The Book My Mother Was Supposed to Write by Alicia Duncan  

On October 29, 2021, my mother was released from an involuntary psychiatric hold in British Columbia.  Four hours later, she died through Canada’s assisted-dying program, officially known as Medical  Assistance in Dying. She was sixty-one, she was not terminally ill, and three days earlier, she had  attempted suicide.  

In the years since, I have returned to those facts often enough to recite the timeline without notes.  Repetition has not made it any easier to understand. How could one part of the healthcare system consider  my mother a suicide risk while another considered her capable of choosing an assisted death?  

That unresolved contradiction became the foundation of my memoir, The Other Side of the Straitjacket,  although the book itself had been conceived more than thirty years earlier.  

I first heard the title when I was a child. My mother was a psychiatric nurse, and she told me she wanted  to write a book about mental illness from the patient’s point of view. She had already decided what she  would call it: The Other Side of the Straitjacket. I promised that when she wrote it, I would design the  cover.  

After she died, I began having recurring dreams in which she told me to write the book. I did not listen  right away. It was her title and the book she had imagined writing. But more than thirty years later, it  remained unwritten, and the story behind it had changed in a way neither of us could have imagined. My  mother was no longer the nurse hoping to tell a patient’s story. She had become the patient whose story I  was trying to piece together.  

Her decline began after a car accident in February 2020 left her with a concussion. Over the next twenty  months, she became increasingly anxious and paranoid while growing physically frail. In her final  months, our family had no idea she was considering assisted dying, much less that she had begun seeking  approval.  

We later discovered that the accident had triggered the return of a lifelong pattern of disordered eating.  What our family understood as part of a serious mental health crisis was viewed differently by her two  assisted-dying assessors, who considered her physical deterioration evidence that her death was  “reasonably near.”  

After she died, I expected the medical records to explain how those decisions had been made. I wanted to  know how her suicide attempt had been considered and why she had been placed on the pathway intended  for people whose natural deaths were reasonably foreseeable. Instead, police investigating her death were  denied access to key assisted-dying assessment records on privacy grounds. The investigation eventually  closed without any illegality being established.  

If I wanted to understand what had happened, I realized, I would have to reconstruct the story myself.  

I began with thousands of pages of medical charts, text messages, emails, legal documents and  correspondence. I built a timeline, compared accounts and looked closely at the places where the records  contradicted one another. The documents could tell me what had been written down, but they could not  fully explain how the woman my family knew had been understood so differently by the people assessing  her.  

For most of her life, my mother had been funny, playful and relentlessly optimistic. She was a two-time  cancer survivor, a mother, a grandmother, a nurse and my closest friend. If I began with the final months  of her life and treated everything that came before as background, I risked reducing her to her illness in  the same way she had once feared patients were reduced by the psychiatric system. 

It took three complete rewrites before I found the shape of the book. A purely personal memoir could not  account for the wider questions raised by her death, but an investigation built only from documents would  lose the woman at its centre. The final version became both: a daughter’s account of her mother and an  examination of the system that approved her death.  

At first, I believed that if I gathered enough information, I would eventually find the answer that made  everything fit together. I thought there would be one missing record, one overlooked fact or one definitive  explanation that would allow me to understand what had happened. I also believed, although I did not  fully recognize it at the time, that finding that answer would bring me peace.  

The book did not give me that kind of certainty. There are things about my mother’s death I may never  understand. But somewhere in the writing, I realized that peace was not waiting for me at the end of one  final answer. It came from learning to live with what I could know while remaining open to what I could  not.  

Assisted dying is often treated as a question with only two possible positions: for it or against it. I wanted  the book to make room for the questions between those positions. I wrote it so readers could see what our  family saw, follow the evidence we uncovered and decide for themselves which questions still demand  answers.  

As a child, I imagined designing the cover of my mother’s book. I never imagined that I would one day  investigate her death in order to write it. I began the process searching for certainty. Instead, I learned that  curiosity, not certainty, is how we move forward. 

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Alicia Duncan is a Canadian author and mental health advocate whose work explores the intersection of healthcare, ethics and human rights in end-of-life policy. She has spent years amplifying the voices of vulnerable
communities through advocacy, public speaking, parliamentary testimony in Canada and the UK and media appearances. Her work has been featured in national and international media, including CBC’s The Fifth Estate and the groundbreaking BBC documentary Better Off Dead? She is passionate and articulate about examining how assisted dying is reshaping families, medicine and democracy itself and has spoken at numerous public forums on all sides of the debate.

LINKS:
www.aliciaduncan.com

INSTA @aliciaduncanwrites/
FACEBOOK @aliciaduncanauthor/
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The Other Side of the Straitjacket: A Daughter’s Story of Mental Illness and Assisted Dying

Clinicians must assess mental capacity before approving medical assistance in dying. But what happens when the system designed to ensure safety misses what matters most?

When Donna Duncan chose medical assistance in dying (MAiD), her daughter, Alicia, searched for understanding. How had a woman struggling with mental health challenges been allowed to make such a choice?

Looking for answers, Alicia succeeded in launching a police investigation, the first in Canada. What began as a private heartbreak quickly became a matter of national controversy as she uncovered troubling gaps in medical safeguards, exposing a system that often prioritizes policy over people, especially those living at the margins. The Other Side of the Straitjacket lays bare the human cost of end-of-life legislation and the devastating consequences of unrecognized mental health struggles.

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Category: On Writing