Aid in Dying: A Good or a Harm?
Various views on this issue at:
http://www.nytimes.com/2016/04/30/opini ... ef=opinion
Euthanasia
Canada doesn't want to be a 'suicide tourism' destination
North America’s assisted-suicide landscape changed in a profound, historic way on Friday. As NPR reported, that was when Canada’s Senate approved that nation’s new physician-assisted-suicide law. The law was initially brought about by a ruling from Canada’s Supreme Court last year that banned a law against physician-assisted suicide, but left it to the country’s legislature to regulate and determine the scope of the practice.
One interesting aspect of Canada’s version of physician-assisted suicide is that only Canadians are eligible for it. This mirrors how it’s done in the handful of U.S. states where physician-assisted suicide is already legal, which include Washington, Oregon, and Vermont (California’s state legislature approved assisted suicide there recently, but things haven’t been finalized).
......
Belgium, which enacted its euthanasia law in 2002, is seen as taking one of the most liberal approaches, which has led to some rather strange and heart-wrenching stories. “In 2013, [the famous/infamous Belgian euthanasia physician] Wim Distelmans euthanized a forty-four-year-old transgender man, Nathan Verhelst, because Verhelst was devastated by the failure of his sex-change surgeries; he said that he felt like a monster when he looked in the mirror,” wrote Rachel Aviv in her absolute must-read piece on this subject for The New Yorker a year ago. “‘Farewell, everybody,’ Verhelst said from his hospital bed, seconds before receiving a lethal injection.” More recently, the BBC reported on a Belgian man who wants to end his life because, he says, he can’t live with his pedophilia; the first step of his application was approved. As the BBC noted, “There were 1,807 confirmed cases of euthanasia in 2013, the most recent year for which figures are available.”
There are no easy or obvious answers for any of this, but if you want to know more about how physician-assisted suicide works in Europe, definitely read that New Yorker article or watch VICE’s recent mini-doc, which I mentioned in another recent post on the subject. These controversies are only going to grow more heated.
http://www.msn.com/en-ca/news/canada/ca ... lsignoutmd
North America’s assisted-suicide landscape changed in a profound, historic way on Friday. As NPR reported, that was when Canada’s Senate approved that nation’s new physician-assisted-suicide law. The law was initially brought about by a ruling from Canada’s Supreme Court last year that banned a law against physician-assisted suicide, but left it to the country’s legislature to regulate and determine the scope of the practice.
One interesting aspect of Canada’s version of physician-assisted suicide is that only Canadians are eligible for it. This mirrors how it’s done in the handful of U.S. states where physician-assisted suicide is already legal, which include Washington, Oregon, and Vermont (California’s state legislature approved assisted suicide there recently, but things haven’t been finalized).
......
Belgium, which enacted its euthanasia law in 2002, is seen as taking one of the most liberal approaches, which has led to some rather strange and heart-wrenching stories. “In 2013, [the famous/infamous Belgian euthanasia physician] Wim Distelmans euthanized a forty-four-year-old transgender man, Nathan Verhelst, because Verhelst was devastated by the failure of his sex-change surgeries; he said that he felt like a monster when he looked in the mirror,” wrote Rachel Aviv in her absolute must-read piece on this subject for The New Yorker a year ago. “‘Farewell, everybody,’ Verhelst said from his hospital bed, seconds before receiving a lethal injection.” More recently, the BBC reported on a Belgian man who wants to end his life because, he says, he can’t live with his pedophilia; the first step of his application was approved. As the BBC noted, “There were 1,807 confirmed cases of euthanasia in 2013, the most recent year for which figures are available.”
There are no easy or obvious answers for any of this, but if you want to know more about how physician-assisted suicide works in Europe, definitely read that New Yorker article or watch VICE’s recent mini-doc, which I mentioned in another recent post on the subject. These controversies are only going to grow more heated.
http://www.msn.com/en-ca/news/canada/ca ... lsignoutmd
Terminally ill woman holds party before ending her life
SAN DIEGO — In early July, Betsy Davis emailed her closest friends and relatives to invite them to a two-day party, telling them: "These circumstances are unlike any party you have attended before, requiring emotional stamina, centeredness and openness."
And just one rule: No crying in front of her.
The 41-year-old artist with ALS, or Lou Gehrig's disease, held the gathering to say goodbye before becoming one of the first Californians to take a lethal dose of drugs under the state's new doctor-assisted suicide law for the terminally ill.
"For me and everyone who was invited, it was very challenging to consider, but there was no question that we would be there for her," said Niels Alpert, a cinematographer from New York City.
"The idea to go and spend a beautiful weekend that culminates in their suicide — that is not a normal thing, not a normal, everyday occurrence. In the background of the lovely fun, smiles and laughter that we had that weekend was the knowledge of what was coming."
1/4 SLIDES © Associated Press
This July 24, 2016 photo provided by Niels Alpert, Betsy Davis, smiles during a going away party with her family and friends in California
Davis worked out a detailed schedule for the gathering on the weekend of July 23-24, including the precise hour she planned to slip into a coma, and shared her plans with her guests in the invitation.
More than 30 people came to the party at a home with a wraparound porch in the picturesque Southern California mountain town of Ojai, flying in from New York, Chicago and across California.
One woman brought a cello. A man played a harmonica. There were cocktails, pizza from her favorite local joint, and a screening in her room of one of her favorite movies, "The Dance of Reality," based on the life of a Chilean film director.
As the weekend drew to a close, her friends kissed her goodbye, gathered for a photo and left, and Davis was wheeled out to a canopy bed on a hillside, where she took a combination of morphine, pentobarbital and chloral hydrate prescribed by her doctor.
Kelly Davis said she loved her sister's idea for the gathering, which Betsy Davis referred to as a "rebirth."
"Obviously it was hard for me. It's still hard for me," said Davis, who wrote about it for the online news outlet Voice of San Diego. "The worst was needing to leave the room every now and then, because I would get choked up. But people got it. They understood how much she was suffering and that she was fine with her decision. They respected that. They knew she wanted it to be a joyous occasion."
Davis ended her life a little over a month after a California law giving the option to the terminally ill went into effect. Four other states allow doctor-assisted suicide, with Oregon the first in 1997.
Opponents of the law in lobbying against it before state legislators argued that hastening death was morally wrong, that it puts terminally ill patients at risk for coerced death by loved ones and could become a way out for people who are uninsured or fearful of high medical bills.
Marilyn Golden of the Disability Rights Education & Defense Fund, said her heart goes out to anyone dealing with a terminal illness, but "there are still millions of people in California threatened by the danger of this law."
Davis spent months planning her exit, feeling empowered after spending the last three years losing control of her body bit by bit. The painter and performance artist could no longer stand, brush her teeth or scratch an itch. Her caretakers had to translate her slurred speech for others.
"Dear rebirth participants you're all very brave for sending me off on my journey," she wrote in her invitation. "There are no rules. Wear what you want, speak your mind, dance, hop, chant, sing, pray, but do not cry in front of me. OK, one rule."
During the party, old friends reconnected and Davis rolled in and out of the rooms in her electric wheelchair and onto the porch, talking with her guests.
At one point, she invited friends to her room to try on the clothes she had picked out for them. They modeled the outfits to laughter. Guests were also invited to take a "Betsy souvenir" — a painting, beauty product or other memento. Her sister had placed sticky notes on the items, explaining each one's significance.
Wearing a Japanese kimono she bought on a bucket-list trip she took after being diagnosed in 2013, she looked out at her last sunset and took the drugs at 6:45 p.m. with her caretaker, her doctor, her massage therapist and her sister by her side. Four hours later, she died.
Friends said it was the final performance for the artist, who once drew pictures on a stage with whipped cream.
"What Betsy did gave her the most beautiful death that any person could ever wish for," Alpert said. "By taking charge, she turned her departure into a work of art."
Her guests agreed to meet again on her birthday in June to scatter her ashes.
Photo at:
http://www.msn.com/en-ca/news/world/ter ... ailsignout
SAN DIEGO — In early July, Betsy Davis emailed her closest friends and relatives to invite them to a two-day party, telling them: "These circumstances are unlike any party you have attended before, requiring emotional stamina, centeredness and openness."
And just one rule: No crying in front of her.
The 41-year-old artist with ALS, or Lou Gehrig's disease, held the gathering to say goodbye before becoming one of the first Californians to take a lethal dose of drugs under the state's new doctor-assisted suicide law for the terminally ill.
"For me and everyone who was invited, it was very challenging to consider, but there was no question that we would be there for her," said Niels Alpert, a cinematographer from New York City.
"The idea to go and spend a beautiful weekend that culminates in their suicide — that is not a normal thing, not a normal, everyday occurrence. In the background of the lovely fun, smiles and laughter that we had that weekend was the knowledge of what was coming."
1/4 SLIDES © Associated Press
This July 24, 2016 photo provided by Niels Alpert, Betsy Davis, smiles during a going away party with her family and friends in California
Davis worked out a detailed schedule for the gathering on the weekend of July 23-24, including the precise hour she planned to slip into a coma, and shared her plans with her guests in the invitation.
More than 30 people came to the party at a home with a wraparound porch in the picturesque Southern California mountain town of Ojai, flying in from New York, Chicago and across California.
One woman brought a cello. A man played a harmonica. There were cocktails, pizza from her favorite local joint, and a screening in her room of one of her favorite movies, "The Dance of Reality," based on the life of a Chilean film director.
As the weekend drew to a close, her friends kissed her goodbye, gathered for a photo and left, and Davis was wheeled out to a canopy bed on a hillside, where she took a combination of morphine, pentobarbital and chloral hydrate prescribed by her doctor.
Kelly Davis said she loved her sister's idea for the gathering, which Betsy Davis referred to as a "rebirth."
"Obviously it was hard for me. It's still hard for me," said Davis, who wrote about it for the online news outlet Voice of San Diego. "The worst was needing to leave the room every now and then, because I would get choked up. But people got it. They understood how much she was suffering and that she was fine with her decision. They respected that. They knew she wanted it to be a joyous occasion."
Davis ended her life a little over a month after a California law giving the option to the terminally ill went into effect. Four other states allow doctor-assisted suicide, with Oregon the first in 1997.
Opponents of the law in lobbying against it before state legislators argued that hastening death was morally wrong, that it puts terminally ill patients at risk for coerced death by loved ones and could become a way out for people who are uninsured or fearful of high medical bills.
Marilyn Golden of the Disability Rights Education & Defense Fund, said her heart goes out to anyone dealing with a terminal illness, but "there are still millions of people in California threatened by the danger of this law."
Davis spent months planning her exit, feeling empowered after spending the last three years losing control of her body bit by bit. The painter and performance artist could no longer stand, brush her teeth or scratch an itch. Her caretakers had to translate her slurred speech for others.
"Dear rebirth participants you're all very brave for sending me off on my journey," she wrote in her invitation. "There are no rules. Wear what you want, speak your mind, dance, hop, chant, sing, pray, but do not cry in front of me. OK, one rule."
During the party, old friends reconnected and Davis rolled in and out of the rooms in her electric wheelchair and onto the porch, talking with her guests.
At one point, she invited friends to her room to try on the clothes she had picked out for them. They modeled the outfits to laughter. Guests were also invited to take a "Betsy souvenir" — a painting, beauty product or other memento. Her sister had placed sticky notes on the items, explaining each one's significance.
Wearing a Japanese kimono she bought on a bucket-list trip she took after being diagnosed in 2013, she looked out at her last sunset and took the drugs at 6:45 p.m. with her caretaker, her doctor, her massage therapist and her sister by her side. Four hours later, she died.
Friends said it was the final performance for the artist, who once drew pictures on a stage with whipped cream.
"What Betsy did gave her the most beautiful death that any person could ever wish for," Alpert said. "By taking charge, she turned her departure into a work of art."
Her guests agreed to meet again on her birthday in June to scatter her ashes.
Photo at:
http://www.msn.com/en-ca/news/world/ter ... ailsignout
Aid in Dying Movement Advances
New York, Colorado and the District of Columbia may soon join the handful of states where doctors are allowed to help terminally ill patients die by prescribing a lethal dose of painkillers.
A proposal to allow physician-assisted dying will be on the ballot in Colorado next month. In the District of Columbia, the District Council’s Health and Human Services Committee last week approved a physician-assisted dying bill that the full council could vote on before the end of the year. New York lawmakers, meanwhile, are hopeful that support in the Legislature for aid-in-dying bills will soon overcome opposition from religious leaders and some medical groups.
Victories in the three jurisdictions would galvanize a movement that seeks to give terminally ill Americans a dignified alternative to the dismal choices they face in most of the country. In states where assisted dying is banned, some terminal patients manage to get a lethal dose of drugs from medical professionals under the table, which exposes the health care workers to prosecution. Others are advised to starve themselves to death.
More...
http://www.nytimes.com/2016/10/10/opini ... ef=opinion
New York, Colorado and the District of Columbia may soon join the handful of states where doctors are allowed to help terminally ill patients die by prescribing a lethal dose of painkillers.
A proposal to allow physician-assisted dying will be on the ballot in Colorado next month. In the District of Columbia, the District Council’s Health and Human Services Committee last week approved a physician-assisted dying bill that the full council could vote on before the end of the year. New York lawmakers, meanwhile, are hopeful that support in the Legislature for aid-in-dying bills will soon overcome opposition from religious leaders and some medical groups.
Victories in the three jurisdictions would galvanize a movement that seeks to give terminally ill Americans a dignified alternative to the dismal choices they face in most of the country. In states where assisted dying is banned, some terminal patients manage to get a lethal dose of drugs from medical professionals under the table, which exposes the health care workers to prosecution. Others are advised to starve themselves to death.
More...
http://www.nytimes.com/2016/10/10/opini ... ef=opinion
The VSED Exit: A Way to Speed Up Dying, Without Asking Permission
Del Greenfield had endured repeated bouts of cancer over four decades, yet kept working as a peace activist in Portland, Ore., into her 80s. “She was a powerful force,” said her daughter, Bonnie Reagan.
But in 2007, Ms. Greenfield was struggling. She had been her husband’s caregiver until he died that year at 97, never telling her family she was feeling miserable herself. She’d lost much of her hearing. She required supplemental oxygen.
When she fell and broke an arm, “that was the final straw,” her daughter said. “She was a real doer, and she couldn’t function the way she wanted to. Life wasn’t joyful anymore.”
At 91, Ms. Greenfield told her family she was ready to die. She wanted a prescription for lethal drugs, and because she had active cancer, she might have obtained one under Oregon’s Death with Dignity statute for people with terminal illnesses.
Then her son-in-law, a family physician who had written such prescriptions for other patients, explained the somewhat involved process: oral and written requests, a waiting period, two physicians’ assent.
“I don’t have time for that,” Ms. Greenfield objected. “I’m just going to stop eating and drinking.”
In end-of-life circles, this option is called VSED (usually pronounced VEEsed), for voluntarily stopping eating and drinking. It causes death by dehydration, usually within seven to 14 days. To people with serious illnesses who want to hasten their deaths, a small but determined group, VSED can sound like a reasonable exit strategy.
Unlike aid with dying, now legal in five states, it doesn’t require governmental action or physicians’ authorization. Patients don’t need a terminal diagnosis, and they don’t have to prove mental capacity. They do need resolve.
“It’s for strong-willed, independent people with very supportive families,” said Dr. Timothy Quill, a veteran palliative care physician at the University of Rochester Medical Center.
He was speaking at a conference on VSED, billed as the nation’s first, at Seattle University School of Law this month. It drew about 220 participants — physicians and nurses, lawyers, bioethicists, academics of various stripes, theologians, hospice staff. (Disclosure: I was also a speaker, and received an honorarium and some travel costs.)
What the gathering made clear was that much about VSED remains unclear.
Is it legal?
For a mentally competent patient, able to grasp and communicate decisions, probably so, said Thaddeus Pope, director of the Health Law Institute at Mitchell Hamline School of Law in St. Paul, Minn. His research has found no laws expressly prohibiting competent people from VSED, and the right to refuse medical and health care intervention is well established.
Still, he pointed out, “absence of prohibition is not the same as permission.” Health care professionals can be reluctant to become involved, because “they want a green light, and there isn’t one of those for VSED,” he added.
The question grows much murkier for patients with dementia or mental illness who have specified VSED under certain circumstances through advance directives. Several states, including Wisconsin and New York, forbid health care surrogates to stop food and fluids. (Oregon legislators, on the other hand, are considering drafting a bill to allow surrogates to withhold nutrition.)
The question intrigues bioethicists. Can your current competent self cut off nutrition and hydration for your future demented self? In a handful of court decisions, judges have declined to enforce such directives.
Can VSED be comfortable and provide a peaceful death?
“The start of it is generally quite comfortable,” Dr. Quill said he had found, having cared for such patients. The not-eating part comes fairly easily, health professionals say; the seriously ill often lose their appetites anyway.
Coping with thirst can be much more difficult. Yet even sips of water prolong the dying process.
“You want a medical partner to manage your symptoms,” Dr. Quill said. “It’s harder than you think.”
Keeping patients’ mouths moistened and having aggressive pain medication available make a big difference, health professionals say.
At the conference, the Dutch researcher Dr. Eva Bolt presented results from a survey of family physicians in the Netherlands, describing 99 cases of VSED. Their patients (median age: 83) had serious diseases and depended on others for everyday care; three-quarters had life expectancies of less than a year.
In their final three days, their doctors reported, 14 percent suffered pain, and smaller percentages experienced fatigue, impaired cognition, thirst or delirium.
Still, 80 percent of the physicians said the process had unfolded as the patients wanted; only 2 percent said it hadn’t. The median time from the start of their fasts until death was seven days.
Those results mirror a 2003 study of hospice nurses in Oregon who had cared for VSED patients. Rating their deaths on a scale from 0 to 9 (a very good death), the nurses assigned a median score of 8. Nearly all of the patients died within 15 days.
The slower pace of death from fasting, compared with ingesting barbiturates, gives people time to say goodbye and, for the first few days, to change their minds. Several conference speakers described patients who had fasted and stopped a few times before continuing until death.
That’s hard on families and caregivers, though. And slowness won’t benefit people who are dying with severe shortness of breath or pain. “Two weeks is a lifetime in that situation,” Dr. Quill said.
Other obstacles could restrict VSED. A quiet choice in a private home, it could be derailed in nursing homes and assisted living facilities where administrators fear lawsuits or regulatory sanctions. Physicians might decline to participate; home care aides might quit.
Moreover, major religious groups have yet to declare whether they consider VSED an acceptable act of self-determination or a suicide, anathema in most faiths.
Phyllis Shacter and her husband, Alan Alberts, a computer scientist who received a Alzheimer’s disease diagnosis in 2011, had few doubts, however. VSED allowed him to escape the disease that had slowly killed his mother.
No state allows a person with dementia to use a “death with dignity” law, but with support from his wife, doctor and two caregivers, Mr. Alberts, 76, died peacefully at home in 2013 after a nine-day fast.
“I’m glad my husband fulfilled his desire not to live into the final stages of Alzheimer’s,” Ms. Shacter said.
On the other hand, Judith Schwarz, clinical coordinator of End of Life Choices New York, told of an 81-year-old attempting VSED with inadequate pain medication, crying out to his wife at night, “I’m dying of thirst.”
“And of course, he was, but slowly,” Dr. Schwarz said. “This was a horror show.”
Del Greenfield fared better. “She didn’t use any medicines, just some oxygen,” her daughter said. Ms. Greenfield’s children, grandchildren and great-grandchildren came to see her, and “she was completely peaceful, chatting and joking and telling people she loved them.”
She announced that she had one regret. “We all leaned in,” Bonnie Reagan said. “And she said, ‘I wish I’d seen the Rolling Stones the last time they came to Portland.’”
On the fifth day of fasting, “she just fell asleep,” and died about 36 hours later.
http://www.nytimes.com/2016/10/25/healt ... dline&te=1
Del Greenfield had endured repeated bouts of cancer over four decades, yet kept working as a peace activist in Portland, Ore., into her 80s. “She was a powerful force,” said her daughter, Bonnie Reagan.
But in 2007, Ms. Greenfield was struggling. She had been her husband’s caregiver until he died that year at 97, never telling her family she was feeling miserable herself. She’d lost much of her hearing. She required supplemental oxygen.
When she fell and broke an arm, “that was the final straw,” her daughter said. “She was a real doer, and she couldn’t function the way she wanted to. Life wasn’t joyful anymore.”
At 91, Ms. Greenfield told her family she was ready to die. She wanted a prescription for lethal drugs, and because she had active cancer, she might have obtained one under Oregon’s Death with Dignity statute for people with terminal illnesses.
Then her son-in-law, a family physician who had written such prescriptions for other patients, explained the somewhat involved process: oral and written requests, a waiting period, two physicians’ assent.
“I don’t have time for that,” Ms. Greenfield objected. “I’m just going to stop eating and drinking.”
In end-of-life circles, this option is called VSED (usually pronounced VEEsed), for voluntarily stopping eating and drinking. It causes death by dehydration, usually within seven to 14 days. To people with serious illnesses who want to hasten their deaths, a small but determined group, VSED can sound like a reasonable exit strategy.
Unlike aid with dying, now legal in five states, it doesn’t require governmental action or physicians’ authorization. Patients don’t need a terminal diagnosis, and they don’t have to prove mental capacity. They do need resolve.
“It’s for strong-willed, independent people with very supportive families,” said Dr. Timothy Quill, a veteran palliative care physician at the University of Rochester Medical Center.
He was speaking at a conference on VSED, billed as the nation’s first, at Seattle University School of Law this month. It drew about 220 participants — physicians and nurses, lawyers, bioethicists, academics of various stripes, theologians, hospice staff. (Disclosure: I was also a speaker, and received an honorarium and some travel costs.)
What the gathering made clear was that much about VSED remains unclear.
Is it legal?
For a mentally competent patient, able to grasp and communicate decisions, probably so, said Thaddeus Pope, director of the Health Law Institute at Mitchell Hamline School of Law in St. Paul, Minn. His research has found no laws expressly prohibiting competent people from VSED, and the right to refuse medical and health care intervention is well established.
Still, he pointed out, “absence of prohibition is not the same as permission.” Health care professionals can be reluctant to become involved, because “they want a green light, and there isn’t one of those for VSED,” he added.
The question grows much murkier for patients with dementia or mental illness who have specified VSED under certain circumstances through advance directives. Several states, including Wisconsin and New York, forbid health care surrogates to stop food and fluids. (Oregon legislators, on the other hand, are considering drafting a bill to allow surrogates to withhold nutrition.)
The question intrigues bioethicists. Can your current competent self cut off nutrition and hydration for your future demented self? In a handful of court decisions, judges have declined to enforce such directives.
Can VSED be comfortable and provide a peaceful death?
“The start of it is generally quite comfortable,” Dr. Quill said he had found, having cared for such patients. The not-eating part comes fairly easily, health professionals say; the seriously ill often lose their appetites anyway.
Coping with thirst can be much more difficult. Yet even sips of water prolong the dying process.
“You want a medical partner to manage your symptoms,” Dr. Quill said. “It’s harder than you think.”
Keeping patients’ mouths moistened and having aggressive pain medication available make a big difference, health professionals say.
At the conference, the Dutch researcher Dr. Eva Bolt presented results from a survey of family physicians in the Netherlands, describing 99 cases of VSED. Their patients (median age: 83) had serious diseases and depended on others for everyday care; three-quarters had life expectancies of less than a year.
In their final three days, their doctors reported, 14 percent suffered pain, and smaller percentages experienced fatigue, impaired cognition, thirst or delirium.
Still, 80 percent of the physicians said the process had unfolded as the patients wanted; only 2 percent said it hadn’t. The median time from the start of their fasts until death was seven days.
Those results mirror a 2003 study of hospice nurses in Oregon who had cared for VSED patients. Rating their deaths on a scale from 0 to 9 (a very good death), the nurses assigned a median score of 8. Nearly all of the patients died within 15 days.
The slower pace of death from fasting, compared with ingesting barbiturates, gives people time to say goodbye and, for the first few days, to change their minds. Several conference speakers described patients who had fasted and stopped a few times before continuing until death.
That’s hard on families and caregivers, though. And slowness won’t benefit people who are dying with severe shortness of breath or pain. “Two weeks is a lifetime in that situation,” Dr. Quill said.
Other obstacles could restrict VSED. A quiet choice in a private home, it could be derailed in nursing homes and assisted living facilities where administrators fear lawsuits or regulatory sanctions. Physicians might decline to participate; home care aides might quit.
Moreover, major religious groups have yet to declare whether they consider VSED an acceptable act of self-determination or a suicide, anathema in most faiths.
Phyllis Shacter and her husband, Alan Alberts, a computer scientist who received a Alzheimer’s disease diagnosis in 2011, had few doubts, however. VSED allowed him to escape the disease that had slowly killed his mother.
No state allows a person with dementia to use a “death with dignity” law, but with support from his wife, doctor and two caregivers, Mr. Alberts, 76, died peacefully at home in 2013 after a nine-day fast.
“I’m glad my husband fulfilled his desire not to live into the final stages of Alzheimer’s,” Ms. Shacter said.
