Month: January 2017

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What does my family need to know about end-of-life care?

By Sunrise Senior Living

[T]he loss of a loved one is always a somber experience, but thankfully, due to the continuing advancements in health services, the number of Americans that are able to spend their final days in a comfortable and controlled setting is growing.

End-of-life care allows individuals to experience that final chapter in life with a dignified and calm feeling, as well as offer family members that peace of mind, support and a sense of comfort that can help ease that sorrow during this time. Being informed and conscious of this subject makes taking those steps in coordinating this care much easier and straightforward for everyone involved.

When is it time?
There are many conditions in existence that over time can become increasingly difficult and expensive to treat. This not only can be a burden for the patient, but can also create a painful and challenging experience as well. While deteriorating conditions and intolerable discomfort are two chief concerns when considering hospice care for a loved one, things such as complicated health care needs, sustained pain, and loss of mobility or capacity are also matters that should be taken into account.

It is hard to decipher the “right time” when deciding to make the decision to begin end-of-life care. Each and every family has a different approach and belief that can affect their decision. Ultimately, this choice is one that is deeply personal and involves tough choices for the whole group.

What does end-of-life care look like?
There are several types of end-of-life care available. Hospice care is for individuals that are nearing the end of their lifetime, with a terminal prognosis of six months or fewer. Palliative care is one that is more fitting for older adults living with a chronic condition and are in need of relief from the on-going pain and symptoms. In some cases, families may also choose to provide end-of-life care from home.

In either case, a full team of medical professionals and support staff work around the clock to make sure that patients are as comfortable and well-cared for as possible. Every facility is different, which means that nurses and doctors may be supported by home health aides, spiritual counselors and social workers depending on the circumstance.

With that being said, there are people dedicated to helping family members navigate this new challenge and providing guidance with whatever might come next.

Paying for end-of-life care
The Kaiser Family Foundation reported that hospice care is covered by Medicare for eligible older adults, usually individuals with a terminal diagnosis. This organization makes affording end-of-life care easier for many families.

Other than that, Medicaid, private insurance and other sources of payment such as a pension or retirement fund may be used to pay for these services. Families should discuss different payment models and work with a knowledgeable provider to uncover all available options.

Selecting the right partner
One thing families should understand when facing the possibility of end-of-life care is being aware of all available resources available that offer support and guidance during this difficult time. The care professionals at Sunrise Senior Living can advise and help coordinate care for an older loved one. With the help of Sunrise, the best, most appropriate end-of-life care can be identified and any transition can be made as smooth and as comfortable as possible.

Complete Article HERE!

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Vancouver Island a leader in medically assisted death


Sue Rodriguez, of North Saanich, on March 8, 1993. Rodriguez lost her legal challenge to the Criminal Code’s prohibition on assisted death, but died in 1994 with assistance from an anonymous physician.

By Amy Smart

[S]eventy-seven people on Vancouver Island died with medical assistance in 2016, more than any other region in B.C. — and most other provinces.

Some speculate the high number might be the result of demographics and a long history of advocacy for the right to assisted death.

For each assisted death performed, between five and 10 patients are deemed ineligible, Island Health said.

A Times Colonist survey of provincial coroners, health ministries and health authories found that British Columbia ranked among the highest of medical assistance in dying, with 188 assisted deaths recorded. That was one more than Ontario, where the chief coroner recorded 187 deaths.

Prince Edward Island, with a population of 148,600, recorded the lowest number of assisted deaths at zero.

Within B.C., the most deaths were recorded in the Vancouver Island Health Authority’s jurisdiction, followed by Vancouver Coastal Health at 58, Fraser Health at 24, Interior Health at 23 and Northern Health at six.

Dr. David Robertson, Island Health’s executive lead on medical assistance in dying, said there seems to be a strong base of supporters for assisted dying, including physicians willing to deliver the procedure.

“They have made the service, medical assistance in dying, probably more available than it might be in other parts of the country,” he said.

