More from author, cancer survivor and psychospiritual specialist David Maginley! Building on our conversation from last week, David and I continue to explore the impact of Medical Assistance in Dying in Canada.

As he says, “This goes far beyond the hospital bed and goes to the heart of our culture.” I would agree – MAiD is huge topic for our time. I certainly don’t have answers, but wow did I enjoy the depth of these conversations and David’s book Early Exits: Spirituality, Mortality, and Meaning in an Age of Medical Assistance in Dying.

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Transcript:

Diane Hullet: [00:00:00] Hi, you’re listening to the Best Life Best Death podcast, and I’m your host, Diane Hullet. This week I’m back with David McGinley, author of this incredible book called Early Exits. This book is about medical assistance in dying, written by Canadian chaplain and author and cancer survivor, and just incredible thinker.

David McGinley. Welcome back, David.

David Maginley: Thanks Diane. I really enjoyed our conversation, but there’s so much to cover.

Diane Hullet: There’s so much to cover. And I was thinking we would start this part too, just by, I thought I would just kind of name some of the sections of the book. You know, the, the book is so, it’s dense, but very accessible is what I would say.

And it’s really, it’s written in four parts and you dive into, made an ego. You dive into made and culture, which I find particularly interesting. This goes beyond just what are we doing individually, but also how does this impact our culture [00:01:00] made and meaning. And then maid in spirit. And I tell you what listeners, he dives into everything from psychedelics to meditation to the role of religion, to kind of there’s a whole chapter for physicians and nurses and folks involved in delivering maid.

What is that existential distress like for them? So there’s really, there’s something for everyone here, I think, to take away. But the big piece we were ending with last time is this idea that, ah, you know, culturally in the West at this time, you know, 2025, we have, we don’t have a good map for the psycho-spiritual dimensions of what happens when we die.

And we are very identified with our bodies. We’re very identified with our thoughts and minds and our individual lives. And we think, well, when my body goes. I don’t wanna be around anymore and I’m a burden to my family and I don’t wanna be in pain. So absolutely. Let’s go for the lights out [00:02:00] light switch and switch this thing off, and I’m moving on.

Yet there’s an impoverishment of thought in that that misses the. I think the, the, the psychospiritual transcendent opportunity available at death that I think you would say David, is, is almost available to us in no other time of our lives like it is at the end of life. So that’s a mouthful, but what would you say, you know, what would you say in response to that?

David Maginley: Yeah. In our culture, it’s no surprise that made or physician assisted death is a very utilitarian approach to dying because we’re saying in our consumer’s mindset what, what’s the point? Where’s the good, where’s the value? The mean

Diane Hullet: what you I what You I is almost what people, yeah. Right. Like if I’m, if I’m useless, what’s the point?

You know, I’m done. And

David Maginley: yeah. Yet it is in our dependency, increasing dependency as we die, that activates the [00:03:00] community’s compassion and to come in close. And so death is a community building event that deepens our humanity, that enriches our compassion and care for each other, that awakens us to our mortality, and so helps us invest ourselves wisely in the measure of our days.

Diane Hullet: Yeah. What, what do you see as the psychospiritual map or psychological map and spiritual map? Maybe they’re not even the same thing.

David Maginley: Yeah. The map is complex. We learn, need to learn to read it, so I appreciate that. What I say may sound very abstract. That’s why I try to begin every chapter with a real story and end with an exercise so you can implement what, what I’m trying to explore.

But let’s talk about this ego deconstruction. Who and what you are. Build slowly [00:04:00] through your life. When you come into the world, you’ve come from a state of being where you’re one with the environment, you’re in the womb. There is no ego. And so you are pure being, and there’s there, there may be thoughts, but Right.

And perceptions, but there’s no, there’s no ego, there’s no, you’re, you’re very much a mystery. And then as soon as you’re born into the world. You undergo four contractions of consciousness. Now I’m basing this on the work of, of amazing hospice worker, Kathleen Dowley Singh, S-I-N-G-H, and her book The Grace in Dying.

Now, if you think my book’s heavy, go to hers, but there’s no better cartography of the dying process. Okay? So you’re born now suddenly you’re in an environment. That’s a separation and [00:05:00] contraction away from the ground of being There is a self and another. And that increases because then you realize there are objects in the environment.