On the other hand, Judith Schwarz, clinical coordinator of End of Life Choices New York, told of an 81-year-old attempting VSED with inadequate pain medication, crying out to his wife at night, “I’m dying of thirst.”
“And of course, he was, but slowly,” Dr. Schwarz said. “This was a horror show.”
Del Greenfield fared better. “She didn’t use any medicines, just some oxygen,” her daughter said. Ms. Greenfield’s children, grandchildren and great-grandchildren came to see her, and “she was completely peaceful, chatting and joking and telling people she loved them.”
She announced that she had one regret. “We all leaned in,” Bonnie Reagan said. “And she said, ‘I wish I’d seen the Rolling Stones the last time they came to Portland.’”
On the fifth day of fasting, “she just fell asleep,” and died about 36 hours later.
http://www.nytimes.com/2016/10/25/healt ... dline&te=1
On Assisted Suicide, Going Beyond ‘Do No Harm’
DURHAM, N.C. — Out of nowhere, a patient I recently met in my clinic told me, “If my heart stops, doctor, just let me go.”
“Why?” I asked him.
Without hesitating, he replied, “Because there are worse states than death.”
Advances in medical therapies, in addition to their immense benefits, have changed death to dying — from an instantaneous event to a long, drawn-out process. Death is preceded by years of disability, countless procedures and powerful medications. Only one in five patients is able to die at home. These days many patients fear what it takes to live more than death itself.
That may explain why this year, behind the noise of the presidential campaign, the right-to-die movement has made several big legislative advances. In June, California became the fifth and largest state to put an assisted suicide law into effect; this week the District of Columbia Council passed a similar law. And on Tuesday voters in Colorado will decide whether to allow physician-assisted suicide in their state as well.
Yet even as assisted suicide has generated broader support, the group most vehemently opposed to it hasn’t budged: doctors.
That resistance is traditionally couched in doctors’ adherence to our understanding of the Hippocratic oath. But it’s becoming harder for us to know what is meant by “do no harm.” With the amount of respirators and other apparatus at our disposal, it is almost impossible for most patients to die unless doctors’ or patients’ families end life support. The withdrawal of treatment, therefore, is now perhaps the most common way critically ill patients die in the hospital.
While “withdrawal” implies a passive act, terminating artificial support feels decidedly active. Unlike assisted suicide, which requires patients to be screened for depression, patients can ask for treatment withdrawal even if they have major depression or are suicidal. Furthermore, withdrawal decisions are usually made for patients who are so sick that they frequently have no voice in the matter.
Some doctors skirt the question of assisted suicide through opiate prescriptions, which are almost universally prescribed for patients nearing death. Even though these medications can slow down breathing to the point of stoppage, doctors and nurses are very comfortable giving them, knowing that they might hasten a “natural” death.
In extreme cases, when even morphine isn’t enough, patients are given anesthesia to ease their deaths. The last time I administered what is called terminal sedation, another accepted strategy, was in the case of a patient with abdominal cancer whose intestines were perforated and for whom surgery was not an option. The patient, who had been writhing uncontrollably in pain, was finally comfortable. Yet terminal sedation, necessary as it was, felt closer to active euthanasia than assisted suicide would have.
While the way people die has changed, the arguments made against assisted suicide have not. We are warned of a slippery slope, implying that legalization of assisted suicide would eventually lead to eugenic sterilization reminiscent of Nazi Germany. But no such drift has been observed in any of the countries where it has been legalized.
We are cautioned that legalization would put vulnerable populations like the uninsured and the disabled at risk; however, years of data from Oregon demonstrate that the vast majority of patients who opt for it are white, affluent and highly educated.
We are also told that assisted suicide laws will allow doctors and nurses to avoid providing high-quality palliative care to patients, but the data suggests the opposite: A strong argument for legalization is that it sensitizes doctors about ensuring the comfort of patients with terminal illnesses; if suicide is an option, they’ll do what they can to preclude it.
And, again, we are counseled that physicians should do no harm. But medical harm is already one of the leading causes of death — and in any case, isn’t preventing patients from dying on their terms its own form of medical harm?
With the right safeguards in place, assisted suicide can help give terminally ill patients a semblance of control over their lives as disease, disability and the medical machine tries to wrest it away from them. In Oregon, of the exceedingly few patients who have requested a lethal prescription — 1,545 in 18 years — about 35 percent never uses it; for them, it is merely a means to self-affirmation, a reassuring option.
Instead of using our energies to obfuscate and obstruct how patients might want to end their lives when faced with life-limiting disease, we physicians need to reassess how we can help patients achieve their goals when the end is near. We need to be able to offer an option for those who desire assisted suicide, so that they can openly take control of their death.
Instead of seeking guidance from ancient edicts, we need to re-evaluate just what patients face in modern times. Even if it is a course we personally wouldn’t recommend, we should consider allowing it for patients suffering from debilitating disease. How we die has changed tremendously over the past few decades — and so must we.
Haider Javed Warraich, a fellow in cardiovascular medicine at Duke University Medical Center, is the author of the forthcoming book “Modern Death: How Medicine Changed the End of Life.”
http://www.nytimes.com/2016/11/05/opini ... inion&_r=1
DURHAM, N.C. — Out of nowhere, a patient I recently met in my clinic told me, “If my heart stops, doctor, just let me go.”
“Why?” I asked him.
Without hesitating, he replied, “Because there are worse states than death.”
Advances in medical therapies, in addition to their immense benefits, have changed death to dying — from an instantaneous event to a long, drawn-out process. Death is preceded by years of disability, countless procedures and powerful medications. Only one in five patients is able to die at home. These days many patients fear what it takes to live more than death itself.
That may explain why this year, behind the noise of the presidential campaign, the right-to-die movement has made several big legislative advances. In June, California became the fifth and largest state to put an assisted suicide law into effect; this week the District of Columbia Council passed a similar law. And on Tuesday voters in Colorado will decide whether to allow physician-assisted suicide in their state as well.
Yet even as assisted suicide has generated broader support, the group most vehemently opposed to it hasn’t budged: doctors.
That resistance is traditionally couched in doctors’ adherence to our understanding of the Hippocratic oath. But it’s becoming harder for us to know what is meant by “do no harm.” With the amount of respirators and other apparatus at our disposal, it is almost impossible for most patients to die unless doctors’ or patients’ families end life support. The withdrawal of treatment, therefore, is now perhaps the most common way critically ill patients die in the hospital.
While “withdrawal” implies a passive act, terminating artificial support feels decidedly active. Unlike assisted suicide, which requires patients to be screened for depression, patients can ask for treatment withdrawal even if they have major depression or are suicidal. Furthermore, withdrawal decisions are usually made for patients who are so sick that they frequently have no voice in the matter.
Some doctors skirt the question of assisted suicide through opiate prescriptions, which are almost universally prescribed for patients nearing death. Even though these medications can slow down breathing to the point of stoppage, doctors and nurses are very comfortable giving them, knowing that they might hasten a “natural” death.
In extreme cases, when even morphine isn’t enough, patients are given anesthesia to ease their deaths. The last time I administered what is called terminal sedation, another accepted strategy, was in the case of a patient with abdominal cancer whose intestines were perforated and for whom surgery was not an option. The patient, who had been writhing uncontrollably in pain, was finally comfortable. Yet terminal sedation, necessary as it was, felt closer to active euthanasia than assisted suicide would have.
While the way people die has changed, the arguments made against assisted suicide have not. We are warned of a slippery slope, implying that legalization of assisted suicide would eventually lead to eugenic sterilization reminiscent of Nazi Germany. But no such drift has been observed in any of the countries where it has been legalized.
We are cautioned that legalization would put vulnerable populations like the uninsured and the disabled at risk; however, years of data from Oregon demonstrate that the vast majority of patients who opt for it are white, affluent and highly educated.
We are also told that assisted suicide laws will allow doctors and nurses to avoid providing high-quality palliative care to patients, but the data suggests the opposite: A strong argument for legalization is that it sensitizes doctors about ensuring the comfort of patients with terminal illnesses; if suicide is an option, they’ll do what they can to preclude it.
And, again, we are counseled that physicians should do no harm. But medical harm is already one of the leading causes of death — and in any case, isn’t preventing patients from dying on their terms its own form of medical harm?
With the right safeguards in place, assisted suicide can help give terminally ill patients a semblance of control over their lives as disease, disability and the medical machine tries to wrest it away from them. In Oregon, of the exceedingly few patients who have requested a lethal prescription — 1,545 in 18 years — about 35 percent never uses it; for them, it is merely a means to self-affirmation, a reassuring option.
Instead of using our energies to obfuscate and obstruct how patients might want to end their lives when faced with life-limiting disease, we physicians need to reassess how we can help patients achieve their goals when the end is near. We need to be able to offer an option for those who desire assisted suicide, so that they can openly take control of their death.
Instead of seeking guidance from ancient edicts, we need to re-evaluate just what patients face in modern times. Even if it is a course we personally wouldn’t recommend, we should consider allowing it for patients suffering from debilitating disease. How we die has changed tremendously over the past few decades — and so must we.
Haider Javed Warraich, a fellow in cardiovascular medicine at Duke University Medical Center, is the author of the forthcoming book “Modern Death: How Medicine Changed the End of Life.”
http://www.nytimes.com/2016/11/05/opini ... inion&_r=1
Physician Aid in Dying Gains Acceptance in the U.S.
Extract:
In recent months, this option has become available to a growing number of Americans. Last June, aid-in-dying legislation took effect in California, the most populous state. In November, Colorado voters approved a ballot measure by nearly a two-thirds majority. The District of Columbia Council has passed a similar law, and the mayor quietly signed it last month.
Aid in dying was already legal in Washington, Vermont, Montana and Oregon. So even if the District of Columbia’s law is blocked, as a prominent Republican representative has threatened to do, the country has arrived at a remarkable moment: Close to 20 percent of Americans live in jurisdictions where adults can legally end their lives if they are terminally ill and meet eligibility requirements.
More..
https://www.nytimes.com/2017/01/16/heal ... 05309&_r=0[/b]
Extract:
In recent months, this option has become available to a growing number of Americans. Last June, aid-in-dying legislation took effect in California, the most populous state. In November, Colorado voters approved a ballot measure by nearly a two-thirds majority. The District of Columbia Council has passed a similar law, and the mayor quietly signed it last month.
Aid in dying was already legal in Washington, Vermont, Montana and Oregon. So even if the District of Columbia’s law is blocked, as a prominent Republican representative has threatened to do, the country has arrived at a remarkable moment: Close to 20 percent of Americans live in jurisdictions where adults can legally end their lives if they are terminally ill and meet eligibility requirements.
More..
https://www.nytimes.com/2017/01/16/heal ... 05309&_r=0[/b]
1,300 Canadians have died with medical assistance since legalization — here's one man's story
'I just told him I loved him, held him,' man's husband tells CBC about medically assisted death
On Friday Jan. 6, Rob Rollins and his husband John MacTavish woke up just as they would any other morning. John got his brother Bobby MacTavish, who is unable to speak or walk, ready to go to his day program. But this time, before he left, Bobby spent about an hour with Rollins in his bedroom. The two were saying goodbye.
One of the couple's closest friends, Claire Cowley, soon arrived and sat in the living room with Rollins and MacTavish. The three were chatting "like it was any other morning," MacTavish says. "Which was weird, because I kept looking at the clock, knowing that, you know, the doctor was going to drive in that driveway."
Before the doctor arrived, Rollins, 56, wanted to make sure some practical things were in order.
"[He] tidied up his desk, made sure I knew where things were and gave me the passwords," MacTavish, 54, says. "You know, made sure that I knew how to run the dishwasher."
A nurse from their rural village of Delta, northeast of Kingston, Ont., who had cared for Rollins as he battled throat and neck cancer, arrived at about 10 a.m. and inserted an IV tube into his arm. His family doctor also came, although he wasn't required to, and the group kept chatting.
MacTavish says when the local doctor who would do the final procedure arrived at the house "he talked to Rob to make sure that Rob knew what was happening and still agreeable."
The couple walked down the hallway of their small house and Rollins had a cigarette, while MacTavish held his hand. Then, they came back to the living room.
"He said goodbye to Claire, who's his best friend, to the doctors and the nurse," MacTavish remembers. "We went into the bedroom, he got into bed. I covered him up with his quilt. I laid down beside him. The doctor came in and asked if there was anything we needed to say to each other."
Then, he administered the lethal dose of medication through Rollins's IV tube.
"I just told him I loved him, held him," MacTavish says through tears. "And it was over in about five minutes. Very peaceful."
More..
http://www.cbc.ca/beta/news/health/medi ... -1.4056700
'I just told him I loved him, held him,' man's husband tells CBC about medically assisted death
On Friday Jan. 6, Rob Rollins and his husband John MacTavish woke up just as they would any other morning. John got his brother Bobby MacTavish, who is unable to speak or walk, ready to go to his day program. But this time, before he left, Bobby spent about an hour with Rollins in his bedroom. The two were saying goodbye.
One of the couple's closest friends, Claire Cowley, soon arrived and sat in the living room with Rollins and MacTavish. The three were chatting "like it was any other morning," MacTavish says. "Which was weird, because I kept looking at the clock, knowing that, you know, the doctor was going to drive in that driveway."
Before the doctor arrived, Rollins, 56, wanted to make sure some practical things were in order.
"[He] tidied up his desk, made sure I knew where things were and gave me the passwords," MacTavish, 54, says. "You know, made sure that I knew how to run the dishwasher."
A nurse from their rural village of Delta, northeast of Kingston, Ont., who had cared for Rollins as he battled throat and neck cancer, arrived at about 10 a.m. and inserted an IV tube into his arm. His family doctor also came, although he wasn't required to, and the group kept chatting.
MacTavish says when the local doctor who would do the final procedure arrived at the house "he talked to Rob to make sure that Rob knew what was happening and still agreeable."
The couple walked down the hallway of their small house and Rollins had a cigarette, while MacTavish held his hand. Then, they came back to the living room.
"He said goodbye to Claire, who's his best friend, to the doctors and the nurse," MacTavish remembers. "We went into the bedroom, he got into bed. I covered him up with his quilt. I laid down beside him. The doctor came in and asked if there was anything we needed to say to each other."
Then, he administered the lethal dose of medication through Rollins's IV tube.
"I just told him I loved him, held him," MacTavish says through tears. "And it was over in about five minutes. Very peaceful."
More..
http://www.cbc.ca/beta/news/health/medi ... -1.4056700
Should I Help My Patients Die?
OAKLAND, Calif. — I WAS leafing through a patient’s chart last year when a colleague tapped me on the shoulder. “I have a patient who is asking about the End of Life Option Act,” he said in a low voice. “Can we even do that here?”
I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.) Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.
That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn’t.
I could see my own discomfort mirrored in his face. “Can you help us with it?” he asked me. “Of course,” I said. Then I felt my stomach lurch.
California’s law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.
But that is where the law leaves off. The details of patient selection and protocol, even the composition of the lethal compound, are left to the individual doctor or hospital policy. Our hospital, like many others at that time, was still in the early stages of creating a policy and procedure. To me and many of my colleagues in California, it felt as if the law had passed so quickly that we weren’t fully prepared to deal with it.
More...
https://www.nytimes.com/2017/08/05/opin ... inion&_r=0
OAKLAND, Calif. — I WAS leafing through a patient’s chart last year when a colleague tapped me on the shoulder. “I have a patient who is asking about the End of Life Option Act,” he said in a low voice. “Can we even do that here?”
I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.) Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.
That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn’t.
I could see my own discomfort mirrored in his face. “Can you help us with it?” he asked me. “Of course,” I said. Then I felt my stomach lurch.
California’s law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.
But that is where the law leaves off. The details of patient selection and protocol, even the composition of the lethal compound, are left to the individual doctor or hospital policy. Our hospital, like many others at that time, was still in the early stages of creating a policy and procedure. To me and many of my colleagues in California, it felt as if the law had passed so quickly that we weren’t fully prepared to deal with it.
More...
https://www.nytimes.com/2017/08/05/opin ... inion&_r=0
A sombre success
The Australian state of Victoria legalises assisted dying
Some 50 bills have been introduced in different Australian states. This is the first to pass
THE quest has failed many times. The past 20 years have seen around 50 attempts to pass laws in different Australian states to allow doctors to help terminally ill people end their lives. All have suffered defeat. But on November 29th Victoria finally made history, when its parliament passed Australia’s first state law to legalise doctor-assisted dying.
The law, which will take effect in 2019, allows people with an advanced, incurable illness to request “assisted dying” if their suffering cannot be relieved “in a manner that the person considers tolerable”. Patients must make three successive requests for such help; doctors are banned from initiating discussion of it as an option. The original bill had proposed limiting eligibility to those who were expected to live no more than a year. Victoria’s lawmakers reduced that to six months, with a few exceptions.
Most earlier attempts to legalise assisted dying were private members’ bills, but the state government proposed this one. Brian Owler, a neurosurgeon advising the government, believes this was crucial to its success. Daniel Andrews, Victoria’s premier, and Jill Hennessy, its health minister, both said that seeing a parent suffer from a debilitating illness had led them to support the law.
Assisted dying is legal only in Colombia, Canada, a few European countries and some American states. Mr Andrews says the new law is the most conservative in the world. Yet it has rankled some other members of his party, Labor. Paul Keating, a former Labor prime minister, says it “stands for everything a truly civil society should stand against”.
It has divided doctors, too. Michael Gannon, head of the Australian Medical Association, a lobby group, says Victoria’s parliament has “changed one of the fundamentals of medical ethics”. Doctors are “concerned about where it might lead”. Mr Owler retorts: “It’s not about doctors. It’s about people who are suffering and dying.” Andrew McGee, a health-law specialist at Queensland University of Technology, thinks Victoria’s law prevailed because the government had embarked earlier on a “thorough” public inquiry that reassured people “this type of regime can succeed.”
Australia has six states and two self-governing territories. The Northern Territory legalised assisted dying 21 years ago. But the national government can overturn territorial legislation, and did so on that occasion within a year. It has no such power over state laws, however. Malcolm Turnbull, Australia’s prime minister, who leads the right-wing Liberal Party, says he would not have voted for Victoria’s law. But Mr Owler is confident it will become a “blueprint” for change elsewhere in Australia.
https://www.economist.com/news/asia/217 ... lydispatch
The Australian state of Victoria legalises assisted dying
Some 50 bills have been introduced in different Australian states. This is the first to pass
THE quest has failed many times. The past 20 years have seen around 50 attempts to pass laws in different Australian states to allow doctors to help terminally ill people end their lives. All have suffered defeat. But on November 29th Victoria finally made history, when its parliament passed Australia’s first state law to legalise doctor-assisted dying.
The law, which will take effect in 2019, allows people with an advanced, incurable illness to request “assisted dying” if their suffering cannot be relieved “in a manner that the person considers tolerable”. Patients must make three successive requests for such help; doctors are banned from initiating discussion of it as an option. The original bill had proposed limiting eligibility to those who were expected to live no more than a year. Victoria’s lawmakers reduced that to six months, with a few exceptions.
Most earlier attempts to legalise assisted dying were private members’ bills, but the state government proposed this one. Brian Owler, a neurosurgeon advising the government, believes this was crucial to its success. Daniel Andrews, Victoria’s premier, and Jill Hennessy, its health minister, both said that seeing a parent suffer from a debilitating illness had led them to support the law.
Assisted dying is legal only in Colombia, Canada, a few European countries and some American states. Mr Andrews says the new law is the most conservative in the world. Yet it has rankled some other members of his party, Labor. Paul Keating, a former Labor prime minister, says it “stands for everything a truly civil society should stand against”.
It has divided doctors, too. Michael Gannon, head of the Australian Medical Association, a lobby group, says Victoria’s parliament has “changed one of the fundamentals of medical ethics”. Doctors are “concerned about where it might lead”. Mr Owler retorts: “It’s not about doctors. It’s about people who are suffering and dying.” Andrew McGee, a health-law specialist at Queensland University of Technology, thinks Victoria’s law prevailed because the government had embarked earlier on a “thorough” public inquiry that reassured people “this type of regime can succeed.”
Australia has six states and two self-governing territories. The Northern Territory legalised assisted dying 21 years ago. But the national government can overturn territorial legislation, and did so on that occasion within a year. It has no such power over state laws, however. Malcolm Turnbull, Australia’s prime minister, who leads the right-wing Liberal Party, says he would not have voted for Victoria’s law. But Mr Owler is confident it will become a “blueprint” for change elsewhere in Australia.
https://www.economist.com/news/asia/217 ... lydispatch
Guernsey considers whether to legalise assisted dying
Coming out in favour could put the island on course for a constitutional clash with Britain
PEOPLE used to joke, “Welcome to Guernsey, please put your watch back 50 years,” recalls Tony Lee, who moved to the island in the 1970s to work as a doctor. The British crown dependency off the coast of France, formerly part of the ancient duchy of Normandy, is a conservative place (its politics are characterised by “inertia”, notes one politician). Only in 2015 did all shops gain the right to trade on a Sunday, for instance, and its narrow lanes are dotted with churches. All this makes it an unlikely location for the trailblazing introduction of a controversial policy.
Nevertheless, in May the island’s parliament, the States of Deliberation, will vote on whether to legalise assisted dying. If its 40 members come down in favour, a working party would examine issues like whether to restrict the right to those with terminal illnesses, and how doctors’ approval might work, before returning with a fleshed-out proposal in 18 months. Such a vote would set Guernsey on the path to becoming the first place in the British Isles to legalise assisted dying—and, in doing so, raise thorny constitutional questions.
More...
https://www.economist.com/news/britain/ ... m=20180410
Coming out in favour could put the island on course for a constitutional clash with Britain
PEOPLE used to joke, “Welcome to Guernsey, please put your watch back 50 years,” recalls Tony Lee, who moved to the island in the 1970s to work as a doctor. The British crown dependency off the coast of France, formerly part of the ancient duchy of Normandy, is a conservative place (its politics are characterised by “inertia”, notes one politician). Only in 2015 did all shops gain the right to trade on a Sunday, for instance, and its narrow lanes are dotted with churches. All this makes it an unlikely location for the trailblazing introduction of a controversial policy.
Nevertheless, in May the island’s parliament, the States of Deliberation, will vote on whether to legalise assisted dying. If its 40 members come down in favour, a working party would examine issues like whether to restrict the right to those with terminal illnesses, and how doctors’ approval might work, before returning with a fleshed-out proposal in 18 months. Such a vote would set Guernsey on the path to becoming the first place in the British Isles to legalise assisted dying—and, in doing so, raise thorny constitutional questions.
More...
https://www.economist.com/news/britain/ ... m=20180410
Why David Goodall, 104, Renowned Australian Scientist, Wants to Die
David Goodall, 104, an accomplished Australian scientist, isn’t terminally ill, but he wants to die.
Mr. Goodall says his quality of life has deteriorated so badly that he has no reason to live, and he would like to end his life through assisted suicide. But he can’t do it in his own country, where the practice is banned.
So on Wednesday, he took what was expected to be his last flight, bound for Europe, to accomplish his goal — and his quest has renewed a debate in Australia about the right to end one’s life and what role others should play.
Mr. Goodall left his home in Perth to fly to an assisted-dying agency in Basel, Switzerland, a country where assisted suicide has been allowed for decades.
Though nations like Belgium, Canada, Colombia, Luxembourg and the Netherlands (along with some American states and the District of Columbia) permit euthanasia or assisted suicide, Switzerland is the only country with centers that offer assisted-suicide services to foreigners if the person assisting acts unselfishly.
More....
https://www.nytimes.com/2018/05/03/worl ... 9877220504
David Goodall, 104, an accomplished Australian scientist, isn’t terminally ill, but he wants to die.
Mr. Goodall says his quality of life has deteriorated so badly that he has no reason to live, and he would like to end his life through assisted suicide. But he can’t do it in his own country, where the practice is banned.
So on Wednesday, he took what was expected to be his last flight, bound for Europe, to accomplish his goal — and his quest has renewed a debate in Australia about the right to end one’s life and what role others should play.
Mr. Goodall left his home in Perth to fly to an assisted-dying agency in Basel, Switzerland, a country where assisted suicide has been allowed for decades.
Though nations like Belgium, Canada, Colombia, Luxembourg and the Netherlands (along with some American states and the District of Columbia) permit euthanasia or assisted suicide, Switzerland is the only country with centers that offer assisted-suicide services to foreigners if the person assisting acts unselfishly.
More....
https://www.nytimes.com/2018/05/03/worl ... 9877220504
Was a Scientist’s Death Murder or an ‘Act of Mercy’?
Excerpt:
Then, one evening this month, Ms. White was found dead. She was 92. Several days later, her daughter was charged with murdering her.
The accusations have stunned people who knew Ms. White and her family, as well as Bundanoon, the small town where neighbors remembered an attentive daughter who would take her mother to the salon for haircuts and stop in the cafe across the street. Many insist that whatever happened must have been motivated by compassion and love.
“It would have been done as an act of mercy,” said Jenny Goldie, a friend who had known Ms. White for 30 years. “There wouldn’t have been any malice attached to it at all.”
