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What I fail to understand is how she could have taken such drastic action possibly a decade before it was necessary. I also marvel that, even in Switzerland, the law allowed it. It states that a Swiss physician assesses any request on the basis of medical documents. All applicants from abroad must have two discussions with the physician. Eligibility seems to involve the applicant having a terminal illness or an incurable disease; conditions such as motor neuron disease or multiple sclerosis. The website offers only a post box and I could find no details of payment beyond a small membership fee.

The more established Dignitas offers clear financial guidelines. How ethical is it for organisations to take payments from people who are well? Their hopes of a change in Scottish law were dashed when the Assisted Suicide Scotland Bill was defeated by 82 votes to He argued that, at present, only the rich can go to Switzerland. The majority depend on amateur assistance and the compassionate are treated like criminals.

This made a persuasive case. The bill would allow doctors to prescribe a lethal dose to a patient judged to have six months or fewer to live who requested it. It could help someone like Jeffrey Spector, a happy husband and father with an inoperable tumour on his spine. He described himself as a walking time-bomb. He so dreaded paralysis that he went to Dignitas early for fear of being unable to travel. Which of us could? But people in his position must fear that the Gill Pharaoh case will influence parliamentarians. Will they regard a law that allows the assisted suicide of the terminally ill as a wedge in the door that, in due course, will allow the healthy to opt for death too?

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The Borisification of columnists. Mark Smith: The lessons Unionists can learn from the pro-independence march She realized "there would be a need for providers, and I needed to learn how to do it. At first, Dr. Wiebe thought, "What a patriarchal attitude. There are laws and regulations about medical procedures, but there are also lessons to be learned from patients, and interpretations to be made by doctors.

But helping somebody die is different from merely accommodating a patient's request, say, to give birth in a squatting position, because, as Dr. Now, Dr. Wiebe provides choice to patients at both ends of life, in the same clinic. She believes that a physician-assisted death is a basic human right for grievously suffering patients, but she "certainly did not do it until it was legal.

The court had given the government a four-month extension, to June, , on its legislative timetable. But Quebec had already enacted and implemented its own assisted-dying regime. During the extension period, qualifying patients in Quebec could receive medical assistance in dying. Patients elsewhere, however, had to petition a Superior Court judge for an amendment under the criteria outlined in the Carter ruling. Hanne Schafer, a clinical psychologist in Calgary, was the first person to request a judicial exemption.

Schafer had been in her early 60s when she was diagnosed with ALS in Two years later, she could no longer speak or swallow. With the help of close friends and family, Ms. Schafer hired a lawyer, prepared the argument and the affidavits, and secured a hearing before a senior judge at the Court of Queen's Bench in Alberta. Then she had to find two doctors: one who was willing to provide a medically assisted death and another who could provide an independent assessment that she met the Carter criteria for grievous and irremediable suffering.

So her friends and family mined their contacts, following a web of connections from Calgary to Toronto to Amsterdam to Vancouver, and came up with Dr.

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Schafer, who by then was only able to use the thumb on her right hand, flew from Calgary to Vancouver, where Dr. Wiebe had to persuade a pharmacy to release the lethal medications in B. After an arduous journey, both legal and geographical, Ms. Schafer died, as she wished, on Feb. Shamed by the media coverage of Dr. Schafer's risky trek from Calgary to Vancouver, Alberta hastily released its patient plan. None of that would have happened so quickly without Dr.

Wiebe's audacity as a provider. W ho controls dying — patients or doctors — is the dilemma that has always been at the heart of the right-to-die movement. The Supreme Court had opted for patients. Despite the recommendations of two independent committees — the Ontario-initiated Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying and the government's own bipartisan Special Joint Committee on Physician-Assisted Dying — the law did not shelter MAID underneath a compassionate umbrella of end-of-life care, as Quebec had done in its legislation.

Both committees had gone beyond the "floor" that Mr. Arvay had defined before the Supreme Court in the Carter decision: Both recommended allowing MAID for dementia patients who had completed advance requests, after diagnosis but while competent. In addition, the parliamentary committee had recommended that publicly funded institutions with religious affiliations should not be exempted from providing MAID.

Forget the floor. However, it did agree to study the literature on the excluded categories and to report back although not to make recommendations before the end of Patient eligibility, meanwhile, would be determined by two independent medical opinions. Qualifying patients had to wait out a reflection period, and also had to be lucid enough to confirm consent immediately before the drugs were administered either by one of the assessors or by a nurse practitioner.

