On March 4th a rally took place at the BC Law Courts in Vancouver. Watch Hanno Pinder’s CBC interview about self-chosen death of Farewell Foundation member, Ruth Goodman: http://www.cbc.ca/player/News/Raw+Video/ID/2340190305/
On March 4th a rally took place at the BC Law Courts in Vancouver. Watch Hanno Pinder’s CBC interview about self-chosen death of Farewell Foundation member, Ruth Goodman: http://www.cbc.ca/player/News/Raw+Video/ID/2340190305/
On February 2, 2013 Ginette Leblanc died in hospice. Ms Leblanc had launched a constitutional challenge against Canada’s prohibition against aiding suicide. Her case was to be heard in March, but must now be abandoned. Below is a statement from the AQDMD, an intervening party in support of Ms Leblanc’s court case:
Press Release: February 6, 2013: Montreal
AQDMD brings an end to its involvement in Ginette Leblanc’s court case
Mrs. Ginette Leblanc has died. Members of the Quebec Association for the Right to Die with Dignity – AQDMD will fondly remember her and her loved ones’ constant support. Ginette Leblanc valiantly fought to obtain the right to obtain assistance in putting an end to her suffering once she would have deemed that it had become unbearable. But it was not to be. We nevertheless hope that her fight to secure this right will indeed prove beneficial to others.
Ginette Leblanc’s courage has contributed to bringing closer to fruition the expressed opinion of a majority of Quebecers that they should have the right to obtain medical assistance in dying painlessly and with dignity. It is for her and so many others who unfortunately share similar health conditions that the AQDMD will relentlessly continue to secure this right. Ginette Leblanc’s fight was and is our fight.
As soon as Mrs. Leblanc filed her motion, the AQDMD worked with her as intervener in the legal proceedings. We could not have done so without the pro bono support of Patrick Ferland, Marie-Josee Hogue, Veronique Roy and Melissa McMahon-Mathieu, lawyers with the legal firm of Heenan Blaikie. It was indeed a privilege to work with them.
Helene Bolduc, President, AQDMD – Association québécoise pour le droit de mourir dans la dignité (514) 341-4017 info@aqdmd.qc.ca
Farewell Foundation’s Russel Ogden was on CBC’s “The Current” to discuss Quebec’s proposal for “medical aid in dying.” Listen here: http://www.cbc.ca/thecurrent/episode/2013/01/18/quebecs-right-to-die-legislation-will-other-provinces-follow/
Background: On January 15th Québec advanced toward allowing assistance with dying for residents of the province. A highly anticipated report, the Ménard Report, was commissioned by the provincial government in response to the Select Committee on Dying with Dignity recommendations in March, 2012, which proposed reform to permit “medical aid in dying.”
The “Ménard Report” (authored by Jean-Pierre Ménard, Jean-Claude Hébert, and Michelle Giroux):
The 450 page Ménard Report concludes Québec can implement a provincial framework for doctor assisted dying without coming into conflict with federal law that prohibits assisted suicide. The Report proposes “medical aid in dying” as “new form of end-of-life care” that would be covered by provincial health law.
Medical Aid in Dying: A New Form of Health Service
Canada’s federal Criminal Code prohibits assistance with suicide. Enforcing this federal law, however, is a provincial responsibility. The Ménard Report says that the Québec government could craft a new law to make an exception to allow doctors to provide assisted death to patients who suffer from terminal or intolerable medical conditions. The exception would fall under provincial health law. Doctors who comply with the provincial law would not be prosecuted for violating the Criminal Code.
According to the Ménard Report, the Québec Medical Association would have to revise its Code of Ethics so that doctors would oversee the practices of both terminal sedation and assisted dying. In the case of assisted dying, the onus would be on patients to request euthanasia or assisted suicide, and a conscience provision would allow doctors to opt out. Guidelines would require free and informed consent, absence of undue influence by mental illness, two medical opinions, and a minimum of two requests by the patient not less than five days apart.
An after-the-fact protection would require reporting to the coroner’s office within five days of the death. The coroner’s office would be responsible for deciding whether there was compliance, and if not, the case would be referred to the provincial prosecution service. This protection is similar to Farewell Foundation’s current policy for attending at unassisted suicides of it members, which requires prompt reporting to the coroner.
Next Steps:
The Ménard Report is now on the desk of Québec junior health minister, Veronique Hivon. She says she hopes to draft legislation for medical aid in dying and put it before the Québec National Assembly before summer.