The case has saddened and confused Ms. White’s friends. But it has also tapped into the broader debate in Australia over euthanasia and assisted dying, which has been renewed in recent weeks as Parliament considered a proposal to overturn a two-decade-old ban on the practice in the nation’s territories.
The legislation ultimately failed, but last year, the state of Victoria became the first in Australia to legalize assisted dying, allowing someone with an incurable illness and limited life expectancy to obtain a dose of a lethal drug, and other states are considering their own legislation. (The Victoria law requires that a patient be mentally sound enough to make the request on his or her own, preventing relatives or caretakers from applying on an ill person’s behalf.)
More...
https://www.nytimes.com/2018/08/28/worl ... 3053090830
Excerpt:
Then, one evening this month, Ms. White was found dead. She was 92. Several days later, her daughter was charged with murdering her.
The accusations have stunned people who knew Ms. White and her family, as well as Bundanoon, the small town where neighbors remembered an attentive daughter who would take her mother to the salon for haircuts and stop in the cafe across the street. Many insist that whatever happened must have been motivated by compassion and love.
“It would have been done as an act of mercy,” said Jenny Goldie, a friend who had known Ms. White for 30 years. “There wouldn’t have been any malice attached to it at all.”
The case has saddened and confused Ms. White’s friends. But it has also tapped into the broader debate in Australia over euthanasia and assisted dying, which has been renewed in recent weeks as Parliament considered a proposal to overturn a two-decade-old ban on the practice in the nation’s territories.
The legislation ultimately failed, but last year, the state of Victoria became the first in Australia to legalize assisted dying, allowing someone with an incurable illness and limited life expectancy to obtain a dose of a lethal drug, and other states are considering their own legislation. (The Victoria law requires that a patient be mentally sound enough to make the request on his or her own, preventing relatives or caretakers from applying on an ill person’s behalf.)
More...
https://www.nytimes.com/2018/08/28/worl ... 3053090830
Could I Kill My Mother?
I am not a doctor. I am not very brave. But I want to do what she wants.
Excerpt:
Lung cancer is a frightening illness. In its final stages, it can make you feel as though you’re drowning, or suffocating. A formidable pharmacological stew of medications can help to suppress the symptoms, but no pill can take away the pain of waking up each day and remembering all over again that you are about to die.
I know what I’m supposed to do, because she has told me many times. One of the stories passed down as gospel in our tiny family is about how my late father, a doctor, helped his own mother — my grandmother Cecilia, whom I never met — at the end of her life. Her cancer was unbearable. “So he gave her a big dose of morphine to stop the pain,” my mother has always told my brother and me, as if reaching the end of a fairy tale. “It had the side effect of stopping her heart.”
As it happens, I have a big dose of morphine right here in the house. I also have some hefty doses of codeine, Ambien, Haldol and Ativan that I’ve cunningly stockpiled from the hospice service, like a squirrel hoarding for winter. In my top drawer, next to Mom’s passport, are more than 100 micrograms worth of fentanyl patches — enough to kill her and several passers-by.
But I am not a trained assassin. I am not a doctor. I am not very brave. I’m just a person who wants to do the most important thing that her mother has ever asked of her. I’m also a resident of New York State, where assisted suicide is illegal.
More...
https://www.nytimes.com/2018/08/31/sund ... 3053090901
I am not a doctor. I am not very brave. But I want to do what she wants.
Excerpt:
Lung cancer is a frightening illness. In its final stages, it can make you feel as though you’re drowning, or suffocating. A formidable pharmacological stew of medications can help to suppress the symptoms, but no pill can take away the pain of waking up each day and remembering all over again that you are about to die.
I know what I’m supposed to do, because she has told me many times. One of the stories passed down as gospel in our tiny family is about how my late father, a doctor, helped his own mother — my grandmother Cecilia, whom I never met — at the end of her life. Her cancer was unbearable. “So he gave her a big dose of morphine to stop the pain,” my mother has always told my brother and me, as if reaching the end of a fairy tale. “It had the side effect of stopping her heart.”
As it happens, I have a big dose of morphine right here in the house. I also have some hefty doses of codeine, Ambien, Haldol and Ativan that I’ve cunningly stockpiled from the hospice service, like a squirrel hoarding for winter. In my top drawer, next to Mom’s passport, are more than 100 micrograms worth of fentanyl patches — enough to kill her and several passers-by.
But I am not a trained assassin. I am not a doctor. I am not very brave. I’m just a person who wants to do the most important thing that her mother has ever asked of her. I’m also a resident of New York State, where assisted suicide is illegal.
More...
https://www.nytimes.com/2018/08/31/sund ... 3053090901
British doctors move to end their opposition to assisted dying
But the circumstances have provoked accusations of a stitch-up
IN THE HALF-MILLENNIUM since it was founded the Royal College of Physicians has seen plenty of squabbles, including the storming of its building in the 18th century over its exclusion of non-Oxbridge graduates, and a long battle over whether to admit women (which, after four centuries, it did). The latest row is over one of the most fundamental medical questions of all: should doctors help willing patients to die?
The college is surveying its 35,000 members on whether to back changes to the law on assisted dying, which is illegal in Britain. Five years ago 44% of them voted against and 25% in favour (the rest were neutral). Under the rules then, the plurality of votes against changing the law was enough to carry the day. This time, the college has decided that a supermajority of 60% is needed for either side to win. Since neither the pro nor anti doctors are expected to reach this threshold, the organisation looks likely to default to a neutral stance.
More...
https://www.economist.com/britain/2019/ ... sted-dying
But the circumstances have provoked accusations of a stitch-up
IN THE HALF-MILLENNIUM since it was founded the Royal College of Physicians has seen plenty of squabbles, including the storming of its building in the 18th century over its exclusion of non-Oxbridge graduates, and a long battle over whether to admit women (which, after four centuries, it did). The latest row is over one of the most fundamental medical questions of all: should doctors help willing patients to die?
The college is surveying its 35,000 members on whether to back changes to the law on assisted dying, which is illegal in Britain. Five years ago 44% of them voted against and 25% in favour (the rest were neutral). Under the rules then, the plurality of votes against changing the law was enough to carry the day. This time, the college has decided that a supermajority of 60% is needed for either side to win. Since neither the pro nor anti doctors are expected to reach this threshold, the organisation looks likely to default to a neutral stance.
More...
https://www.economist.com/britain/2019/ ... sted-dying
Aid in Dying Soon Will be Available to More Americans. Few Will Choose It.
By October, more than one in five U.S. adults will be able to obtain lethal prescriptions if terminally ill. But for those who try, obstacles remain.
On Aug. 1, New Jersey will become the eighth state to allow doctors to prescribe lethal medication to terminally ill patients who want to end their lives. On Sept. 15, Maine will become the ninth.
So by October, 22 percent of Americans will live in places where residents with six months or less to live can, in theory, exercise some control over the time and manner of their deaths. (The others: Oregon, Washington, Vermont, Montana, California, Colorado and Hawaii, as well as the District of Columbia.)
But while the campaign for aid in dying continues to make gains, supporters are increasingly concerned about what happens after these laws are passed. Many force the dying to navigate an overly complicated process of requests and waiting periods, critics say.
And opt-out provisions — which allow doctors to decline to participate and health care systems to forbid their participation — are restricting access even in some places where aid in dying is legal.
More....
https://www.nytimes.com/2019/07/08/heal ... 3053090709
By October, more than one in five U.S. adults will be able to obtain lethal prescriptions if terminally ill. But for those who try, obstacles remain.
On Aug. 1, New Jersey will become the eighth state to allow doctors to prescribe lethal medication to terminally ill patients who want to end their lives. On Sept. 15, Maine will become the ninth.
So by October, 22 percent of Americans will live in places where residents with six months or less to live can, in theory, exercise some control over the time and manner of their deaths. (The others: Oregon, Washington, Vermont, Montana, California, Colorado and Hawaii, as well as the District of Columbia.)
But while the campaign for aid in dying continues to make gains, supporters are increasingly concerned about what happens after these laws are passed. Many force the dying to navigate an overly complicated process of requests and waiting periods, critics say.
And opt-out provisions — which allow doctors to decline to participate and health care systems to forbid their participation — are restricting access even in some places where aid in dying is legal.
More....
https://www.nytimes.com/2019/07/08/heal ... 3053090709
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Teen Rape Survivor Who Requested Euthanasia Ends Her Life
Newser — Jenn Gidman
"After years of struggling and fighting, it's over." So reads a Dutch teen's "sad last post" Saturday on her Instagram account, noting she'd stopped eating and drinking and would soon be free from "[unbearable] suffering." The Washington Post reports on the right-to-die case of 17-year-old Noa Pothoven, who suffered from PTSD, depression, and anorexia after being sexually assaulted at age 11, then raped at 14.
Noa's sister confirmed her death Sunday, with the Australian reporting Noa died at her Arnhem home after saying goodbye to family and friends. Noa wrote that her decision wasn't "impulsive," made only "after many conversations and assessments." It's not clear whether Noa had the help of any doctors in dying.
Noa kept her sexual assaults secret for years from her parents out of "fear and shame," per an autobiography she wrote; her mom finally found out what she'd been through when she found goodbye letters Noa had written.
Noa had sought doctors' assistance last year at the Hague's end-of-life clinic, without her parents' knowledge, and was rejected. Her mom and dad had hoped she'd change her mind: Her father told a Dutch paper they wished Noa would "see bright spots [in life] again, perhaps fall in love or learn to discover that life is worth living," per the New York Post. In the Netherlands, which legalized euthanasia in 2001, kids as young as 12 can seek assisted suicide, though until they're 17 they need a parental OK and, like all euthanasia seekers, must demonstrate "hopeless and unbearable suffering." In the US, seven states and the District of Columbia permit assisted suicide, though patients have to take life-ending drugs themselves; New Jersey is set to join that list starting Aug.
This article originally appeared on Newser: Teen Rape Survivor Who Requested Euthanasia Ends Her Life
//start.att.net/news/read/article/newser-teen_rape_survivor_who_requested_euthanasia_ends_h-rnewsernor/category/news
Newser — Jenn Gidman
"After years of struggling and fighting, it's over." So reads a Dutch teen's "sad last post" Saturday on her Instagram account, noting she'd stopped eating and drinking and would soon be free from "[unbearable] suffering." The Washington Post reports on the right-to-die case of 17-year-old Noa Pothoven, who suffered from PTSD, depression, and anorexia after being sexually assaulted at age 11, then raped at 14.
Noa's sister confirmed her death Sunday, with the Australian reporting Noa died at her Arnhem home after saying goodbye to family and friends. Noa wrote that her decision wasn't "impulsive," made only "after many conversations and assessments." It's not clear whether Noa had the help of any doctors in dying.
Noa kept her sexual assaults secret for years from her parents out of "fear and shame," per an autobiography she wrote; her mom finally found out what she'd been through when she found goodbye letters Noa had written.
Noa had sought doctors' assistance last year at the Hague's end-of-life clinic, without her parents' knowledge, and was rejected. Her mom and dad had hoped she'd change her mind: Her father told a Dutch paper they wished Noa would "see bright spots [in life] again, perhaps fall in love or learn to discover that life is worth living," per the New York Post. In the Netherlands, which legalized euthanasia in 2001, kids as young as 12 can seek assisted suicide, though until they're 17 they need a parental OK and, like all euthanasia seekers, must demonstrate "hopeless and unbearable suffering." In the US, seven states and the District of Columbia permit assisted suicide, though patients have to take life-ending drugs themselves; New Jersey is set to join that list starting Aug.
This article originally appeared on Newser: Teen Rape Survivor Who Requested Euthanasia Ends Her Life
//start.att.net/news/read/article/newser-teen_rape_survivor_who_requested_euthanasia_ends_h-rnewsernor/category/news
On assisted suicide, the slope is proving every bit as slippery as feared
When, in 2015, the Supreme Court of Canada struck down the section of the Criminal Code forbidding assisting suicide, it overturned not only the law but its own previous ruling, in the celebrated 1993 case of Sue Rodriguez.
Courts are usually loath to do this: Under the legal doctrine of stare decisis, they are generally bound to follow precedent. However, the court found “the matrix of social and legislative facts” surrounding the 2015 case, known as Carter v. Canada, had changed so dramatically since the Rodriguez case as to justify it in taking the opposite approach.
For whereas the court had been persuaded, in Rodriguez, that an absolute prohibition on the practice was necessary to prevent a more general erosion of the taboo against taking human life, by 2015 it felt confident in setting aside this concern. The potential threat to vulnerable people, whether through error, coercion or systemic prejudice, could be averted by “a carefully designed and monitored system of safeguards.”
Evidence of widespread evasion of such safeguards in Belgium and the Netherlands, where assisted suicide had previously been legalized, was dismissed as “anecdotal,” while the widening of its application in those countries, from the consenting adults originally envisaged, to children and the mentally ill, was waved away as the product of a different “medico-legal culture.” In essence, the court said, it can’t happen here.
This was not just an incidental point. This was central to the court’s reasoning, the thing that allowed it to ignore the precedent set in Rodriguez. Legalizing assisted suicide, relaxing the prohibition in place for centuries in virtually all Western countries, need not open the floodgates, as feared. It could be limited to consenting adults, of sound mind, in the last agonizing stages of a terminal illness – the sorts of people who had come before the court in Carter and Rodriguez, the sorts of cases that had moved the public to support their cause.
Yet here we are, in 2020, considering whether to legalize assisted suicide for non-terminal cases, for the mentally ill, even for children – sorry, “mature minors.” The government has launched a two-week public consultation exercise on these and other issues, with legislation likely to follow later in the year. The slope has in fact proved every bit as slippery as the critics had warned.
Indeed, the court itself began the process. All of the evidence before it had concerned those in unbearable physical pain – and not only pain but incapacity, such as to require the assistance of another to end their lives. The court noted the “cruel choice” faced by those who, while still physically capable of killing themselves at present, might not be so in future, as the disease progressed. Assisted suicide was thus presented as, oddly, a way of prolonging life, rather than shortening it, allowing patients to have others do later what they would otherwise be forced to do themselves, earlier.
And yet in its decision, the court opened the doors to assisted suicide, not merely in cases of physical but also psychological pain. There was no necessity that the illness be terminal, or incapacitating: only that it be a “grievous and irremediable medical condition” that imposed suffering that was “intolerable to the individual.”
Hardly had the decision been issued, moreover, when the clamour went up to further loosen the law. Federal legislation, drafted in response, that included a requirement that the patient’s “natural death has become reasonably foreseeable,” was assailed as unconstitutional, as a Quebec court eventually ruled – the ostensible reason for the current exercise.
But it was always clear that this was just the start: Even as it was presenting the legislation, the Trudeau government signalled its openness to further liberalization. Which is why the coming review will embrace much more than whether the right to assisted suicide should be restricted to the terminally ill.
STORY CONTINUES BELOW ADVERTISEMENT
It could not be otherwise. Once you have accepted the logic of legalization – that death is no longer to be viewed as a terrible tragedy, something we should wish if possible to prevent, but as a blessing, a release from suffering we should wish to assist – all else follows.
The notion underlying the court’s ruling, that we could erase or elide certain important moral distinctions – between killing yourself, say, and enlisting others to kill you, or between death by natural causes and death by human intervention – while insisting on a host of others, appealing to the unlimited personal autonomy to decide one’s fate on the one hand while hedging it about with all manner of limits on the other, was always bound to collapse on itself.
Was it really to be imagined that we would extend the right to free themselves, or rather have others free them, from intolerable suffering to adults, but would condemn children to years of unendurable pain? Did we honestly think the courts would continue to restrict assisted suicide to those capable of “consenting” to it – as if mere mental incapacity should be any more of a barrier to those in need of its relief than physical?
We may not have fully realized it at the time, but what we were entertaining when we took our first steps down this road was not the legalization of a previously prohibited practice, but the normalization of it. Which is how assisted suicide passed, almost instantaneously, from criminal, to legal, to mandatory – with doctors and hospitals ordered to provide the “service,” or refer patients to others who will, and at public expense.
Which raises a peculiar irony. If the fundamental premise underlying the court’s ruling in Carter, that the fears to which it had deferred in Rodriguez had proved unfounded, has itself proved unfounded; if the limited, exceptional cases it foresaw have already become widespread and unexceptional (more than 4,000 cases of assisted suicide, 1.1 per cent of all deaths, were reported across Canada in 2018, up from roughly 2,500 the previous year), with whatever limits remain likely to be removed; has the “matrix of social and legislative facts” not changed again? Is there not ample cause for the court to revisit Carter, as earlier it revisited Rodriguez?
https://www.theglobeandmail.com/opinion ... VgMaFxFnIY
When, in 2015, the Supreme Court of Canada struck down the section of the Criminal Code forbidding assisting suicide, it overturned not only the law but its own previous ruling, in the celebrated 1993 case of Sue Rodriguez.
Courts are usually loath to do this: Under the legal doctrine of stare decisis, they are generally bound to follow precedent. However, the court found “the matrix of social and legislative facts” surrounding the 2015 case, known as Carter v. Canada, had changed so dramatically since the Rodriguez case as to justify it in taking the opposite approach.
For whereas the court had been persuaded, in Rodriguez, that an absolute prohibition on the practice was necessary to prevent a more general erosion of the taboo against taking human life, by 2015 it felt confident in setting aside this concern. The potential threat to vulnerable people, whether through error, coercion or systemic prejudice, could be averted by “a carefully designed and monitored system of safeguards.”
Evidence of widespread evasion of such safeguards in Belgium and the Netherlands, where assisted suicide had previously been legalized, was dismissed as “anecdotal,” while the widening of its application in those countries, from the consenting adults originally envisaged, to children and the mentally ill, was waved away as the product of a different “medico-legal culture.” In essence, the court said, it can’t happen here.
This was not just an incidental point. This was central to the court’s reasoning, the thing that allowed it to ignore the precedent set in Rodriguez. Legalizing assisted suicide, relaxing the prohibition in place for centuries in virtually all Western countries, need not open the floodgates, as feared. It could be limited to consenting adults, of sound mind, in the last agonizing stages of a terminal illness – the sorts of people who had come before the court in Carter and Rodriguez, the sorts of cases that had moved the public to support their cause.
Yet here we are, in 2020, considering whether to legalize assisted suicide for non-terminal cases, for the mentally ill, even for children – sorry, “mature minors.” The government has launched a two-week public consultation exercise on these and other issues, with legislation likely to follow later in the year. The slope has in fact proved every bit as slippery as the critics had warned.
Indeed, the court itself began the process. All of the evidence before it had concerned those in unbearable physical pain – and not only pain but incapacity, such as to require the assistance of another to end their lives. The court noted the “cruel choice” faced by those who, while still physically capable of killing themselves at present, might not be so in future, as the disease progressed. Assisted suicide was thus presented as, oddly, a way of prolonging life, rather than shortening it, allowing patients to have others do later what they would otherwise be forced to do themselves, earlier.
And yet in its decision, the court opened the doors to assisted suicide, not merely in cases of physical but also psychological pain. There was no necessity that the illness be terminal, or incapacitating: only that it be a “grievous and irremediable medical condition” that imposed suffering that was “intolerable to the individual.”
Hardly had the decision been issued, moreover, when the clamour went up to further loosen the law. Federal legislation, drafted in response, that included a requirement that the patient’s “natural death has become reasonably foreseeable,” was assailed as unconstitutional, as a Quebec court eventually ruled – the ostensible reason for the current exercise.
But it was always clear that this was just the start: Even as it was presenting the legislation, the Trudeau government signalled its openness to further liberalization. Which is why the coming review will embrace much more than whether the right to assisted suicide should be restricted to the terminally ill.
STORY CONTINUES BELOW ADVERTISEMENT
It could not be otherwise. Once you have accepted the logic of legalization – that death is no longer to be viewed as a terrible tragedy, something we should wish if possible to prevent, but as a blessing, a release from suffering we should wish to assist – all else follows.
The notion underlying the court’s ruling, that we could erase or elide certain important moral distinctions – between killing yourself, say, and enlisting others to kill you, or between death by natural causes and death by human intervention – while insisting on a host of others, appealing to the unlimited personal autonomy to decide one’s fate on the one hand while hedging it about with all manner of limits on the other, was always bound to collapse on itself.
Was it really to be imagined that we would extend the right to free themselves, or rather have others free them, from intolerable suffering to adults, but would condemn children to years of unendurable pain? Did we honestly think the courts would continue to restrict assisted suicide to those capable of “consenting” to it – as if mere mental incapacity should be any more of a barrier to those in need of its relief than physical?
We may not have fully realized it at the time, but what we were entertaining when we took our first steps down this road was not the legalization of a previously prohibited practice, but the normalization of it. Which is how assisted suicide passed, almost instantaneously, from criminal, to legal, to mandatory – with doctors and hospitals ordered to provide the “service,” or refer patients to others who will, and at public expense.
Which raises a peculiar irony. If the fundamental premise underlying the court’s ruling in Carter, that the fears to which it had deferred in Rodriguez had proved unfounded, has itself proved unfounded; if the limited, exceptional cases it foresaw have already become widespread and unexceptional (more than 4,000 cases of assisted suicide, 1.1 per cent of all deaths, were reported across Canada in 2018, up from roughly 2,500 the previous year), with whatever limits remain likely to be removed; has the “matrix of social and legislative facts” not changed again? Is there not ample cause for the court to revisit Carter, as earlier it revisited Rodriguez?
https://www.theglobeandmail.com/opinion ... VgMaFxFnIY
The fight over medical assistance in dying in one B.C. community is getting ugly
A couple of months ago, Angelina Ireland was invited to speak at the Bringing America Back to Life conference in Cleveland.
It’s billed as one of the largest gatherings of the Christian right in the world. Ms. Ireland, from Delta, B.C., was asked to recount her experiences as the president of a hospice society that has gained notoriety in this country for its efforts to ban medical assistance in dying (MAID) from taking place in its facility.
Ms. Ireland told her mainly U.S. audience that she was arriving with a warning: What was happening in Canada would soon be showing up in their country. “It’s like a contagion.” But first she wanted to clarify her bona fides. “I’m a wife, I’m a mother, I’m a Catholic, I’m pro-life, I’m pro-family and I’m pro-gun.”
A resumé that won a healthy round of applause from the crowd.
I recently watched her nearly hour-long appearance in mid-March on YouTube. It was quite a performance. The picture she painted of life in this country since the government decriminalized medical assistance in dying in 2016 was frightening. Among the things she declared:
That the legislation has ushered in the “dawn of the death industry.” Ms. Ireland defended her stance against MAID by saying she is president of the “Delta Hospice Society, not the Delta Auschwitz Society.” When the B.C. government threatened to strip the society’s funding if it didn’t offer MAID services, she said, it was effectively an order: “Kill or be killed.”
Ms. Ireland also cautioned her audience that this is coming to the U.S., and they need to start developing strategies to fight it “before they compel you to kill your neighbours and your family – because that’s where we are.”
She said there was legislation being drafted that will make MAID available to not just the elderly, but to the disabled, the mentally challenged and children. She offered up the scenario of parents getting a call from a distraught teenager who’d just broken up with her boyfriend wanting to take advantage of MAID. “This is what’s happening now [in Canada],” said Ms. Ireland, who was an unsuccessful candidate for Maxime Bernier’s People’s Party of Canada in the last election. She characterized what was taking place here as “stone-cold communism” and “cultural Marxism.”
When she was asked by someone in the audience what they could do to help, Ms. Ireland said, “The best thing you could do is vote President Trump back in the next election.”
As we say, Ms. Ireland is at the centre of a debate in Delta over a hospice’s right to deny MAID services. She has organized a special meeting of the society next week in the hopes of altering the organization’s constitution to establish it as a Christian-based body. It would have the rejection of MAID entrenched in its bylaws.
Under the language being proposed, any attempt to overturn that bylaw, once passed, would require consent by 100 per cent of the members – a near impossibility as long as the organization has a prominent base of people supporting the mandate being propagated by Ms. Ireland.
Recently, there have been allegations that the current board has been stacking the membership with supporters ahead of the critical June 15 meeting - while denying membership to others who disagree with the direction the society is taking. Ms. Ireland denies this.
What is taking place at the hospice society is simply wrong. The fact is, while it may be a private institution, it was built with money raised from the broader community. It was always intended to meet the needs of those contributors as well. I doubt many donated hoping that one day the society would be taken over by a closed-minded religious element that imposed its Christian canon on the operation.
The province has promised to cut off the $1.5-million in operating funds that go to the Delta Hospice every year if it doesn’t comply with government policy to offer the services of MAID. If the society persists on its present course, the government could move in and close the facility down — it owns the land on which the facility was built.
In some respects, the province must own part of this dispute. The government has offered MAID exemptions to faith-based facilities. This exemption has been linked to the exclusion offered under the federal legislation to doctors who have a “conscientious objection” to participating in the MAID program.
The B.C. government should rethink this policy. It’s one thing to absolve an individual whose conscience won’t allow them to perform a certain procedure. It’s another to give the same pass to a facility that is supposed to serve a broad, polylithic community.
https://www.theglobeandmail.com/opinion ... VgMaFxFnIY
A couple of months ago, Angelina Ireland was invited to speak at the Bringing America Back to Life conference in Cleveland.