Robertson said some support on the Island likely comes in part from the fact that Sue Rodriguez lived in North Saanich.

Rodriguez suffered from amyotrophic lateral sclerosis and wanted the legal right to end her life with the help of a physician. She lost her legal challenge to the Criminal Code’s prohibition on assisted death, but died in 1994 with assistance from an anonymous physician.

“Many of the other high-profile patients who’ve been part of the history of the change of the law come from B.C. too,” Robertson said.

He also noted that there seems to be an older, fairly well-off population on the Island.

“This is just my observation as a citizen, but we have an older population, many of whom have moved here to retire. And these are people used to making decisions that control their lives. And it seems to me not very surprising that they want to make a decision, too, about the end of their lives.”

High demand on Vancouver Island doesn’t mean there isn’t also opposition, said Eike-Henner Kluge, a biomedical ethics professor at the University of Victoria whom Rodriguez consulted before pursuing her lawsuit.

“There will always be individuals who say life is sacred and under no circumstances may you artificially end a life,” he said.

He also pointed to Victoria’s aging population as a reason for the higher demand on Vancouver Island.

“Whenever you look at why a particular medical intervention is at a certain level, you want to look at the population in question,” he said.

“You may recall Victoria used to be described as the ‘newlywed and nearly dead.’ As the population gets older, it gets more susceptible to disease and more moribund and, that being the case, you will find more individuals who don’t want to die unpleasant deaths.”

Cory Ruf, communications co-ordinator for Dying with Dignity Canada, said he couldn’t speculate on the cultural reasons why Vancouver Island might have a higher rate of assisted deaths than other parts of the country.

“But we can say that we’re in touch with at least as many assisted-dying providers on Vancouver Island as we are in Toronto,” he said. According to the 2011 census, the most recent year available, 2.6 million people live in Toronto, compared with 759,366 on Vancouver Island.

“It suggests that resources and supports for physicians on Vancouver Island may be better than they were in other parts of the country [when assisted dying was legalized]. We do know that Island Health was very proactive in devleoping its policies for medical assistance in dying,” Ruf said.

“There may be underlying reasons we can’t fully grasp in terms of culture and demographics, but I think that … in some places more than others, decision-makers have created a climate where physicians feel supported [on Vancouver Island].”

Data was not available for all provinces, including Quebec and New Brunswick.

Alberta Health Services had the most complete data, reporting that cancer, multiple sclerosis and ALS were the most cited health conditions. Some of the reasons applicants were found ineligible included a loss of capacity or competency, mental illness or death was not deemed “reasonably foreseeable.”

Four patients in Alberta were transferred from faith-based facilities for the procedure.

In Manitoba, ages ranged from 29 to 100 and averaged 70. Nine died in hospital, one in hospice and 14 at home.

Complete Article HERE!

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Put end-of-life wishes at the top of your to-do list

By John Muscedere

[T]he new year is a good time to put making end-of-life wishes at the top of your to-do list.

It’s a perfect time to tell family and friends your health-care preferences in case one day you’re unable to speak for yourself. This advance care planning is good for your peace of mind and for your loved ones, too.

Studies show that people who have conversations about their end-of-life preferences are much more likely to be satisfied with the care received. And their caregivers are less likely to suffer from depression or be left wondering if they made the right decisions for their loved ones.

The majority of those nearing end of life are often unable to make decisions for themselves. Yet a recent poll found that only half of Canadians had discussed their wishes with family or friends – and only 10 per cent had discussed the topic with health-care providers

So here are four steps to help guide conversations about your advance care plan:

1. Reflect on what makes life meaningful for you
What do you value most about your physical and mental health? For many, this includes independence, interacting with family and friends, and favourite hobbies. Now imagine what might make life unacceptable for you.

Modern medicine can and will prolong life in many cases. But it can also mean prolonging the end of life and may require living with severe limitations, such as reduced mental capacity, loss of ability to control bodily functions, lack of mobility and loss of privacy. This is unacceptable to many people; one study found that over half of seriously-ill patients in hospital would rather not be kept alive on life support when there is little hope for a meaningful recovery.