Nitschke inquiry: AMA slams AHPRA inquest
www.medicalobserver.com.au/news/nitschke-inquiry-ama-slams-ahpra-inquest#comments
Medical Observer 20th Nov 2012 Byron Kaye
THE AMA has blasted AHPRA’s investigation into pro-euthanasia GP Dr Philip Nitschke, questioning whether it should have jurisdiction to scrutinise a practitioner’s non-medical activities and suggesting it even fund Dr Nitschke’s defence itself.
AHPRA, acting on a single complaint from anti-euthanasia campaigner Paul Russell, has told Dr Nitschke he “may not be a fit and proper person to hold registration as a medical practitioner” because of his pro-euthanasia activities. Dr Nitschke told MO he had never been the subject of a patient complaint.
The association threw its support behind Dr Nitschke last week after he revealed his regular indemnity provider, Medical Insurance Group Australia (MIGA), would not fund his defence since the investigation was unrelated to his practice of medicine.
MIGA CEO Mandy Anderson has told MO that Dr Nitschke also had “a specific policy exclusion… to the effect that no cover is provided for expenses arising from any of his activities that are connected with, that further the aims of, or that arise as an officer of Voluntary Euthanasia Research Foundation Inc, now known as Exit International”.
AMA president Dr Steve Hambleton said regardless of whether people agreed with Dr Nitschke’s views he should not be subjected to the ordeal of an AHPRA investigation if they did not affect his practice of medicine.
“Has he ever promoted that [euthanasia] product in the consulting room?” he said.
“Should someone’s utterances which are unrelated to their medical practices lead them to be examined by their accreditation body when it may have no impact on their practice?
“Where has he transgressed good medical practice? Where does it say… that he’s not allowed to hold a certain point of view? Should [AHPRA] have jurisdiction in the matter?”
As previously reported by MO, Dr Nitschke said he felt left “high and dry” after MIGA refused to back him and that he was obliged to seek pro bono legal support. A subsequent online poll of 211 MO readers found that 73% thought Dr Nitschke’s indemnity provider should support him.
But Dr Hambleton said it should not be up to Dr Nitschke to seek the support of his insurer and instead asked: “Why doesn’t [AHPRA] fund his defence if they want to test something out?”
An AHPRA spokesperson said the agency would not comment on individual matters except to say “the role of the Medical Board of Australia and AHPRA is to protect the public”.
Ms Anderson meanwhile also told MO that MIGA members could “be very confident that we will support them if investigated by AHPRA for matters that relate to their practice of medicine for which they are insured with us”.
Gloria Taylor Will Be Remembered
Gloria Taylor of Westbank, BC, died on October 4, 2012. Diagnosed in 2009 with ALS—a fatal degenerative disease, Gloria died suddenly and unexpectedly in Kelowna General Hospital, due to an infection. Gloria will be remembered for her courageous participation in a landmark constitutional court case for the right to die with the assistance of a doctor. She won a special right to receive court authorization for either physician assisted suicide or euthanasia.
The oldest of four girls, Gloria grew up in Castlegar, BC. She married, had two sons, and divorced. In her younger days Gloria enjoyed motorcycling and rode a Harley Davidson. Gloria established the Interior Association for Injured Motorcyclists, which provides aid to fallen bikers. She considered herself a fighter, refused to be bullied, and was known for standing on principle. She was frustrated that as a non-native living on First Nation’s land she had no voting rights, so in 2009 she stood for election for a position in the Westbank First Nation council.
Gloria’s career included working for the post office, residential care, and property management. Despite the progressive disability due to ALS, Gloria continued to live independently in her own home with the support of family and professionals. She told the BC Supreme court that one of her greatest fears was being reduced to a condition of dependence on others to meet her needs.
In a statement published by the BC Civil Liberties Association, Gloria’s mother Anne Fomenoff, remembered her legacy: “Gloria will be dearly missed by her devoted family and friends, but we are grateful that Gloria was given the solace of knowing that she had a choice about how and when she would die. Thanks to the ruling of the B.C. Supreme Court, Gloria was able to live her final days free from the fear that she would be sentenced to suffer cruelly in a failing body. The exemption she was granted allowed her to face her illness and death with dignity and grace. In the end, Gloria was spared a long and painful death from ALS — she was able to die peacefully surrounded by her friends and family. Until the moment she died, Gloria firmly believed that all Canadians should have choice in dying, and we, her family, completely supported her in that belief. I am so proud of my feisty, determined daughter – she struggled to make the world better for Canadians. I speak on behalf of my entire family when I say we are so proud of her legacy. We are blessed to have known and loved this special woman.”