You don’t have a language yet, but you’re creating differentiation, which is creating the individual. Then there’s a third separation ’cause some of those objects are moving and not moving. And so you’re, you’re beginning more separation from the unity of all, and then any aspect or experience that’s not able to support your growing ego or sense of individual identity is then placed in a warehouse called the subconscious.

And we keep piling stuff in there. Now, the challenges of life are gonna come up inevitably. Maybe a sibling is born into your family and it disrupts your role. So that’s a challenge to ego identity or you move to a different grade or to a different [00:06:00] town, you gain a friend and lose a friend. All of these challenges are invitations through the life journey to greater and greater states of maturity and healthy individuality.

So. Then illness comes along and it compromises our ability to function in the world as we want and are used to. So this is activating the material in the subconscious ’cause we may resist and resent and that’s connected to other material in our past. And that subconscious stuff is asking for integration.

Right. So this is a repair of that split away from the unity of everything. And then another repair happens in the split between there, there was a split between mind and body, right? And [00:07:00] now that unfortunately is, is fused through pain and dependency and suffering. It’s not pleasant. And then the split.

Between you and the parent, separate people and objects around you is healed through achieving a state of expanded consciousness. But diminished physical ability, we are ego Resistance to this deconstruction is usually quite intense. During this process resulting in existential distress. I know this is sounding quite theoretical, but then as we die, there is a final breaking away from the sense of separation and arresting in just being, instead of doing or thinking or having a role or a function, you are just [00:08:00] what you are.

And you are, you are achieving the wisdom of a simple blade of grass that has no pretensions about what it is and is able to relax and do it naturally. And this is a precursor or an awakening to a fundamentally non-physical, spiritual state of consciousness exhibited by most people as they die.

You don’t need to be religious. It doesn’t matter what you believe, it doesn’t matter it’s universal. The dying tend to perceive spiritual forces and entities filled with peace especially when pain is properly controlled and they’re able to surprisingly do something they never imagined they could do, which is to say goodbye.

I remember one person. She was just amazing and, and she died young of cancer. And she said the most remarkable thing. She said, you know what? I choose to be [00:09:00] curious. Not angry. Oh my goodness. Huge. Oh my. Huge. Yeah.

Diane Hullet: Oh, could we all choose to be curious? Not angry. Woof. There’s, there’s something, you know, I’m thinking that, that I can imagine that a lot of people listening to this, while it’s theoretical, they also, many people have had an experience of this.

I can think of one friend who recently was with her mom. And, you know, her and her two sisters had to kind of come together and take shifts as mom was dying and they had hospice involved early, which made a really big difference. But still, the, the whole thing took weeks and everybody sort of thought it would move faster, but it often doesn’t.

And mom would say, why is this taking so long? And the daughters would simply, you know, be reassuring and say, it’s okay. We’re here and we’re, we’re supporting you. There was this [00:10:00] frustration with the time it took on both the part of the dying and the living, and yet there was this softening that happened and this gentle moving towards death ultimately that I think.

The whole family benefited from, and it wasn’t rushed, but it, but it was disruptive to, you know, the doing right, the like productive lives that everybody had to leave and the time off work and the traveling from other places. Because I think this is one of our, our challenges in the modern world is it is disruptive to what we’re expected to do and where we live.

But there was this, this peacefulness to it and this. Touching that greater ground of being by the whole family, by the whole experience. And I’ve certainly heard people over and over say that they have pretty extraordinary experiences at this portal of death with somebody. And yet there are also really difficult [00:11:00] deaths.

Very medicalized deaths. Deaths without much, time or space or gentleness around them that leave people traumatized and leave people saying, I don’t want that, so I’m gonna do something different than that. But I love your assertion. That made is kind of a, it’s kind of a jump over. This psycho dissolution and spiritual transformation that’s possible at this, I wanna call it like the apex of the human experience, is that the right term for it, like this dying is, is this pinnacle moment that we shy away from for a variety of reasons.

And yet there is this possibility of having it be truly, I would call it a transcendent experience, even though some people might say, no way. That’s not possible.