Advance care planning is typically thought about in the context of advanced age or specific diagnoses such as cancer. However, it’s important for everybody to do, and particularly for those with multiple medical problems and frailty. While frailty increases with age, it can occur at any age and increases the chances of dying. Although catastrophic illness can occur at any time, frailty increases the likelihood that end of life is nearing and when life-prolonging procedures may not be appropriate or effective.

While many people reaching the end of life say they want to die at home, without an advance care plan, they are often trapped in hospital enduring heroic procedures  rather than receiving comfort care during the little time they might have left. Comfort care includes pain and symptom management to prevent or relieve suffering at the end of life

2. Find out your care options and choose a substitute decision maker
Learning about care procedures for end of life will help inform your advance care plan. You can find some common medical and legal terms at advancecareplanning.ca. And talk to your doctor.

Many sick or elderly people worry about being a burden to their families. The good news is that patients who have end-of-life conversations place less of a strain on caregivers, and are more likely to receive hospice care or palliative support at home.

Think about and designate a substitute decision maker. This is someone you trust to make health-care decisions based on your wishes in the event you can’t make them.

3. Talk about your wishes
Talk to your substitute decision maker, loved ones and your doctor

Your loved ones will be grateful that you spoke up. When patients have an advance care plan, their families are much more likely to know that their loved one’s wishes were known and followed. Lack of planning has been shown to leave families less satisfied during terminal illness or in the months following death.

There are many ways to get the conversation started and it doesn’t have to be grim. The pallimed.org blog recommends humour as a useful strategy. It may take a few tries to be heard but don’t give up

4. Write it down – just like a will
Once you’ve arrived at a plan, write it down and make sure everyone knows. In particular, make sure that health-care providers and institutions are aware and have noted it in your chart. At present, patient preferences are only known in a minority of cases.

Canadians are living longer and healthier. A little planning can ensure the well-being of you and your loved ones at the end of life as well.

You’ve probably already written a will for your things, so why not write an advance care plan for yourself?

Complete Article HERE!

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What to say to a dying person

A hospice chaplain offers some insight

By Rona Tyndall

[P]erhaps like I, you like to eat pizza and watch movies on Friday nights.

One night, I watched, “Cleaner.” Samuel L. Jackson plays a former police detective who owns a company that cleans up death scenes.
The opening scene takes place at his 30th high school reunion.  His former classmates are all standing around awkwardly with drinks, making small talk about what they’ve been doing for the past 30 years.  Someone asks The Cleaner what he does.   He responds with the utmost respect and compassion necessary for speaking an ugly truth,

“I handle the remnants of heartache and disappointment so that people can go about the business of healing. Most people don’t know this, but someone dies in your home, you are left to clean it up.”  

The classmates look confused.  The Cleaner shares in vivid detail, right down to the special mixture he invented from Listerine to un-coagulate blood.  Everyone is horrified; mouths agape, shifting from one foot to another, coughing nervously.  Noticing their discomfort, he tries to avert attention, asking one of the guys how things have been going for him for the last 30 years;

“Oh, married to the same woman since college, the kids are great, playing a little golf, just got a bigger house so my mother-in-law could move it.  It’s fine; she almost never leaves her room.  Some day she won’t come out.”
Then, a funny look of realization flits across his face and he says to the cleaner, “Um, can I have one of your cards?”  “Sure,” comes the response, “sooner or later, everyone needs us.”  One at a time, each person in the crowd steps forward for a card.

The opening scene touched me; it felt familiar.  People who deal with death know what it feels like to be a skunk at a lawn party.  

That’s pretty much how people react when I tell them I am a hospice chaplain; initial discomfort that such service is necessary, followed by the realization that almost everyone needs hospice care for themselves or a loved one eventually, and finally the realization that the person standing in front of them, who tends to the very deepest of sorrows, does so from a place of deep compassion and love. Then, they ask for my card.

