Episode 45 - The Role of Dying With Dignity Canada in End-of-Life Advocacy with Alex Muir
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In today's episode, Greg and Nicole welcome Alex Muir, Chair of Metro Vancouver’s Dying With Dignity Canada. Together, they discuss the evolution of Medical Assistance in Dying (MAID) in Canada, eligibility criteria, and the importance of advanced care planning. Alex shares personal insights, addresses common myths, and highlights the organization’s role in supporting informed end-of-life choices. The conversation emphasizes balancing autonomy with safeguards, and encourages open family discussions about end-of-life wishes to ensure dignity and clarity for all Canadians.
Nicole 00:00:02 Hello and welcome to Your Estate Matters with your host, my colleague Greg Brennand and myself, Nicole Garton of Heritage Trust.
Greg 00:00:09 Your Estate Matters is a podcast dedicated to everything estates, including building and preserving your legacy.
Nicole 00:00:16 If it's estate related, we'll be talking about it. We're having the conversations today that will help Canadians protect their families, their assets and their legacies tomorrow.
Greg 00:00:34 With us today on Your Estate Matters is Alex Muir, chair of the Metro Vancouver chapter of Dying With Dignity Canada, a national charity dedicated to advancing end of life rights and education across Canada. In his leadership role, Alex coordinates community outreaches, organizes educational events, and advocates for improved access to Medical Assistance in Dying, MAID, and advanced care planning throughout the region. Prior to becoming the local chapter chair. He oversaw the chapter's independent witnessing program, which helped some individuals initiating their MAID request prior to his involvement with dying with Dignity Canada. Alex retired from a 34 year career working in the oil and gas industry in various capacities. Today we'll chat with him about his interest in end of life rights.
Greg 00:01:24 Alex, thank you for being here with us today to talk about dying with Dignity Canada. Can you tell us a little bit about yourself and how you became involved with Dying with Dignity Canada?
Alex 00:01:33 Sure. Thank you for having me, by the way. My sister was on the board of dying with Dignity Canada way back in the early 1990s, long before me was available to Canadians. So I was familiar with the fight for end of life rights. And at that point I started donating to Die with dignity, got on their mailing list. And so I kept current on the issues as the argument was building. Thing. And then what happened in the early 2000? I was close to two pretty gruesome deaths. I had a cousin who died of ALS, and my dad in 2008 died, but it took about 18 months. He had COPD and then he had macular degeneration, which was misdiagnosed. And he lost his sight basically. And then he had hearing issues and that led to losing mental capacity.
Alex 00:02:21 So it was a long, drawn out, horrible demise. And I thought to myself, you know, there must be a better way. And that was when I decided, when I retired in 2017, that I would get more actively involved with Dying with Dignity.
Greg 00:02:36 And what is your current role at Dying with Dignity and what drew you? I think you've already explained your personal experience with the work, but was there anything else that drew you towards that?
Alex 00:02:45 Well, it just happened that there was a women's fair at the roundhouse, and I had a friend who was involved with an organization, and I had mentioned that I wanted to get involved with dying with dignity. And she said, oh, I know, I know the person who's the chair of the local chapter. So I started actually as an independent witness, and that's going in and witnessing people who are applying for it. And that's how I got involved. And then I very quickly became the witness coordinator for the Metro Vancouver area.
Alex 00:03:12 And then a couple of years later, I became the chair of the Metro Vancouver chapter of Dying With Dignity.
Nicole 00:03:18 So for listeners that aren't familiar, can you tell us about what dying with Dignity Canada is and what services and supports it offers?
Alex 00:03:26 Sure. Dying With Dignity Canada is a national human rights charity committed to improving the quality of dying so people don't needlessly suffer. That includes protecting end of life rights through our advocacy work, and helping Canadians avoid suffering by referring them to appropriate health care resources. We educate the public about legal end of life choices, patient rights, and advanced care planning using webinars, public presentations, online resources, and media interviews as well. We're also actively involved in advocacy work with politicians, focusing on changes to assisted dying legislation, and we also support healthcare practitioners who assess for and improve and provide need.
Nicole 00:04:13 So what specific supports does it offer individuals and families that are navigating life decisions?
Alex 00:04:19 We do presentations on advanced care planning, which includes guidance on choosing a substitute decision maker, which in British Columbia is called the representative.
