Physically healthy depressed man died by euthanasia in British Columbia

By Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition

Alan Nichols with his brother

Avis Favaro, the Medical correspondent with CTV News, produced an excellent news story concerning the death of Alan Nichols, a 61-year-old man who was physically healthy but lived with chronic depression.

This story clearly shows how the recent Québec court decision that struck down the terminal illness criteria in the law will lead to an expansion of euthanasia, in Canada–to people who are physically healthy but experience psychological suffering.

Favaro interviews the family, and others, about the death of Alan. The news report states:

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 [Royal Canadian Mounted Police] to investigate the case.

Favaro described the history of Alan’s health condition.

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 was concerned about Alan and they unsuccessfully sought guardianship for his care. The family stated that Alan did not fit the criterion for euthanasia, Favaro reported:

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 the 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.”

The family tried to stop the lethal injection, but the hospital said that only Alan can stop the euthanasia, even though the family insisted that Alan was not competent.

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.

The family urged the hospital to stop 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?”

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

“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 foreseeable 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.”

This is the family that EPC has been working with to attain justice.

Editor’s note. This appeared on Mr. Schadenberg’s blog and is reposted with permission.