Love, loss and longing…those are the themes that I work with every day in my ministry. 

I love my job, but the most frequent question I get asked is, “Isn’t it depressing?”  It isn’t.  It is sad, often, but not depressing.  Depression is isolating, lonely, hopeless.  Sadness (sorrow) is a point of deep connection, because as human beings, we all experience it at various points throughout our lives.  Joining in that emotion, and the emotions of love, loss and longing that drive sorrow (sadness) begets a deep heart-connection, one to another; the very antithesis of the isolation, loneliness and hopelessness of depression; the very essence of what it means to be in communion, in community, in common, with one another.

Do you know what people talk about when they are dying?  We talk about love; pretty much exclusively.  When we come to the end of our lives and the conversation has narrowed down to, “What was the point of me?” people reflect on love.  It is true that dying people never talk about the unfinished business at work.  We talk about the unfinished business in our intimate relationships.  We talk about the loves that made us whole; the loves that gave us joy and meaning and pride…and the loves that broke our hearts.  We talk about the ones that we loved well and the ones we forsook.  We talk about the intimate love of family and dear friends, and the love for humanity that compels us to reach out to strangers in our professional and private lives.

People are made for love.  We are made to love.  The measure of a life well-lived is always and only a person’s courage in loving.

But though our lives are meant to be a love story, we learn along the way that all love stories end in tragedy.  Whether through choice or through death, someone always is left to grieve. 

Leaving friends and family and home for school or work or marriage is a kind of a death.  Broken relationships are a death.  Divorce is a death.  The end of a life is a death.  The grief that goes with any death is heartbreaking.

Heartbreak hurts!  The feeling of ripping and then aching in our chest, the initial agony of waking up crying, being utterly consumed by the sense of loss, feeling hopeless. 

My eldest daughter loaned me a novel recently.  It was a light read.  Nevertheless, just as even the most simple people contain great wisdom, so does simple reading. 

“When you drop a glass of wine or a plate to the ground, it makes a loud crashing sound. When a window shatters, a table leg breaks, or a picture falls off the wall, it makes a noise.

“But as for your heart, when it breaks, it’s completely silent. You would think, as it’s so important, it would make the loudest noise in the whole word or even have some sort of ceremonious sound like the gong of a cymbal or the ringing of a bell. But it is silent and you almost wish there was a noise to distract you from the pain.” If You Could See Me Now by Celia Ahern

Isn’t that the truth?

When a heart breaks, it is completely silent. But loss is the price we pray for living into our purpose, which is to love.  Love, loss, longing; they are all of one piece.  Life.

In the months following my nephew, Mark’s sudden death at aged 7, none of us could have ever imagined that his parents would smile again.  But then, unexpectedly, like a rainbow arching over the deep, wild, mysterious ocean, something struck my sister-in-law funny one night at dinner, and she laughed.  We never stopped missing Mark, of course. His life and his love and his death shaped our lives and expanded our souls.  But his mother’s laughter was testimony that there is yet hope and joy and life to be had after loss.  Something good is always waiting to be had, eventually.  The resiliency of the human spirit is extraordinary.  The human capacity to hope beyond hope is truly amazing.

Every day, I keep company with men and women and children who are dying and with their families.  It can be a time of profound grace, even in the midst of deep sorrow. Time to look back, pay honor to, and close out a life is precious time. 

There are four phrases that chaplains often offer to people who are dying and to those they love the most, to facilitate sacred conversations:

  • “I love you.”
  • “I am sorry for what has gone wrong between us.”
  • “I ask your forgiveness for the part I had in any hurt between us.
  • “I thank you for your role in my life.”

There is no need to wait for such sacred conversations.  We can have them at any time, and be blessed by the sharing.    

I leave you with a reflection on love, from Dr. Peter Kreeft, from “The Turn of the Clock”

“What to say to a dying person: the profoundest thing you can ever say to a dying person is: I love you.  Not even God ever said anything more profound than that.”