David Maginley: I agree. That excruciating waiting was what my family went through with my mom and my dad as they died. And those are in the book? Yes. We experienced our own [00:12:00] existential distress.

I, the expert in the dying process became really bad company. I was so grumpy ’cause mom was taking a long time to die. And I was like. Why is this taking so long? What’s the point? I said those things. I needed to go for a good long walk. And yet looking back I realized I was resisting how bums, abiding, and, and stasis was an invitation for me to be more deeply present and just be still.

I didn’t know how to be still. I reached my breaking point. And and yet what unfolded after that was nothing short of mystical and, and astonishing in a way we never could have predicted.

Diane Hullet: Yeah, I’m struck too. I’m thinking about you know, Sarah Kerr is another Canadian end of life doula and teacher, and she says, you know, the story we tell ourselves really impacts how we experience it.

[00:13:00] And she describes the story of someone who came to her and said, oh, my father had this terrible death. You know, he lived by himself. He was mowing his lawn, and then he, he had a, a heart event and he went to the hospital and we brought him home and we were all there. You know, two weeks later he died and the whole thing was just awful.

And Sarah said to her, well, let’s re reframe that, right? Like, in fact, he was living alone exactly how he wanted to be. He was mowing his lawn. The family was able to come, everyone was with him. Perhaps this was an okay death or even a good death. And the woman kind of was taken aback and said. Oh, I framed it as a bad experience, but the reframe is actually, maybe that was okay.

And there was much to learn on both sides. So this idea that we tell ourselves what suffering is or we tell ourselves what death will be and assume it’s [00:14:00] problematic is, is a very interesting piece too.

David Maginley: Yeah, and I wanna note that if any of your listeners are angry. At the moment over my position, I wanna amplify that indeed there are some bad horrid deaths, and your anger comes from a place of such noble love for your desire, for your loved ones to feel safe and comfortable as they die.

So you’re, you become a beautiful human being in that regard. I’m not talking about a panacea. I’m not talking about some lofty ideal spiritual death. I’m talking about 25 years experience with hundreds of people as they’ve died and, and research that is coming from minds and hearts and, and people far more wise and experienced than, than I am.

All of them. Pointing to how a bad death [00:15:00] really represents a failure on our, our culture’s part to to care for the least among us. With the best within us. I am very anxious about the development of Maid because what was intended as a rare exception in the face of untreatable suffering. It has now become almost casual.

People are being euthanized for poverty and loneliness and obesity in Canada. People are being euthanized as a way of not addressing those. Endemics cultural issues this is about more than death and dying. This is about the health of our society to care for each other. This, this goes far beyond the hospital bed.

It goes to the heart of economics and priorities in our culture.

Diane Hullet: Yes, Y yeah. You’ve said a [00:16:00] mouthful there. It’s, it’s interesting to me that as your research showed. Or the research that you found showed that a, a large number of people choose medical assistance in dying. For existential crisis and fear not outta physical.

So we say we don’t wanna suffer physically, we say we don’t wanna be a burden, but most often it’s fear driving it. And some of that fear can be addressed by a system that could address it. Oh, now this was a really interesting thing that I, I think you said early on in the book, you kind of flat out said, I’m.

Maybe exaggerating this, but you kind of flat out said, why are doctors in charge of making this decision not to disparage doctors? But you said it really should be spiritual counselors who are brought in to help make a decision whether someone is eligible for maid because so much of it, it is [00:17:00] existential crisis.

And people like you are trained in those deeper conversations in terms of saying, what is unresolved? What is it that you fear? Lean into this, talk to me about your deepest, unresolved issues. That’s very different than a two page forum that says, are you suffering and in and physical pain, you kind of want out.

So you’re proposing a much greater intervention. Like really it’s palliative. Conversation for the soul is what you’re saying is needed as well as good palliative care for the physical symptoms. But I love that part where you’re kind of like, wait, why are doctors making this decision?

David Maginley: Yes, and the assessors, God bless them, their good hearts and their desire to help are completely unfamiliar.

They’re certainly untrained in the dynamics of ego deconstruction and what existential distress really means. They check a box, [00:18:00] they write in a few comments. Now, there are some assessors who will spend a few hours, right, for deeper conversation, but they still are not addressing the issue. Existential distress is an invitation to go deeper.