Alex 00:04:30 So when you become incapacitated, this person would make healthcare decisions on your behalf. And we take people through that whole process. And on our website there is a kit that takes you through, you know, understanding your values and beliefs and then deciding who should be the person to make decisions on your behalf. There's also a patient rights guide as well on our website that explains to people you know, what, what rights they have in terms of choosing end of life options if it gets to that point. Also, when people are at the point where they're making end of life choices, our support team will direct them to appropriate resources in their province, and we also help them navigate the MAID process in their province, if that's the route that they're going to take.
Greg 00:05:14 Hey, Alex, what is Medical Assistance in Dying in Canada? It's MAID for short.
Alex 00:05:20 Yes. Well, MAID is a planned death with the assistance of a trained health care professional. So either a doctor or a nurse practitioner in Canada MAID can be either clinician assisted by injection or self-administered by oral medication.
Alex 00:05:36 Although the doctor or nurse practitioner must be in the room under either scenario. The use of oral medication is very rare in Canada. There are fewer than 15 cases every year out of 15,000. So it's it's less than 0.1% of all MAID cases are by oral medication. So almost everyone chooses injection.
Greg 00:05:57 So how has the legal framework for MAID evolved over time? And where does it stand in today's scenario?
Alex 00:06:03 Okay, I don't know how much detail you want, but I'll just go back and quickly highlight the evolution of MAID in Canada. Discussion about assisted dying goes back a long way, but really it became a public issue in 1993 with Sue Rodriguez, who probably most people have heard of. She was a 42 year old woman in Victoria who had ALS, and with the help of the B.C. Civil Liberties Association, she applied to the courts for a doctor to help end her life. And she asked the courts, if I cannot give consent to my own death, whose body is this? Who owns my life? And this case was escalated to the Supreme Court of Canada, where, unfortunately, she lost in a 5 to 4 decision.
Alex 00:06:45 By the way, she ended her life the following year. She found there was a sympathetic doctor who did help end her life the following year. But the case was really significant because what it did, it brought the issue of assisted dying out of the closet, out into the open, and people started talking about this survey, started asking people, what do you think about this? And support for assisted dying back then was probably in the 60 to 65% range. It's now in the 80 to 85% range. But it really was the start of serious discussion about about changing the legislation in Canada. So what happened over the next 15 to 20 years is that the interpretation of the Canadian Charter of Rights and Freedoms started to change, and judges started looking at elements of it to address what they called liberty and security of the person. And they said that also applies to end of life rights. And so we need to allow people autonomy at end of life. So that was the backdrop in 2011 when the B.C. Civil Liberties Association went back to the courts with two BC women again.
Alex 00:07:48 It was Gloria Taylor who had ALS and Kay Carter who had spinal stenosis, and they again went back to the course with the same arguments, basically, you know, saying that, that basically we're not allowing people the autonomy to make choices at end of life. And I think the change in public opinion, plus the interpretation of the Charter of Rights and Freedoms were significant. And they went to the Supreme Court and the challenge passed in a 9 to 0 decision. So basically the court said to the government, you have to amend the Criminal Code to allow doctors to help people end their life. So what happened in that court decision is they established what are now known as the charter criteria. And I'll talk about those a bit later. That became the foundation of Bill C-14, which was passed in June of 2016. So that was the beginning of MAID in Canada. But that wasn't the end of it. What happened with that legislation is that when Bill C-14 passed, the parliament actually added something to the legislation, which wasn't in the Carter criteria.
Alex 00:08:52 They added a criterion called reasonably foreseeable death. So what they're saying is this legislation will only apply if someone's natural death is reasonably foreseeable. And there were a bunch of people who took exception to that, especially people with disabilities, who said, you know, why can't I have this same right? And so there were court challenges that popped up across the country. The most significant one was the one in Quebec with Jean Chrétien, who had cerebral palsy, and Nicole Glasgow, who had post-polio syndrome. And they argued that that limitation infringed their charter rights to liberty and security of the person, and it was unconstitutional since it violated the Constitution. So it went to the court in Quebec. And so in September of 2019, a Quebec judge agreed with them and they said no. This law is discriminatory. And they said to the government, okay, you need to change this law to allow people whose death is not reasonably foreseeable. The federal Liberal government at the time didn't disagree with that. And so they said, okay, we'll change the legislation.