Complete Article HERE!

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Crofton couple chooses doctor-assisted death: “Kay and I have lived a rich and full life. All is now in order, and we’re ready to move on.”

Crofton’s Ernie Sievewright and wife Kay (in picture) died with the assistance of a doctor.

by  Robert Barron

Surrounded by his many friends and loved ones, Ernie Sievewright finally died with dignity in his Crofton home on Jan. 15.

After wading his way through a long bureaucratic process that began late last spring, the wheelchair-bound senior from Crofton was finally allowed to legally commit suicide with the assistance of a physician on Sunday under Canada’s new Medical Aid in Dying legislation, which became law in June.

His death follows the physician-assisted suicide in their home on Jan. 11 of his beloved wife Kay.

Kay had been suffering for some time from complications of multiple sclerosis and other medical issues at a nursing home in Duncan.

That makes Ernie and Kay among the first couples to successfully access doctor-assisted suicide in Canada since the Supreme Court of Canada voted unanimously to strike down the federal prohibition against it in Bill C-14.

Bill C-14 restricts physician-assisted deaths to mentally competent adults who have a serious and incurable illness, disease or disability.

Sievewright suffered from cauda equina syndrome, a serious neurological condition that causes loss of function of nerve roots along the spinal cord.

Before his death, Sievewright said the quality of life he and Kay had was continuing to deteriorate rapidly, so they decided that death was preferable.

“It was very difficult for me to see Kay in pain all the time, and I live at home alone in a wheelchair dealing with the pain of my own illness and counting on friends to come by and pick me up when I fall,” he said.

“There’s no value in our lives anymore, so we had to ask ourselves what was the point of sticking around. We didn’t want to minimize our decision, but it was well thought out and we had discussions with friends and family. We all agreed that this was the best for both of us.”

But the approval process was long, and both had to meet with countless doctors and other specialists for their assessment and approval, so it took many months before they were finally given the green light.

Both died quickly and painlessly by lethal injections delivered by a doctor.

Sievewright invited the Cowichan Valley Citizen to his home just 36 hours before his scheduled death.

It was the happiest this reporter had seen him in the four months since I first met the Irishman with his infectious grin.

During that encounter in October, Sievewright was frustrated with all the meetings and consultations with doctors and delays he and Kay were facing in the process.

All that was in the past in the hours after he held Kay’s hands on Jan. 11 while the lethal injection was being administered to her.

“I feel really, really good,” he said at his kitchen table while friends looked on.

“I was a little upset that we couldn’t go together, but now I’m glad that Kay went first and I was with her at the time. She went so peaceful and beautifully and it was a great relief for me to see that. I’m not frightened now of my own death.”

Sievewright said he still wished the process could have been easier and quicker, but all the doctors and medical officials he and Kay dealt with were very kind, and did the best they could for the couple under the new law.

Dr. David Robertson is the co-chairman of Dying with Dignity Canada’s physicians advisory council.

He said there are no day-to-day records of exactly how many people have died through doctor-assisted suicides across Canada since Bill C-14 was legislated in June.

But Robertson said it’s been estimated that approximately three doctor-assisted deaths have been occurring a week on Vancouver Island for the last six months.

“I think the numbers across Canada are steadily increasing, particularly on the Island which has a long history of activism on this issue,” he said.

Robertson said it’s a fact that some doctors and nurses have personal views and are reluctant to participate in doctor-assisted deaths, “but many others are very willing”.

He said there are currently only 12 physicians on the Island who have taken the required training to perform the deaths, and many more are in the process of completing the education.

But Robertson said the numbers of medical staff who have the training and expertise have little to do with the amount of time it takes for people to make their way through the medical bureaucracy.

“We have the same requirements in B.C. as the rest of the country, and there are numerous documents and forms to be filled out and steps that have to be taken,” he said.