Yes.

Diane Hullet: Oh, I love that. And you have a beautiful section in the book where you talk about, I’m just flipping through it, trying to find it. You, you talk about Dignity Care. Do I have that correct? Is it Dignity Care? Yeah. And, and it’s a beautiful example in, in fact, Harvey. Hanoff is somebody that I’ve interviewed on the Best Life, best Death podcast.

We talked about his platinum Standard of Care and how this was a, a little bit of a different approach. T talk about Dignity Care. Tell us what that piece is.

David Maginley: Yeah, di Dignity in Care begins with a simple question, what do I need to know about you so that I can provide the best care for you? It opens up this [00:19:00] conversation and exploration of who and what I am in the world.

And this actually processes the unfinished love story and the unexamined dimensions of the subconscious now, not, not in a psychotherapeutic approach just in a relational, conversational compassion approach. And it takes the time for a person to meet themself in a new way. Embedded in the quality of presence of the clinician, your deep, compassionate presence and will, and ability to stay for hours and go where, go to the places that scare people.

That is a transformative journey. And Harvey found that those who desired an accelerated death no longer did. So after they had these deep, rich conversations,

Diane Hullet: they felt deeply seen, their, their life story was summarized, that was added [00:20:00] to their medical chart, and then they could be treated as a whole person rather than as a patient.

David Maginley: Right. But we live in a culture where loneliness is epidemic. Yeah. Where we don’t know how to sit and truly listen and be in, swim in someone else’s suffering, right, and allow ourselves to get wet. We don’t know how to be still with the unknown and the mystery and, and simply be present. We are a distracted, erratic, and rather terrified culture.

Can I quote you

Diane Hullet: on that? We are distracted, erratic, and terrified culture. Wow. Yeah. And, and what does that mean for us in our spiritual development?

David Maginley: Yeah. Because as a person is dying, spiritual issues rise to prominence. They dominate. [00:21:00] And again, this is not about religion or about belief. Because actually if God is loved, then your spirituality is determined much more by the quality of your love than it is by the content of your belief.

Even if your belief is rock solid and tight, whatever’s out on the other side is gonna be far beyond what your, your ideas and beliefs. So focus on your love and that sense of meaning, purpose, and identity, which are foundational to spirituality. Those are processed and emerge and, and come into the, the sacred story just through company and sharing and, and really exploring those existential aspects of who am I, what do I regret, what am I most proud of?

What am I most scared of? Why am I scared? And how can that be best addressed? This is the homework waiting for all of us. [00:22:00] I’m hope hoping that for anyone cramming for the exam, my book is gonna help.

Diane Hullet: That’s great. Yeah. I, I’ve recommended this book to everyone I can meet lately because I just think it’s such an interesting dive into not only what is medical assistance in dying, what is medical aid in dying in the us.

Also, what is the meaning of death? What is the purpose of death? And this is, this is the big question, and, and there’s a really, you have a beautiful chapter about mysterious experiences at the end of life, near death experiences. And you, yourself had a near death experience when you were 17. Do you wanna say a little about that?

David Maginley: Yeah. It was because of the cancer and it, it stopped my. Shut me off. I, I had parent glioma, often known as pheochromocytoma, so I’ll let anyone look that up. But I was temporarily transformed into a realm of complete connection and awareness. I still was my [00:23:00] individual self and yet fully connected to this natural environment that I was in.

And I met a guide who told me I wasn’t done yet. And I had work to do and I protested and I didn’t wanna leave. And he, he said, well, you gotta go back and we’ll be with you. And it, it was, it, it lives in me, it lives in me even now. And I’ve heard hundreds and hundreds of accounts from my patients and I’ve heard that mystical nearing death awareness from family members who say, when Charlie died, right?

He started talking to his grandmother. Do you think she was really here? These are so common. Dr. Christopher Kirk, a hospice doctor in Buffalo, New York, he found in a big study that 88% of his patients as they died, began having mystical states of consciousness. It begins with lucid dreaming [00:24:00] and then it expands, but it’s fleeting moments.