A constitutional challenge against Ireland’s prohibition on assisted suicide is being launched by Marie Fleming and her husband Tom Curran. Marie suffers from multiple sclerosis and is cared for full time by Tom. They are arguing that Ireland’s 1993 law that bans assisted suicide is unconstitutional because it discriminates against severely disabled individuals. Ireland’s constitution provides for equality, so this case is similar to the Carter case in British Columbia, in which the BC Supreme Court ruled that Canada’s absolute prohibition on assisted suicide was unconstitutional because it discriminated against individuals who, due to severe disability, cannot end their own lives.
There is a key difference between the Canadian case and the Irish case. The Irish case is demedicalised in that it will argue for Marie’s life to be ended with the compassionate assistance of her husband. Canada’s case, brought on by the BC Civil Liberties Association is specifically for physician assistance with suicide and euthanasia. 
Tom Curran and Marie Fleming (source, Irish Independent)
The idea of demedicalising assistance with suicide would mean that physicians would not have the discomforting role that the “right to die” often puts on them. Thomas Szasz, a famous professor of psychiatry, has argued that assistance with suicide is an issue for law, politics, and morality, but not medicine. In his 2011 book, Suicide Prohibition: The Shame of Medicine, Szasz calls physician assisted suicide “semi-legal bootlegging of barbiturates by doctors.” Szasz says while medical ethicists and civil libertarians see physician assisted suicide as “progress in patient autonomy,” he sees it as “just the opposite.” Szasz says that the voluntary ending of one’s life is the product of a decision, not disease or mental illness, and therefore it is not a medical problem.
The Irish case brought on by Marie Fleming and Thomas Curran is one to watch. Mr. Curran leads the Ireland branch of Exit International and as such will possess insights into non-medical approaches for ending life, discussed in books such as Final Exit and the Peaceful Pill Handbook. The Irish Independent reports that Mr. Curran is prepared to go to jail if it is necessary for him to help his wife to die. http://www.independent.ie/national-news/i-would-risk-jail-to-end-maries-needless-suffering-says-partner-3243856.html
CBC Radio’s “White Coat, Black Art” broadcast about Nagui Morcos’s last day is available at this podcast link http://www.cbc.ca/whitecoat/popupaudio.html?clipIds=2279230574
The interview includes personal interviews with Nagui, his wife Jan, and Meg Westley of DWD. It discusses the moments leading to his death and the police response afterwards. Nagui’s death was eventually ruled suicide and the criminal investigation was concluded with no charges.
The police and coroner investigation into Nagui’s death would have been deemed a “suspicious/homicide” death investigation. As such, coroner policy is to order a post-mortem to assist the criminal investigation (opening the head, chest & stomach cavities). The compassionate eye-witnesses at Nagui’s death would not be enough, since they were “suspects” in an unnatural death. Nagui’s peaceful death would be followed by a State-authorized and tax-payer funded mutilation of his body. Interestingly, part of Gloria Taylor’s constitutional exemption (Carter v. Canada) for an assisted death is that her death would be officially documented as by “natural” cause. This would negate any legal duty to report her death to the coroner or police and therefore no forensic autopsy. While this may seem a less than honest way to classify cause of death, BC’s Supreme Court has given Gloria Taylor the opportunity for dignified death and protected her from the indignity of a mutilating forensic autopsy.
Note: When Nagui Morcos died in April 2012, Dying with Dignity reported on it in their Spring newsletter. DWD_newsletter_june2012_colour_ The Toronto Star story below offers additional personal information and details about the police investigation.
Toronto man ends his life to avert horrors of Huntington’s disease
September 7, 2012, Toronto Star, Robert Cribb
The son hoped to escape his father’s fate. His life depended on it. As Nagui Morcos watched his university professor dad weaken and eventually die an anguished death from Huntington’s disease in 1988, he gathered visceral evidence of what might lie ahead. Being tied down to a bed in hospital. Vacant. In constant pain. Deteriorating.
“Nagui always made it very clear to me that if he had the gene for Huntington’s, he had no intention of seeing it through to the end,” his wife Jan Crowley says. When they first met in 1987, Nagui was a vibrant man, energetic, passionate, unlike anyone she’d ever met. Both were in relationships at the time. But a chance meeting two years later would bring them together for good. They married in 1991 after a two-year courtship. Just as the couple was trying to conceive a child, medical tests revealed he had indeed inherited the Huntington’s gene. His two brothers, both eventually tested, were clear. Nagui would be the final family member to carry the disease.
After lying in wait inside him for 45 years, the disease began revealing itself through symptoms that seemed all too familiar. By January of this year, at the age of 54, he stumbled and could no longer control his constant, involuntary movements. Drinks would fall from his hands. He would choke when he ate. He was dizzy and exhausted all the time. He struggled to remember words. His speech became indistinct.With a terminal diagnosis, he decided to seize what little control he had over his life: to end it. He would pre-empt the disease. He would leave his life as himself.