“There are very high standards to fit the criteria, so this is no simple process. It’s not a decision that patients or the medical community take lightly. We’ll continue to monitor physician-assisted suicides across the Island and the country and develop the process as we go to better fit the needs out there.”

As for Sievewright, he was just happy to finally get to the end of his long journey.

“Kay said she’d have the boat in the water with a full bait bucket and at least one dog on board waiting for me when I get there, and we’ll go fishing on flat and calm seas,” he said with a smile.

“I’m hoping that this really happens because it would be fantastic. Kay and I have lived a rich and full life. All is now in order, and we’re ready to move on.”

Complete Article HERE!

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Discussing end-of-life care for children

Kris Catrine

By Jana Shortal

[E]very year 43,000 children die in the United States.

But, when people talk about death they rarely talk about kids. For many, the death of a child can be too much to even consider talking about. But, kids do get sick and face the end of life.

When your work concerns the children facing the longest odds you do not get to ignore the truth.

“I can’t tell you how many times kids have answered that question of ‘What are you worried about?’ with ‘I’m afraid I’m dying and it scares mom to talk about it,’” says Kris Catrine at Children’s Hospitals and Clinics of Minnesota.

“Anything else a kid wants to talk about they can talk about with their family and have support and this is sort of taboo. So, the scariest thing in their mind they can’t talk about; that’s a lot of weight on a child,” adds Catrine.

Dr. Stefan Friedrichsdorf at Children’s Minnesota and his staff work tirelessly to fight for life, but also realize another conversation has to happen.

“What we are asking is like considering what your daughter is up against, what are you hoping for? And, most of time, we hear ‘I hope for miracle cure.’ And, then you look them in the eye and say ‘I hope this too,’” said Dr. Friedrichsdorf. “Just in case a miracle does not happen, what else are you hoping for?”

They talk about what will make the child happy. Whether that’s just to go outside, go to school again or just to talk about what’s going on.

Kris Catrine and Dr. Friedrichsdorf work in the Palliative Care program at Children’s Minnesota.

Complete Article HERE!

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The final chapter

A look at the obstacles of a physician-assisted death in Canada

By

[K]ay Carter had been suffering from spinal stenosis for years and knew she was going to become debilitated before she would die. Rather than wait until she was no longer in possession of her own body, the 89-year-old chose to die on her own terms. She left this world peacefully at the hands of a Swiss palliative care physician with her loved ones by her side.

Physician-assisted suicide was not legal in Canada at the time of Carter’s death, and as her condition worsened she knew she would lose the capacity to consent to have a physician assist her, so she travelled to Switzerland while she was still able-bodied.

“She had a premature assisted death because she couldn’t get one here in Canada,” explained Michael Begg, a professor of legal studies at Capilano University. “Some would say that the criminal prohibition killed Kay Carter, since it forced her to die years early.”

Carter’s story made up the framework for the legal case, Carter v. Canada, which over a five-year period would challenge the Harper government to reform the assisted suicide law in the Supreme Court of Canada. Carter was able to die on her own terms, but many before her had been denied that right, and their stories date as far back as Canada’s founding.

She received death threats and found herself having to wear a bulletproof vest into the clinic where she work … Many abortion doctors who ultimately quit practicing did so because of threats or attacks made against themselves or their families.

The Criminal Code of Canada was written in 1892 according to the moral guidelines of Victorian society. Protestant Christian worldview shaped legislature, and both suicide and assisted suicide were outlawed. The taking of one’s own life was an unforgivable sin, and those who were found guilty of it could not be buried in consecrated ground or ever hope to gain access to heaven.

In 1972, the law prohibiting suicide was repealed. The right to refuse life-saving medical treatment or intervention was also introduced, giving people more autonomy over their health care. Assisted suicide was still illegal, classified as murder for which physicians could receive a prison sentence of up to 14 years, but support was growing with newfound understanding of detrimental ailments that were prolonging people’s suffering well beyond what they were willing or able to cope with.