However restrictive, MAID provided a legislative framework, and that meant a lot in a country that values "peace, order and good government" over unbridled individual freedoms. The Netherlands had had decades of on-the-ground experience developing due-care criteria — under which doctors wouldn't be prosecuted for helping their suffering patients to die — before it passed its euthanasia law in The law countermanded generations of training and practice, and few provisions had been made to recruit and train willing providers in a momentous and sudden change in patient care.

Wiebe "was one of the very, very few people, if not the only one, who was publicly available to do this work very early on," says Stefanie Green, a family doctor specializing in women's health and, like Dr. Green, a slim, chestnut-haired woman with an easy banter, lives and works in Victoria, a ferry ride away from Dr. A generation younger, Dr.

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Green was interested in expanding her family practice to include MAID. She attended the biannual international conference of the World Federation of Right-to-Die Societies in Amsterdam in May, , expecting to see lots of similarly minded Canadian doctors there. Only a handful showed up, which shouldn't have been a surprise, considering the distaste for MAID within the medical profession. Among those attending was Dr. Wiebe, and she and Dr. That was "more per capita than anywhere else except for Quebec, which was ahead of us," Dr.

Green invited the core group of willing providers to stay in touch by e-mail, using a listserv to compare notes and educate each other about techniques, drugs and assessment tools. What exactly did it mean? She went in the other direction, in an interpretation that would have repercussions throughout the neophyte assisted-dying culture in Canada. She based her understanding of "reasonably foreseeable" on a statement defending the proposed legislation made in the House of Commons by Justice Minister Jody Wilson-Raybould while Bill C was being debated.

The minister was responding to opposition critics who argued that Kay Carter, the key plaintiff in the Supreme Court decision, would not have qualified for an assisted death — an allegation that had been raised in a press conference by Ms. At 89, Ms. Carter had been suffering from a degenerative and immobilizing condition called spinal stenosis, which was restricting her independence, causing her extreme pain and forcing her to lie flat in bed, "like an ironing board," as she herself described her condition.

Despite her physical and emotional suffering, Ms. Carter was not terminally ill. Would she even qualify for MAID, under the "reasonably foreseeable death" criterion? Carter would indeed qualify, the minister responded, based on a combination of her degenerative medical condition, her suffering and her age. While some critics accused Ms. Wilson-Raybould of ageism, Dr. Wiebe took the explanation at face value. As she explained to me, she consulted actuarial tables to calculate that Ms.

Carter could have lived another five or six years, had she not travelled in secret to die in Switzerland in Consequently, Dr. Wiebe expanded her interpretation even further in June, , following a court case involving an Ontario patient, known only as A. At 77, A. Her condition had deteriorated, causing her intolerable suffering for which there were no further treatment options. Both assessed her medical condition and agreed, separately, that her suffering was grievous. But while one doctor was willing to provide an assisted death, the other balked, fearing that A.

Consequently, A. But by then, the first doctor declined to help A. After hearing the case, Justice Paul M. Perell ruled that A. Neither of the attorneys-general of Ontario or Canada, both of whom were opposed to A. After studying the A. Wiebe consulted her actuarial tables once again, and calculated that, at 77, A. If she was eligible for an assisted death, perhaps there were other patients on Dr. One of these patients was Robyn Moro, a Delta, B. Wiebe in March, , to request an assisted death.

Wiebe had refused, because she didn't think Ms. Moro's death was "reasonably foreseeable" under the law. Disappointed, Ms. Moro joined what had become known as the Lamb constitutional challenge to the "reasonably foreseeable" natural-death criterion in Bill C The challenge had been mounted a year earlier by the BC Civil Liberties Association, the same group that had initiated the Carter challenge. The Lamb case was named after the initial plaintiff, Julia Lamb, a year-old woman who had been diagnosed at 16 months of age with spinal muscular dystrophy, an incurable progressive disease that affects breathing, swallowing, speaking and walking.

While the constitutional challenge stagnated in the B. Moro's pain markedly increased. She was "suffering terribly," her husband, Len Moro, said in a written statement to The Canadian Press. Moro again consulted Dr. Wiebe about an assisted death. Based on the A. Wiebe calculated that Ms. Moro, at 68, couldn't live for another 10 years, given the severity of her condition. Therefore, her death was reasonably foreseeable.