It’s billed as one of the largest gatherings of the Christian right in the world. Ms. Ireland, from Delta, B.C., was asked to recount her experiences as the president of a hospice society that has gained notoriety in this country for its efforts to ban medical assistance in dying (MAID) from taking place in its facility.
Ms. Ireland told her mainly U.S. audience that she was arriving with a warning: What was happening in Canada would soon be showing up in their country. “It’s like a contagion.” But first she wanted to clarify her bona fides. “I’m a wife, I’m a mother, I’m a Catholic, I’m pro-life, I’m pro-family and I’m pro-gun.”
A resumé that won a healthy round of applause from the crowd.
I recently watched her nearly hour-long appearance in mid-March on YouTube. It was quite a performance. The picture she painted of life in this country since the government decriminalized medical assistance in dying in 2016 was frightening. Among the things she declared:
That the legislation has ushered in the “dawn of the death industry.” Ms. Ireland defended her stance against MAID by saying she is president of the “Delta Hospice Society, not the Delta Auschwitz Society.” When the B.C. government threatened to strip the society’s funding if it didn’t offer MAID services, she said, it was effectively an order: “Kill or be killed.”
Ms. Ireland also cautioned her audience that this is coming to the U.S., and they need to start developing strategies to fight it “before they compel you to kill your neighbours and your family – because that’s where we are.”
She said there was legislation being drafted that will make MAID available to not just the elderly, but to the disabled, the mentally challenged and children. She offered up the scenario of parents getting a call from a distraught teenager who’d just broken up with her boyfriend wanting to take advantage of MAID. “This is what’s happening now [in Canada],” said Ms. Ireland, who was an unsuccessful candidate for Maxime Bernier’s People’s Party of Canada in the last election. She characterized what was taking place here as “stone-cold communism” and “cultural Marxism.”
When she was asked by someone in the audience what they could do to help, Ms. Ireland said, “The best thing you could do is vote President Trump back in the next election.”
As we say, Ms. Ireland is at the centre of a debate in Delta over a hospice’s right to deny MAID services. She has organized a special meeting of the society next week in the hopes of altering the organization’s constitution to establish it as a Christian-based body. It would have the rejection of MAID entrenched in its bylaws.
Under the language being proposed, any attempt to overturn that bylaw, once passed, would require consent by 100 per cent of the members – a near impossibility as long as the organization has a prominent base of people supporting the mandate being propagated by Ms. Ireland.
Recently, there have been allegations that the current board has been stacking the membership with supporters ahead of the critical June 15 meeting - while denying membership to others who disagree with the direction the society is taking. Ms. Ireland denies this.
What is taking place at the hospice society is simply wrong. The fact is, while it may be a private institution, it was built with money raised from the broader community. It was always intended to meet the needs of those contributors as well. I doubt many donated hoping that one day the society would be taken over by a closed-minded religious element that imposed its Christian canon on the operation.
The province has promised to cut off the $1.5-million in operating funds that go to the Delta Hospice every year if it doesn’t comply with government policy to offer the services of MAID. If the society persists on its present course, the government could move in and close the facility down — it owns the land on which the facility was built.
In some respects, the province must own part of this dispute. The government has offered MAID exemptions to faith-based facilities. This exemption has been linked to the exclusion offered under the federal legislation to doctors who have a “conscientious objection” to participating in the MAID program.
The B.C. government should rethink this policy. It’s one thing to absolve an individual whose conscience won’t allow them to perform a certain procedure. It’s another to give the same pass to a facility that is supposed to serve a broad, polylithic community.
https://www.theglobeandmail.com/opinion ... VgMaFxFnIY
Assisted dying is a matter of conscience – and so our lawmakers must be allowed to vote on the issue freely
For the second time in just four years, Parliament is poised to expand the conditions by which it is lawful for doctors in Canada to end the lives of their patients. The federal government recently tabled legislation that would expand assisted death to persons who are not close to death but are intolerably suffering from serious and incurable physical illnesses. Persons suffering solely from mental illness would remain ineligible for assisted death under the proposed legislation, but it remains to be seen if that line will hold.
This legislation, Bill C-7, would build on Canada’s existing assisted death law enacted in 2016; that law currently requires that death be “reasonably foreseeable” before a patient’s life is ended. Persons whose deaths are not near, but who might be suffering terribly, are ineligible for assisted death.
But last year, a court in Quebec determined that the foreseeability of death requirement violates the Charter. More specifically, the requirement discriminates against disabled persons who are far from death and also violates their right to life, liberty, and security of the person.
In 2016, all federal parties allowed their caucuses to vote freely on assisted death. But on Bill C-7, only the leader of the Conservatives, Erin O’Toole, has said that his caucus would be able to vote freely and vote their conscience. The other party leaders have not yet indicated where they stand on a free vote.
This is not acceptable. If there is any topic that merits freedom from party discipline, this is it.
The question of when it is legal or illegal for persons to end the lives of others is – regardless of partisan allegiance – a matter that touches on the moral fabric of a society. This is not merely a question of public policy; it is a matter of life and death, and a change to the law on this issue, no matter how small, represents a structural change for our society. For good or ill, depending on your viewpoint, the legalization of assisted death has transformed the work of Canadian doctors, nurses, pharmacists and other health care professionals, who spent their careers operating under the centuries-old belief that the intentional termination of life to stop suffering was antithetical to the medical profession. The same kind of radical change will happen again if Bill C-7 passes. Assisted death would no longer be restricted to the dying.
Indeed, how a society deals with assisted death will deeply and inevitably affect how we attribute value to human life – that of ourselves, family members, friends, colleagues, and others. As assisted death expands, the message that life is an asset that can depreciate, that life has a “best before” date, gains traction. This message is sent regardless of one’s position on assisted death. It should not surprise us that once the door to assisted death is cracked open, as it was in 2016, it is difficult to stop it from being opened further. Bill C-7 confirms, four short years later, that with respect to assisted death, the slippery slope or the path of progress – again, depending on how you view the direction of the slide – is real.
The two sides of the debate agree on little; supporters of assisted death say that it is a human right, ends suffering, and ensures a dignified death, while critics say that palliative care is sorely lacking in Canada, human life is never robbed of its basic dignity, and intentional termination of life is effectively a killing. But in their passion is one common belief: that assisted death is a matter of crucial importance to Canada’s future, that this issue will leave a lasting mark on who we are and what we stand for as a society, and that it represents a turning point for our country.
This shared belief shows how imperative it is that Bill C-7 receives a free vote, across party lines, when it comes up in the House of Commons. When our elected representatives vote on assisted death, they should have the freedom that all of us would legitimately seek if we were in their position – the ability to decide, with their own conscience, a matter of conscience for Canada.
https://www.theglobeandmail.com/opinion ... VgMaFxFnIY
For the second time in just four years, Parliament is poised to expand the conditions by which it is lawful for doctors in Canada to end the lives of their patients. The federal government recently tabled legislation that would expand assisted death to persons who are not close to death but are intolerably suffering from serious and incurable physical illnesses. Persons suffering solely from mental illness would remain ineligible for assisted death under the proposed legislation, but it remains to be seen if that line will hold.
This legislation, Bill C-7, would build on Canada’s existing assisted death law enacted in 2016; that law currently requires that death be “reasonably foreseeable” before a patient’s life is ended. Persons whose deaths are not near, but who might be suffering terribly, are ineligible for assisted death.
But last year, a court in Quebec determined that the foreseeability of death requirement violates the Charter. More specifically, the requirement discriminates against disabled persons who are far from death and also violates their right to life, liberty, and security of the person.
In 2016, all federal parties allowed their caucuses to vote freely on assisted death. But on Bill C-7, only the leader of the Conservatives, Erin O’Toole, has said that his caucus would be able to vote freely and vote their conscience. The other party leaders have not yet indicated where they stand on a free vote.
This is not acceptable. If there is any topic that merits freedom from party discipline, this is it.
The question of when it is legal or illegal for persons to end the lives of others is – regardless of partisan allegiance – a matter that touches on the moral fabric of a society. This is not merely a question of public policy; it is a matter of life and death, and a change to the law on this issue, no matter how small, represents a structural change for our society. For good or ill, depending on your viewpoint, the legalization of assisted death has transformed the work of Canadian doctors, nurses, pharmacists and other health care professionals, who spent their careers operating under the centuries-old belief that the intentional termination of life to stop suffering was antithetical to the medical profession. The same kind of radical change will happen again if Bill C-7 passes. Assisted death would no longer be restricted to the dying.
Indeed, how a society deals with assisted death will deeply and inevitably affect how we attribute value to human life – that of ourselves, family members, friends, colleagues, and others. As assisted death expands, the message that life is an asset that can depreciate, that life has a “best before” date, gains traction. This message is sent regardless of one’s position on assisted death. It should not surprise us that once the door to assisted death is cracked open, as it was in 2016, it is difficult to stop it from being opened further. Bill C-7 confirms, four short years later, that with respect to assisted death, the slippery slope or the path of progress – again, depending on how you view the direction of the slide – is real.
The two sides of the debate agree on little; supporters of assisted death say that it is a human right, ends suffering, and ensures a dignified death, while critics say that palliative care is sorely lacking in Canada, human life is never robbed of its basic dignity, and intentional termination of life is effectively a killing. But in their passion is one common belief: that assisted death is a matter of crucial importance to Canada’s future, that this issue will leave a lasting mark on who we are and what we stand for as a society, and that it represents a turning point for our country.
This shared belief shows how imperative it is that Bill C-7 receives a free vote, across party lines, when it comes up in the House of Commons. When our elected representatives vote on assisted death, they should have the freedom that all of us would legitimately seek if we were in their position – the ability to decide, with their own conscience, a matter of conscience for Canada.
https://www.theglobeandmail.com/opinion ... VgMaFxFnIY
Canadians not near death gain access to assisted dying as Senate passes Bill C-7
OTTAWA — Intolerably suffering Canadians who are not near the natural end of their lives now have the right to seek medical assistance in dying.
And that will eventually include people suffering solely from grievous and irremediable mental illnesses.
The expansion of Canada's assisted dying regime went into effect Wednesday night after the Senate accepted a revised version of Bill C-7.
The bill received royal assent a few hours later — just over a week ahead of a final March 26 deadline imposed by the court, which had granted four extensions to bring the law into compliance with a 2019 Quebec Superior Court ruling.
With royal assent granted, intolerably suffering Canadians who aren't near death immediately gained the right to seek medical assistance in dying.
People suffering solely from mental illnesses will have to wait two years to gain the same right.
The government had originally intended to impose a blanket ban on assisted dying for people suffering solely from mental illnesses. But, under pressure from senators who believed that exclusion was unconstitutional, it subsequently put a two-year time limit on it.
In the meantime, the government committed to setting up an expert panel to advise on the safeguards and protocols that should apply to people with mental illnesses.
The government rejected a Senate amendment to allow people who fear losing mental competence to make advance requests for an assisted death.
But it committed to launching within 30 days a joint parliamentary committee to review that issue and other unresolved matters, including whether mature minors should have access to the procedure.
"For Canadians who are suffering intolerably, this process has taken too long, but their wait is now over," Justice Minister David Lametti tweeted shortly after the bill received royal assent.
"This is an important milestone but there is more work to do."
The bill was triggered by two Quebecers with severe disabilities who went to court to successfully fight for their right to choose an assisted death even though their natural deaths were not "reasonably foreseeable."
But disability rights groups have strenuously opposed the bill, arguing it devalues the lives of people with disabilities, particularly those who are Black, racialized, Indigenous or otherwise already marginalized and face discrimination in the health system. They fear such vulnerable people will be pressured — either directly or indirectly through societal attitudes and lack of support services — to end their lives prematurely.
Many mental health advocates have also weighed in against the eventual inclusion of people suffering solely from mental illnesses. They argue that it's harder to predict the outcomes of mental illnesses, many of which can be treated, and point out that a wish to die is often a symptom of these illnesses.
But Sen. Stan Kutcher, a psychiatrist and member of the Independent Senators Group who first proposed a time limit on the mental illness exclusion, argued that all competent Canadians suffering from irremediable and grievous illnesses, physical or mental, deserve the right to make their own choice.
"It is not for us to decide if a person's suffering is intolerable to them," he told the Senate shortly before the vote.
Dying with Dignity Canada welcomed the Senate's sign-off on the bill, calling it "a momentous day for end-of-life rights in Canada."
All 20 Conservative senators voted against the bill, several because they believed it didn't go far enough but most were fundamentally opposed to expanding the assisted dying regime, particularly to those with mental illnesses.
In an emotional speech just before the vote, Conservative Senate leader Don Plett pleaded with his colleagues to reject the bill.
"If there was ever a time to exercise sober second thought, it is now," he told the Senate.
"It is not often that we can truly say that with this vote we have the opportunity to save lives, to prevent the unnecessary premature death of the vulnerable, to offer hope to those who have lost it. But today we do."
For people who are near the natural end of life, the bill relaxes some of the rules for getting an assisted death.
It drops the requirement that a person must be able to give final consent immediately before the procedure is performed. That's intended to ensure that someone who has been approved for the procedure won't be denied if they lose mental capacity before it can be carried out.
It also drops the requirement that a person must wait 10 days after being approved for an assisted death before receiving the procedure. And it reduces the number of witnesses required to one from two.
People not near death will face higher hurdles.
Among other things, they'll face a minimum 90-day period for assessments of their requests for an assisted death. They'll have to be made aware of all alternatives, including counselling and they'll have to be able to give final consent immediately before receiving the procedure.
This report by The Canadian Press was first published March 17, 2021.
Joan Bryden, The Canadian Press
https://www.msn.com/en-ca/news/canada/c ... li=AAggNb9
OTTAWA — Intolerably suffering Canadians who are not near the natural end of their lives now have the right to seek medical assistance in dying.
And that will eventually include people suffering solely from grievous and irremediable mental illnesses.
The expansion of Canada's assisted dying regime went into effect Wednesday night after the Senate accepted a revised version of Bill C-7.
The bill received royal assent a few hours later — just over a week ahead of a final March 26 deadline imposed by the court, which had granted four extensions to bring the law into compliance with a 2019 Quebec Superior Court ruling.
With royal assent granted, intolerably suffering Canadians who aren't near death immediately gained the right to seek medical assistance in dying.
People suffering solely from mental illnesses will have to wait two years to gain the same right.
The government had originally intended to impose a blanket ban on assisted dying for people suffering solely from mental illnesses. But, under pressure from senators who believed that exclusion was unconstitutional, it subsequently put a two-year time limit on it.
In the meantime, the government committed to setting up an expert panel to advise on the safeguards and protocols that should apply to people with mental illnesses.
The government rejected a Senate amendment to allow people who fear losing mental competence to make advance requests for an assisted death.
But it committed to launching within 30 days a joint parliamentary committee to review that issue and other unresolved matters, including whether mature minors should have access to the procedure.
"For Canadians who are suffering intolerably, this process has taken too long, but their wait is now over," Justice Minister David Lametti tweeted shortly after the bill received royal assent.
"This is an important milestone but there is more work to do."
The bill was triggered by two Quebecers with severe disabilities who went to court to successfully fight for their right to choose an assisted death even though their natural deaths were not "reasonably foreseeable."
But disability rights groups have strenuously opposed the bill, arguing it devalues the lives of people with disabilities, particularly those who are Black, racialized, Indigenous or otherwise already marginalized and face discrimination in the health system. They fear such vulnerable people will be pressured — either directly or indirectly through societal attitudes and lack of support services — to end their lives prematurely.
Many mental health advocates have also weighed in against the eventual inclusion of people suffering solely from mental illnesses. They argue that it's harder to predict the outcomes of mental illnesses, many of which can be treated, and point out that a wish to die is often a symptom of these illnesses.
But Sen. Stan Kutcher, a psychiatrist and member of the Independent Senators Group who first proposed a time limit on the mental illness exclusion, argued that all competent Canadians suffering from irremediable and grievous illnesses, physical or mental, deserve the right to make their own choice.
"It is not for us to decide if a person's suffering is intolerable to them," he told the Senate shortly before the vote.
Dying with Dignity Canada welcomed the Senate's sign-off on the bill, calling it "a momentous day for end-of-life rights in Canada."
All 20 Conservative senators voted against the bill, several because they believed it didn't go far enough but most were fundamentally opposed to expanding the assisted dying regime, particularly to those with mental illnesses.
In an emotional speech just before the vote, Conservative Senate leader Don Plett pleaded with his colleagues to reject the bill.
"If there was ever a time to exercise sober second thought, it is now," he told the Senate.
"It is not often that we can truly say that with this vote we have the opportunity to save lives, to prevent the unnecessary premature death of the vulnerable, to offer hope to those who have lost it. But today we do."
For people who are near the natural end of life, the bill relaxes some of the rules for getting an assisted death.
It drops the requirement that a person must be able to give final consent immediately before the procedure is performed. That's intended to ensure that someone who has been approved for the procedure won't be denied if they lose mental capacity before it can be carried out.
It also drops the requirement that a person must wait 10 days after being approved for an assisted death before receiving the procedure. And it reduces the number of witnesses required to one from two.
People not near death will face higher hurdles.
Among other things, they'll face a minimum 90-day period for assessments of their requests for an assisted death. They'll have to be made aware of all alternatives, including counselling and they'll have to be able to give final consent immediately before receiving the procedure.
This report by The Canadian Press was first published March 17, 2021.
Joan Bryden, The Canadian Press
https://www.msn.com/en-ca/news/canada/c ... li=AAggNb9
P.E.I. couple who used medically assisted dying 'went out on their own terms,' says family
'They were both terminal — there was no coming out of the situation'
Watch video at:
https://www.cbc.ca/news/canada/prince-e ... -1.6050270
The obituary last week may have caught some people's attention: Bob Wilson, 71, and his wife Margi, 73, died on the same day, May 25, at Charlottetown's Queen Elizabeth Hospital.
They planned it that way.
"They went out on their own terms," said their son Scott Wilson, sitting beside his sister Nicolle Hogan in her sunny kitchen in Cumberland, overlooking the sparkling Northumberland Strait.
The doctors told the Wilsons' three children they would be the first couple in P.E.I. to use medical assistance in dying (MAID) at the same time.
Although their parents handled their deaths privately, Scott and Nicolle agreed to talk to CBC News about it to celebrate their parents' bravery and to try to reduce any stigma around MAID.
'Loved each other immensely'
Bob and Margi Wilson were lifelong partners, "the love of each other's life," said Scott. They met at Prince of Wales College (now Holland College) in Charlottetown and married 50 years ago.
Nicolle Hogan and Scott Wilson's parents, Bob and Margi Wilson, both used medical assistance in dying last week. (Sara Fraser/CBC)
"Just a cute, beautiful couple that loved each other immensely ... they lived a really good life," Scott said. They were never apart.
Bob was a solid, happy man, working first with his mother and then Margi at their real estate business. After Bob retired, the couple came to live with Nicolle and her family.
Margi worked alongside her husband at his business, but had suffered from the pain of multiple sclerosis for the last 30 years. Early on, it put her in a wheelchair, but when her grandchildren were born, she rallied and became very active, even walking several half-marathons.
In August 2019, Bob was diagnosed with Stage 4 kidney cancer that had spread to his lungs.
Bob was determined to fight it and stick around as long as possible. He tried many different therapies, and he'd actually had some positive news that his cancer had stopped growing when Margi's MS flared up and put her in the hospital this past February. She didn't come home after that.
The Wilsons on their wedding day. The family says the couple was the first in P.E.I. to receive medical assistance in dying together. (Submitted by Nicolle Hogan)
Mutual care
The couple had been trying to look after one another, but they became run down and frail. They weren't able to winter in Alabama the last two years because of Bob's illness. The warm climate had helped Margi feel better.
In hospital, Margi continued to go downhill. She didn't feel like eating or drinking much, and her weight plummeted. In mid-March, Margi told her family she was ready to die, and would do so naturally — and that they shouldn't to try to revive her if the time came.
"She was just sick and tired of being sick and tired," Scott said. "It's a big shock to be told, 'I don't want to live anymore because my life is so miserable.'"
The family decided they needed to support their mother in her decision.
"You might not personally like the decision, but from us it's a selfish side that you don't want them to go and leave," Scott said.
"It wasn't about us anymore," said Nicolle.
Their father was also shocked, they said.
"I just remember seeing his face. When he heard the news, his heart — it was broken," Scott said. "The love of his life was giving up."
CBC EXPLAINS Here's the latest on the review of Canada's assisted dying law
Delta hospice reopens after bitter fight over medically assisted death
'He wanted to go with his love'
At the hospital, as the family was talking about options including nursing care, Nicolle heard about MAID. She mentioned it to her mother.
In April, the couple celebrated their 50th wedding anniversary at the Queen Elizabeth Hospital in Charlottetown. (Submitted by Nicolle Hogan)
"We are definitely a family that is always about looking at, what are all of our options? Let's explore all of our options," Nicolle said.
Margi told the family she'd like to choose assisted dying. Bob got all the assessments he needed if he also decided to choose assisted dying, but he didn't make a decision until May 7.
He'd become increasingly frail, unsteady on his feet and lacked an appetite. His pain was unbearable. He decided he and Margi would take their final milestone as a couple: an assisted death, together.
As they did in life, they would do this final step together.
— Scott Wilson
"He wanted to go with his love," Scott said. "The pain of not going with her would have broken him."
The hospital bed next to Margi was available, so it became Bob's. Scott and Nicolle's brother Tony was permitted to travel from his home in Brooklyn, N.Y., to P.E.I. on compassionate grounds.
Scott and Nicolle said doctors checked in with the couple often to make sure they hadn't changed their minds.
In the last weeks, the grandchildren gathered in their grandparents' room to keep them company, doing crafts and playing music. They reminisced about fun times the close-knit family had spent together. Nothing went unsaid.
"It was bittersweet," Scott said of the scene.
"I joked with my mom, I said it's almost Romeo and Juliet without the poison," Scott said. "We use humour in our family as a coping mechanism. In a way, there was somewhat of a relief that a decision had been made, because it was very up and down."
Watching the clock
The Wilsons were the love of each other's lives, their children say. (Submitted by Nicolle Hogan)
Margi lost consciousness in the days before, and the family thought she might die naturally before the agreed-upon date. They kept a vigil around the clock, with one or more of the three children always in the room with Bob and Margi for the week before they died.
Nicolle and Tony stayed awake most of the night on May 24 and into the early hours of the next day, watching the clock and counting down the hours they had left with their parents. "We were just left with our own thoughts and emotions," she said.
At 7 a.m. on May 25, doctors came into the room for a final check. They took the family to a different room, away from their parents, and briefed them on the procedure.
Even though Margi wasn't able to verbally consent, recent changes to the assisted dying law made it possible for doctors to carry out her wishes. Bob indicated to the doctors that he wanted to go through with it, too.
"He was committed that, as they did in life, they would do this final step together," Scott said. "They were both terminal — there was no coming out of the situation."
They pushed the couple's beds together so they could be close.
Nicolle held her father's hand and they said "I love you" to one another.
First, doctors gave the couple injections that put them to sleep. After Bob was snoring peacefully, doctors gave them both a series of further injections over about 10 minutes.
They died together, peacefully.
"You could just see the weight of all the pain and the suffering was gone," said Scott.
LISTENPsychiatrists divided over Canada's new medical assistance in dying law
Do changes to assisted dying in Canada help the most vulnerable or endanger them? Advocates are divided
'Really proud of my parents'
Nicolle said she wants people who are terminally ill to be aware that "options do exist" and they should be informed of all choices available to them.
In the weeks leading up to the chosen day, there was always plenty of family in the couple's hospital room. (Submitted by Nicolle Hogan)
"Know that the option is available, if you so choose," she said. "My message is — really look at the quality of life and remember those happy times and think of what's right for you as an individual rather than everybody else around you.
"There shouldn't be any judgment," she added.
Scott said he wanted to share his parents' journey because he is immensely proud of them.
"I'm really proud of my parents and the hard decision they had to make — that takes a lot of guts," he said.
The family is still in mourning and say they will have to adjust to all the "firsts" without their parents.
Nicolle's house is quiet without Bob and Margi living downstairs. Nicolle grips the crocheted heart her father held as he died tightly.
"I do sleep with it sometimes," she said. "It's comfort."
https://www.cbc.ca/news/canada/prince-e ... -1.6050270
'They were both terminal — there was no coming out of the situation'
Watch video at:
https://www.cbc.ca/news/canada/prince-e ... -1.6050270
The obituary last week may have caught some people's attention: Bob Wilson, 71, and his wife Margi, 73, died on the same day, May 25, at Charlottetown's Queen Elizabeth Hospital.
They planned it that way.
"They went out on their own terms," said their son Scott Wilson, sitting beside his sister Nicolle Hogan in her sunny kitchen in Cumberland, overlooking the sparkling Northumberland Strait.
The doctors told the Wilsons' three children they would be the first couple in P.E.I. to use medical assistance in dying (MAID) at the same time.