In 1993, ALS patient Sue Rodriguez appealed for the right to die with a physician’s assistance. She argued that in not being allowed to seek help, the law circumvented section seven of the Charter of Rights and Freedoms, which guarantees any individual rights to life, liberty and security of person.

“The government can violate a Charter right – but only where the courts find the violation is ‘justifiable’,” said Begg. People recognized that in denying Rodriguez the right to die, her personal autonomy was stripped away and in essence, the government claimed ownership of her body. The Supreme Court ruled that the state of the law was justifiable. “In 1993 there was a fear of potential abuse,” Begg continued, but the fear displayed by the courts was unfounded, because at the time there was no evidence to prove that the practice of euthanasia would go down a slippery slope. Rodriguez ultimately took her own life with the assistance of an anonymous physician.

“The political parties had no will to change the law to allow assisted dying because it was such a political hot potato. Most Canadians didn’t have a strong opinion on it, liberals and conservatives were not eager to take proactive steps to change the law,” said Begg. Carter’s family challenged the law again in 2011. In the time since Rodriguez had gone to court, Oregon, Belgium, Luxembourg and the Netherlands had legalized assisted suicide and set up regimes to carefully monitor assisted death and ensure that the practice was not being abused. The Canadian courts saw this and overturned the previous ruling, legalizing assisted suicide on Feb. 6, 2015.

Legalizing assisted suicide couldn’t be achieved overnight however, so the Supreme Court suspended the law for one year so regulations could be drafted. The Harper government put off writing the bill until Justin Trudeau entered office in Nov. 2015, and the Liberal government was hard pressed to draft euthanasia proceedings in time for the Feb. 6 deadline. The bill was further extended, and on June 6, 2016 formally became law, with regulations introduced on June 17.

“This is a legal right that Canadians have but if you don’t have a provider, you don’t have access, then you can’t exercise your right,” said Dr. Ellen Wiebe, a former full-service family doctor who specializes in women’s health and end of life treatment. “When I discovered that the palliative care physicians, who normally would be doing the end of life care would not…have anything to do with assisted death, then I realized that there would be a need for providers and that I could be one.”

As one of few doctors who provide abortion services and euthanasia, Wiebe has risked her life to tend to patients. Those who she has treated have been extraordinarily grateful for her services, she explained, but certainly there have been others who have frowned upon her work.

In 1994, an anti-abortion terrorist shot her colleague, Gary Romalis. The attack put Dr. Wiebe at risk since she was known publicly. She received death threats and found herself having to wear a bulletproof vest into the clinic where she worked. Her young son was terrified, and it was his fear that caused her to wonder if her work was putting her children at risk. Many abortion doctors who ultimately quit practicing did so because of threats or attacks made against themselves or their families.

Saddened that the stigma surrounding abortion never subsided as she had hoped, Wiebe pressed on and ultimately began performing end of life care for the same reasons she had when she began performing abortions. Wiebe was determined to provide a service that few others would because it was so steeped in stigma. She calls herself an activist for complete bodily autonomy.

Following the outcome of Carter v. Canada, Wiebe had one year to learn all of the skills she would need to administer euthanasia treatment. She travelled to the Netherlands and studied under doctors who had been practicing euthanasia for years. In Canada she set up a support group where doctors could learn and support each other in preparation for June 6 when the ruling became law.

Though she has observed far greater support in Canada for the right to die since then, Wiebe knows that controversy will linger for years to come. “The support is certainly solid, but there’s still lots of people who disagree,” she said, “and that will always continue, I think, because in the Netherlands where they’ve had decades of legal euthanasia they still have people who are against it.”

There are several activist groups in Canada currently speaking out against assisted suicide, including the Quebec-based Physicians’ Alliance Against Euthanasia. The coalition has spoken out against assisted suicide on the basis that intentionally ending life is a complete contradiction of the goals of practicing medicine. Some anti-euthanasia physicians have affirmed that they will not be participating in the practice while activists have stated that they intend to reverse the law yet again and call for a total ban on assisted suicide.