It’s not permanent, and you gotta be embedded at the bedside. Most people who receive physician-assisted dying or maid, are shut off before they achieve that state of consciousness. A state, the rational mind cannot comprehend or explain. And again, I’m not saying that they don’t go to whatever love and grace or heaven or whatever because of maid.

I’m simply saying it’s an impoverished response that prevents us from reaching that final stage of human development, which is beyond the rational. It is a transcendent equanimity. It is an integral state of being, and it’s wired into us. We don’t need to be so afraid.

Diane Hullet: Oh, that just makes me think of a quote that I’ve gotta read from the book because you say it so beautifully.

[00:25:00] You say this is on page 2 62? Yes. This is a thick book with many pages. You say, we die the way we live. True to form. As much as I want people to understand how made is the ultimate act of ego, self-preservation in the face of the process, which naturally deconstructs. As much as I want you to trust that you are wired with the wisdom to leave this world without rushing to life’s end, as much as I don’t want to do this again, I must acknowledge that it is not my homework, but it is our homework.

As a culture, it is our responsibility. I can only hope that as a society and a healthcare system, as families and individuals, we can help each other do it well. I also wanna say, David, you’ve got a a, a really wonderful piece, whi, which I sort of love, right? In the introduction of the book, you say, Hey, this is kind of a big [00:26:00] book and if you don’t have time to read the whole thing, ’cause maybe you’re dying and you just wanna cut to the chase, or you’re considering medical assistance and dying, read the summary.

And so you’ve got just this very simple three page summary with footnotes because again, this is a very. Carefully researched and, and documented book, which I appreciated about it. And you just summarize it in four points very simply. So folks can you know, pick this up at the library or the bookstore and read the four points and know what the book is about and if they wanna buy it and read more.

David Maginley: Yeah. I, I can’t waste your time. I know the book is thick, but if you’re suffering. If you are if you’re being with dying I, I need to honor that. So I cut to the chase and say, just jump to the end of the book and here’s a four point summary. Now you’ll miss the stories and the exercises and the nuance, but you’ll get the gist of it.

Diane Hullet: Yeah. Yeah.

David Maginley: It’s there for healthcare professionals too, who are swamped with paperwork and [00:27:00] caseloads and so hopefully it’s a, it’s an appetizer. That will get them to, to, to explore a bit deeper. I do wanna mention something. One of the options that a lot of people talk about is something they’re scared of.

It’s palliative sedation. If your physical suffering is indeed intractable and pain meds are not able to alleviate it, and I’ve seen that. And palliative sedation is a compassionate and reasonable alternative. However, a lot of people are anxious about that because they worry they’ll be hanging in limbo, able to hear their loved ones, but not interact.

They’ll be trapped in their body, right? But I, I wanna assure you, palliative sedation is monitored and measured to maximize your comfort. And it’s, it’s very, very effective. So that is a reasonable alternative. To [00:28:00] what has been called intractable suffering. I also wanna note that the, the nature of the suffering being untreatable in Canadian law is left to the patient, to the person to decide and determine not to the doctor.

And the Dr. May offer, well, we can do this, or this, or this, or this. And they’re very effective. It’s still within the person’s right to say, that’s simply not acceptable to me and I want you to shut me off. And there’s no counterargument to this, right? That’s a distortion of the role that medicine plays.

And you, you cannot insist on one particular treatment over another. When a person says, that’s not acceptable to me. I am saying that’s an invitation to a big conversation. And they may be angry and resistant to that, yet it’s aching to [00:29:00] be addressed nonetheless. So it gets into complex dynamics that require a deep commitment to travel the rough, rocky road of existential distress and suffering and meaning in a society.

That doesn’t know how to do it.

Diane Hullet: Yeah. That metaphor is so good. It’s like our society wants the newly paved freeway. You know, we want the easy, the easy road. So when you say the rough, rocky road of existential conversations, I, I really wonder how many people wanna travel that route and yet. You know, the, the, the payoff of that seems, seems real to me.

I just, I don’t know if other people would agree with me or not. Do they wanna really dive in?

David Maginley: How many people have those kind of conversations through their life?

Diane Hullet: Exactly. Exactly.