Although their parents handled their deaths privately, Scott and Nicolle agreed to talk to CBC News about it to celebrate their parents' bravery and to try to reduce any stigma around MAID.
'Loved each other immensely'
Bob and Margi Wilson were lifelong partners, "the love of each other's life," said Scott. They met at Prince of Wales College (now Holland College) in Charlottetown and married 50 years ago.
Nicolle Hogan and Scott Wilson's parents, Bob and Margi Wilson, both used medical assistance in dying last week. (Sara Fraser/CBC)
"Just a cute, beautiful couple that loved each other immensely ... they lived a really good life," Scott said. They were never apart.
Bob was a solid, happy man, working first with his mother and then Margi at their real estate business. After Bob retired, the couple came to live with Nicolle and her family.
Margi worked alongside her husband at his business, but had suffered from the pain of multiple sclerosis for the last 30 years. Early on, it put her in a wheelchair, but when her grandchildren were born, she rallied and became very active, even walking several half-marathons.
In August 2019, Bob was diagnosed with Stage 4 kidney cancer that had spread to his lungs.
Bob was determined to fight it and stick around as long as possible. He tried many different therapies, and he'd actually had some positive news that his cancer had stopped growing when Margi's MS flared up and put her in the hospital this past February. She didn't come home after that.
The Wilsons on their wedding day. The family says the couple was the first in P.E.I. to receive medical assistance in dying together. (Submitted by Nicolle Hogan)
Mutual care
The couple had been trying to look after one another, but they became run down and frail. They weren't able to winter in Alabama the last two years because of Bob's illness. The warm climate had helped Margi feel better.
In hospital, Margi continued to go downhill. She didn't feel like eating or drinking much, and her weight plummeted. In mid-March, Margi told her family she was ready to die, and would do so naturally — and that they shouldn't to try to revive her if the time came.
"She was just sick and tired of being sick and tired," Scott said. "It's a big shock to be told, 'I don't want to live anymore because my life is so miserable.'"
The family decided they needed to support their mother in her decision.
"You might not personally like the decision, but from us it's a selfish side that you don't want them to go and leave," Scott said.
"It wasn't about us anymore," said Nicolle.
Their father was also shocked, they said.
"I just remember seeing his face. When he heard the news, his heart — it was broken," Scott said. "The love of his life was giving up."
CBC EXPLAINS Here's the latest on the review of Canada's assisted dying law
Delta hospice reopens after bitter fight over medically assisted death
'He wanted to go with his love'
At the hospital, as the family was talking about options including nursing care, Nicolle heard about MAID. She mentioned it to her mother.
In April, the couple celebrated their 50th wedding anniversary at the Queen Elizabeth Hospital in Charlottetown. (Submitted by Nicolle Hogan)
"We are definitely a family that is always about looking at, what are all of our options? Let's explore all of our options," Nicolle said.
Margi told the family she'd like to choose assisted dying. Bob got all the assessments he needed if he also decided to choose assisted dying, but he didn't make a decision until May 7.
He'd become increasingly frail, unsteady on his feet and lacked an appetite. His pain was unbearable. He decided he and Margi would take their final milestone as a couple: an assisted death, together.
As they did in life, they would do this final step together.
— Scott Wilson
"He wanted to go with his love," Scott said. "The pain of not going with her would have broken him."
The hospital bed next to Margi was available, so it became Bob's. Scott and Nicolle's brother Tony was permitted to travel from his home in Brooklyn, N.Y., to P.E.I. on compassionate grounds.
Scott and Nicolle said doctors checked in with the couple often to make sure they hadn't changed their minds.
In the last weeks, the grandchildren gathered in their grandparents' room to keep them company, doing crafts and playing music. They reminisced about fun times the close-knit family had spent together. Nothing went unsaid.
"It was bittersweet," Scott said of the scene.
"I joked with my mom, I said it's almost Romeo and Juliet without the poison," Scott said. "We use humour in our family as a coping mechanism. In a way, there was somewhat of a relief that a decision had been made, because it was very up and down."
Watching the clock
The Wilsons were the love of each other's lives, their children say. (Submitted by Nicolle Hogan)
Margi lost consciousness in the days before, and the family thought she might die naturally before the agreed-upon date. They kept a vigil around the clock, with one or more of the three children always in the room with Bob and Margi for the week before they died.
Nicolle and Tony stayed awake most of the night on May 24 and into the early hours of the next day, watching the clock and counting down the hours they had left with their parents. "We were just left with our own thoughts and emotions," she said.
At 7 a.m. on May 25, doctors came into the room for a final check. They took the family to a different room, away from their parents, and briefed them on the procedure.
Even though Margi wasn't able to verbally consent, recent changes to the assisted dying law made it possible for doctors to carry out her wishes. Bob indicated to the doctors that he wanted to go through with it, too.
"He was committed that, as they did in life, they would do this final step together," Scott said. "They were both terminal — there was no coming out of the situation."
They pushed the couple's beds together so they could be close.
Nicolle held her father's hand and they said "I love you" to one another.
First, doctors gave the couple injections that put them to sleep. After Bob was snoring peacefully, doctors gave them both a series of further injections over about 10 minutes.
They died together, peacefully.
"You could just see the weight of all the pain and the suffering was gone," said Scott.
LISTENPsychiatrists divided over Canada's new medical assistance in dying law
Do changes to assisted dying in Canada help the most vulnerable or endanger them? Advocates are divided
'Really proud of my parents'
Nicolle said she wants people who are terminally ill to be aware that "options do exist" and they should be informed of all choices available to them.
In the weeks leading up to the chosen day, there was always plenty of family in the couple's hospital room. (Submitted by Nicolle Hogan)
"Know that the option is available, if you so choose," she said. "My message is — really look at the quality of life and remember those happy times and think of what's right for you as an individual rather than everybody else around you.
"There shouldn't be any judgment," she added.
Scott said he wanted to share his parents' journey because he is immensely proud of them.
"I'm really proud of my parents and the hard decision they had to make — that takes a lot of guts," he said.
The family is still in mourning and say they will have to adjust to all the "firsts" without their parents.
Nicolle's house is quiet without Bob and Margi living downstairs. Nicolle grips the crocheted heart her father held as he died tightly.
"I do sleep with it sometimes," she said. "It's comfort."
https://www.cbc.ca/news/canada/prince-e ... -1.6050270
Re: Euthanasia
Do Patients Without a Terminal Illness Have the Right to Die?
Paula Ritchie wasn’t dying, but under Canada’s new rules, she qualified for a medically assisted death. Was that kindness or cruelty?
“I cannot get through a day,” Paula had said at an assessment for MAID eligibility. “It’s physical torture.”Credit...Oliver Farshi for The New York Times
By Katie Engelhart
Katie Engelhart has been reporting about medicine and ethics for nearly a decade. For this article, she interviewed dozens of clinicians, ethicists, lawyers, advocates and patients.
June 1, 2025
Updated 9:35 a.m. ET
One of the doctors wanted to know why, despite everything, Paula Ritchie was still alive. “I’m just curious,” she said. “What has kept you from attempting suicide since August of 2023?”
“I’m not very good at it,” Paula said. “Obviously.” Then she started to cry. She said that everything was getting worse. She said she didn’t want to suffer anymore. “This is a more dignified way to go than suicide.”
Listen to this arti
Paula was lying in the big bed that she had pulled into the center of the living room, facing an old TV and a window that looked out on a row of garbage bins. The room’s brown linoleum floors were stained, and its walls were mostly unadorned. On a bookshelf, there was a small figurine of an angel, her arm raised in offering. At 52, Paula had a pale, unblemished face and a tangle of dark hair that fell around her waist. The day before the appointment, in January this year, she washed her hair for the first time in weeks, but then she was not able to lift herself out of the bathtub. When, after hours, she managed to get out, her pain and dizziness was so bad that she had to crawl across the floor.
Dr. Matt Wonnacott sat in a folding chair at the foot of the bed. He was there as Paula’s “primary assessor”: one of two independent physicians, along with Dr. Elspeth MacEwan, a psychiatrist, who drove through the snow to Smiths Falls, Ontario, to evaluate Paula’s eligibility for Canada’s Medical Assistance in Dying (MAID) program — what critics call physician-assisted suicide.
“You’re a difficult case,” Wonnacott admitted. Another clinician had already assessed Paula and determined that she was ineligible — but there was no limit to how many assessments a patient could undergo, and Paula had called the region’s MAID coordination service every day, sometimes every hour, demanding to be assessed again, until the nurse on the other line had practically begged Wonnacott and his colleagues to take Paula off her roster.
Wonnacott had met Paula once before, and he found her to be a fairly accurate narrator of her own medical history. They had spoken about how, precisely, Paula suffered and why she wanted to die. For the last few months, Wonnacott had been reading through her medical records, which were copious, and thinking about her case. “I just sort of let it percolate,” he said. “I have to sit with this for a little while. It’s kind of a gestalt thing.”
Paula started thinking about MAID in the spring of 2023, after suffering a head injury. In the days following, she had vertigo and a migraine that wouldn’t go away. Her muscles jerked, and her legs buckled underneath her when she tried to walk. At night, she couldn’t sleep. Same for the next night and the next one. Physicians in the local emergency department did a CT scan and later an M.R.I. but could not find an obvious cause for her symptoms. Based on Paula’s presentation, several diagnosed her with a concussion — and then, when the symptoms didn’t go away, and when Paula kept returning to the hospital in tears, with post-concussion syndrome. Others told Paula that her symptoms were caused by depression and anxiety. “Go home,” they said, after running a few tests and referring her to county mental-health services.
When Paula was alone at her apartment, her symptoms grew worse. She was dizzy. She vomited all the time. Paula said it was like the world was spinning. Like she was on a “roller-coaster ride at full warped speed.” Her body hurt, too. Like the blood in her veins had been replaced with burning gasoline. Like her brain was going to blow. She couldn’t focus. She couldn’t cook or do laundry. She couldn’t cut her toenails; they grew inches long, yellowing and curling in on themselves, before breaking off at the base.
The pain was worse than anything she had ever felt, and Paula had always been in pain. Over the years, she had collected varied and sometimes competing diagnoses: fibromyalgia, chronic fatigue syndrome, chronic pain, chronic migraine. Also bipolar disorder, borderline personality disorder, post-traumatic stress disorder, depression, anxiety, substance-use disorder (marijuana). Paula told a friend that a veterinarian would put a dog down for feeling better than she did.
In the months after the concussion, she took Percocet, for joint pain, and Lyrica, for nerve pain, and Ativan, for anxiety. She took pills for vertigo and insomnia, and she tried a drug called Lamotrigine: an anti-epileptic that is also used as a mood stabilizer. When that didn’t work, she spent money that she didn’t really have on chiropractors and acupuncturists and reiki energy healers. Everything just made her dizzier, and nothing touched the pain.
Once, after being sent home from the hospital, Paula tried to take her own life, using two plastic grocery bags. She passed out but did not suffocate, and when she woke up, gasping and tearing at the plastic, everything was worse again. Her vocal cords were damaged from the pressure on her neck, and her smooth, low voice had turned into a permanent high-pitched squeak.
In June 2023, Paula went to Brockville General Hospital, a 45-minute drive from her home, to see if its E.R. doctors could help her. There, she was involuntarily admitted and put on a weeklong psychiatric hold. Two months later, Paula took a taxi to a different hospital, in Ottawa. She asked, “Do you guys do MAID?” Again she was placed on a psychiatric hold, this time for three weeks.
By then, MAID was in the air. That year, 15,343 Canadians — one out of 20 who died — received a physician-assisted death, making Canada the No. 1 provider of assisted dying in the world, when measured in total figures. This, just seven years after the procedure was legalized in Canada. In one province, Quebec, there were more MAID deaths per capita than anywhere else. Paula, who watched TV all day long, had seen lots of stories about MAID on the news.
Some of the coverage was about a recent expansion to the legislation. While MAID was initially restricted to patients with terminal conditions, the law in Canada was amended, in 2021, to include people who were suffering but who weren’t actually dying: people like Paula, who might have years or decades of life ahead of them.
ImageA man with dark, close-cropped hair and a short beard stands outside. He is wearing a black coat and a brown cross-body bag.
Dr. Matt Wonnacott served as Paula’s “primary assessor” for the MAID program.Credit...Oliver Farshi for The New York Times
Wonnacott already believed that Paula met most of the criteria for MAID, on the basis of her neurological disorder and lingering symptoms. Still, he wondered if there was anything he could do to make her life better, or at least good enough that she wouldn’t want to die. In particular, Wonnacott wanted to know if Paula would consider seeing a neuropsychiatrist, a specialist who worked at the intersection of chronic pain and brain injury.
“I don’t want to seem difficult if I say no,” Paula said hesitantly. She had been called “difficult” before. The thing was, she knew that it could take months to get a specialist appointment in Ontario, as in the rest of Canada. And even then, it might not help. Paula had already seen a neurologist, who told her that “there is no magic wand.”
“That’s a thing that people say a lot,” Wonnacott said. “And it comes off as pretty callous.” What the neurologist probably meant, he suggested, was that there was nothing any individual doctor could do to make Paula instantly and all-the-way better. “I think it’s possible, theoretically possible, that months to years of sustained work over many visits could make you marginally better. So I want you to just think about a hypothetical here: What if there was a magic wand that would make you mostly better, five years from now? Would you wait the five years?”
“I cannot get through a day,” Paula said. “It’s physical torture.” She wanted to know at what point she was allowed to refuse more treatment.
“That’s a great question,” Wonnacott said. The answer was: at any point she wanted. There wasn’t a specific number of treatments she was required to undergo before she could get MAID, or some specific period of time she had to suffer before she was deemed, under the law, to have suffered enough. Paula was allowed to say no. To say enough is enough.
“It’s not my role to force you to do anything, even if I genuinely think it would really help you,” Wonnacott said. In the doctor’s opinion, Paula’s understanding of her injury was not perfect, but it was not distorted by her mental illness either. Her MAID request didn’t seem to be a cry for help, or a lashing out, or a manipulation. She had tried to get better, after all. She seemed to be thoughtful about the costs and benefits of dying. “I think you have capacity,” he told her.
“That sounds like you are saying that you find Paula eligible,” said MacEwan, who was sitting on a chair on the other side of the bed.
“Yeah, I will go ahead,” Wonnacott said. “You?”
“Yes,” she answered. And Paula started to weep.
“It’s really a question of my schedule,” Wonnacott said. “I can probably do next week.”
When Canada’s first MAID law, Bill C-14, passed in 2016, it was reserved for those who were over 18, eligible for health care and mentally competent to consent to death. They needed to have a “serious and incurable illness, disease or disability”; be in an “advanced state of irreversible decline in capability”; and have “enduring physical or psychological suffering” that was “intolerable.” Their natural deaths also had to be “reasonably foreseeable.” In other words, they had to be dying.
The early paradigmatic cases were people in their 70s and 80s with terminal cancer: educated, affluent men and women who didn’t want to die slowly, perhaps in pain, perhaps slipping in and out of consciousness for hours or days. In one poll, an overwhelming 86 percent of Canadians were found to support MAID’s legalization.
But clinicians who agreed to assess dying patients were visited by other kinds of patients too: people with chronic pain or spinal-cord injuries or slow-moving, early-stage neurological disorders, like Parkinson’s and multiple sclerosis — people who were suffering terribly but who weren’t dying of their conditions in any immediate way. MAID assessors would have to tell these patients that they didn’t qualify.
At the same time, Canadian newspapers were publishing stories about people who were denied MAID and then went on to take their own lives, alone or fearful. One was Cecilia Bernadette Chmura, a 59-year-old with chronic pain who killed herself with a handful of hoarded pills, crushed in a coffee grinder, and whose husband was taken into custody after her death. Her husband had insisted that his wife die in her own bed, in his arms, instead of alone in a motel room, as she initially suggested to protect him from prosecution. (He was not charged.)
In 2017, Bill C-14 was challenged, in a Quebec court, as being too restrictive. One plaintiff was Jean Truchon, a 51-year-old who had suffered from spastic cerebral palsy from birth. Truchon was almost completely immobile; he had movement only in his left arm. Still, he could function with assistance and, in adulthood, even live with some independence in a supervised apartment. Then, in 2012, Truchon lost sensation in his left arm. He was moved into an assisted-living facility, where he experienced constant pain and muscle spasms and monotony.
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A man wearing a green shirt sits in a wheelchair surrounded by bookshelves.
Jean Truchon was a plaintiff in the lawsuit that led to the expansion of Canada’s MAID program. Credit...Ivanoh Demers
His days were a wash: hours spent being moved from his bed, to an armchair, to a bathroom for a scheduled bowel-movement break at 1 p.m., to a common room, then back to bed to watch hours of television. “That’s basically my life,” he explained in a summary to the court. “My poor life.” Truchon told lawyers that he had considered maneuvering his wheelchair in front of a truck or a bus, but that he didn’t want to traumatize the driver. He had also considered starvation, but he thought he might suffer too much. His evaluating psychiatrist testified that Truchon was, as the judge later summarized, “not suicidal, despite his wish to die.” He just couldn’t see the point in living anymore.
Truchon was granted a legal exemption and allowed to die by MAID. As a result of the lawsuit, in 2021, the Canadian government passed Bill C-7, which removed the requirement that a patient’s death be “reasonably foreseeable.” Now Canada’s law resembled the liberal legislation that was already in place in a few small European countries: the Netherlands, Belgium, Luxembourg. Now a Canadian who was chronically sick or disabled could receive MAID from a doctor or a nurse practitioner. Within Canada, this new kind of MAID came to be known as Track 2.
Technically, this second track was also open to people who did not have any physical condition at all, who were applying because of mental illness. But in response to an outcry from some Canadian psychiatrists who argued that the mental-health-care system was wholly unprepared for the change — and who worried about psychiatry’s ability to know, with any certainty, whether any given patient was incurable — MAID for “mental illness as the sole underlying condition” was delayed for a period of two years, and then delayed again and again. (It is now set to begin in 2027.) Track 2 came into effect with a mental-health exclusion and remained relatively rare; in 2023, there were 14,721 Track 1 deaths and 622 deaths from Track 2.
Still, Track 2 quickly became a subject of national contention and even obsession. To supporters, the passage of Bill C-7 was an act of profound political empathy: a recognition that human suffering knows no temporal bounds, and an extension of mercy to people who might otherwise be driven to suicides that were painful or violent. For critics, Track 2 was a moral stain on a nation that believed itself to be a bulwark of decency. It was proof of the slippery slope. Dr. K. Sonu Gaind, chief of psychiatry at Toronto’s Sunnybrook Health Sciences Centre, told The National Post that “we have gone so far over the line with Track 2 that people cannot even see the line that we’ve crossed.”
How we reported this article:Katie Engelhart spent hours interviewing Paula Ritchie about her life and medical history, as well as reviewing her medical records, legal documents and personal diaries. Paula granted permission for the reporter to be present for critical appointments and for herself and her home to be photographed by Oliver Farshi. Paula agreed to have her story shared by The New York Times; as she told the reporter, “I’m an open book.”
From the start, some clinicians wanted nothing to do with Track 2. “There are whole regions of the country where doctors are just saying, ‘Well, we don’t do that,’” Dr. Stefanie Green, a prominent MAID provider in British Columbia and the founding president of the Canadian Association of MAID Assessors and Providers, told me. Others tried but then stopped, after seeing how complicated and onerous a Track 2 assessment could be. This was nothing like evaluating a Track 1 patient with, say, pancreatic cancer, one Alberta provider told me. An evaluation like that could take 15 minutes. “The janitor could do the assessment,” the provider said. “No disrespect to janitors.”
While a Track 1 patient could technically apply for and receive MAID within a day, the process for Track 2 was slower; there had to be at least 90 days from the start of the assessment to the patient’s death. Each patient was assessed by two independent clinicians, and if neither of the assessing clinicians had expertise in the patient’s medical condition, they had to consult with a clinician who did. The patient requesting assisted death also had to be informed of “the reasonable and available means” to relieve the suffering — and to give “serious consideration” to those means.
By law, a MAID patient had to be suffering in some way. The suffering could come either directly from the medical condition or indirectly from the condition’s follow-on effects. It could be either physical or psychological, as long as it was “enduring.” The law did not define exactly what it meant to suffer, or exactly how a medical professional was meant to evaluate the suffering. It was up to individual clinicians to figure out, in conversation with their patients. In a “Model Practice Standard” published by Health Canada, the country’s federal health regulator, MAID assessors were instructed to “respect the subjectivity of suffering.”
For other clinicians, the concern about Track 2 was more philosophical. Dr. Madeline Li, a cancer psychiatrist who developed the MAID program for Toronto’s University Health Network and who has personally overseen hundreds of Track 1 patients, told me that she was hesitant to involve herself in Track 2 because it didn’t fit with her larger understanding of medicine and its purpose. “If you want to allow people to end their lives when they want to, then put suicide kits in hardware stores, right?” Li told me. It was not “assistance in dying” if the patient was not actually dying.
But Wonnacott, Paula’s MAID assessor, started seeing Track 2 patients right away. He believed that bodily autonomy and patient choice should be the guiding tenets of his practice, and that many doctors didn’t respect these things enough. Every week or so, he would receive an email from the regional case-coordination service with a list of prospective patients, and when he had the time, he would take a few names from the bottom of the list: the people who had been waiting the longest for an assessment — sometimes because they were difficult cases.
The straightforward Track 2 patients were those with a clear diagnosis and a trail of paperwork. They were people who had, over the years, tried very hard to get better or at least to tolerate their conditions. An Alberta man in his mid-30s who had been having multiple seizures a day since he was a child, and who said he was tired of living in the drugged-out, half-sedation that his medication induced. A 39-year-old Nova Scotia woman with a progressive spinal condition that caused relentless pain. Other cases were less obvious. Clinicians debated what to do with patients who wanted assisted death for conditions that affected large numbers of people, many of whom seemed to be coping all right: diabetes, back pain, blindness.
Rick Martins, a retired electrical contractor in St. George, Ontario, was 67 when he lost almost all the vision in his left eye. It went over the course of a few days: the peripheral vision first, and then the rest. He was told that he had giant cell arteritis. At the time, Martins’s wife was sick with congenital heart disease and was in the hospital, and Martins visited her for 169 days. When she died in 2024, he found himself overwhelmed with grief — and then he lost vision in his right eye. That day, Martins decided that he wanted MAID. “It was too much all at once,” he told me. He was approved several months later.
In the meantime, Martins tried to adjust to things. He got an audio player so that he could listen to books. He continued to have coffee with a grieving widow he met at a support group. He allowed his two adult sons to care for him. But ultimately, Martins decided that, at nearly 70, he did not want to learn to live as a blind man. During Martins’s assessment, a psychiatrist asked him whether he would still want to die if his wife were alive. Probably not, Martins said; if she were alive, he would find a way to live. But she was not alive.
Other clinicians insisted that patients slow down — that, after a dramatic loss, they try to acclimate to their new bodies before requesting to die. Dr. Donna Stewart, a psychiatrist at Toronto General Hospital, told me about a patient in his late 20s who “took magic mushrooms, thought he could fly, found out he couldn’t and sadly crushed and broke his neck and ended up quadriplegic.” Almost immediately, he applied for MAID. Stewart consulted with rehabilitation experts. “And boy, I really got an earful,” she said.
Some pointed to research showing that over time, usually years, patients with spinal-cord injuries adjusted to things and then were glad to be alive. Others believed that it wasn’t the job of a MAID assessor to force people to stay alive for years in the hope that they might one day be grateful for it. Stewart reviewed the literature on long-term well-being after paralysis, and it gave her pause. “I said: ‘You know, I can’t go along with this. Let’s revisit in a year.’” The young man agreed to go to rehab. A year later, he asked for MAID again, and Stewart approved him. She believes that she was justified in asking him to wait. Others would have made him wait longer. But then again, Stewart thought, he had suffered for a year longer than he wanted to.
Often, Track 2 patients had suffering that was caused by social forces — and often, clinicians had to disentangle how much that kind of suffering was contributing to a MAID request. Many would-be Track 2 patients had been sick for years or decades and had, in that time, slipped out of the work force and into poverty. About half reported that they were lonely. About half perceived themselves to be a burden on loved ones. Stefanie Green, the co-founder of the Canadian Association of MAID Assessors and Providers, told me about assessing a sick patient who had been homeless, on and off, for years. “And obviously his fluctuating housing status could not be ignored,” Green said. “Why are you coming to see me? Because you’ve lost your room, you have nowhere to go? What is really driving this?”
And then there were the Track 2 patients whose suffering couldn’t be pinned down at all. They had chronic aches, or mysterious fevers, or fatigue that no amount of sleep would resolve. They had “functional disorders” that couldn’t be picked up on any blood test or body scan, that had no obvious medical explanation — disorders that are poorly understood within medicine, and disputed within medicine, and that some clinicians believe have a significant psychological component. Fibromyalgia, chronic fatigue, irritable-bowel syndrome, some kinds of chronic headaches, many types of chronic pain. Whether a clinician found such a patient eligible depended, in part, on how comfortable he or she was with ambiguity. The law itself did not require diagnostic certainty.
