Dr. Shona MacKenzie took a deep breath before she entered Bill’s bedroom. She had met the family just five days earlier and had found herself waking up each night since, worrying about them. This was her second visit to see Bill at home.
The diagnosis of ALS (a fatal progressive neuromuscular illness, also known as Lou Gehrig’s disease) struck Bill three years before he planned to retire from the company he founded right out of high school. His daughter Elizabeth had joined him in the business after doing her MBA, and the family business succession plan had been well underway.
Bill’s disease had progressed rapidly over eighteen months and by the time the hospice home care team was consulted, he was almost completely paralyzed and had chosen not to be artificially fed or ventilated. His swallowing reflex was weak and his affected vocal cords reduced his voice to a whisper.
“Good morning Bill,” Shona said, in a cheerier voice than she had intended. Anxiety had a way of lifting up her voice.
“There’s no point dragging this out, Dr. MacKenzie. I want to die,” Bill whispered, holding the hospice doctor’s gaze with a command that required an immediate response. Before Shona had the chance to respond, Bill’s daughter Elizabeth jumped out of the armchair next to the bed and leaned over the bedrail. “I’m not ready, Dad. I need you here. I’ve too many questions still about the business.” Her voice was tinged in panic.
Shona leaned in close from the opposite side of the bed. “You are dying, Bill, and because you are not eating or drinking any more, it won’t be long---likely a week or two at the most.”
“That’s too long. I’ve had enough. Give me something to take me out of this misery. Please,” Bill pleaded.
Waves of relief mixed with anguish washed through Shona’s body, knowing that for the next six months at least, she wouldn’t have to help Bill end his life, or anyone in Bill's situation, or refer them to other doctors who would.
“I’m so sorry. I can’t do that,” she said, “but what I can promise is not to prolong your life in any way, and relieve as much of your suffering as I can.” Shona’s face was flushed and her hands trembled so slightly that no one would likely have noticed.
“I know the law is changing soon,” Bill said. “But clearly it won’t be soon enough for me.” He then closed his eyes, one of the few actions left to him, to make his point.
Tears rolled down Shona’s face as she left the room. I’ve never killed a person, in all my thirty years of medicine, she thought to herself. I’ve treated symptoms with the intention to ease pain and suffering but I’ve never given a dose of medication that I knew would be fatal. I have sedated people with severe restlessness and agitation as death approaches but I don’t want to give someone a medication that will definitively cause their death. I know other doctors will be able to though, and Bill has the right to choose to die. I just can’t be the one to do it.
On February 6th, 2015, the Supreme Court of Canada struck down the Canadian Criminal Code prohibitions on voluntary euthanasia and assisted suicide, making physician-assisted death legal in Canada within one year. Canadians who clearly consent to the termination of life and have a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable, will soon have the legal right to ask for assistance in dying.
The deadline of one year was extended by four months, to ensure there was time for legislation to be written across all provinces in Canada. By June 2016, a physician like Dr. Shona MacKenzie will be required by law to provide assistance to a person, like Bill, if another physician concurs that the patient is eligible for assistance, or, if she chooses not to, she will be required to refer the person to a physician who will provide the means to end his suffering, and his life.
On Thursday February 25, 2016, the report by a joint all-party committee of MPs and senators was tabled in the House of Commons. It is clear what the legislation requires of the medical profession in Canada. What is not clear yet is how we are going to support the patient, and the family member who may not be ready, and the physician who chooses to assist someone to die, and the physician who chooses not to. Assisted dying is a matter of justice and it is a matter of the heart and the spirit.