“I told him that I worried that he’d do something violent or brutal or something that might not work and he might survive in very bad shape and that I didn’t want him to have to think about that on his own or feel that he was alone,” says Jan. “He told me, yes, he had been considering bridges and subway trains and the usual means of suicide but that he didn’t know what he’d do.”
Together they contacted Dying With Dignity, a Canadian right-to-die advocacy group that supports and provides information to those considering suicide. “We’d never been able to talk to anyone else about it,” Jan says. “It was just our secret for a long, long time.”
Meg Westley, president of Dying With Dignity, understood the agony. The path that brought Westley to Marcos followed a familiar narrative arc. Fifteen years earlier, she watched her mother’s “wretched” death to breast cancer. “She lost her breast, vision in one eye, her hair, she developed hideous widow’s hump on her back and became bedridden and in pain. It was a barbaric situation. You witness it and think, ‘What’s the point of this?’ It was miserable, undignified, horrible, and she wished there was an easy exit.” For her, there wasn’t. For Nagui, there could be, she believed.
Those seeking the organization’s help must have a terminal diagnosis or a progressive, incurable physical illness, be mentally capable and be free of any coercion, says Westley. “If they are very determined in their own minds and clear having considered all options available to them that what they want to do is end their own lives, (we) provide information about safe ways to do this.” Morcos decided he wanted Westley to be there when it happened. She agreed. He had found another confidant. While Nagui felt most of his doctors at North York General were disapproving of his plans to end his own life, Dr. Sharon Cohen was different. She listened carefully as he explained his plans to her last year. Then, he asked her opinion. It’s a difficult question for a doctor in Canada. Assisting suicide is illegal. Physicians fear for their careers and their reputations. Few will even engage in the discussion.
“I made it clear that I fully supported him and everything he was saying and doing made sense to me,’” Cohen says. “He felt good that I did agree. He was very grateful.” She put him through cognitive testing to make sure he was of sound mind and that his mental capacity was well-documented. Then, she worried. “It was a stressful period for me,” she says. “I felt nervous about whether I was doing the right thing from a legal standpoint and what the law might have to say about the conversations I had with him, although I felt morally I was absolutely doing the right thing.”
Nagui knew it wouldn’t be long before he would lose the physical dexterity required to accomplish the task. He understood planning and logistics. He knew what it took to get things done. A professional life spent in corporate boardrooms and entrepreneurial endeavours had taught him that. Born in Cairo, Nagui came to Canada with his family in 1967, when he was 10 years old. After graduating from McMaster University with a commerce degree in 1979, he forged a successful career in food marketing and retailing, working for some of the largest manufacturers in North America. At one point, he also ran a popular local cheese shop — The Cheese Dairy — in the city’s west end. They were life skills he would redeploy for the purpose of ending his life.
“In deciding on the timing for hastening my death, and to stay within the current laws, I had to do this myself and couldn’t get any help,” Nagui wrote in a farewell message to family and friends. “It was a precarious balance between doing it too early and missing out on my rich life, and doing it too late when I was no longer capable.”
In January, after two years of planning, he set a date for his own death: April 22. In the year leading up to the day, Jan took a leave from her job as a college professor to be with him. They travelled, talked, reflected. She played devil’s advocate from time to time and went for counselling and therapy to help her resolve her own feelings. “How can you possibly prepare yourself to let someone you love go like that?” she says. “Thinking about it and anticipating are not at all the same things as going through it. I felt a lot of fear and trepidation and dread. But it wasn’t about me. It was really about him and his need to have control over his own life and body and destiny.”
Two nights before the appointed day, Nagui and Jan sat in Roy Thompson Hall listening to opera singer Renée Fleming. One music reviewer in attendance wrote of Fleming “bewitching” the audience with songs of “love, loss and enchantment.” The next day, Westley and a colleague met with Nagui and Jan at their Toronto apartment. He still seemed mentally sharp and mobile to Westley, moving around the kitchen making coffee as they spoke. “It was a real tragedy that he had to do this with a year or two of quality of life left,” she says. “But his fear was that he would not be able to perform this act he’d chosen if he waited.”
Westley asked Nagui if he was sure. He was. They agreed to meet at his home again the next day at 2 p.m. “We told people we’d be out of town that weekend so the phone wouldn’t be ringing,” says Jan. “It was a beautiful final evening eating his favourite meal and drinking champagne.”