Alex 00:09:59 And that's what they did. So what happened over the next year or so, they developed new legislation. And in March of 2021, Bill C-7 was introduced. So so what we have now is legislation, whether there are two different tracks. So someone whose death is reasonably foreseeable follows track one. So that's basically been in place since 2016, but now since 2021 track two. So if your death is not reasonably foreseeable, you can apply under track two. The other change that happened with Bill C-7 was that there was an exclusion that was put in. They put in a temporary exclusion to MAID access for those individuals with a mental disorder as the sole underlying medical condition. And they said temporarily that they set a two year sunset clause. And they said, we will not allow access to people because we need to figure out how this is going to work for people with mental disorders. And so that was in place as of March of 2021. But that's sort of well, I can talk about extensions to that, but that's kind of where we are right now.
Greg 00:11:00 So that's sort of the governing framework. Who is eligible to access MAID and what are the main steps. So if they're practically thinking about it how does that occur.
Alex 00:11:10 The as I mentioned, the Carter criteria in 2015 kind of established the main criteria and they were adopted by the government. So basically what those criteria include is you have to be eligible for public health services in Canada. You have to be at least 18 years of age and capable of making health care decisions for yourself. And on the medical side, these are the important criteria. You have to have what's called a grievous and irremediable medical condition. So what that means is grievous is you have to be experiencing unbearable physical or mental suffering that cannot be relieved under conditions that that you consider acceptable. So this is something that's kind of determined by the patient. And then irremediable means you must have a serious illness, disease or disability and be in an advanced state of decline that cannot be reversed. And this is determined by two independent medical assessments. Also, the request must be voluntary with no external pressure.
Alex 00:12:07 And that's something that is tested throughout the process to make sure the individual is not being coerced into this. And informed consent and counseling has to be provided. So during the whole assessment period, the individual must be informed of the means that are available to relieve suffering, including palliative care. So those are the basic criteria for applying for medically assisted death. And as I mentioned, the major legislation is federal is an exemption to the criminal code. But because it falls under health care, The administration of it is provincial. And so that's why each province has its own forms, and processes are fairly similar, but there are separate forms for each province. And in British Columbia, each of the five regional health authorities and the First Nations Health Authority have a team that specifically handles MAID cases. They are really good at helping people navigate the whole process. Now to answer your question about track one and track two, the application process is similar for track one and track two, but what is distinctly different about it is that for track one, once someone is assessed and approved, then they can choose a date whenever they want.
Alex 00:13:20 They could even choose, you know, with the next day if they wanted to. There's no waiting period. Track two though, because it is used because your death is not reasonably foreseeable. There is a 90 day assessment period, and so one of the two assessors has to have expertise in the condition that the person is applying for, and if they don't, they have to go and find it and make sure that they're talking to someone who really understands the condition that the person is applying for or under which they're applying. And so that's why there's a 90 day waiting period. And also during that period, the individual has to be advised of all the means that could be available to relieve their suffering. So they have to be provided with consultations, including counseling, mental health supports, disability supports and community services and palliative care. So all of these things have to be investigated. And that's why there's that minimum 90 day period. So those are the kind of the significant differences between track one and track two.
Nicole 00:14:20 And what's the status of people that have a mental illness. Are they allowed currently or. No.
Alex 00:14:28 no, not right now. So I mentioned before that there was initially a, a two year sunset clause. But what happened is it got pushed back even more. So what came out of it, he said. And was this parliamentary review process. And so there were tons of consultation. They had meetings. I think there were they received 350 briefs and they met with about 180 people who were both for and against, you know, extending this to people with mental illness. And as a two year deadline approach, the government said, oh, we're not ready. So they pushed it off for another year. So it was supposed to be available in March of 2023. And so in February they said, no, we're not ready. They pushed it off another year in March 2024. Then there was more discussion, more debate. And so in February of 2024, it was pushed off again another three years.
Alex 00:15:16 So where it stands right now is that someone with a mental illness cannot access me. If that's if that's your soul underlying medical condition, they cannot access me until at least March of 2027.
Nicole 00:15:28 So we're in BC, so maybe we'll ask about our province. So say there's an individual who has maybe ALS. A classic condition, I guess. If people think of who might choose this, what would they do to action this process?
Alex 00:15:45 Okay. So I think it's important that we draw the distinction between that sort of neurocognitive issues and mental illness. So this so this exclusion that we talked about is really for psychiatric disorders. So you know a manic depressive schizophrenia. So they're basically psychiatric clinicians. They're the ones that are currently excluded from accessing MAID. So neurocognitive and neurodegenerative diseases like ALS though do qualify. So people with those illnesses are able are able to access me. And so they can apply under track one and access me.
