When Kay Carter travelled to a clinic in Switzerland more than three years ago to drink a toxic dose of sodium pentobarbital and end her body's steady decline, the journey was cloaked in secrecy.
With assisted suicide still a crime in Canada, the plan was kept from the 89-year-old's family, friends and caregivers. Her grandchildren were not told until two months before the trip, when preparations were well under way. Others found out after Ms. Carter's ashes were scattered in a Swiss forest.
A day before her death in January, 2010, surrounded by several of her children in Zurich, Ms. Carter dictated a brief letter explaining her decision.
"In my latter years, as my health deteriorated, I witnessed friends whose body had totally collapsed and did not want to follow in their path," Ms. Carter, who had been diagnosed with a degenerative spinal cord condition two years earlier, wrote to 125 friends, family members and colleagues.
"My journey to Zurich … was filled with laughter and fond reminiscing. Do not mourn my passing, but rejoice, as I have, in our shared memories."
The letter set the stage for Ms. Carter to become a central figure in a legal challenge of Canada's assisted-suicide ban on which the B.C. Court of Appeal will rule on Thursday.
"At that moment, when we mailed those letters just after she died, it became public," recalls Ms. Carter's daughter, Lee, who is among the plaintiffs in the case. "She wanted it that way. She wanted Canadians to have a dialogue and a discussion. She would just be thrilled if she knew where this has gone."
The B.C. Supreme Court ruled last year that the ban on assisted suicide violates the rights of the gravely ill.
The judge concluded the law must allow physician-assisted suicide and physician-assisted death – also known as voluntary euthanasia – for patients who are diagnosed with a serious illness or disability and have "intolerable" physical or psychological suffering with no chance of improvement.
The court gave Parliament a year to fix the law, while also granting another plaintiff in the case, ALS patient Gloria Taylor, an immediate exemption from the ban. Ms. Taylor died in October of last year, without taking advantage of the exemption.
Ottawa appealed, arguing physician-assisted suicide would demean the value of life and put vulnerable people at risk.
The issue is expected to end up at the Supreme Court of Canada, which last considered assisted suicide in 1993, when it upheld the current law in a case involving Sue Rodriguez. Ms. Rodriguez, who also had ALS or Lou Gehrig's Disease, died with the help of a doctor the next year.
The issue of physician-assisted suicide is receiving renewed attention across the country.
The Royal Society of Canada issued a report two years ago that recommended legalizing physician-assisted suicide, and an editorial last year in the Canadian Medical Association Journal called for a national debate.
Politicians in Quebec are examining a bill that would permit physician-assisted suicide.
Two weeks ago, a video recorded by Donald Low, a respected doctor who guided Toronto through the 2003 SARS crisis, made headlines for his impassioned argument in favour of legalizing doctor-assisted suicide.
Wayne Sumner, a professor emeritus from the University of Toronto and author of Assisted Death: A Study in Ethics and Law, says the winds appear to be changing.
"The Rodriguez decision was 20 years ago, and so much has changed. Even then, it was a split decision," Mr. Sumner said, referring to judgments at the B.C. Court of Appeal and the Supreme Court of Canada in the Rodriguez case.
Mr. Sumner says even if the federal Conservatives opposed assisted suicide, Ottawa may have to open up the debate.
The federal government has insisted there will be no debate, warning that any attempts by the provinces to allow assisted suicide would likely spark new court challenges.