A terminally ill Toronto man is the first person in Ontario to be granted a physician-assisted death, likely to take place this weekend.
Superior Court Justice Paul Perell agreed to the 81-year-old's request for an assisted death, the third of its kind in Canada outside Quebec, after an emotional 30-minute hearing on Thursday during which the judge choked back tears.
Justice Perell said the condition and circumstances of the man, who can only be identified as A.B. and suffers from aggressive lymphoma, met the Supreme Court of Canada's criteria under a recent ruling for an exemption to Criminal Code provisions on assisted suicide.
"A.B. deposes that his suffering is intolerable and unbearable," the judge said, adding that granting the exemption was "not a routine exercise."
The married grandfather said in a statement read to the court, "My only regret in these last months is that my family and I have had to expend what little energy I have left to fight this court battle.
"My wish is that our government will see fit to make permanent changes in the law so that no other family will have to do this ever again."
A.B. is the third person in Canada outside Quebec to be approved for a physician-assisted death in as many weeks. His request follows that of an Alberta woman suffering from amyotrophic lateral sclerosis who died with physician assistance in British Columbia this month and a Manitoba patient whose request to die was granted on Tuesday.
The issue of assisted death remains contentious, even after a Supreme Court ruling last year paved the way for competent adults suffering intolerably, without a cure, to request court authorization in order to die with the assistance of their health-care providers.
Doctors and nurses have been hesitant to come forward publicly to offer to provide an assisted death, with many being warned by health authorities to seek legal counsel if approached.
Cardinal Thomas Collins, the Archbishop of Toronto, delivered a sermon on March 6 to Canada's largest Catholic archdiocese arguing that forcing doctors and nurses to go against their religious beliefs and refer patients to assisted-dying services is a "violation of conscience."
A Forum Research poll from last August found that 77 per cent of those surveyed supported doctor-assisted dying in cases of terminal illness.
Last week, the Ontario Superior Court ordered the identity of the patient, his family and any doctors involved be kept secret. However, lawyer Peter Jacobsen, representing The Globe and Mail, Postmedia, CBC and CTV, argued that it may be in the public interest to know the names of the doctors "for those who may wish to come forward in the future."
Justice Perell said on Thursday that A.B's condition and circumstances meet all of the Supreme Court's criteria for the exemption, including his mental competence, extreme pain and the fact that he made the assisted-death request without coercion or manipulation.
He also agreed that there would be no need to notify the coroner when the man dies, saying the cause of death would be deemed the disease itself.
Ontario legislation requires the coroner to be notified of non-natural deaths, including death by drug toxicity, after which the coroner is obliged to take possession of the body and investigate.
In his application to the Superior Court filed on Monday, A.B. called it absurd and distressing that his death might lead to a full-blown investigation, which could include an autopsy.
Justice Perell noted that the man's family and doctors support his request.
"I would say I have been a diligent hard worker, always wanting to give back to this wonderful country that took us in," A.B. said in an affidavit, praising his life as an immigrant to Canada. "I feel so grateful to have been able to spend nearly half of my life here."
"I have lived a wonderful and exciting life, and have seen so much of the world. I am so lucky to have a beautiful family who remain close to me. Although the decision to end my suffering is one that I alone have made, it is important to me to know that I have their support."
The man's daughter also filed an affidavit in support of her father's decision, calling him an "inherently happy man with a positive outlook on life."
"He is a kind and loving grandfather who has had a positive impact on my son. He is a sentimentalist who made his family his priority, a lover of politics and current affairs … a romanticist and a great poet," she said.
"There is no greater pain than to feel entirely helpless as you watch someone you love suffer. I am proud of my dad for fighting this awful disease. Almost four years after his first diagnosis, my dad has expressed that his fight is over. Our family supports my dad's wish to have a dignified death to culminate his rich and well-lived life."
Last year, the Supreme Court of Canada struck down laws that bar doctors from helping someone die, but put the ruling on hold for one year to allow the federal government to draft a new framework for the laws. The court later granted the government a four-month extension, but it said the terminally ill could ask the courts for an exemption to the ban in the interim, until June 6.
Quebec set up its own legislative regime on assisted death in December.
Court filings show that A.B. is said to be in "intolerable pain or distress," owing to pain radiating from his spine, to where the cancer has spread. He said the disease and subsequent treatment have made him "a skeleton of the man he used to be."
In addressing the court, lawyer Andrew Faith said his client's condition was worsening and he stressed the urgency of the request to die.
Court filings show the man's hematologist, who has been treating the patient since he was diagnosed with B-cell lymphoma in July, 2012, has offered to help him die in accordance with Quebec's detailed protocol.
The hematologist involved said he would be willing to prescribe two drugs – pentobarbital or secobarbital – in a dose that would be deadly if taken orally. However, based on his inquiries, it was apparent that the drugs are not currently available in Ontario in the prescribed oral dose.
"Therefore, I am also willing to assist [the man] in dying by following … the 'Quebec protocol,' " the physician said in an affidavit.
The protocol involves a three-step process starting with sedation to help the patient relax. The patient is then put into an artificial coma, before a powerful muscle relaxant is administered that causes breathing and heartbeat to stop.
The protocol stresses that the patient can change his or her mind at any time.
"It is advisable to explain to those present, before starting the injections, that death might come relatively quickly, and that the heart may keep beating for a long time after breathing has stopped."
In an affidavit, A.B. said he understands that the planned drug injection would result in "my certain death."
"For all of my love of life, I do not fear death," the man said. "I have a strong wish to die with dignity at the time of my choosing."
With a report from The Canadian Press