On Aug. Wiebe provided Ms. Afterward, Len Moro complained that it was wrong to deny a suffering patient an assisted death simply because they were not close to death, and he deplored the lack of consistency in applying the terms of the Carter decision across the country. That, says Dr. Gardam, the Toronto infectious-disease specialist, is why physicians such as Dr. The position that Dr. Wiebe has carved out "is not a pleasant place to be in.

Even though the culture is changing, however glacially, access remains a serious issue, one that puts enormous stress on already-suffering patients and their families. That's why Dr. Gardam came forward as an assessor and provider.

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Watching extremely ill patients experience delay after delay, as though scheduling MAID is as mundane as making an appointment to "get your snow tires on," is "heartbreaking," he says. But as the provider, he needs to know that "there is no ambiguity" in the process; that all the evaluations have been done; that both he and the patient are convinced that an assisted death is legal, ethical and appropriate.

And so it should. Helping somebody die is a supremely intimate and definitive medical intervention. Sandra Martin outlines the battle for our 'final human right' with sympathy and solemnity, Michael Harris writes. Plus: In an excerpt from the book, Sandra Martin explores why a Dr. Kevorkian-like figure never emerged in Canada. T he biggest attitudinal change in the medical community has been among palliative-care doctors. Russell Goldman, director of the Temmy Latner Palliative Care Centre at Mount Sinai Hospital in Toronto, told me early in June, , that, for two years, his group had been trying to reach a consensus between doctors willing to provide MAID and those opposed to doing so.

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Finally, they decided that any patient accepted as palliative was entitled to "autonomy. The hospice where I volunteer in Toronto was once adamantly opposed to assisted dying. But then the law was passed, and slowly doctors came forward, and now the hospice does allow patients to have an assisted death on its premises.

Very few ask for such assistance, and the administrator is personally opposed to MAID on religious and professional grounds, believing it is contrary to hospice values. Even the conservative 85,member-strong Canadian Medical Association has had a change of heart. As recently as January, , the CMA executive — grudgingly — modified its adamant opposition to physician-assisted death by releasing an update to its long-standing policy.

Compare that chilly condescension to a vote among delegates at the CMA's annual convention last August in Quebec City. Not only were they in favour of a patient's right to choose MAID, they wanted the service expanded.

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  • Eighty-three per cent of attendees voted in favour of permitting assisted death for patients suffering from grievous illnesses — including dementia — who had made advance requests while they were still competent. Two-thirds supported access for terminally ill mature minors. In fact, mental illness, the condition that is getting the least support from doctors, is the only one of the three excluded categories to have been specifically tested in court.

    An Alberta woman, known only as E. She argued that she qualified under Section of the Carter ruling, in which the Court defined the criteria for asking for such a death. The patient has to be adult, competent, clearly consenting to the "termination of life" and with "a grievous and irremediable medical condition including an illness, disease or disability that causes enduring suffering that is intolerable to the individual in the circumstance of his or her condition. According to court documents, E. The spasms had caused her eyelids to fuse shut, so that she was, effectively, blind and had so compromised her digestive system that she had lost a significant amount of weight and muscle mass.

    Unable to walk, she had to be carried, or use a wheelchair. In her deposition, she said that she was not depressed or suicidal: Since diagnosis, nearly a decade earlier, she had undergone many failed traditional and experimental treatments and therapies. Unlike Ms. Schafer's application three months earlier in the same court, E. The problem, government lawyers contended, was the nature of E.

    Both were exclusions that the federal government was trying to establish in Bill C The Carter decision "does not require that the applicant be terminally ill," the judges ruled, and furthermore, "an exclusion for psychiatric illness cannot be found expressly" in Carter. Having been given a judicial exemption, E.

    Nobody has yet raised a constitutional challenge on the exclusion of mental illness, yet no patient other than E. One of those psychiatric patients was Adam Maier-Clayton, a year-old business-school graduate who booked himself a motel room in Southwestern Ontario in mid-April, In the months before his suicide, Mr.

    Maier-Clayton had appealed to Dr.

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    • Weibe for an assisted death. She had communicated with him several times by Skype and e-mail and had read his psychiatric file. He "had severe pain that disabled him," Dr.