Nicole 00:16:21 So what would they if this was an individual, what would they do if they wanted to start that process?
Alex 00:16:27 The very first step is to fill out the application form.
Alex 00:16:31 There's a form on the website and it's fairly easy. What I tell people is that if you just Google medical assistance in dying in B.C., the first link that comes up is the government website that has all the information on the process and all the forms, and it actually it's actually quite good. I think what the government website does, and it describes the whole process and also has links to the, the regional health authorities, how, how, how to access the aid teams that are in each health authority. And it's actually it actually works fairly well. So that's the first step is getting that form in. And once the form is signed which has to be witnessed, which is a service actually that provides if someone doesn't want to use, it has to be someone who won't benefit from the person's death. So it generally excludes family members. And some people don't want to use friends or someone else. And so they can actually say to the health authority, we need a witness. Then they come to us and we will provide a witness to witness the form.
Alex 00:17:30 So this form goes to the health authority. And then the next step is setting up the two independent medical assessments. And they can help with that step.
Greg 00:17:39 I was curious if the form said the form process starting. Is that what determines if you're in process one or process two, like your pathway?
Alex 00:17:48 Yes, that would be part of it. So basically you have to put down you have to write down your diagnosis like why you think you qualify basically is us on the form. And then it goes to the assessment and then it gets to the assessment stage. That's when the doctors will look at the situation, you know, and they will determine whether or not they think you would qualify under track one or track two.
Nicole 00:18:08 So I understand that Canada is really an outlier in the world, and that the approximately 15,000 people a year that elect this, that we have more people than any country in the world and a higher percentage of people. So I think that might raise Eyebrows. Why are we anomalous in that way? And I guess related to that.
Nicole 00:18:33 How are we protecting against vulnerable people and people that might have moral or religious grounds against this? They might say, what are the checks and balances or safeguards? Can you talk to you about that
Alex 00:18:47 Sure. In terms of the numbers, were fairly close to where the Netherlands is, but the argument is that we've gotten there a lot faster because Netherlands has had it for years and years, and our numbers are about the same. Part of it, quite honestly, is education. This started out fairly slowly in 2016, and we saw about a 30% increase each year until 2022, and then from 2022 to 23, it was about a 16% increase. So we think it's starting to level off. But what happened I think as more people found out about Maid availability and also, you know, as more people get it, then you have more people talking about it. And so I think that's why we've seen, you know, a growth. I know that those who are opposed to this, I think this is horrible, that these numbers are climbing.
Alex 00:19:33 But the way we view it is, you know, we are allowing people to make a decision to end their suffering. And so people are saying, and this is something it's, it's quite clear that, you know, the individual has to make these choices. Right. And so this gets to the safeguards in terms of safeguards. Well, as I mentioned, the request has to come from the individual. So no one no one can apply for me on your behalf. So the individual has to make the decision. So that's kind of the first safeguard. And it has to be signed by an independent witness. And what is checked throughout the process is to make sure that there is no undue influence from anywhere else. And there are two independent medical assessments. And I talked about already about the additional safeguards for track two, the fact that it's 90 days and you have they have to discuss all the different other treatment options that they may not have considered. So there are quite a few safeguards in place.
Nicole 00:20:29 So what about there's been stories in the media that have caused controversy where some people maybe they, you know, we've had difficulty having timely access to medical care, like for example, cancer care. And maybe people have chosen MAID because they haven't had access to treatment or wasn't there a case where a veteran was suggested he might choose me? I don't know if that was accurate, but there was a there was kind of a notorious case. Can you talk about that? I guess the concern is, what about if it's people that are choosing this because they have financial or medical needs that aren't being met?
Alex 00:21:09 You know, it is concerning, as we know, there are some issues with our health care system and people are not getting the supports that they should be getting. And so this is something that that we support along with everyone else that that we need an improvement in supports for people who are suffering. But I think we need to keep that separate from who should be able to access need. No one is able to access MAID if they don't meet the medical criteria.
