Dying with Dignity, a 30-year-old organization dedicated to expanding end-of-life options, is reporting "goodbye" letters that say, "I don't want to end up like Margot Bentley."
"People are angry with us" says Wanda Morris, the organization's CEO. "They say we told them advance-care directives about dying are followed these days."
Not for Margot Bentley.
Bentley, 83, a retired nurse who looked after patients with dementia, wrote what she called her "statement of wishes" in 1991. That statement appeared clear to her and her family, but a judge did not see it that way.
Bentley's case demonstrates just how complicated advance-care directives are.
She authorized her husband and daughter to make medical decisions on her behalf "if I reach the point when I cannot recognize my family."
She wrote, "I direct that I be allowed to die," and she specified no heart resuscitation, no surgery, no breathing intervention and "no nourishment or liquids."
Bentley was diagnosed with Alzheimer's disease 16 years ago. Now she languishes in a semi-vegetative state in a care home run by Fraser Health, the regional health care authority in Abbotsford, B.C.
She is unresponsive in every way but one: She continues to eat when prodded with a spoon.
Fraser Health refused to follow her directive, when Bentley's family asked it to do so.
Katherine Hammond, her daughter and also a nurse, asked as an alternative to take her mother home and with the help of palliative care nurses allow her mother to die at home.
The response from Fraser Health was to put a "police order" on Margot Bentley's chart. Abbotsford police were to be called if Hammond or her stepfather attempted to remove Bentley.
The family went to court. Earlier this year the court ruled that by opening her mouth Bentley was consenting to be fed.
The judge said feeding with a spoon is not medical care. It is personal care, and thus not included in Bentley's directive.
"It sure starts to feel like splitting hairs," says Krista James, national director of the Canadian Centre for Elder Law.
Margot Bentley's family says they want the care home to stop spoon-feeding their mother, who barely moves on her own. "The family is very clear that they are doing what their mother wanted. The hospital says they can't deny food to someone in their care."
The unresolved question is whether a son or a daughter, a legally appointed representative, would be permitted to refuse food or water on a patient's behalf.
"We do not know," says Joanne Taylor, executive director of Nidus, B.C.'s personal planning resource centre. "We have not had a case."
James says, "The worst thing about this case is that it scares people into thinking they have absolutely no power over their lives as an illness progresses."
Confounding the confusion in Bentley's case is the recent Supreme Court of Canada decision in the Carter case, which removed the prohibition against physician-assisted death in Canada.
Hammond has run out of legal options, but she continues to visit her mother.
"When caregivers, well-meaning people, say 'But we have to feed your mom.' I say, 'This isn't about what you want — this is about what my mother wanted.'"
This week on The Sunday Edition
Starting at 9 a.m. ET on Sunday, June 14 on CBC Radio's The Sunday Edition:- Michael Enright: The culture of sexual abuse in the RCMP and Canada's military.
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