Some assessors refused to see patients with functional disorders. They argued that MAID for these conditions was, in effect, MAID for mental illness. Other clinicians assessed and approved them. Under Bill C-7, mental illness was not disqualifying as long as it existed alongside a physical condition. Many of these assessors argued that they were capable of deciphering exactly what was motivating a request to die.
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A round side table holds a vase of flowers, a pillar candle, a Bible and an old-fashioned analog alarm clock with bells.
Friends arranged a collection of belongings on Paula’s bedside table. Credit...Oliver Farshi for The New York Times
In the beginning, Wonnacott said, he could get hung up on a patient’s complexity — even distracted by it. He would try to map out the contours of a request: the shape and scope of different kinds of suffering. He learned to stop doing that. It was an impossible exercise that produced meaningless conclusions. Also, it didn’t matter. “The phrase I find myself saying a lot is, ‘I’m not going to judge people for why they’re suffering,’” he told me. “In some jurisdictions, you have to meet specific criteria for suffering, and I think it’s good that in Canada, you don’t. I don’t particularly care why you’re suffering. If you tell me that you’re suffering, who am I to question that?”
Paula said she had suffered from the day she was born. She was an unhappy baby, and then an unhappy child. She grew up in Perth, Ontario, in a motel that her parents owned, left to play all day in the lobby and the hallways. It was in that motel, Paula recalled, that her father abused her, in every way that a father can abuse a daughter. “He was a brutal monster,” she said. When her father was away, Paula could be vibrant and playful, but she also cried all the time. At night, she prayed for him to die: “God, please take him.”
When her father died in a car crash, Paula was 16, and she was left to wonder if her prayers had anything to do with it. She started getting terrible headaches and sometimes blacking out. She was always tired.
Paula went to college, to study sociology — she took a class on how to care for abused children — but she had to drop out because she was always in pain. Eventually, she was diagnosed with endometriosis and had a hysterectomy. Even then, the surgery didn’t take the ache away. It stayed there, deep in her hips and pelvis. Paula saw different doctors who proposed new diagnoses, like fibromyalgia. She went through bottles of Ibuprofen and prescription opioids.
Over the years, she tried to take her life several times: once with pills; once in a river, with weights in her pockets — like Virginia Woolf, except that Paula came up coughing and swam back to shore. Several times, beginning when she was 24, she was admitted to inpatient psychiatric units. Different doctors had different theories about why she was unwell and prescribed different things: antidepressants, antipsychotics, benzodiazepines. Sometimes she stayed on a particular drug for many years, but other times she decided that the drugs weren’t working, or that their side effects were too debilitating, or that they were making her fat, and she stopped them.
At home, Paula was treated by psychiatrists and caseworkers at Lanark County Mental Health, which provides publicly funded care. She was also seen, on and off, by a private therapist, whom she loved and who agreed to work with her for free because she couldn’t afford the help. Paula would attend appointments regularly for months, but then she would inevitably disappear, until she reappeared a few months later. “Paula is responsible and desires tremendously to carry her own weight in the world,” the therapist wrote in a letter of support. “Although Paula still has a long way to go, I fully expect Paula to become a happy and successful member of society.”
With friends, Paula could be sweet one minute and vicious the next. “You had to kind of tread carefully with her,” David Robinson told me. At one of her apartment buildings, Paula befriended David, who was three decades her senior. David was drawn to Paula’s big energy: the way she radiated it when she smoked a bit of weed and then went walking through town with her ponytail swinging, saying, “Hey, doll!” to everyone she came across. To David, everything about Paula was loud and excessive. Her voice. Her strut. The way she used a half a bottle of shampoo every time she washed her hair. Early in their friendship, Paula showed up at his door and told him that she was weaning herself off oxycodone — and could she lie on his bed for a while, so she wasn’t alone? She just lay there, in front of his window, sweating and talking, looking thin and beautiful. Sometimes David found himself thinking that if he had been born three decades later, he would have been all over Paula — but he never said it.
There were stretches of stability, of Paula feeling OK in her body. For a few years, she worked in group homes for people with disabilities. Some of her patients had Down syndrome and autism. Another, a young girl, was deaf and blind, and she just sat in a corner, alone, making buzzing sounds and sometimes hitting herself. “It drove people nuts,” Paula said. “But I loved her.” Paula would talk to the girl: close enough that she could feel the vibration of Paula’s voice. In the evenings, she would sit in bed with her.
But when Paula was 30, her mother died of stomach cancer, and everything fell apart. She felt abandoned. She struggled to take care of herself. Soon she was broke and had to sell her car. She started walking everywhere: up to 18 miles around town in a single day. She moved into a motel and then another. When, after years on the affordable-housing wait list, a unit finally opened up, it was not in Perth but in neighboring Smiths Falls, where Paula knew nobody. Paula did not want to move, but she had nowhere else to go.
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An old photograph of Paula and her mother at a beach with a pier in the background.
Paula (left) and her mother, who died of stomach cancer when Paula was 30.Credit...Oliver Farshi for The New York Times
“She just went downhill really fast,” her aunt Dorothy Zoppa told me. Paula stopped seeing her therapists and her social workers. She stopped seeing a family doctor because she couldn’t find one. She stopped taking mood stabilizers. She didn’t have a cellphone or a computer, and she spent hours a day just talking on an old black landline phone to people back in Perth. Still, Paula said, she was managing things — she was holding it together — until the concussion.
In Paula’s telling, she was followed into town one day in March 2023 by two women: one, the daughter of someone who lived in her affordable-housing complex and whom Paula had been feuding with. The women punched Paula in the left side of the head until she blacked out. And when she awoke, “I’m like, I’m in trouble.”
Paula eventually found a family doctor who prescribed a variety of drugs and wrote a referral to a neurologist. But then she started calling the doctor’s office all the time, demanding more referrals and yelling at the staff. She made appointments and then did not show up: because she couldn’t find anyone to drive her the 45 minutes it took to get to the doctor’s office, or because she felt too sick to get in the car. After a year, the doctor sent Paula a letter saying that she had “decided to discontinue providing medical care for you at this time. … Please understand that this decision is in no way a reflection of your personal worth.” Later, a brain-injury clinic agreed to examine Paula, but she did not show up to her intake appointment.
Paula stopped leaving her apartment. She stopped bathing. She gained 30 pounds. Once, when David came to visit, he was stunned to see that Paula now resembled an old woman: soft and trembling, barely able to walk.
In May 2024, more than a year after the concussion, and months after she started asking doctors about MAID, Paula went to see a neurologist who diagnosed her with post-traumatic headaches. During the examination, the doctor observed “an on/off postural tremor” in both of Paula’s arms but found that it was “distractible” — as in, if Paula were distracted, by a task or in conversation, the tremors ceased. Paula was also observed to have “giveaway weakness in all muscles.” When the doctor pushed against a limb, Paula would initially be able to resist the touch at normal strength, before her muscles would suddenly buckle and give way. This suggested that the buckling was due to psychological causes or a lack of effort.
“Her neurological examination is normal,” the doctor wrote, indicating that her symptoms might be linked to depression and anxiety, perhaps triggered by the concussion. She recommended that, in addition to taking medication for migraines, Paula go to therapy and start an S.S.R.I.; she noted that Paula refused to try any of it. “I don’t think that she has permanent brain damage,” the neurology report concluded. “I have already told her that none of these diagnoses would qualify for her MAID at this time.”
Paula panicked. She started calling MAID coordinators in other regions. She called radio stations and newspapers and nonprofit organizations and the mayor, trying to plead her case. She called police stations too, asking if someone could administer a polygraph test, so that she could prove to everyone that her wanting MAID had nothing to do with mental illness but was instead about her brain damage. That if she seemed mad, it was only because the injury had driven her to the point of madness.
When Paula finally met Wonnacott and he told her that she had the capacity to consent to MAID, she decided that he must be an angel sent by God. By the grace of God, she said, the doctor had believed her.
The opponents said they knew all along that Bill C-7 would be dangerous. That when Canada severed the act of MAID from the condition of dying, the remaining law would be so expansive as to allow death for any manner of “suffering.” And that the first casualties would be the poor and the marginalized and the disabled and the mentally ill.
These people, whose medical problems were so obviously made worse by their material conditions, would end up applying for MAID because of suffering that was, effectively, imposed on them by the system. They would be judged “incurable” and “irremediable” because they had not been provided with the means to become well. MAID, a procedure initially meant to help dying patients avoid painful deaths, would now be used to help nondying patients shortcut their painful lives. For the system, this would be less expensive too. A report released by the Parliamentary budget officer estimated that Bill C-7 would save the provincial governments an estimated $149 million annually in net health care costs.
Even some MAID defenders acknowledged that social and economic factors could confuse a MAID assessment. One 2023 academic paper, titled “Are Unmet Needs Driving Requests for Medical Assistance in Dying?” collected testimony from 20 MAID providers who had together done over 3,700 assessments. The clinicians told researchers that unmet needs were rare, but that some patients were impoverished and lonely, and that this led to an “ethical dilemma,” because providers knew “that some of their suffering was due to society’s failure to provide for them.” The paper noted that “many evidence-based treatments that ameliorate quality of life” for people with chronic conditions were not covered by public health insurance.
Critics pointed to federal data from 2023 showing that Track 2 patients were more likely than the average Canadian to live in the lowest-income neighborhoods. (This is also true of Canadians who are chronically sick or disabled and who do not choose MAID.) For critics, this was further evidence that the supportive fabric of Canadian society was just not strong enough — or stretched widely enough — to allow an ethical practice of Track 2 MAID. Gaind, the Toronto physician, wrote an article suggesting Canada was committing “social murder.”
But it was all legal. “That’s why it’s so complicated,” said Li, the cancer psychiatrist. In her opinion, the problem was in what the law left space for. “If a patient meets eligibility criteria — and because the laws are kind of vague, it’s actually not that hard to meet eligibility criteria — then you can provide the MAID. But that doesn’t mean that, clinically, you should provide the MAID.” Especially without putting up a fight. “It’s odd to me. There’s no other branch of medicine where we just do what a patient wants without asking, ‘Is this the right decision?’”
Other countries had constructed their laws differently. In the Netherlands, for instance, where assisted dying for nonterminal patients is also legal, the law required the physician and patient to agree that all potentially effective means of alleviating suffering had been tried before the patient was approved. By contrast, in Canada, according to a 2018 paper in The Canadian Journal of Public Health, there was an “emphasis on the absolute right of patients to decide to die.”
“I do think there is a swing toward, you know, autonomy über alles,” said Ed Weiss, a family physician in Toronto. In this view, Bill C-7 had created a bureaucracy, even an aesthetics, of medical care, when all that some MAID assessors were really doing was letting patients do whatever they wanted.
By February 2023, a poll by the Angus Reid Institute, a nonprofit research foundation, showed that “more than half of Canadians (55 percent) say they worry about MAID taking the place of improvements in social service.” At academic conferences in the United States and South Africa, and in debates about assisted dying in Britain and Ireland, Canada was presented as a warning and a threat: Pass any MAID law, however narrow, and the law would expand, and the practice would degrade. In Canada, critics argued, MAID had stopped being a “last resort.” Now it was just another way to relieve suffering.
The most organized critique of Canada’s law came from disability rights advocates. In September 2024, two people with disabilities and several nonprofit organizations announced a legal challenge to Bill C-7. Their case argues that, by definition, all Track 2 MAID patients are disabled — people with medical conditions that limit daily functioning — and thus, that the law is discriminatory. If a nondisabled person is suffering and wants to die, her desire will be understood as pathological, and she will be offered suicide prevention. If a disabled person is suffering and wants to die, her doctor will hand her the proverbial gun.
According to legal filings, one party in the case, a 40-year-old woman named Kathrin Mentler, went to Vancouver General Hospital in 2023 after experiencing an “acute mental-health crisis.” There, in the throes of her calamity, “a clinician advised her on MAID and discussed MAID in positive terms, even though she was seeking help to live and did not ask for information about how to die.”
As it was, people with disabilities said they were used to having to beg for not much of anything. They were used to having to apologize for their existence and their needs. In every Canadian province and territory, disability benefits fall below the poverty line. “In some places in our country, it is easier to access MAID than it is to get a wheelchair,” Carla Qualtrough, then the minister in charge of Canada’s “disability inclusion,” acknowledged in 2020.
Many advocates referred to the case of a 66-year-old Quebec man named Normand Meunier, who died with MAID in 2024. Meunier was a truck driver until a 2022 spinal-cord injury left his arms and legs paralyzed. In January, his partner took him to the emergency room because he had a respiratory infection. She explained that Meunier had quadriplegia and that he required a special mattress that shifted pressure points on his body, so that he wouldn’t develop bedsores. Meunier was not given a special mattress, or any bed at all, and instead spent four days on a stretcher. He developed a serious pressure sore on his buttocks, a few centimeters in diameter, that worsened until bone and muscle were exposed. Doctors told Meunier that, at best, it would take months for the sore to heal. At worst, the sore wouldn’t heal at all and would instead lead to infection, sepsis, death.
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Two people are in a small room with a hospital bed. One is in a sling being lifted into the bed, and the other is helping.
Normand Meunier was approved for MAID on the basis of a serious pressure sore he developed during a hospital stay. Credit...Ivanoh Demers
Meunier requested MAID and was approved quickly on the basis of the pressure sore. “I don’t want to be a burden,” he told Radio-Canada, shortly before he died from MAID at this home. Later, the regional health authority confirmed that it had 145 alternating pressure mattresses available upon request. “I don’t understand how this can happen,” Meunier’s partner said. “A mattress is the most basic thing.”
“I’m certainly not going to argue that the system is in good shape,” Wonnacott said. He tended to receive criticism of MAID with equanimity. Of course the system was broken. Of course people ended up on the wrong side of it. And of course the government should work urgently to improve it. But then again, it was the system. There was no other system on offer. “And to force people to continue suffering as we wait an indefinite amount of time to fix it is unfair.” Sure, in any given MAID assessment, Wonnacott could allow himself to get caught up in the past conditional of what should have been done, what could have been. But there was the suffering patient sitting in front of him, here and now, wanting an answer.
Wonnacott also disagreed with the solution that the critics offered: to shut it all down. Fundamentally, he didn’t think the best way to protect poor and marginalized patients was to force them to stay alive, because in some counterfactual version of events, in which the world was a better and more just place, they might have chosen differently. That wasn’t how anything in medicine worked; a doctor always treated the patient as she was. How could it be otherwise? If only those who were rich or well connected were recognized to have autonomy and allowed to choose?
To defenders of Track 2, this was just the same old clinical paternalism, recast as concern for the downtrodden. Critics of MAID had grouped patients together, based on a few crude socioeconomic or medical characteristics, declared them collectively “vulnerable” and were now trying to deny them a legal right on the basis of that vulnerability. If a patient was assumed to be vulnerable, and viewed as incapable because of it, there was no limit to what her doctor might decide she could not do.
Even if resources were bountiful, patients would not always be healed. Modern medicine was especially bad at treating Track 2 conditions like chronic pain that lacked a clear structural etiology. Clinicians also struggled to treat chronic psychological symptoms like depression. Even the best palliative-care doctors — physicians whose entire careers were devoted to pain management — came up against symptoms they could not beat: because some physical pain clings to a body; because some patients get acclimated to the strongest drugs; because some kinds of human suffering are resistant to medical intervention. Denying eligible patients Track 2, on the grounds that they could be cured with more and more treatment, was allowing them to be held hostage to an unfounded belief in total recovery.
The critics seemed to imply that a few hundred Track 2 deaths each year were, together, taking the pressure off government officials to improve the system. And that, inversely, if enough people who wanted to die were instead forced to live, their suffering would create the moral imperative for a wide-reaching social-welfare revolution. Wonnacott and his colleagues thought this seemed unlikely. As it was, Canada had more publicly funded health care than many other countries.
For Wonnacott, it wasn’t that hard to approve Paula. If he was troubled about her case, it had more to do with what happened before he even met her. “If I could go back in time to the Paula of two years ago, when she still had the energy to go to emergency and ask for help, I think, in theory, this could have taken a different route and turned out differently,” he said. He could have tried her on one or two other medications. He could have referred her to a concussion clinic or a pain clinic, or maybe even an inpatient rehab unit.
“I think she could have been quite a lot better. But that’s too hypothetical.” If Wonnacott referred Paula to a specialty clinic now, it could be months or years before she even had an intake interview. (According to a 2023 survey, nearly one in 10 Canadians who need a medical specialist wait more than a year to see one.) In the meantime, Paula would grow more fearful, stop doing more things, become more depressed. Lose abilities. Lose resilience. Come to see herself, fundamentally and unshakably, as a person with chronic pain.
Wonnacott had to deal with the patient in front of him. The question was: Would this Paula get better? Not some other patient who was open to different theories about her suffering. Who had the stamina to work hard at therapy. Who, at a basic level, was capable of showing up to medical appointments and taking her drugs on schedule. Wonnacott thought the answer to that question was no.
He had read the report from Paula’s neurologist, which said that Paula did not have permanent brain damage and was not eligible for MAID. But he thought the specialist, who was not a MAID provider herself, misunderstood the eligibility criteria. There was nothing in the law that said that Paula’s neurological condition had to be tied to actual, physical damage to the brain. Paula’s pain was real either way. She felt it the same either way.
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Two hands reach into a small black doctor’s bag, which is resting on a stovetop.
Wonnacott’s doctor’s bag. In Canada, almost all MAID patients die by lethal injection.Credit...Oliver Farshi for The New York Times
In recent years, some ethicists have argued that Canada should make its MAID law even more liberal — notably, by doing away with the “suffering” criteria altogether. They argue that the suffering requirement is redundant; of course a person who wants to die is suffering. And also, that a patient shouldn’t have to be suffering in a way that is legible to her medical providers for her to be found worthy of death. It should be enough for her to decide, autonomously, that her life is not worth living.
For these advocates, the idea that MAID in Canada was no longer a last resort was not, itself, suggestive of anything being wrong. If a person did not have a religious objection to assisted death — if she didn’t think that earthly suffering was noble or important or redemptive, if she didn’t think she owed it to anybody else to stay alive — then why did she need to suffer through any number of “reasonable” treatments before she asked for MAID? Why did she need to suffer at all?
The plan had been for Paula’s friend to arrive early with her “last meal”: a McChicken with pickles and an iced tea. But that morning, on the day of her scheduled death, Paula called to say she wasn’t hungry.
When her handful of friends arrived, Paula was lying in bed in blue and white pajamas. By then, her apartment was nearly empty; she had spent the previous week giving everything away. On the wall in the living room, behind the bookshelf, there was a scattering of nails where pictures used to hang. Beside the bed, there was a round table with a small alarm clock on it. Paula had asked for the alarm clock because she wanted to keep track of how much time she had left.
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People gather around Paula’s bed. Two women, Paula’s childhood friend and her death doula, kneel at the foot of the bed.
Those close to Paula gathered at her bedside.Credit...Oliver Farshi for The New York Times
The doctor was due in a few hours, and Paula was still preoccupied with logistics: where her belongings would go, who would manage everything with the bank. Everyone had told her not to spend her final hours worrying about that, but Paula said she didn’t want to leave a mess behind.
She wrote out a list of instructions in a notebook. The TV and the small corner shelf were to go to her Aunt Dorothy. The microwave could be thrown out, as could the fan. There were two bananas and an apple in the kitchen that David could take, assuming they weren’t rotten.
“Are you comfy enough?” Nancy Maynard, Paula’s childhood friend asked. “I can tuck you in.”
“How am I going to say goodbye to you?” Paula started crying again, her face pinched and anguished. “I just pray to God that the Lord is going to take me.”
“I have no doubt,” said Valerie Oldfield, a death doula Paula met a few months earlier.
“You’re safe now, baby,” Nancy said.
“Then why am I so terrified?”
Valerie shrugged. “It’s human nature.”
Then the minister walked in. Paula had spent days calling religious leaders and asking if they would come sit with her while she died. Some said they would not but that they would pray for her. Others wouldn’t even do that. But then, finally, someone agreed to come. She introduced herself as the Rev. Takouhi Demirdjian-Petro, from the United Church of Canada, and she was tall and sturdy, in a pink clerical blouse. She looked down at Paula and took stock of the tearful situation. “You’re in the hands of the everlasting love of God,” she said firmly.
Paula started to cry harder, until she was nearly convulsing. “God have mercy on my soul.”
“God is with you,” the minister said. “And he is guiding you.”
“What if I get lost?” Paula asked. “My mind doesn’t have a very good GPS. I’m scared of getting lost.”
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An older man in a plaid shirt leans over to hug Paula in her bed.
https://static01.nyt.com/images/2025/06 ... &auto=webp
Paula and her friend David Robinson said goodbye.Credit...Oliver Farshi for The New York Times
“You won’t. I promise you, honey.” The minister told Paula that she had a vision of Paula’s mother waiting for her, like a mother might wait for her daughter at the airport. “And I’m not B.S.ing you. So just let go of this empty, empty world.”
Paula stopped crying and turned to the nurse coordinator who had worked on her MAID request. “Do you need to put sheets underneath me, in case — ”
“Nope,” the nurse said.
“Do you know? Do your bowels release?”
The nurse shook her head. “Don’t worry about that.”
When Dr. Wonnacott came in, he was carrying a black leather doctor’s bag. He told Paula that he hadn’t scheduled anything else for the rest of the day, and that things could go as quickly or as slowly as she needed them to. Paula wanted to know how long it would take for her to die. “From the time the meds are in until you’re gone, five or 10 minutes,” Wonnacott said. “But from your perspective: a minute.”
In the American states where assisted dying is legal, patients are required to die by drinking a cocktail of lethal drugs. In Canada, almost all MAID patients die by lethal injection. “It feels like falling asleep for surgery,” Wonnacott told her. “You’re going to get really relaxed, and you’re going to fall asleep.”
Wonnacott asked everyone but Paula to step into the kitchen, in the back of the apartment. He wanted to speak with his patient alone, so that he could get her final consent, as the law required. Once, an elderly woman changed her mind right before Wonnacott administered her drugs. He had literally been doing a silent countdown in his head before squeezing the syringe — “five, four, three … ” — when the woman told him to stop. Paula told Wonnacott she wanted to proceed.
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Wonnacott’s hands administer drugs to Paula via an IV line in her right arm.
“I’m going to take Paula’s hand now,” Wonnacott said softly.Credit...Oliver Farshi for The New York Times
After a few minutes, Wonnacott joined the small crowd in the kitchen. “I want to let people know what to expect,” he said. “This is fast enough that it can be unsettling.” Paula was going to lose consciousness very quickly, and once her eyes closed, she wouldn’t be able to feel anything. Sometimes, when people died, they looked as if they were in pain, but they weren’t really; that was just an involuntary muscle reaction.
When everyone entered the living room again, the lights were dim, and Paula was lying with a beige blanket pulled around her chest. She said she was ready.
“I’m going to take Paula’s hand now,” Wonnacott said softly.
“Now?”
“Now.”
For days, Paula had worried that, at the final moment, she would waver, as she did when she tried to take her life before: pick up the pills, put them down, pick them up again; wade into the river, swim back, over and over. She imagined that when Wonnacott reached for the syringe, she would flinch. But Paula was calm and still as the drugs went in. “I don’t feel anything,” she whispered.
“You will.”
“Oh, wow,” she said. “This is horrible. I’m just so sorry.” Paula coughed as if she might vomit. Deep, guttural hacks. After a few moments, her body relaxed. A wet tissue fell from her hands. Her skin slowly turned a pale white.
Wonnacott pressed his stethoscope to Paula’s chest. “It’s over.”
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Paula’s body, shown from the chest down, lies on the bed under a thin beige blanket. A pink tulip rests lengthwise on her midsection.
Two friends stayed with Paula’s body until it was removed.Credit...Oliver Farshi for The New York Times
Read by Gabra ZackmanNarration produced by Krish SeenivasanEmma Kehlbeck and Tanya PérezEngineered by Devin Murphy
Takeaways from this story
Five Things to Know About Assisted Dying in Canada https://www.nytimes.com/2025/06/01/maga ... aways.html
Canada’s MAID law, which expanded the right to die to people without a terminal illness, raises ethical and medical dilemmas.
June 1,
https://www.nytimes.com/2025/06/01/maga ... roid-share
Paula Ritchie wasn’t dying, but under Canada’s new rules, she qualified for a medically assisted death. Was that kindness or cruelty?
“I cannot get through a day,” Paula had said at an assessment for MAID eligibility. “It’s physical torture.”Credit...Oliver Farshi for The New York Times
By Katie Engelhart
Katie Engelhart has been reporting about medicine and ethics for nearly a decade. For this article, she interviewed dozens of clinicians, ethicists, lawyers, advocates and patients.
June 1, 2025
Updated 9:35 a.m. ET
One of the doctors wanted to know why, despite everything, Paula Ritchie was still alive. “I’m just curious,” she said. “What has kept you from attempting suicide since August of 2023?”
“I’m not very good at it,” Paula said. “Obviously.” Then she started to cry. She said that everything was getting worse. She said she didn’t want to suffer anymore. “This is a more dignified way to go than suicide.”