Alex 00:21:36 So we do have situations where someone they meet the criteria and they could be facing homelessness, right. And that will add to their suffering. And so you're right. It could actually affect their decision. They will choose me because they can't get access to the services that they need. And that's really unfortunate. But take that one step further and say, you know, therefore we're not going to allow people in those situations to access need. How have we improved their situation? They're just going to continue to suffer. So the answer is to fix those supports and make sure people get all those supports that they need. The answer isn't just to deny a whole group of people from being able to access me. And, you know, it's funny, there's a court case going on right now where a bunch of disability groups in Ontario have challenged track to basically arguing that what we're doing is we're railroading people into track two and we've done surveys. And when you survey people with disabilities, 78% want access to MAID.
Alex 00:22:36 They want the ability, they want the same rates. And if you remember, it's going to be interesting to see where this case goes because as I mentioned, you know, the true Shawn. Glad you case in Quebec. Those were people with disabilities who challenged the legislation which led to track two. So, you know, that's how the that's how the legislation evolved. And now you've got disability groups challenging it, saying we shouldn't we shouldn't have access to it. So it'll be interesting to see where, you know, where that goes.
Nicole 00:23:07 Well, there's certainly moral and ethical complexity in that. You know, on one hand, we want autonomy and rights of self-determination, and certainly we don't allow animals to suffer needlessly. So why would we maybe not offer that suffering relief to. Human beings. But on the other hand, you know, there is with disability groups and vulnerability and I guess particularly mental health issues and socioeconomic concerns. I think there's a concern, like we judge a society by how we treat our most vulnerable.
Nicole 00:23:42 And, you know, maybe it would be really terrible if our most vulnerable or poorest were disproportionately choosing mate because their quality of life was so affected. I don't know, what do you think, Greg?
Greg 00:23:54 Yeah, well, it's early days and I think a lot has to be worked through. And they have to establish that the people in the system are good players, basically that there is nobody that's, you know, outside the family, undue influencing. But nobody in the system is under influencing as well. And I think, you know, it's hit and miss I think somewhat at this point. But that develops over time, likely of a better system.
Alex 00:24:21 I can tell you that the numbers show that people with lower social economic sphere are not disproportionately choosing MAID. In fact, what we find is your typical MAID patient is a Caucasian, they tend to be more educated. And I think what it is is that these are people who have latched on to this autonomy. You know, these are people who have had a lot of control during their lives, and they want to maintain this control at the end of life.
Alex 00:24:48 And so that's one of the reasons, and I think the other reason, I think the number I saw for seniors in general, I think that Caucasians represented about 72% or something of seniors. And what we have found as well is that there are some other cultures that are not as accepting of MAID. And we have found that we go out and do education sessions, and we actually find it hard when we've gone into, you know, we go into other communities trying to do presentations we find it hard sometimes to get audiences because it's something that's just not that accepted, right? So I think that's why you see why the numbers are kind of skewed either way.
Nicole 00:25:28 So speaking of that, I referenced when we talked about booking this, that the famous Nobel Prize winning writer and academic Daniel Kahneman was 90 and made an appointment in Switzerland and didn't have…I don't think we know all the details, but I'm not aware that he had a diagnosis. What are your thoughts about that? People just think, you know, I've had a good life.
Nicole 00:25:57 I've achieved a lot. I just want to maybe. I won't put you on the spot personally. But do you see Canada moving that way or.
Alex 00:26:04 No, I you know, I'm not sure. I, I think that would be a bit of a leap. I mean, you can you can see the resistance already just to where we are already to go that far. I would. I honestly don't see it happening. So where our focus is as an organization is, is to make sure Canadians are aware of what their rights are now and then we're pushing forward. We want to make sure that a broad base of people have the ability and are able to access, maybe, if they so choose. I can't see us going further than that. We're kind of we're kind of looking at the legislation and what can we do through the legislative route.
Nicole 00:26:41 So I'll say as an estate planner, so I don't see clients anymore, but I did for many, many years and have done many, many representation agreements when I was doing so in British Columbia.
Nicole 00:26:55 As you know, that is a document where you can appoint a substitute or actually a decision maker to make decisions on your behalf for your health care or personal care. And you can put in health care wishes. You could say, I don't want to be kept alive by artificial means, but you're not permitted to do mate because, as you know, you can't do me by proxy. You have to have the requisite capacity and jump through the hoops. But I would be asked once a week by somebody to have a pre-emptive MAID clause. And it was really interesting. And the other thing I noticed was during Covid, my husband was my witness because clients couldn't come in and we put on masks and met people outside and signed up a lot of documents. And, you know, our families in the Orthodox Christianity faith. And he was flabbergasted. It's interesting. I think people don't necessarily know how ubiquitous it might be, because we signed up a number of people who had upcoming MAID appointments. And from his perspective, from a religious viewpoint, that that that that is God's decision and that it's in his perspective that's not a human.
