With a few minutes of her time and a pen, Ellen Agger has been helping to remove a little-known barrier to assisted dying in Canada.
Ms. Agger is one of dozens of volunteers across the country trained by the advocacy group Dying with Dignity to sign the application papers for patients who want a physician to help them die but cannot find the two independent witnesses federal law requires to start the process.
Canada's assisted-dying legislation bars anyone who might benefit financially from a patient's death, including through a will, from being an independent witness. Health care providers, personal care providers and the owners and operators of any health care facility treating an applicant are ineligible too.
Some people have had to scramble to find acceptable signatories for their medical-aid-in-dying applications, which is how Ms. Agger wound up as an independent witness for six complete strangers on Vancouver Island.
"Without the witnessing, it can't move forward for the person," said Ms. Agger, the co-chair of Dying with Dignity's Victoria chapter. "It's a small thing, but it's very important."
The independent-witness rule is one of the small hurdles patients in Canada still have to clear to access medical aid in dying, a procedure that became legal across the country last June.
Dying with Dignity volunteer witnesses have signed paperwork for 35 patients seeking an assisted death.
Proponents of assisted dying say other barriers also remain, including the refusal of some faith-based hospitals and nursing homes to hasten patients' deaths, and the reluctance of some doctors to provide the service for fear of unwittingly running afoul of the new law and landing in legal trouble.
The Globe and Mail wrote this week about the case of Ernie and Kay Sievewright, an ill Vancouver Island couple who, after 55 years of marriage, wanted to die together with the help of a doctor.
The Sievewrights, both 76, were deemed eligible for assisted deaths – their medical conditions were grievous and irremediable, their natural deaths "reasonably foreseeable" – but the physician who assisted them had to schedule the events four days apart because the Canadian Medical Protective Association, the mutual-defence group for doctors in Canada, raised serious concerns.
Douglas Bell, the associate executive director of the CMPA, would not comment on the Sievewrights' case, but he said that, in general, providing two assisted deaths at the same time could raise questions about whether one party pressed the other to take part.
The federal law says requests must be voluntary and "not made as a result of external pressure."
Shanaaz Gokool, the chief executive officer of Dying with Dignity, said the Sievewrights' story underscores how much time and effort must sometimes be devoted to assisted-dying cases – the doctor who hastened the Sievewrights' deaths spent months working out the details.
"All of the physicians that I know that are involved in medical aid in dying are really ethical, compassionate, careful people. They don't just want to meet somebody for 10 minutes. This is not that kind of a treatment," she said.
Jeff Blackmer, the vice-president of medical professionalism at the Canadian Medical Association, said he knows of some doctors who provided assisted deaths after the law took effect, but stopped offering the service because they find it too difficult.
"I have spoken to people in some provinces who've said they had a long list of potential [medical-aid-in-dying] providers and that's short now because a lot of physicians and other health-care providers are finding that it does have a psychological toll," he said.
Still, at least 784 people in Canada have received a medically-assisted death since it 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.
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.