From the time they met as teenagers in a seaside town south of Dublin, Ernie and Kay Sievewright tried to do everything together.
They both immigrated to Canada, although he crossed the ocean first. They married in 1961. They raised dogs, fished, sailed and drove their camper to Mexico regularly, relishing a life that Mr. Sievewright called "fantastic" until the couple's health began to fail.
She developed multiple sclerosis. He had spinal stenosis, kidney problems and a heart murmur. When medically assisted dying became legal in Canada last year, the Sievewrights, both 76, decided to apply, hoping they could share a gentle death together after 55 years of marriage.
Four doctors deemed Mr. Sievewright and Ms. Sievewright eligible for the procedure, but in the end, they were forced to die four days apart because of legal concerns raised by the Canadian Medical Protective Association (CMPA), the mutual-defence group for physicians.
"It's absolutely cruel and inhumane treatment, to both of us," Mr. Sievewright said in an interview a week and a half before he sat beside his wife's wheelchair and held her wrist as a doctor helped her die in the couple's Vancouver Island home.
Four days later, on Jan. 15, he died with drugs administered by the same physician.
The Sievewrights' story illuminates a major challenge that Canadian doctors, medical lawyers and patients are facing as they navigate this country's new assisted-dying landscape.
The CMPA's lawyers, fearful of exposing their clients to disciplinary action or criminal charges, are advising doctors against proceeding with cases that could open them up to extra scrutiny from coroners' officers which are reviewing assisted deaths in some provinces to ensure they meet the letter of the federal legislation.
With no precedents yet to guide them, the medical lawyers' group and an untold number of doctors are erring on the side of caution, raising the possibility that patients who might otherwise qualify for medical aid in dying could be denied the procedure.
"The lawyers are not practising good patient-centred care. They are trying to reduce our risk," said Ellen Wiebe, one of the doctors who assessed the Sievewrights and found they qualified for assisted deaths.
"Why is four days apart less [legally] risky than together? It was a terrible thing to do to this couple."
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.
Bill C-14, the federal medical-aid-in-dying law that took effect last June, says requests must be voluntary and "not made as a result of external pressure."
"The concern would be that, if you have a suicide pact, is the one influencing the other?" Dr. Bell said. "I'm not commenting on this case, but that would be the issue."
By the time the Sievewrights were preparing for their own deaths, Ms. Sievewright had for two years been living in a nursing home in Duncan, B.C., about 20 minutes from the couple's two-bedroom home in Crofton, a coastal town of just over 1,000 people with a view of Salt Spring Island.
Diagnosed with MS in 2003, Ms. Sievewright had deteriorated to the point where she needed help dressing, bathing and getting in and out of bed.
She was no longer the pioneering industrial engineer who strapped on men's work boots and marched on to the shop floor to demand equal pay, or the tough bird who once chased off a gun-toting bandit with an axe while the couple vacationed in Mexico.
Mr. Sievewright, a retired engineering technician, began to feel worse, too. Spinal stenosis left him with no feeling in his calves and feet. His kidneys and heart began to fail, he said. He had to use a catheter. "I'm wearing damn diapers because I can't control my bowels. I get up in the morning, it takes me an hour to do my ablutions," he said during a interview over Skype.
Ms. Sievewright, on the phone from her nursing home, added, laughing a little: "Life's not that wonderful."
"It used to be fantastic," Mr. Sievewright said.
When she hung up, Mr. Sievewright's jovial demeanour cracked. He put his face in his hands. "Here I go," he said, breathing deeply to regain his composure. "I don't know if we'll ever meet again. I don't know these things. But I know that if we do, it'll be somewhere where there's lots and lots of dogs and old curmudgeons like myself."
Konia Trouton, the doctor who provided assisted deaths to Mr. and Ms. Sievewright, spent weeks consulting CMPA lawyers about how best to handle the Sievewrights' deaths.
She declined to comment directly on their case. But she said by e-mail that however "arduous" the legal discussions around assisted dying may be for patients, families and doctors, it is important to be "absolutely confident that the criteria for MAID [medical aid in dying] are truly met," especially in the law's first year.
"I feel passionately about offering and providing MAID, but want to be very careful in the correct implementation of that new law. Part of that correct implementation means working with my professional colleagues as assigned by CMPA – they are ultimately working with us and not against us, despite the feeling it may feel otherwise in the middle of the journey," Dr. Trouton wrote.
The CMPA has received requests for medical-aid-in-dying advice in 478 cases, Dr. Bell said. CMPA lawyers review the facts and advise doctors if they think a case carries a high legal risk but the decision whether to proceed or not is ultimately left up to physicians, he said.
At least 784 people have died with medical help since the practice became legal, according to a Globe and Mail survey of all provinces and territories.