The next morning, they awoke to sunshine streaming through the windows. It was quiet. “There was nothing more to do or say,” Jan says, struggling with the words. “Just to be close.” Nagui prepared himself to die that afternoon with paperwork neatly arranged and organized. Yo-Yo Ma played on the stereo.
He sat in a chair in the bedroom as Jan said goodbye. She asked one more time: “Are you sure?”
“Yes,” he said.
She asked: “Are you afraid?”
“No,” he replied.
Jan’s last memory is of looking in his eyes exchanging one final declaration of love. “He told me he wanted me to be happy and he was ready and he was sure. It was time. It was the hardest thing I’ve ever done.”
In his farewell letter, Nagui apologies for the “grief” caused by his decision. Then, he explains. “For people like me, who are terminally ill or have an incurable progressive disease and are steadfast in their resolve to hasten their death, nothing that anyone could say or do would make a difference. This issue will never go away — people like me will continue to hasten our death somehow. You must let us go.”
A few days prior, Jan had sought the advice of a lawyer on the legalities of witnessing her husband’s suicide. His strong recommendation was to remove herself from the apartment when it happened. Take a walk, he urged. She couldn’t do it, afraid that something might go wrong or that her husband might have a final thought to share with her. So, she and Nagui agreed that she would go into the next room when he committed the act. She rose from their embrace and walked away. She would never see him again. As she left the room, Westley and her colleague entered and remained with Nagui. Jan waited in the next room, Mozart playing on the stereo. She passed the minutes writing in a journal she’d been keeping over the past year — called “The Year of Last Times” — that documented all of their final celebrations, from birthdays to Canada Day to Thanksgiving.
Neither Jan nor Westley will discuss the details of how Nagui ended his life, citing privacy and the ever-looming legal concerns about assisted death. “I felt some anxiety that something would go wrong,” Westley says, “that he might not die, that something unpleasant would happen, and I wasn’t sure that I would know how to deal with it.” She watched his breath until it eventually stopped. Silence.
Eventually, they reappeared before Jan in the next room. “They both looked pretty shattered to me,” Jan recalls. “It was very quiet. Very quiet.” About an hour later, Jan called the non-emergency police number to report her husband’s suicide. The time delay was Nagui’s wish. He didn’t want paramedics attempting to resuscitate him.
Within minutes, the sound of sirens from EMS and police cars grew louder. Police and officials from the coroner’s office arrived. “At first, they couldn’t believe what we were telling them,” Westley recalls. “We said we were there. Within a short time, they came to the realization that we were witnesses and had to be separated because we might be cooking up some story.”
The three were separated in the lobby of the Toronto apartment building to be interviewed. Westley agreed to go to the police station to give a statement. “We were trying to be very co-operative because we didn’t want to act as though we’d done anything wrong.”
After several hours of waiting, two detectives told her they would ask the Crown the next day how to proceed. “They repeatedly said, ‘We’ve never seen anything like this before. We don’t know exactly how to handle it.’ They really were gobsmacked. They didn’t know what to do.” Last week, police called Jan to tell her they had closed their four-month investigation. No charges were laid. The death was declared a suicide.
Dr. Cohen’s voice begins to soften and gently break when she recalls the impact Nagui had on her, both professionally and personally. “I was impressed with the determination of Nagui Morcos in following through with what he strongly believed and doing something very difficult at a time in Canada where he had to hasten his death without any assistance from his wife or his physician.” As a specialist treating people with degenerative diseases like ALS, Alzheimer’s and Huntington’s, she often finds herself casting her mind forward a decade to imagine what her patients will be like. “It’s not pretty,” she says. “It’s not what they want. It’s not what I want for them. And I was very glad for Nagui not to go down that path. I felt even more committed to be the best doctor I can for people. You couldn’t help but be inspired. He did the right thing for him.”
For Jan, recovery from the emotional loss of a man she was married to for 21 years comes slowly. She hasn’t returned to work yet. She’s considering extending her leave from her teaching job at Seneca College. “I don’t have the heart to teach now.” Her voice wavers. “I’m glad that he’s free now,” she says. “Death comes in very slowly to your awareness. I know intellectually that he is gone but it’s taken me a long, long time to accept it in my body and heart. It’s hard. I miss him terribly.”
“I am so proud of Canada for being such a progressive nation — we’ve accepted divorce, abortion and same sex marriage,” Nagui Morcos wrote in his farewell letter. “It is now time for us to do the humane thing and embrace choice for the terminally ill to have medical assistance to end their life when it has become unbearable. I now pass the torch to you, my dearest family and friends, to do the right thing and change this so that you and your loved ones will have more choice than I did.”