die? Why did they give him permission?” 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."