Noreen Campbell wanted to die in her sunroom.
A friend gave her a nice bottle of Riesling to drink. She'd eat some dark chocolate with ginger. Her husband, two grown daughters and son-in-law would be there, but alas, not her geriatric cat named Speedy.
"She doesn't like strangers, so I think I'm on my own for that," Ms. Campbell said with a laugh.
The stranger in the room would be her doctor. She would administer the intravenous drugs designed to take Ms. Campbell's pain away – forever.
The 71-year-old retired registered nurse from North Saanich, B.C., has worked in intensive-care units, become an expert on wound care and helped develop a program for people with leg ulcers from losing their limbs.
"I always had a concern with people suffering," she said.
But she never thought she'd become an advocate for assisted death. Not until she needed one herself.
At least 784 people in Canada have received a medically-assisted death since the practice first became legal in Quebec a little more than a year ago, according to a Globe and Mail survey of provincial health ministries and coroners' offices.
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The vast majority of doctor-hastened deaths – 722 out of 784, or 92 per cent of the total – took place in Quebec, Ontario, Alberta and British Columbia. Quebec's law took effect in December, 2015, and the new federal law in June of last year.
A quarter of all assisted deaths – 195 – happened in British Columbia, even though that province contains only about 13 per cent of Canada's population. There have been at least 71 assisted deaths in Alberta.
Ms. Campbell breathed heavy. Each inhale through her tracheostomy tube was laboured, forcing her to pause between sentences. She had a serious lung condition, called chronic obstructive pulmonary disease, which developed after her surgery for oral cancer four years ago, although she thought she always had something wrong with her lungs. Now, at the end stage of her disease, facing other unspecified illnesses, she spent all day managing her symptoms, could not walk for long, could barely ride her beloved horse, Dasha. She described her condition as living day to day.
"Sometimes I have the feeling I'm on my last breath," the grandmother of three said.
"Why is society allowed to slowly strangle me? If you cannot make me better, what is the benefit of having me feeling like I'm suffocating for months?"
And so, Ms. Campbell wanted to die – on her own terms. She applied and was approved for a medically-assisted death.
Canada passed its first assisted-dying law last June, drafted in response to a Supreme Court decision that struck down the laws prohibiting medically-assisted death for grievously ill, consenting adults who experience intolerable suffering.
Ms. Campbell closely followed the passionate debate in Parliament, as some politicians argued for the sanctity of life, and others, the relief brought by death. She was disappointed when the Liberal government took a cautious approach in its legislation, despite last-ditch efforts by senators to make the law more permissive.
The law limits the practice to grievously ill and suffering adults who are in an advanced state of decline and whose death has become "reasonably foreseeable." The term isn't defined and is not included in the court's decision. Some have even called it unconstitutional, because it excludes those in intolerable pain who are not at the end of life. But the government said it is intended to protect disabled or mentally-ill patients who may want, or be encouraged, to end their own lives prematurely. "It is imperative to protect vulnerable persons, individually and collectively, from coercion and disrespect," Health Minister Jane Philpott said when the bill was introduced last April.
Ms. Campbell said she wanted to explain her decision, first to Dying with Dignity, where she is a member of the advocacy group's disability advisory council, and later with The Globe and Mail, to explain why it's important for Canadians who are suffering to choose their own deaths.
"The ability to do this enables people to end their life before they're desperate. That to me is amazing," she said.
"Since my decision, I've had a degree of calmness I find surprising."
Originally from Edmonton, Ms. Campbell worked as a nurse for 50 years, becoming a well-known wound-care specialist in Canada and even travelling to Fiji to work on a program to help those with diabetes save their feet from amputation.
"That's what I wanted to continue doing," Ms. Campbell said. "However, I got my cancer."
Ms. Campbell never smoked, but in 2013, a toothache turned out to be cancer, and after numerous surgeries, she developed lung disease, which can be treated but not cured. Her health has declined steadily ever since.
Before she was approved for an assisted death, Ms. Campbell planned to travel to Switzerland, where the procedure is legal. "I felt that the odds were that I would need the services of assisted dying," she said.
But she worried about the toll the flights would take on her, and her ability to self-administer drugs, which is a requirement in that country. She might have had to end her life earlier than she wanted to – for fear that she would lose her ability to travel or consent to the procedure.
"When I've seen people die in respiratory distress, it is not at all pleasant. And I just have to pinch myself that I have the privilege – I don't want to call it a privilege, it should be our right," Ms. Campbell said.
She applied for an assisted death soon after the law was passed. With the help of a lawyer, Ms. Campbell composed a letter to her family doctor, outlining the progression of her disease. In August, she had her case formally approved by two doctors, including her own. She continued living for several more months, which could bolster the government's argument that foreseeable death does not necessarily mean death is imminent.
Still, Ms. Campbell was highly critical of the way the Liberals handled the legislation. She said the criteria should be determined by the patient's quality of life, not when they are expected to die. "To me, this is a political cop-out, or incompetence," she said.
The Canadian Medical Association, which represents some 80,000 doctors, says many cases thus far have been terminal patients, but not all.
"It's not cut and dry, and that's part of the challenge, is that we're figuring things out as we go," said Dr. Jeff Blackmer, CMA's vice-president of medical professionalism.
In her case, Ms. Campbell said she could develop an infection at any moment, or her oxygen-saturation levels, which determines how much oxygen gets into the blood, could drop to alarming rates.
After an oxygen scare on Dec. 27 that left her feeling panic and frantic, she decided to schedule her death for this month.
"I am at the edge," she said.
Speaking a few days before her scheduled death, Ms. Campbell said she was not afraid. The alternative, she said, is much worse.
"I'd be suffocating. I'd be frantic, I'd trying to breathe. I would be resistant, I'd possibly be tied down," she said. "My family would have to witness it. Imagine witnessing somebody being drowned in a pool."
And so, Ms. Campbell wanted to die.
On the day of her death, she'd watch her grandson play hockey, have brunch with her family. There would be tears. Laughter.
As she says goodbye, Ms. Campbell wanted to have one final memory.
"Grateful," she said. "Just grateful I have this."
At 2:48 p.m. on Jan. 12, she was. She died the way she planned.
With a report from Kelly Grant in Toronto
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