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Paula was lying in the big bed that she had pulled into the center of the living room, facing an old TV and a window that looked out on a row of garbage bins. The room’s brown linoleum floors were stained, and its walls were mostly unadorned. On a bookshelf, there was a small figurine of an angel, her arm raised in offering. At 52, Paula had a pale, unblemished face and a tangle of dark hair that fell around her waist. The day before the appointment, in January this year, she washed her hair for the first time in weeks, but then she was not able to lift herself out of the bathtub. When, after hours, she managed to get out, her pain and dizziness was so bad that she had to crawl across the floor.
Dr. Matt Wonnacott sat in a folding chair at the foot of the bed. He was there as Paula’s “primary assessor”: one of two independent physicians, along with Dr. Elspeth MacEwan, a psychiatrist, who drove through the snow to Smiths Falls, Ontario, to evaluate Paula’s eligibility for Canada’s Medical Assistance in Dying (MAID) program — what critics call physician-assisted suicide.
“You’re a difficult case,” Wonnacott admitted. Another clinician had already assessed Paula and determined that she was ineligible — but there was no limit to how many assessments a patient could undergo, and Paula had called the region’s MAID coordination service every day, sometimes every hour, demanding to be assessed again, until the nurse on the other line had practically begged Wonnacott and his colleagues to take Paula off her roster.
Wonnacott had met Paula once before, and he found her to be a fairly accurate narrator of her own medical history. They had spoken about how, precisely, Paula suffered and why she wanted to die. For the last few months, Wonnacott had been reading through her medical records, which were copious, and thinking about her case. “I just sort of let it percolate,” he said. “I have to sit with this for a little while. It’s kind of a gestalt thing.”
Paula started thinking about MAID in the spring of 2023, after suffering a head injury. In the days following, she had vertigo and a migraine that wouldn’t go away. Her muscles jerked, and her legs buckled underneath her when she tried to walk. At night, she couldn’t sleep. Same for the next night and the next one. Physicians in the local emergency department did a CT scan and later an M.R.I. but could not find an obvious cause for her symptoms. Based on Paula’s presentation, several diagnosed her with a concussion — and then, when the symptoms didn’t go away, and when Paula kept returning to the hospital in tears, with post-concussion syndrome. Others told Paula that her symptoms were caused by depression and anxiety. “Go home,” they said, after running a few tests and referring her to county mental-health services.
When Paula was alone at her apartment, her symptoms grew worse. She was dizzy. She vomited all the time. Paula said it was like the world was spinning. Like she was on a “roller-coaster ride at full warped speed.” Her body hurt, too. Like the blood in her veins had been replaced with burning gasoline. Like her brain was going to blow. She couldn’t focus. She couldn’t cook or do laundry. She couldn’t cut her toenails; they grew inches long, yellowing and curling in on themselves, before breaking off at the base.
The pain was worse than anything she had ever felt, and Paula had always been in pain. Over the years, she had collected varied and sometimes competing diagnoses: fibromyalgia, chronic fatigue syndrome, chronic pain, chronic migraine. Also bipolar disorder, borderline personality disorder, post-traumatic stress disorder, depression, anxiety, substance-use disorder (marijuana). Paula told a friend that a veterinarian would put a dog down for feeling better than she did.
In the months after the concussion, she took Percocet, for joint pain, and Lyrica, for nerve pain, and Ativan, for anxiety. She took pills for vertigo and insomnia, and she tried a drug called Lamotrigine: an anti-epileptic that is also used as a mood stabilizer. When that didn’t work, she spent money that she didn’t really have on chiropractors and acupuncturists and reiki energy healers. Everything just made her dizzier, and nothing touched the pain.
Once, after being sent home from the hospital, Paula tried to take her own life, using two plastic grocery bags. She passed out but did not suffocate, and when she woke up, gasping and tearing at the plastic, everything was worse again. Her vocal cords were damaged from the pressure on her neck, and her smooth, low voice had turned into a permanent high-pitched squeak.
In June 2023, Paula went to Brockville General Hospital, a 45-minute drive from her home, to see if its E.R. doctors could help her. There, she was involuntarily admitted and put on a weeklong psychiatric hold. Two months later, Paula took a taxi to a different hospital, in Ottawa. She asked, “Do you guys do MAID?” Again she was placed on a psychiatric hold, this time for three weeks.
By then, MAID was in the air. That year, 15,343 Canadians — one out of 20 who died — received a physician-assisted death, making Canada the No. 1 provider of assisted dying in the world, when measured in total figures. This, just seven years after the procedure was legalized in Canada. In one province, Quebec, there were more MAID deaths per capita than anywhere else. Paula, who watched TV all day long, had seen lots of stories about MAID on the news.
Some of the coverage was about a recent expansion to the legislation. While MAID was initially restricted to patients with terminal conditions, the law in Canada was amended, in 2021, to include people who were suffering but who weren’t actually dying: people like Paula, who might have years or decades of life ahead of them.
ImageA man with dark, close-cropped hair and a short beard stands outside. He is wearing a black coat and a brown cross-body bag.
Dr. Matt Wonnacott served as Paula’s “primary assessor” for the MAID program.Credit...Oliver Farshi for The New York Times
Wonnacott already believed that Paula met most of the criteria for MAID, on the basis of her neurological disorder and lingering symptoms. Still, he wondered if there was anything he could do to make her life better, or at least good enough that she wouldn’t want to die. In particular, Wonnacott wanted to know if Paula would consider seeing a neuropsychiatrist, a specialist who worked at the intersection of chronic pain and brain injury.
“I don’t want to seem difficult if I say no,” Paula said hesitantly. She had been called “difficult” before. The thing was, she knew that it could take months to get a specialist appointment in Ontario, as in the rest of Canada. And even then, it might not help. Paula had already seen a neurologist, who told her that “there is no magic wand.”
“That’s a thing that people say a lot,” Wonnacott said. “And it comes off as pretty callous.” What the neurologist probably meant, he suggested, was that there was nothing any individual doctor could do to make Paula instantly and all-the-way better. “I think it’s possible, theoretically possible, that months to years of sustained work over many visits could make you marginally better. So I want you to just think about a hypothetical here: What if there was a magic wand that would make you mostly better, five years from now? Would you wait the five years?”
“I cannot get through a day,” Paula said. “It’s physical torture.” She wanted to know at what point she was allowed to refuse more treatment.
“That’s a great question,” Wonnacott said. The answer was: at any point she wanted. There wasn’t a specific number of treatments she was required to undergo before she could get MAID, or some specific period of time she had to suffer before she was deemed, under the law, to have suffered enough. Paula was allowed to say no. To say enough is enough.
“It’s not my role to force you to do anything, even if I genuinely think it would really help you,” Wonnacott said. In the doctor’s opinion, Paula’s understanding of her injury was not perfect, but it was not distorted by her mental illness either. Her MAID request didn’t seem to be a cry for help, or a lashing out, or a manipulation. She had tried to get better, after all. She seemed to be thoughtful about the costs and benefits of dying. “I think you have capacity,” he told her.
“That sounds like you are saying that you find Paula eligible,” said MacEwan, who was sitting on a chair on the other side of the bed.
“Yeah, I will go ahead,” Wonnacott said. “You?”
“Yes,” she answered. And Paula started to weep.
“It’s really a question of my schedule,” Wonnacott said. “I can probably do next week.”
When Canada’s first MAID law, Bill C-14, passed in 2016, it was reserved for those who were over 18, eligible for health care and mentally competent to consent to death. They needed to have a “serious and incurable illness, disease or disability”; be in an “advanced state of irreversible decline in capability”; and have “enduring physical or psychological suffering” that was “intolerable.” Their natural deaths also had to be “reasonably foreseeable.” In other words, they had to be dying.
The early paradigmatic cases were people in their 70s and 80s with terminal cancer: educated, affluent men and women who didn’t want to die slowly, perhaps in pain, perhaps slipping in and out of consciousness for hours or days. In one poll, an overwhelming 86 percent of Canadians were found to support MAID’s legalization.
But clinicians who agreed to assess dying patients were visited by other kinds of patients too: people with chronic pain or spinal-cord injuries or slow-moving, early-stage neurological disorders, like Parkinson’s and multiple sclerosis — people who were suffering terribly but who weren’t dying of their conditions in any immediate way. MAID assessors would have to tell these patients that they didn’t qualify.
At the same time, Canadian newspapers were publishing stories about people who were denied MAID and then went on to take their own lives, alone or fearful. One was Cecilia Bernadette Chmura, a 59-year-old with chronic pain who killed herself with a handful of hoarded pills, crushed in a coffee grinder, and whose husband was taken into custody after her death. Her husband had insisted that his wife die in her own bed, in his arms, instead of alone in a motel room, as she initially suggested to protect him from prosecution. (He was not charged.)
In 2017, Bill C-14 was challenged, in a Quebec court, as being too restrictive. One plaintiff was Jean Truchon, a 51-year-old who had suffered from spastic cerebral palsy from birth. Truchon was almost completely immobile; he had movement only in his left arm. Still, he could function with assistance and, in adulthood, even live with some independence in a supervised apartment. Then, in 2012, Truchon lost sensation in his left arm. He was moved into an assisted-living facility, where he experienced constant pain and muscle spasms and monotony.
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A man wearing a green shirt sits in a wheelchair surrounded by bookshelves.
Jean Truchon was a plaintiff in the lawsuit that led to the expansion of Canada’s MAID program. Credit...Ivanoh Demers
His days were a wash: hours spent being moved from his bed, to an armchair, to a bathroom for a scheduled bowel-movement break at 1 p.m., to a common room, then back to bed to watch hours of television. “That’s basically my life,” he explained in a summary to the court. “My poor life.” Truchon told lawyers that he had considered maneuvering his wheelchair in front of a truck or a bus, but that he didn’t want to traumatize the driver. He had also considered starvation, but he thought he might suffer too much. His evaluating psychiatrist testified that Truchon was, as the judge later summarized, “not suicidal, despite his wish to die.” He just couldn’t see the point in living anymore.
Truchon was granted a legal exemption and allowed to die by MAID. As a result of the lawsuit, in 2021, the Canadian government passed Bill C-7, which removed the requirement that a patient’s death be “reasonably foreseeable.” Now Canada’s law resembled the liberal legislation that was already in place in a few small European countries: the Netherlands, Belgium, Luxembourg. Now a Canadian who was chronically sick or disabled could receive MAID from a doctor or a nurse practitioner. Within Canada, this new kind of MAID came to be known as Track 2.
Technically, this second track was also open to people who did not have any physical condition at all, who were applying because of mental illness. But in response to an outcry from some Canadian psychiatrists who argued that the mental-health-care system was wholly unprepared for the change — and who worried about psychiatry’s ability to know, with any certainty, whether any given patient was incurable — MAID for “mental illness as the sole underlying condition” was delayed for a period of two years, and then delayed again and again. (It is now set to begin in 2027.) Track 2 came into effect with a mental-health exclusion and remained relatively rare; in 2023, there were 14,721 Track 1 deaths and 622 deaths from Track 2.
Still, Track 2 quickly became a subject of national contention and even obsession. To supporters, the passage of Bill C-7 was an act of profound political empathy: a recognition that human suffering knows no temporal bounds, and an extension of mercy to people who might otherwise be driven to suicides that were painful or violent. For critics, Track 2 was a moral stain on a nation that believed itself to be a bulwark of decency. It was proof of the slippery slope. Dr. K. Sonu Gaind, chief of psychiatry at Toronto’s Sunnybrook Health Sciences Centre, told The National Post that “we have gone so far over the line with Track 2 that people cannot even see the line that we’ve crossed.”
How we reported this article:Katie Engelhart spent hours interviewing Paula Ritchie about her life and medical history, as well as reviewing her medical records, legal documents and personal diaries. Paula granted permission for the reporter to be present for critical appointments and for herself and her home to be photographed by Oliver Farshi. Paula agreed to have her story shared by The New York Times; as she told the reporter, “I’m an open book.”
From the start, some clinicians wanted nothing to do with Track 2. “There are whole regions of the country where doctors are just saying, ‘Well, we don’t do that,’” Dr. Stefanie Green, a prominent MAID provider in British Columbia and the founding president of the Canadian Association of MAID Assessors and Providers, told me. Others tried but then stopped, after seeing how complicated and onerous a Track 2 assessment could be. This was nothing like evaluating a Track 1 patient with, say, pancreatic cancer, one Alberta provider told me. An evaluation like that could take 15 minutes. “The janitor could do the assessment,” the provider said. “No disrespect to janitors.”
While a Track 1 patient could technically apply for and receive MAID within a day, the process for Track 2 was slower; there had to be at least 90 days from the start of the assessment to the patient’s death. Each patient was assessed by two independent clinicians, and if neither of the assessing clinicians had expertise in the patient’s medical condition, they had to consult with a clinician who did. The patient requesting assisted death also had to be informed of “the reasonable and available means” to relieve the suffering — and to give “serious consideration” to those means.
By law, a MAID patient had to be suffering in some way. The suffering could come either directly from the medical condition or indirectly from the condition’s follow-on effects. It could be either physical or psychological, as long as it was “enduring.” The law did not define exactly what it meant to suffer, or exactly how a medical professional was meant to evaluate the suffering. It was up to individual clinicians to figure out, in conversation with their patients. In a “Model Practice Standard” published by Health Canada, the country’s federal health regulator, MAID assessors were instructed to “respect the subjectivity of suffering.”
For other clinicians, the concern about Track 2 was more philosophical. Dr. Madeline Li, a cancer psychiatrist who developed the MAID program for Toronto’s University Health Network and who has personally overseen hundreds of Track 1 patients, told me that she was hesitant to involve herself in Track 2 because it didn’t fit with her larger understanding of medicine and its purpose. “If you want to allow people to end their lives when they want to, then put suicide kits in hardware stores, right?” Li told me. It was not “assistance in dying” if the patient was not actually dying.
But Wonnacott, Paula’s MAID assessor, started seeing Track 2 patients right away. He believed that bodily autonomy and patient choice should be the guiding tenets of his practice, and that many doctors didn’t respect these things enough. Every week or so, he would receive an email from the regional case-coordination service with a list of prospective patients, and when he had the time, he would take a few names from the bottom of the list: the people who had been waiting the longest for an assessment — sometimes because they were difficult cases.
The straightforward Track 2 patients were those with a clear diagnosis and a trail of paperwork. They were people who had, over the years, tried very hard to get better or at least to tolerate their conditions. An Alberta man in his mid-30s who had been having multiple seizures a day since he was a child, and who said he was tired of living in the drugged-out, half-sedation that his medication induced. A 39-year-old Nova Scotia woman with a progressive spinal condition that caused relentless pain. Other cases were less obvious. Clinicians debated what to do with patients who wanted assisted death for conditions that affected large numbers of people, many of whom seemed to be coping all right: diabetes, back pain, blindness.
Rick Martins, a retired electrical contractor in St. George, Ontario, was 67 when he lost almost all the vision in his left eye. It went over the course of a few days: the peripheral vision first, and then the rest. He was told that he had giant cell arteritis. At the time, Martins’s wife was sick with congenital heart disease and was in the hospital, and Martins visited her for 169 days. When she died in 2024, he found himself overwhelmed with grief — and then he lost vision in his right eye. That day, Martins decided that he wanted MAID. “It was too much all at once,” he told me. He was approved several months later.
In the meantime, Martins tried to adjust to things. He got an audio player so that he could listen to books. He continued to have coffee with a grieving widow he met at a support group. He allowed his two adult sons to care for him. But ultimately, Martins decided that, at nearly 70, he did not want to learn to live as a blind man. During Martins’s assessment, a psychiatrist asked him whether he would still want to die if his wife were alive. Probably not, Martins said; if she were alive, he would find a way to live. But she was not alive.
Other clinicians insisted that patients slow down — that, after a dramatic loss, they try to acclimate to their new bodies before requesting to die. Dr. Donna Stewart, a psychiatrist at Toronto General Hospital, told me about a patient in his late 20s who “took magic mushrooms, thought he could fly, found out he couldn’t and sadly crushed and broke his neck and ended up quadriplegic.” Almost immediately, he applied for MAID. Stewart consulted with rehabilitation experts. “And boy, I really got an earful,” she said.
Some pointed to research showing that over time, usually years, patients with spinal-cord injuries adjusted to things and then were glad to be alive. Others believed that it wasn’t the job of a MAID assessor to force people to stay alive for years in the hope that they might one day be grateful for it. Stewart reviewed the literature on long-term well-being after paralysis, and it gave her pause. “I said: ‘You know, I can’t go along with this. Let’s revisit in a year.’” The young man agreed to go to rehab. A year later, he asked for MAID again, and Stewart approved him. She believes that she was justified in asking him to wait. Others would have made him wait longer. But then again, Stewart thought, he had suffered for a year longer than he wanted to.
Often, Track 2 patients had suffering that was caused by social forces — and often, clinicians had to disentangle how much that kind of suffering was contributing to a MAID request. Many would-be Track 2 patients had been sick for years or decades and had, in that time, slipped out of the work force and into poverty. About half reported that they were lonely. About half perceived themselves to be a burden on loved ones. Stefanie Green, the co-founder of the Canadian Association of MAID Assessors and Providers, told me about assessing a sick patient who had been homeless, on and off, for years. “And obviously his fluctuating housing status could not be ignored,” Green said. “Why are you coming to see me? Because you’ve lost your room, you have nowhere to go? What is really driving this?”
And then there were the Track 2 patients whose suffering couldn’t be pinned down at all. They had chronic aches, or mysterious fevers, or fatigue that no amount of sleep would resolve. They had “functional disorders” that couldn’t be picked up on any blood test or body scan, that had no obvious medical explanation — disorders that are poorly understood within medicine, and disputed within medicine, and that some clinicians believe have a significant psychological component. Fibromyalgia, chronic fatigue, irritable-bowel syndrome, some kinds of chronic headaches, many types of chronic pain. Whether a clinician found such a patient eligible depended, in part, on how comfortable he or she was with ambiguity. The law itself did not require diagnostic certainty.
Some assessors refused to see patients with functional disorders. They argued that MAID for these conditions was, in effect, MAID for mental illness. Other clinicians assessed and approved them. Under Bill C-7, mental illness was not disqualifying as long as it existed alongside a physical condition. Many of these assessors argued that they were capable of deciphering exactly what was motivating a request to die.
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A round side table holds a vase of flowers, a pillar candle, a Bible and an old-fashioned analog alarm clock with bells.
Friends arranged a collection of belongings on Paula’s bedside table. Credit...Oliver Farshi for The New York Times
In the beginning, Wonnacott said, he could get hung up on a patient’s complexity — even distracted by it. He would try to map out the contours of a request: the shape and scope of different kinds of suffering. He learned to stop doing that. It was an impossible exercise that produced meaningless conclusions. Also, it didn’t matter. “The phrase I find myself saying a lot is, ‘I’m not going to judge people for why they’re suffering,’” he told me. “In some jurisdictions, you have to meet specific criteria for suffering, and I think it’s good that in Canada, you don’t. I don’t particularly care why you’re suffering. If you tell me that you’re suffering, who am I to question that?”
Paula said she had suffered from the day she was born. She was an unhappy baby, and then an unhappy child. She grew up in Perth, Ontario, in a motel that her parents owned, left to play all day in the lobby and the hallways. It was in that motel, Paula recalled, that her father abused her, in every way that a father can abuse a daughter. “He was a brutal monster,” she said. When her father was away, Paula could be vibrant and playful, but she also cried all the time. At night, she prayed for him to die: “God, please take him.”
When her father died in a car crash, Paula was 16, and she was left to wonder if her prayers had anything to do with it. She started getting terrible headaches and sometimes blacking out. She was always tired.
Paula went to college, to study sociology — she took a class on how to care for abused children — but she had to drop out because she was always in pain. Eventually, she was diagnosed with endometriosis and had a hysterectomy. Even then, the surgery didn’t take the ache away. It stayed there, deep in her hips and pelvis. Paula saw different doctors who proposed new diagnoses, like fibromyalgia. She went through bottles of Ibuprofen and prescription opioids.
Over the years, she tried to take her life several times: once with pills; once in a river, with weights in her pockets — like Virginia Woolf, except that Paula came up coughing and swam back to shore. Several times, beginning when she was 24, she was admitted to inpatient psychiatric units. Different doctors had different theories about why she was unwell and prescribed different things: antidepressants, antipsychotics, benzodiazepines. Sometimes she stayed on a particular drug for many years, but other times she decided that the drugs weren’t working, or that their side effects were too debilitating, or that they were making her fat, and she stopped them.
At home, Paula was treated by psychiatrists and caseworkers at Lanark County Mental Health, which provides publicly funded care. She was also seen, on and off, by a private therapist, whom she loved and who agreed to work with her for free because she couldn’t afford the help. Paula would attend appointments regularly for months, but then she would inevitably disappear, until she reappeared a few months later. “Paula is responsible and desires tremendously to carry her own weight in the world,” the therapist wrote in a letter of support. “Although Paula still has a long way to go, I fully expect Paula to become a happy and successful member of society.”
With friends, Paula could be sweet one minute and vicious the next. “You had to kind of tread carefully with her,” David Robinson told me. At one of her apartment buildings, Paula befriended David, who was three decades her senior. David was drawn to Paula’s big energy: the way she radiated it when she smoked a bit of weed and then went walking through town with her ponytail swinging, saying, “Hey, doll!” to everyone she came across. To David, everything about Paula was loud and excessive. Her voice. Her strut. The way she used a half a bottle of shampoo every time she washed her hair. Early in their friendship, Paula showed up at his door and told him that she was weaning herself off oxycodone — and could she lie on his bed for a while, so she wasn’t alone? She just lay there, in front of his window, sweating and talking, looking thin and beautiful. Sometimes David found himself thinking that if he had been born three decades later, he would have been all over Paula — but he never said it.
There were stretches of stability, of Paula feeling OK in her body. For a few years, she worked in group homes for people with disabilities. Some of her patients had Down syndrome and autism. Another, a young girl, was deaf and blind, and she just sat in a corner, alone, making buzzing sounds and sometimes hitting herself. “It drove people nuts,” Paula said. “But I loved her.” Paula would talk to the girl: close enough that she could feel the vibration of Paula’s voice. In the evenings, she would sit in bed with her.
But when Paula was 30, her mother died of stomach cancer, and everything fell apart. She felt abandoned. She struggled to take care of herself. Soon she was broke and had to sell her car. She started walking everywhere: up to 18 miles around town in a single day. She moved into a motel and then another. When, after years on the affordable-housing wait list, a unit finally opened up, it was not in Perth but in neighboring Smiths Falls, where Paula knew nobody. Paula did not want to move, but she had nowhere else to go.
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An old photograph of Paula and her mother at a beach with a pier in the background.
Paula (left) and her mother, who died of stomach cancer when Paula was 30.Credit...Oliver Farshi for The New York Times
“She just went downhill really fast,” her aunt Dorothy Zoppa told me. Paula stopped seeing her therapists and her social workers. She stopped seeing a family doctor because she couldn’t find one. She stopped taking mood stabilizers. She didn’t have a cellphone or a computer, and she spent hours a day just talking on an old black landline phone to people back in Perth. Still, Paula said, she was managing things — she was holding it together — until the concussion.
In Paula’s telling, she was followed into town one day in March 2023 by two women: one, the daughter of someone who lived in her affordable-housing complex and whom Paula had been feuding with. The women punched Paula in the left side of the head until she blacked out. And when she awoke, “I’m like, I’m in trouble.”
Paula eventually found a family doctor who prescribed a variety of drugs and wrote a referral to a neurologist. But then she started calling the doctor’s office all the time, demanding more referrals and yelling at the staff. She made appointments and then did not show up: because she couldn’t find anyone to drive her the 45 minutes it took to get to the doctor’s office, or because she felt too sick to get in the car. After a year, the doctor sent Paula a letter saying that she had “decided to discontinue providing medical care for you at this time. … Please understand that this decision is in no way a reflection of your personal worth.” Later, a brain-injury clinic agreed to examine Paula, but she did not show up to her intake appointment.
Paula stopped leaving her apartment. She stopped bathing. She gained 30 pounds. Once, when David came to visit, he was stunned to see that Paula now resembled an old woman: soft and trembling, barely able to walk.
In May 2024, more than a year after the concussion, and months after she started asking doctors about MAID, Paula went to see a neurologist who diagnosed her with post-traumatic headaches. During the examination, the doctor observed “an on/off postural tremor” in both of Paula’s arms but found that it was “distractible” — as in, if Paula were distracted, by a task or in conversation, the tremors ceased. Paula was also observed to have “giveaway weakness in all muscles.” When the doctor pushed against a limb, Paula would initially be able to resist the touch at normal strength, before her muscles would suddenly buckle and give way. This suggested that the buckling was due to psychological causes or a lack of effort.
“Her neurological examination is normal,” the doctor wrote, indicating that her symptoms might be linked to depression and anxiety, perhaps triggered by the concussion. She recommended that, in addition to taking medication for migraines, Paula go to therapy and start an S.S.R.I.; she noted that Paula refused to try any of it. “I don’t think that she has permanent brain damage,” the neurology report concluded. “I have already told her that none of these diagnoses would qualify for her MAID at this time.”