The Carter v. Canada ruling stated that a physician’s decision to participate in assisted dying was a matter left to his or her own conscience or personal religious beliefs. Abortion services are the same. A medical practitioner cannot be forced to provide a service that contradicts their personal beliefs. When there are no providers, a medical service that is a right guaranteed by law is made difficult if not impossible to obtain. Criminal law is mandated at the federal level and health care is regulated at the provincial level. A province can virtually outlaw euthanasia by making it inaccessible, which can be challenged in court on the grounds that personal Charter rights have been violated.

“There is potential to use the Charter to force a particular province to make assisted death more accessible,” said Begg, but if a physician doesn’t want to see their patients die when they believe there is a chance of saving them, they can’t be forced to.

“I had a patient who chose his date six months out…and he did live that long so he was able to die on the date that he had originally chosen.”

A primary fear is that people with non-debilitating or lethal conditions will give up living if an easy death is a viable alternative.

In Dec. 2012, Belgian twin brothers Marc and Eddy Verbessem died by lethal injection after finding out that they were going blind. Already deaf, they had no means of communicating with anyone but each other and their close family. They had lived together all their lives, and their brother reported that they felt they had nothing left to live for. Knowing that they would never see the other’s face again, they couldn’t bear to go on living.

In a bizarre twist, an amendment was added to the assisted suicide bill just days after their deaths enabling minors and Alzheimer’s patients to receive an assisted death. Despite making their wishes clear, the Verbessem brothers were an unusual exception to Belgium’s laws since they were neither terminally ill nor suffering unbearable physical pain. A case of an able-bodied person with no degenerative disease killing themselves followed by additions that would allow children to die also is the slippery slope that legislators feared when judging Rodriguez v. British Columbia.

Another fear is that the sick or the elderly will feel burdened or be pressured into undergoing euthanasia by their relatives if their medical treatments are costing too much. To prevent abuse of the conditions that allow for assisted suicide, Wiebe assesses her patients before they can receive the lethal treatment.

“Certainly it’s part of our job to assess each patient and be sure that they’re not being pressured. I haven’t seen anything that made me worry,” she said. “Every one of them I am satisfied that we did the right thing and that their choice was a good one.” She consults with her patients, often with their families or support groups present, to discuss their illness and their wishes. She asks her patients about their relationships and monitors how they interact with their family members before making a final judgement. It’s a subtle but obvious way, she said, to be sure that their wishes are entirely their own.

Patients are also required to undergo a 10-day reflection period before euthanasia will be administered. The reflection period was mandated to prevent patients from making hasty decisions after being diagnosed.

“There’s two reasons we’re allowed to shorten up the time from the 10 day reflection period, and those are somebody’s in danger of losing capacity — losing the ability to consent — or in danger of dying in those 10 days,” Wiebe explained. “I’ve had people who are within 24 hours of death, for example, and those have to be done very quickly, and others spend a long time deciding. I had a patient who chose his date six months out… and he did live that long so he was able to die on the date that he had originally chosen.”

Since June 6, Wiebe has consulted with over 100 patients and assisted 40 of them in ending their lives on their own terms. “It is wonderful work. Doctors love having grateful patients and I have the luck of being able to do something that people really appreciate,” she said.

The battle for the right to die has hardly abated. The regulations were written hastily so that they would meet the Supreme Court deadline of June 6, and as a result many Canadians believe the laws to be too restrictive. Safeguards such as the mandatory waiting period ensure that vulnerable people cannot undergo euthanasia before the terms of their illness have been fully processed, and two witnesses are required to attest to their wishes.

“The biggest of the flaws in the Trudeau government’s bill, critics say, is that the Criminal Code only allows assisted death for those who are facing imminent death,” said Begg. Only those suffering from a terminal condition can seek assistance, omitting hundreds of people who are suffering irreparably but not likely to die. People like Kay Carter, who would have lived in agony.

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