A woman suffering from the paralyzing degenerative disease known as ALS has become the first to receive a judicially authorized assisted death in Canada.
The woman received permission from a Calgary judge in a hearing last week from which the media and other members of the public were barred. Known as Ms. S in a ruling made public this week, she then travelled to Vancouver where two physicians attended to her on private property.
Ellen Wiebe, a Vancouver physician, confirmed the death Monday night, saying she was with Ms. S. and pronounced her dead at 8:30.
Ms. S. "suffered unnecessarily because she was required to travel from Calgary to Vancouver on the last day of her life, since she could not find a Calgary physician to help her," she said in an e-mail to The Globe and Mail.
Ms. S, a retired psychologist who loved hiking in the mountains, was diagnosed with the incurable disease in 2013 after developing a speech impediment, and was told last October that nothing more could be done to slow its progress.
"I am not suffering from anxiety or depression or fear of death," she said, as quoted by Justice Sheilah Martin of the Alberta Court of Queen's Bench. "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."
In the disease's final stages, she had already begun to experience choking episodes from paralysis and was unable to speak or move anything but her left hand, enabling her to type text that could be produced as a voice. Ms. S. attended the hearing last week along with her spouse and best friend. The court heard her request in an expedited fashion because of her situation.
A newspaper reporter and a physicians' group argued for an open hearing, but Justice Martin said in the circumstances, it was more important to protect Ms. S's privacy, and the publication of the ruling would add openness to the process.
The assisted death is the first under an extraordinary process created by the Supreme Court of Canada, and required Justice Martin to decide how many doctors were needed to verify Ms. S's physical and psychological suffering and whether a psychiatrist was required to assess her mental competence. She also had to decide whether an Alberta ruling would apply in British Columbia, and whether her mental competence must be assessed again on the day of death, as the B.C. Attorney-General argued in this case.
Justice Martin, a former law dean at the University of Calgary, decided statements from two doctors were sufficient, and no psychiatric assessment was necessary. She made it clear that she would not allow Ms. S's request for an assisted death to be defeated on technical or legalistic grounds, and she expressly rejected guidelines from the chief justices of B.C's and Ontario's superior courts, calling for statements from more doctors than Ms. S provided. She also said an assessment of mental competence on the day of death was not necessary, and the ruling would apply across Canada.
"The constitutional exemption for which Ms. S. qualifies is personal to her and should accompany her throughout Canada, a country where she enjoys mobility rights."
Ms. S's disease, amyotrophic lateral sclerosis, also known as Lou Gehrig's disease, had progressed to the point that she was in constant discomfort. She needed constant care from her spouse and found her near-total dependence on others difficult, Justice Martin said.
Dr. Wiebe said Ms. S found her through a network in the Netherlands, and encouraged other doctors who are willing to assist with the end of life to make themselves known. The family doctor caring for Ms. S was willing to write a letter to the court, but not to help hasten her death.
"It is so much like abortion. You have a legal right, but you can't exercise that right unless there is a provider," Dr. Wiebe said in an interview.
Shanaaz Gokool, chief executive officer of Dying with Dignity, noted the decision was made just five days after the hearing. "I would hope that this will be the model for other provinces in this interim period."
Toronto media lawyer Peter Jacobsen objected to the courtroom being closed and documents sealed. "Because of the gravity of the decision, it is all the more important that there be public oversight."
The Supreme Court struck down Canada's ban on doctor-assisted dying last year, and suspended the effect of its ruling for a year. This winter, the federal government asked for a six-month extension to draft a new framework. The court granted four months, and said that people who are suffering intolerably and irremediably are entitled to a "constitutional exemption" from the Criminal Code ban on an assisted death, and could ask a superior court judge for authorization.
Last week, a parliamentary committee drafted a set of proposed rules for assisted death now being considered by the federal government.