Paula panicked. She started calling MAID coordinators in other regions. She called radio stations and newspapers and nonprofit organizations and the mayor, trying to plead her case. She called police stations too, asking if someone could administer a polygraph test, so that she could prove to everyone that her wanting MAID had nothing to do with mental illness but was instead about her brain damage. That if she seemed mad, it was only because the injury had driven her to the point of madness.
When Paula finally met Wonnacott and he told her that she had the capacity to consent to MAID, she decided that he must be an angel sent by God. By the grace of God, she said, the doctor had believed her.
The opponents said they knew all along that Bill C-7 would be dangerous. That when Canada severed the act of MAID from the condition of dying, the remaining law would be so expansive as to allow death for any manner of “suffering.” And that the first casualties would be the poor and the marginalized and the disabled and the mentally ill.
These people, whose medical problems were so obviously made worse by their material conditions, would end up applying for MAID because of suffering that was, effectively, imposed on them by the system. They would be judged “incurable” and “irremediable” because they had not been provided with the means to become well. MAID, a procedure initially meant to help dying patients avoid painful deaths, would now be used to help nondying patients shortcut their painful lives. For the system, this would be less expensive too. A report released by the Parliamentary budget officer estimated that Bill C-7 would save the provincial governments an estimated $149 million annually in net health care costs.
Even some MAID defenders acknowledged that social and economic factors could confuse a MAID assessment. One 2023 academic paper, titled “Are Unmet Needs Driving Requests for Medical Assistance in Dying?” collected testimony from 20 MAID providers who had together done over 3,700 assessments. The clinicians told researchers that unmet needs were rare, but that some patients were impoverished and lonely, and that this led to an “ethical dilemma,” because providers knew “that some of their suffering was due to society’s failure to provide for them.” The paper noted that “many evidence-based treatments that ameliorate quality of life” for people with chronic conditions were not covered by public health insurance.
Critics pointed to federal data from 2023 showing that Track 2 patients were more likely than the average Canadian to live in the lowest-income neighborhoods. (This is also true of Canadians who are chronically sick or disabled and who do not choose MAID.) For critics, this was further evidence that the supportive fabric of Canadian society was just not strong enough — or stretched widely enough — to allow an ethical practice of Track 2 MAID. Gaind, the Toronto physician, wrote an article suggesting Canada was committing “social murder.”
But it was all legal. “That’s why it’s so complicated,” said Li, the cancer psychiatrist. In her opinion, the problem was in what the law left space for. “If a patient meets eligibility criteria — and because the laws are kind of vague, it’s actually not that hard to meet eligibility criteria — then you can provide the MAID. But that doesn’t mean that, clinically, you should provide the MAID.” Especially without putting up a fight. “It’s odd to me. There’s no other branch of medicine where we just do what a patient wants without asking, ‘Is this the right decision?’”
Other countries had constructed their laws differently. In the Netherlands, for instance, where assisted dying for nonterminal patients is also legal, the law required the physician and patient to agree that all potentially effective means of alleviating suffering had been tried before the patient was approved. By contrast, in Canada, according to a 2018 paper in The Canadian Journal of Public Health, there was an “emphasis on the absolute right of patients to decide to die.”
“I do think there is a swing toward, you know, autonomy über alles,” said Ed Weiss, a family physician in Toronto. In this view, Bill C-7 had created a bureaucracy, even an aesthetics, of medical care, when all that some MAID assessors were really doing was letting patients do whatever they wanted.
By February 2023, a poll by the Angus Reid Institute, a nonprofit research foundation, showed that “more than half of Canadians (55 percent) say they worry about MAID taking the place of improvements in social service.” At academic conferences in the United States and South Africa, and in debates about assisted dying in Britain and Ireland, Canada was presented as a warning and a threat: Pass any MAID law, however narrow, and the law would expand, and the practice would degrade. In Canada, critics argued, MAID had stopped being a “last resort.” Now it was just another way to relieve suffering.
The most organized critique of Canada’s law came from disability rights advocates. In September 2024, two people with disabilities and several nonprofit organizations announced a legal challenge to Bill C-7. Their case argues that, by definition, all Track 2 MAID patients are disabled — people with medical conditions that limit daily functioning — and thus, that the law is discriminatory. If a nondisabled person is suffering and wants to die, her desire will be understood as pathological, and she will be offered suicide prevention. If a disabled person is suffering and wants to die, her doctor will hand her the proverbial gun.
According to legal filings, one party in the case, a 40-year-old woman named Kathrin Mentler, went to Vancouver General Hospital in 2023 after experiencing an “acute mental-health crisis.” There, in the throes of her calamity, “a clinician advised her on MAID and discussed MAID in positive terms, even though she was seeking help to live and did not ask for information about how to die.”
As it was, people with disabilities said they were used to having to beg for not much of anything. They were used to having to apologize for their existence and their needs. In every Canadian province and territory, disability benefits fall below the poverty line. “In some places in our country, it is easier to access MAID than it is to get a wheelchair,” Carla Qualtrough, then the minister in charge of Canada’s “disability inclusion,” acknowledged in 2020.
Many advocates referred to the case of a 66-year-old Quebec man named Normand Meunier, who died with MAID in 2024. Meunier was a truck driver until a 2022 spinal-cord injury left his arms and legs paralyzed. In January, his partner took him to the emergency room because he had a respiratory infection. She explained that Meunier had quadriplegia and that he required a special mattress that shifted pressure points on his body, so that he wouldn’t develop bedsores. Meunier was not given a special mattress, or any bed at all, and instead spent four days on a stretcher. He developed a serious pressure sore on his buttocks, a few centimeters in diameter, that worsened until bone and muscle were exposed. Doctors told Meunier that, at best, it would take months for the sore to heal. At worst, the sore wouldn’t heal at all and would instead lead to infection, sepsis, death.
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Two people are in a small room with a hospital bed. One is in a sling being lifted into the bed, and the other is helping.
Normand Meunier was approved for MAID on the basis of a serious pressure sore he developed during a hospital stay. Credit...Ivanoh Demers
Meunier requested MAID and was approved quickly on the basis of the pressure sore. “I don’t want to be a burden,” he told Radio-Canada, shortly before he died from MAID at this home. Later, the regional health authority confirmed that it had 145 alternating pressure mattresses available upon request. “I don’t understand how this can happen,” Meunier’s partner said. “A mattress is the most basic thing.”
“I’m certainly not going to argue that the system is in good shape,” Wonnacott said. He tended to receive criticism of MAID with equanimity. Of course the system was broken. Of course people ended up on the wrong side of it. And of course the government should work urgently to improve it. But then again, it was the system. There was no other system on offer. “And to force people to continue suffering as we wait an indefinite amount of time to fix it is unfair.” Sure, in any given MAID assessment, Wonnacott could allow himself to get caught up in the past conditional of what should have been done, what could have been. But there was the suffering patient sitting in front of him, here and now, wanting an answer.
Wonnacott also disagreed with the solution that the critics offered: to shut it all down. Fundamentally, he didn’t think the best way to protect poor and marginalized patients was to force them to stay alive, because in some counterfactual version of events, in which the world was a better and more just place, they might have chosen differently. That wasn’t how anything in medicine worked; a doctor always treated the patient as she was. How could it be otherwise? If only those who were rich or well connected were recognized to have autonomy and allowed to choose?
To defenders of Track 2, this was just the same old clinical paternalism, recast as concern for the downtrodden. Critics of MAID had grouped patients together, based on a few crude socioeconomic or medical characteristics, declared them collectively “vulnerable” and were now trying to deny them a legal right on the basis of that vulnerability. If a patient was assumed to be vulnerable, and viewed as incapable because of it, there was no limit to what her doctor might decide she could not do.
Even if resources were bountiful, patients would not always be healed. Modern medicine was especially bad at treating Track 2 conditions like chronic pain that lacked a clear structural etiology. Clinicians also struggled to treat chronic psychological symptoms like depression. Even the best palliative-care doctors — physicians whose entire careers were devoted to pain management — came up against symptoms they could not beat: because some physical pain clings to a body; because some patients get acclimated to the strongest drugs; because some kinds of human suffering are resistant to medical intervention. Denying eligible patients Track 2, on the grounds that they could be cured with more and more treatment, was allowing them to be held hostage to an unfounded belief in total recovery.
The critics seemed to imply that a few hundred Track 2 deaths each year were, together, taking the pressure off government officials to improve the system. And that, inversely, if enough people who wanted to die were instead forced to live, their suffering would create the moral imperative for a wide-reaching social-welfare revolution. Wonnacott and his colleagues thought this seemed unlikely. As it was, Canada had more publicly funded health care than many other countries.
For Wonnacott, it wasn’t that hard to approve Paula. If he was troubled about her case, it had more to do with what happened before he even met her. “If I could go back in time to the Paula of two years ago, when she still had the energy to go to emergency and ask for help, I think, in theory, this could have taken a different route and turned out differently,” he said. He could have tried her on one or two other medications. He could have referred her to a concussion clinic or a pain clinic, or maybe even an inpatient rehab unit.
“I think she could have been quite a lot better. But that’s too hypothetical.” If Wonnacott referred Paula to a specialty clinic now, it could be months or years before she even had an intake interview. (According to a 2023 survey, nearly one in 10 Canadians who need a medical specialist wait more than a year to see one.) In the meantime, Paula would grow more fearful, stop doing more things, become more depressed. Lose abilities. Lose resilience. Come to see herself, fundamentally and unshakably, as a person with chronic pain.
Wonnacott had to deal with the patient in front of him. The question was: Would this Paula get better? Not some other patient who was open to different theories about her suffering. Who had the stamina to work hard at therapy. Who, at a basic level, was capable of showing up to medical appointments and taking her drugs on schedule. Wonnacott thought the answer to that question was no.
He had read the report from Paula’s neurologist, which said that Paula did not have permanent brain damage and was not eligible for MAID. But he thought the specialist, who was not a MAID provider herself, misunderstood the eligibility criteria. There was nothing in the law that said that Paula’s neurological condition had to be tied to actual, physical damage to the brain. Paula’s pain was real either way. She felt it the same either way.
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Two hands reach into a small black doctor’s bag, which is resting on a stovetop.
Wonnacott’s doctor’s bag. In Canada, almost all MAID patients die by lethal injection.Credit...Oliver Farshi for The New York Times
In recent years, some ethicists have argued that Canada should make its MAID law even more liberal — notably, by doing away with the “suffering” criteria altogether. They argue that the suffering requirement is redundant; of course a person who wants to die is suffering. And also, that a patient shouldn’t have to be suffering in a way that is legible to her medical providers for her to be found worthy of death. It should be enough for her to decide, autonomously, that her life is not worth living.
For these advocates, the idea that MAID in Canada was no longer a last resort was not, itself, suggestive of anything being wrong. If a person did not have a religious objection to assisted death — if she didn’t think that earthly suffering was noble or important or redemptive, if she didn’t think she owed it to anybody else to stay alive — then why did she need to suffer through any number of “reasonable” treatments before she asked for MAID? Why did she need to suffer at all?
The plan had been for Paula’s friend to arrive early with her “last meal”: a McChicken with pickles and an iced tea. But that morning, on the day of her scheduled death, Paula called to say she wasn’t hungry.
When her handful of friends arrived, Paula was lying in bed in blue and white pajamas. By then, her apartment was nearly empty; she had spent the previous week giving everything away. On the wall in the living room, behind the bookshelf, there was a scattering of nails where pictures used to hang. Beside the bed, there was a round table with a small alarm clock on it. Paula had asked for the alarm clock because she wanted to keep track of how much time she had left.
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People gather around Paula’s bed. Two women, Paula’s childhood friend and her death doula, kneel at the foot of the bed.
Those close to Paula gathered at her bedside.Credit...Oliver Farshi for The New York Times
The doctor was due in a few hours, and Paula was still preoccupied with logistics: where her belongings would go, who would manage everything with the bank. Everyone had told her not to spend her final hours worrying about that, but Paula said she didn’t want to leave a mess behind.
She wrote out a list of instructions in a notebook. The TV and the small corner shelf were to go to her Aunt Dorothy. The microwave could be thrown out, as could the fan. There were two bananas and an apple in the kitchen that David could take, assuming they weren’t rotten.
“Are you comfy enough?” Nancy Maynard, Paula’s childhood friend asked. “I can tuck you in.”
“How am I going to say goodbye to you?” Paula started crying again, her face pinched and anguished. “I just pray to God that the Lord is going to take me.”
“I have no doubt,” said Valerie Oldfield, a death doula Paula met a few months earlier.
“You’re safe now, baby,” Nancy said.
“Then why am I so terrified?”
Valerie shrugged. “It’s human nature.”
Then the minister walked in. Paula had spent days calling religious leaders and asking if they would come sit with her while she died. Some said they would not but that they would pray for her. Others wouldn’t even do that. But then, finally, someone agreed to come. She introduced herself as the Rev. Takouhi Demirdjian-Petro, from the United Church of Canada, and she was tall and sturdy, in a pink clerical blouse. She looked down at Paula and took stock of the tearful situation. “You’re in the hands of the everlasting love of God,” she said firmly.
Paula started to cry harder, until she was nearly convulsing. “God have mercy on my soul.”
“God is with you,” the minister said. “And he is guiding you.”
“What if I get lost?” Paula asked. “My mind doesn’t have a very good GPS. I’m scared of getting lost.”
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An older man in a plaid shirt leans over to hug Paula in her bed.
https://static01.nyt.com/images/2025/06 ... &auto=webp
Paula and her friend David Robinson said goodbye.Credit...Oliver Farshi for The New York Times
“You won’t. I promise you, honey.” The minister told Paula that she had a vision of Paula’s mother waiting for her, like a mother might wait for her daughter at the airport. “And I’m not B.S.ing you. So just let go of this empty, empty world.”
Paula stopped crying and turned to the nurse coordinator who had worked on her MAID request. “Do you need to put sheets underneath me, in case — ”
“Nope,” the nurse said.
“Do you know? Do your bowels release?”
The nurse shook her head. “Don’t worry about that.”
When Dr. Wonnacott came in, he was carrying a black leather doctor’s bag. He told Paula that he hadn’t scheduled anything else for the rest of the day, and that things could go as quickly or as slowly as she needed them to. Paula wanted to know how long it would take for her to die. “From the time the meds are in until you’re gone, five or 10 minutes,” Wonnacott said. “But from your perspective: a minute.”
In the American states where assisted dying is legal, patients are required to die by drinking a cocktail of lethal drugs. In Canada, almost all MAID patients die by lethal injection. “It feels like falling asleep for surgery,” Wonnacott told her. “You’re going to get really relaxed, and you’re going to fall asleep.”
Wonnacott asked everyone but Paula to step into the kitchen, in the back of the apartment. He wanted to speak with his patient alone, so that he could get her final consent, as the law required. Once, an elderly woman changed her mind right before Wonnacott administered her drugs. He had literally been doing a silent countdown in his head before squeezing the syringe — “five, four, three … ” — when the woman told him to stop. Paula told Wonnacott she wanted to proceed.
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Wonnacott’s hands administer drugs to Paula via an IV line in her right arm.
“I’m going to take Paula’s hand now,” Wonnacott said softly.Credit...Oliver Farshi for The New York Times
After a few minutes, Wonnacott joined the small crowd in the kitchen. “I want to let people know what to expect,” he said. “This is fast enough that it can be unsettling.” Paula was going to lose consciousness very quickly, and once her eyes closed, she wouldn’t be able to feel anything. Sometimes, when people died, they looked as if they were in pain, but they weren’t really; that was just an involuntary muscle reaction.
When everyone entered the living room again, the lights were dim, and Paula was lying with a beige blanket pulled around her chest. She said she was ready.
“I’m going to take Paula’s hand now,” Wonnacott said softly.
“Now?”
“Now.”
For days, Paula had worried that, at the final moment, she would waver, as she did when she tried to take her life before: pick up the pills, put them down, pick them up again; wade into the river, swim back, over and over. She imagined that when Wonnacott reached for the syringe, she would flinch. But Paula was calm and still as the drugs went in. “I don’t feel anything,” she whispered.
“You will.”
“Oh, wow,” she said. “This is horrible. I’m just so sorry.” Paula coughed as if she might vomit. Deep, guttural hacks. After a few moments, her body relaxed. A wet tissue fell from her hands. Her skin slowly turned a pale white.
Wonnacott pressed his stethoscope to Paula’s chest. “It’s over.”
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Paula’s body, shown from the chest down, lies on the bed under a thin beige blanket. A pink tulip rests lengthwise on her midsection.
Two friends stayed with Paula’s body until it was removed.Credit...Oliver Farshi for The New York Times
Read by Gabra ZackmanNarration produced by Krish SeenivasanEmma Kehlbeck and Tanya PérezEngineered by Devin Murphy
Takeaways from this story
Five Things to Know About Assisted Dying in Canada https://www.nytimes.com/2025/06/01/maga ... aways.html
Canada’s MAID law, which expanded the right to die to people without a terminal illness, raises ethical and medical dilemmas.
June 1,
https://www.nytimes.com/2025/06/01/maga ... roid-share
Re: Euthanasia
Why the Euthanasia Slope Is Slippery
Eylul Aslan/Connected Archives
Ross Douthat
By Ross Douthat
Opinion Columnist
This week the Legislature of New York State passed a bill, now sitting on Gov. Kathy Hochul’s desk, allowing assisted suicide for people facing a diagnosis that gives them six months or less to live.
A few days before the vote, my colleague Katie Engelhart published a report on the expansive laws allowing “medical assistance in dying” in Canada, which were widened in 2021 to allow assisted suicide for people without a terminal illness, detailing how they worked in the specific case of Paula Ritchie, a chronically ill Canadian euthanized at her own request.
Many people who support assisted suicide in terminal cases have qualms about the Canadian system. So it’s worth thinking about what makes a terminal-illness-only approach to euthanasia unstable, and why the logic of what New York is doing points in a Canadian direction even if the journey may not be immediate or direct.
In a debate about euthanasia I was once asked, by the husband of a woman who sought assisted suicide unsuccessfully before her painful death, what I would have had the doctors offer her in place of the quietus she sought. His implication was that doctors always need to offer something: In most situations, that means care and treatment, but at the exceptional point when nothing further can be given, it’s legitimate to expect them to deliver something else.
This is the logic that undergirds laws that offer assisted suicide only to the terminally ill. It assumes that the dying have entered a unique zone where the normal promises of medicine can no longer be kept, a state of exception where it makes sense to license doctors to deliver death as a cure.
The problem is that a situation where the doctor tells you that there’s nothing more to be done for you is not really exceptional at all. Every day, all kinds of people are told that their suffering has no medical solution: people with crippling injuries, people with congenital conditions and people — like Ms. Ritchie — with an array of health problems whose etiology science does not even understand.
All these people, no less than a dying woman with an inoperable tumor, are in a position where official medicine has nothing meaningful to offer them. It’s true that because they are not imminently dying, they may have a greater hope of some eventual breakthrough than a person with a terminal diagnosis. But it’s equally true that because they are not imminently dying, the scope and duration of their suffering is potentially far greater.
So a justification for suicide that emphasizes the cry for help that medicine can’t answer, the need for control over the uncontrollable, the desire to cure suffering that doctors can’t relieve, will struggle to maintain terminal illness as a special category. There are just too many people in this exceptional position but with no endpoint to their pain.
I have some personal knowledge here, having lived for years with the chronic form of Lyme disease, a sickness whose existence is a matter of medical controversy and that has no official cure.
If you haven’t had such a sickness it’s possible to respond to the argument I’ve just sketched by saying, “Ah, well, at least we shouldn’t allow assisted suicide for conditions that might be psychosomatic or manifestations of mental illness; that’s an easy line to draw.” (Probably some people reading about Ms. Ritchie have that reaction.) Inside the world of chronic illness, though, such distinctions fall apart. Even if chronic Lyme disease were psychosomatic (I promise it is not), the person suffering agonizing pain for some mysterious mental reason might reasonably feel more trapped than other sufferers, even further into the territory where medicine can’t help.
And then, too, the treatments that did help get me better were, from the point of view of the official consensus, much too untested or weird or risky for a respectable, consensus-driven doctor to safely recommend.
Whereas death is certain, reliable, even — from a certain perspective — safe. And official medicine likes certainty and reliability. The Canadian experience shows this clearly — that if the alternatives for a desperately suffering person are low-probability treatments that take a long time to work, some psychological or spiritual adaptation, or an option that’s guaranteed to deliver what it promises, the guaranteed option will begin to crowd out the more difficult alternatives.
That’s why if you offer that option under supposedly restricted conditions, the restrictions may not hold. Suffering is general and not limited, the dying are not really a category unto themselves, and the case for a lethal solution will creep beyond the bounds you set.
In the end, you can have a consensus that suicide is intrinsically wrong, that suffering should be endured to whatever end and that doctors shouldn’t kill you. Or you can have an opening to death that will be narrow only at the start — and in the end, a wide gate through which many, many people will be herded.
https://www.nytimes.com/2025/06/14/opin ... e9677ea768
Eylul Aslan/Connected Archives
Ross Douthat
By Ross Douthat
Opinion Columnist
This week the Legislature of New York State passed a bill, now sitting on Gov. Kathy Hochul’s desk, allowing assisted suicide for people facing a diagnosis that gives them six months or less to live.
A few days before the vote, my colleague Katie Engelhart published a report on the expansive laws allowing “medical assistance in dying” in Canada, which were widened in 2021 to allow assisted suicide for people without a terminal illness, detailing how they worked in the specific case of Paula Ritchie, a chronically ill Canadian euthanized at her own request.
Many people who support assisted suicide in terminal cases have qualms about the Canadian system. So it’s worth thinking about what makes a terminal-illness-only approach to euthanasia unstable, and why the logic of what New York is doing points in a Canadian direction even if the journey may not be immediate or direct.
In a debate about euthanasia I was once asked, by the husband of a woman who sought assisted suicide unsuccessfully before her painful death, what I would have had the doctors offer her in place of the quietus she sought. His implication was that doctors always need to offer something: In most situations, that means care and treatment, but at the exceptional point when nothing further can be given, it’s legitimate to expect them to deliver something else.
This is the logic that undergirds laws that offer assisted suicide only to the terminally ill. It assumes that the dying have entered a unique zone where the normal promises of medicine can no longer be kept, a state of exception where it makes sense to license doctors to deliver death as a cure.
The problem is that a situation where the doctor tells you that there’s nothing more to be done for you is not really exceptional at all. Every day, all kinds of people are told that their suffering has no medical solution: people with crippling injuries, people with congenital conditions and people — like Ms. Ritchie — with an array of health problems whose etiology science does not even understand.
All these people, no less than a dying woman with an inoperable tumor, are in a position where official medicine has nothing meaningful to offer them. It’s true that because they are not imminently dying, they may have a greater hope of some eventual breakthrough than a person with a terminal diagnosis. But it’s equally true that because they are not imminently dying, the scope and duration of their suffering is potentially far greater.
So a justification for suicide that emphasizes the cry for help that medicine can’t answer, the need for control over the uncontrollable, the desire to cure suffering that doctors can’t relieve, will struggle to maintain terminal illness as a special category. There are just too many people in this exceptional position but with no endpoint to their pain.
I have some personal knowledge here, having lived for years with the chronic form of Lyme disease, a sickness whose existence is a matter of medical controversy and that has no official cure.
If you haven’t had such a sickness it’s possible to respond to the argument I’ve just sketched by saying, “Ah, well, at least we shouldn’t allow assisted suicide for conditions that might be psychosomatic or manifestations of mental illness; that’s an easy line to draw.” (Probably some people reading about Ms. Ritchie have that reaction.) Inside the world of chronic illness, though, such distinctions fall apart. Even if chronic Lyme disease were psychosomatic (I promise it is not), the person suffering agonizing pain for some mysterious mental reason might reasonably feel more trapped than other sufferers, even further into the territory where medicine can’t help.
And then, too, the treatments that did help get me better were, from the point of view of the official consensus, much too untested or weird or risky for a respectable, consensus-driven doctor to safely recommend.
Whereas death is certain, reliable, even — from a certain perspective — safe. And official medicine likes certainty and reliability. The Canadian experience shows this clearly — that if the alternatives for a desperately suffering person are low-probability treatments that take a long time to work, some psychological or spiritual adaptation, or an option that’s guaranteed to deliver what it promises, the guaranteed option will begin to crowd out the more difficult alternatives.
That’s why if you offer that option under supposedly restricted conditions, the restrictions may not hold. Suffering is general and not limited, the dying are not really a category unto themselves, and the case for a lethal solution will creep beyond the bounds you set.
In the end, you can have a consensus that suicide is intrinsically wrong, that suffering should be endured to whatever end and that doctors shouldn’t kill you. Or you can have an opening to death that will be narrow only at the start — and in the end, a wide gate through which many, many people will be herded.
https://www.nytimes.com/2025/06/14/opin ... e9677ea768