Nicole 00:28:09 That's not our right to make that choice. So it is interesting. I don't know that people realize how prevalent this is. Greg, were you aware of how common it's increasingly becoming?
Greg 00:28:21 It's starting to see it more. I know in my former position at another employer, I received a call on a Thursday afternoon from somebody told us they had appointed us and they were committing as executor, and we didn't have any copy of the documents. And they said, well, they're doing it tomorrow at ten. And it really, you know, was a bit odd to me that there was this sort of a runway for informing somebody of, you know, just before a weekend. And I thought, oh, there must, there should be a little more formality, you know, for the system to be able to adjust. But we're certainly seeing it more frequently, and we certainly have administered some estates where word came quicker than we thought.
Alex 00:29:05 There was a change in the legislation. And under the initial legislation, there was a ten day waiting period, so if someone was assessed and approved for me, they would have to wait ten days.
Alex 00:29:15 And the reason they changed it in the subsequent legislation in 2021 was what they found was happening. Is that because people were waiting towards the end of their life to apply for a medically assisted death? They were suffering quite a bit at that point. And so then they get approved and then then they go, okay, you're approved. But guess what? You got to suffer for ten more days now. They thought this ten day waiting period wasn't really achieving anything other than forcing the person to suffer for ten more days, and that's why they removed the ten day waiting period.
Greg 00:29:45 Okay, so Alex, what are the most common myths and misunderstandings you encounter about MAID and end of life rights?
Alex 00:29:54 One of the things that we encounter quite a bit in terms of when we read about our organisation, we're not out there promoting me. We are all about choice. We know and respect the fact that it's not for everybody. As we were talking about Some people have religious beliefs or they're ethically opposed to me, and that's fine if that's the route that they want to take.
Alex 00:30:16 However, it is a legal option in Canada for those who meet the criteria. And so it's important that no one, whether they're for or against me, should be forcing their views on other people. So it's an option that people should know about that they have access to this if they if they qualify, but that you shouldn't be telling other people if they should or shouldn't take that route. That's one thing. The other thing about me to have to be clarified, there have been some pretty awful videos circulating about the
MAID death itself. It is a very peaceful death. And then despite, you know, some videos circulating which were based on these executions in the US, which have nothing to do with what we do in Canada, it actually is. And there are several doctors who have who have written articles now supporting this saying it is a very peaceful death and I have been at one, and I can tell you it is a very peaceful death.
Nicole 00:31:11 So is there anything you wish Canadians understood about the work that Dying With Dignity Canada does that they don't generally know?
Alex 00:31:19 I think most people associate us with MAID and, you know, advocating for me.
Alex 00:31:24 And it's true that we've been we've been actively involved in the advocacy work, and we think it should be expanded so that it includes a lot of people, but we do a lot more than that. You know, we do advanced care planning and we help support people and direct them to, you know, resources that they could use. And I would just urge anyone who wants to learn more about what we do just to go to our website. And we have tons of online resources there as well, which I think people will find useful. So that's it's done with dignity
Nicole 00:31:53 So is there anything you'd like to share with our listeners today that we haven't touched on?
Alex 00:31:59 This is coming really back to the advanced care planning side. I, I think it's important that people educate themselves as to what their rights are so that they understand, and also that they don't leave their families in the lurch. And by that I mean start the conversation with your families. And if and if you're the one who's going to be an executor or whatever or be a representative, start the conversation with your parents to understand what their wishes are, because the reality is that the worst time to make these end of life decisions is, at the moment you're in hospital, something drastic has happened, and the doctors are saying, okay, what do we do now? Do you want to do this or this? And everyone's emotional and everyone's upset.
Alex 00:32:39 And if there's been no discussion about these scenarios, what could happen then? It makes it very stressful for everyone. So it's important to have these discussions upfront with your family and say, okay, this is what I would like, you know, under this situation, this is what I would like, and this is what advanced care planning is all about, to get these conversations going. Making sure you have a representative who understands what your values and beliefs are so they make the right decision for you.
Nicole 00:33:05 That's great. Well, thank you so much, Alex. We really appreciate the time you spent with us.
Greg 00:33:09 Thank you.
Alex 00:33:09 Alex. My pleasure. Thank you.
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