The CMPA is not aware of any instances outside Quebec in which coroner's offices or other oversight bodies have referred completed assisted-dying cases to either justice departments for possible criminal charges or to the regulatory colleges that oversee physicians in every province.
Quebec, which passed its own medical-aid-in-dying law before the Supreme Court struck down the Criminal Code provision forbidding it, has a special commission overseeing its medical-aid-in-dying regime.
The commission has sent at least 21 assisted-dying cases to the Collège des médecins du Québec for further investigation, but the regulator has not taken disciplinary action against any of the doctors involved and does not expect to, said Yves Robert, the secretary of Quebec's college.
Dr. Robert said that doctors in Quebec are not pushing the boundaries of the law.
"The problem we're facing is the contrary," he said. "We see more physicians reluctant to provide [medical assistance in dying] because of the potential legal or disciplinary consequences than the reverse."
The college is trying to clarify the law for physicians to help overcome that hesitance, he added.
Dr. Wiebe, one of the country's most outspoken advocates for assisted death, said the CMPA is "being extremely conservative," in interpreting the most contentious aspect of the federal law – the requirement that a patient's natural death be "reasonably foreseeable."
That stipulation, which was not included in the Supreme Court ruling, is already the subject of at least one constitutional challenge to the federal law.
Dr. Wiebe said that last year CMPA lawyers warned her against hastening the death of Debbie McCann, a Vancouver quadriplegic who threatened to stop eating and drinking after Dr. Wiebe said she could not help Ms. McCann die.
"The lawyers said, 'Absolutely not. This is very high risk. Don't do it,'" Dr. Wiebe recalled.
"This is devastating for all of us. I wasn't sleeping. We both [Dr. Wiebe and a second doctor] said she qualified and then we both backed down."
Dr. Wiebe said she managed to convince Ms. McCann to keep eating, telling the patient that the next time she acquired a life-threatening infection – a recurring problem she suffered for years – she would qualify for a medically assisted death. Dr. Wiebe helped Ms. McCann die on July 30.
Resigned to the fact that he and his wife would not be able to die together, Mr. Sievewright began making the arrangements.
The couple, who have no children, found a new family for their Jack Russell, Jessie, and prepared to give their home to a friend.
On Jan. 11, Trevor Cooke, a friend of nearly 40 years, picked up Ms. Sievewright and brought her home to Crofton for the final time.
"Everything they did, they did together," Mr. Cooke said. "That's why I think this rule is so unfair. Now Ernie has to wait four days? Everything they've done in their life they've done together. They wanted to do this together."
Emily Mulleda, a nurse who first met Mr. Sievewright when she cared for him at home after a hip operation and later become his dear friend, said that by the day of Ms. Sievewright's death, the house looked like a sparse bachelor pad. Mr. Sievewright had taken to giving away pictures off the wall and dishes out of the cupboard.
"We were looking for glasses and cups and he'd given most of those away. He's just got a few ugly cups," Ms. Mulleda said, laughing. "We were like, 'nah, this isn't going to do.' So off we went to the thrift store and got some shot glasses and poured everybody a small round of crab-apple liqueur."
Ms. Mulleda was one of a handful of friends who gathered for Ms. Sievewright's death. They drank and told stories; a neighbour made tuna fish and salami sandwiches.
Dr. Trouton, who arrived at 6 p.m., walked Ms. Sievewright through her final consent to an assisted death, then spread her bag of medications at the foot of Ms. Sievewright's wheelchair in the living room. "Kay was not tearful at any time that I saw her for the whole couple of hours. She was not. Ernie teared up a couple of times," Ms. Mulleda said.
The morning after his wife's death, Mr. Sievewright described it as an "absolutely incredible experience."
"Kay was just really ready to go. She just sat there in her wheelchair looking out at the full moon," he said. "I joked and kidded her about old days. She told me a couple of weeks [earlier] that she'd be waiting for me when I come a couple of days later. She said she'd have the boat in the water, she'd have at least one dog in the boat. She'd have all our fishing gear in the boat and she'd have a bait bucket full. That's the mindset she was gone on."
Despite his long-held hope that he and his wife would be able to die together, Mr. Sievewright said that in the end he was happy to have a few extra days to celebrate his wife's life, savour the company of his friends, and to reassure far-flung family and friends that Kay's death had been a good one. "I'm delighted that I'm here to fill in the last few pieces of the puzzle."
Mr. Sievewright's assisted death on Jan. 15 was as peaceful as his wife's, Mr. Cooke said.
"He had a bunch of friends around him. He was just anxious to get it done."
With a file from reporter Tu Thanh Ha
Editor's note: An earlier version of this article included incorrect information on the chart showing the total assisted deaths in Canada, by province. The correct number for Manitoba is 24, not 32 as originally published.
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