W hile her hectic surgical schedule usually has her performing life-sav- ing thyroid cancer procedures in the oper- ating room, occasionally Dr. Karen Devon is assisting patients approved for the Medical Assistance in Dying (MAID) program, as one of about 1,500 specially trained practition- ers in Canada. MAID allows patients suffering from ser- ious or terminal illnesses or disability to be put to death with the help of drugs adminis- tered by a physician or nurse practitioner. Finding herself carrying out an assess- ment in Yiddish is but one example of where her background came in handy. She also happens to be one of the first female Jewish general surgeons to ever work at the University of Toronto. A medical ethics specialist, 47-year-old Dr. Devon is also the daughter of Holocaust survivors, who regularly presents her late father Moishe Devon’s story to generally non-Jewish school groups. And while these two parts of her life have opened her to criticism—specifically, from those wondering how she could condone putting anyone to death after what the Nazis did—she believes her father, who died of natural causes in 2021, would have considered MAID if it was a necessary way for him to avoid pain and suffering. It’s nearing eight years since MAID be- came legal in Canada, on June 6, 2016. Where did it begin for you as part of your practice? One of my own patients with metastatic cancer was suffering terribly. I was present for her MAID procedure, and I was able to see what a peaceful and pain-free death that allowed her to have. It was then that I decided I wanted to be involved with facilitating this for patients in general. Like most MAID practitioners in Canada, it’s not usually the main part of our job, but it’s something we really feel strongly about: giving patients autonomy and the ability to make that choice for themselves. How many patients are you personally helping on an annual basis—and has that number been increasing over time? And have your views on it changed along the way? Certainly we know there’s been a growth in MAID because it’s now about four per- cent of deaths in Canada, about 19,000 per year. I’m a provider who only does
are still able to think of them as a whole person and respond to their needs.
“From a Jewish values perspective—I have no issue with that connection. I’m a proud child of a survivor and I proudly do this work.” Mostly, I’ve just learned what a privilege it is to be in the room, to witness someone suffering and to just be there, to be trusted at this really intimate moment in their life. And I remember, when I first started, think- ing this must be a little of what it’s like to be a rabbi, playing a role in these important life events and helping to counsel patients, especially because several of those who I’ve helped are Jewish. MAID in the hospital, although many of my colleagues do it in people’s homes or other places. Sometimes I’m helping people several times a month—other months have fewer requests. What legal frameworks are you operat- ing under? How would you explain the process of eligibility for MAID? As a physician, I don’t feel a significant amount of legal risk. Certainly, I want to make sure I’m doing my job well and as- sessing a patient thoroughly. The process each person has to go through is pretty rigorous, involving a written request form and two independent assessors—very strict criteria. So, part of my job is to really talk to patients, understand their life, their illness, their suffering, and determine whether or not I can help them in this way. I also talk to them about all the other opportunities or possibilities for alleviating their suffering that might be acceptable to them. We explore other options aside from assisted death. The criticism comes from the view that a doctor is supposed to follow the Hippo- cratic oath of “Do No Harm,” and then you’re killing a patient… Well, certainly that’s not what I see myself as doing. If it’s a disease that’s harming the patient, the disease is killing them. What my colleagues and I are doing is providing help through compassionate care at a point where we can no longer cure someone. We
The federal government has now paused opening up MAID to those with mental illness as a sole criterion, and minors under 18 aren’t in the cards right now. Part of my job is to ensure people under- stand all the options available to them. At the same time, I don’t think we can hold people who are suffering hostage to the feelings of our society. I don’t think that would be fair, but this is a really difficult issue. We all have a lot of guilt about how our system works. But you’re the daughter of a man who spent ages 12 to 15 hiding in an under- ground bunker to evade the Nazis. It leads to you being asked about how you can reconcile counselling Jewish people who want to take their own life when Hitler murdered so many of us. How do you deal with that? My father was well aware of the work I was doing. He supported me. And he was very, very proud of the way in which I’m able to help people. But specifically regarding the Holocaust, people sometimes conflate different issues. What I see as the greatest atrocity of the Shoah is that people had freedom of choice taken away from them, the freedom to choose their own fates. In becoming a MAID provider, that’s exact- ly what I’m doing for people, allowing them to have the freedom to determine their life. For me, there is really—from my moral perspective, from a Jewish values perspective—I have no issue with that connection. I’m a proud child of a survivor and I proudly do this work. And while I’m definitely not an expert on Jewish law, I was raised with Jewish values, and raised to be kind and compassionate with a commitment to social justice. My role as a MAID provider fits well with the way I try to live my life. The overwhelming response I get from all patients is that of immense gratitude. I had a specific discussion with someone who heard about the work that I do and knew that I was the child of a survivor— because I also have done some medical ethics work around medicine and the Holocaust—and he sent me a book about euthanasia and the Holocaust. You know what? It’s a great book.
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