Dr. David Amies reflects on the case of "Ms. S," the first person in English Canada to legally access physician-assisted dying. Despite winning a judge's permission to end her own life with the help of a doctor, the Alberta woman, who was afflicted with advanced ALS, had to leave her home province to have her wish for a peaceful death honoured.
On Monday, February 29, "Ms. S," of Calgary, died in Vancouver with the aid of a British Columbia doctor. Ms. S, whose name is protected under a court-ordered publication ban, was suffering grievously from end-stage amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease. While Ms. S was fortunately able to eventually access physician-assisted dying, her journey was marred by several cruel impediments.
A 1,000-kilometre journey
For one, why was it necessary for a gravely ill woman to travel 1,000 kilometres away from her home city to Vancouver? How could it be that, out of the more than 8,000 physicians that practice in Alberta, two physicians could not be found to assist her? Why did she face last-minute difficulties in obtaining suitable drugs to end her life? We are talking here about an elderly woman who was in considerable pain and whose disease left her unable to speak or move any part of the body except her left hand. What was gained from the pantomime that Ms. S was forced to endure while Calgary doctors and British Columbia pharmacists huffed and puffed?
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Dr. Ellen Wiebe was with Ms. S when she died. Dr. Wiebe and some colleagues have set up an organization, Hemlock Aid, that is prepared to offer physician-assisted dying to suitably qualified persons. She has since made some critical remarks about the College of Pharmacists of British Columbia. Apparently, Dr. Wiebe had made an arrangement with two pharmacists in Vancouver to supply the necessary medications for Ms. S, but at the last minute, they reneged on their agreement when the College advised them to obtain independent legal counsel. The College has unilaterally decided that it must first authorize pharmacists before they can supply drugs to be used for physician-assisted dying.
Justice Sheilah Martin of the Alberta Court of Queen's bench had specifically addressed the position of pharmacists in assisted death and gave protection to them should they fill prescriptions intended for that purpose. It appears that the B.C. College and its members failed to communicate adequately. The consequence of the administrative bungle was great distress to an already distressed woman.
Let us hope that the case of Ms. S is not a foretaste of what is to come after June 6 when new legislation surrounding physician-assisted dying comes into force. No one is suggesting that health professionals who have moral, religious or ethical objections to helping severely ill persons desirous of bringing their lives to an end should be obliged to take part. However, it will be necessary to ensure that such health care workers do not abandon those in their care.
Rules over access are murky
The question concerning publicly funded institutions denying this service on the grounds of conscience is much less clear. Health care is a provincial matter, but the constitution and the criminal law are federal matters. Health care workers’ licensing arrangements in Canada are a dog’s breakfast. All of the provinces and territories have statutory bodies that grant licenses to physicians, nurses, pharmacists and so on, and conditions and requirements vary from place to place. It is noteworthy that the United Kingdom, with a population of close to 70 million, has one organization responsible for licensing doctors, while Canada, with a population of 33 million, has more than a dozen. There are 13 provincial and territory governments. Consequently, there is a myriad of bodies that can have their say in how physician-assisted dying should be carried out. Many of those who work for this plethora of authorities, who have particular axes to grind, will be able to engineer administrative logjams to impede people like Ms. S.
The fate of the United States Supreme Court ruling Roe v. Wade is a good illustration of what is possible. Federal law gives access to women requiring abortion, but many states have created all kinds of barriers. Is this what we want in Canada in the matter of physician-assisted dying?
Ms. S turned out to be a pioneer in the last days of her life because she was the first person to obtain judicial authorization for medically assisted death. Moving forward, we shall have to be on our guard lest ideologues frustrate the will of the majority whose views have been demonstrated in survey after survey.
Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.
(Header photo credit: Teak Sato/Wikimedia)