The case of Ms. S., a Calgary woman granted a personal exemption allowing doctors to help her die, is raising questions about barriers to accessing physician-assisted death (PAD) in Alberta, and potentially across Canada. The woman, who was in the final stages of amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s Disease, travelled to Vancouver to end her life with the help of two physicians.
Dr. Ellen Wiebe, a clinical professor at the University of British Columbia, identified herself as one of the two doctors who helped. She told Global News Ms. S. tried, but couldn’t find a doctor in Alberta who was willing to help her die.
“She found me after searching for a provider in Europe,” Wiebe told Global News Wednesday. “We had about a two-month relationship between Skype and email before she arrived on the final day.”
“She had made her decision six months before, and was absolutely firm. It was just a matter of when.”
Wiebe said she wanted to educate herself after discovering there wouldn’t be enough providers available in Canada. She went to the Netherlands to learn about how to be a good assisted-death caregiver and experts there connected her with Ms. S. Wiebe now belongs to an organization called Hemlock AID that provides B.C. patients with information about and access to assisted death.
But Dying with Dignity CEO Shanaaz Gokool said in many cases, there’s no way for someone to know where they might find a willing doctor, and is encouraging doctors to contact her group if they’re willing to provide PAD.
“There’s also no place at this point, as far as I know, for most doctors provincially to let someone know that they’re willing to support or provide physician-assisted death,” Gokool said. “It’s going to be challenging for people to find doctors.”
A Court of Queen’s Bench of Alberta ruling dated Monday said the application for physician-assisted death was the first of its kind in Alberta, and in all likelihood the first outside Quebec, which passed legislation of its own late last year. In January, the Supreme Court gave the federal government an extra four months to come up with a national assisted dying framework but said that Canadians outside Quebec who are in pain and want help dying can apply to court for permission if they meet certain criteria.
Watch below: Global’s ongoing coverage of the laws around physician-assisted death
The College of Physicians & Surgeons of Alberta (CPSA) said if someone wanted to have the procedure done in Alberta before June 6, and if a judge rules in their favour, they would be legally able to proceed, and would need to find a physician willing to perform PAD.
But the problem is finding such a doctor.
“We know that Canada-wide about one third of physicians say they would provide PAD, but we don’t know which specific physicians within Alberta are willing,” CPSA spokesperson Kelly Eby wrote in an email to Global News.
“There are no plans that I know of for the CPSA to keep a registry of physicians willing to provide this service, so unless some other entity is planning to develop this database, the patient would need to find a physician on their own.”
Eby said the college has started consultation on its standards of practice, which will close March 7 and go to its council at the end of May.
“The college has put a step-by-step process in place,” Eby said. “Quebec has something like that–they have almost like a toolkit–but Alberta hasn’t gotten to that point yet.”
Gokool said Dying with Dignity Canada has a small list (not publicly available) of willing doctors, as well as an advisory council of over 30 doctors willing to provide support—though some are retired or specialize in other areas where they wouldn’t be involved in actually providing assisted death.
The judgment on Ms. S.’s case came down Monday, the same day doctors said she travelled from Calgary to Vancouver and died with family at her side. The ruling was released Tuesday, and her identity is under a court-ordered publication ban.
“People are surprised that she died the same day that she got her permission, but she had been waiting and waiting and waiting,” Wiebe said.
“I am not suffering from anxiety or depression or fear of death,” Ms. S. is quoted as saying in the ruling.
“I would like to pass away peacefully and am hoping to have physician-assisted death soon. I do not wish to have continued suffering and to die of this illness by choking. I feel that my time has come to go in peace.”
Wiebe said in her 40 years as a medical doctor, she’s attended a lot of deaths—but Ms. S. was different.
“This one was truly beautiful because she was in charge,” Wiebe said. “She was going to leave while she could still communicate, and she was very close to losing her ability to communicate.”
“We need the college of nursing, the college of pharmacists and the college of physicians in every province to have guidelines that we can follow so that we are comforted that we are doing the right thing.”