David Maginley: For me, it’s my bread and butter, which means I’m no fun at parties. [00:30:00] But,

Diane Hullet: or you’re super fun at parties, one or the other depends on the party.

David Maginley: Yeah. But I’m gonna be sitting in the corner with one or two people. Right. Right. And yet I found that people are aching for these conversations. They’re longing for that depth of connection. They’re lonely. Yeah. In a world and a, and a journey that in hindsight, feels all too brief. And they’re scared.

They’re scared of how they will leave this world and made, provides a comfortable, safe assurance that your exit will be efficiently managed.

Diane Hullet: Interesting. So we can challenge listeners to. I think about the question that you started with in our first half last week, which was, how would you like to die?

Isn’t that what the question was? Yeah, yeah. How would you like to die and how willing are you to grapple with some of these bigger questions about what that means to walk towards death? [00:31:00] And we don’t have time to get into this, but there’s also the whole question of dementia, right? And people who pass a point of being able to grapple with these conversations in an intellectual way, and yet they’re still living with it.

David Maginley: I really wanna amplify. I get that conversation. My mom died with dementia and she descended into it over a period of years. And you, you wanna talk about the worst of that disease. We lived it with my mom and I talked with my mom about medical assistance and dying, and I’m so grateful that we stayed at her side for all those years caring for her until we had to bring in the help of a nursing home.

But even then, daily visits and not turning away from it at all. And it changed us. It changed our relationship to each other. It changed our ability to sit [00:32:00] with suffering. It changed the depth of our love. And you know, grief is the price you pay for love. So we were able to turn towards our grief and weep our, have our sorrow and our laughter, and it in enriched our humanity in ways we never could have Comprehended.

And there were many times when I sat and thought, oh, this would’ve been so much smoother if mom could have had made, and yet so much different and impoverished.

Diane Hullet: And again, you speak to those bigger issues, right? You have a big enough family to do that. You were close enough to do that. There was financial ability to do that.

And here we struggle with these, these big economic choices of how are we gonna manage our aging population?

David Maginley: You see how multidimensional this is? Yeah. It’s No wonder Maid has appeared on the scene. I get that. If you look at an anthropological lens I’m surprised Maid didn’t show up [00:33:00] earlier. Yeah. So I’m engaging maid as a functional development that will deepen our conversation.

The same way that suffering has a functional role in ego deconstruction. I’m not gonna judge it made as corrupt or evil or bankrupt. It is impoverished, but it is nonetheless infused with an energy to awaken us to the most important conversations of our lives.

Diane Hullet: David, I just, I could go on and on. We could do like four more episodes and just keep scrolling around through chapters of the book.

There’s so much here. But we have to stop, so I’m just gonna say the title again for listeners, early Exits. Spirituality, mortality and meaning in an age of medical assistance and dying. And again, I think David has [00:34:00] used you know, just what you just said used, made as a springboard to jump into other rich, deep questions about meaning at the end of life.

So, David, how can people find out more about the work you do?

David Maginley: You can go to david mcginley.com. Now I have a funny last name. MAG. I-N-L-E-Y. So it’s actually how it sounds. David mcginley.com. I have a private practice in Psychospiritual therapy specialist David with the Canadian Association for Spiritual Care.

I do online support and in person and I do speaking and things like that. And developing courses now to help address these issues ’cause, you gotta go deeper than even the pages 530 pages.

Diane Hullet: Something. It’s a lot of pages. It’s a lot of pages. Yeah. I encourage folks to look into it and to look up your work.

I just think you’re a, a real voice in the field right now of [00:35:00] how to. Almost like round out, like give color to these conversations. It’s not black and white. There’s a, there’s a rich gray area in between that’s filled with these nuances of color that we working in the end of life field. And people grappling with these questions as physicians or, or nurses or hospice people, or lay people with family members dying or considering maid or curious about it yourself.

This is a book that deepens the conversation about what it means to be human and what it means to have made as a possibility. So I thank you so much for your time, David.

David Maginley: Very grateful. Thank you Diane. And I hope this is enriched and animated the imagination of what is possible at the end of life.

Diane Hullet: Mm, great way to put it. As always, you can find out more about the work I do at bestlifebestdeath.com. Thanks so much for listening.