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'Whose Life Is It?'

Nearly two decades after Sue Rodriguez sought assisted suicide in B.C., the answer remains elusive.

By Daniel Wood, 12 Jul 2011, TheTyee.ca

Russel Ogden

Euthanasia researcher Russel Ogden: 'Suicide is legal' so why isn't assisting one?

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[Editor's note: Since this article was first published in the Georgia Straight last November, various civil rights groups have added their voices -- and lawsuits -- to the ongoing debate over the legality of assisted suicide in B.C.

This April, the B.C. Civil Liberties Association filed its "death with dignity" lawsuit, a B.C. Supreme Court challenge against the criminality of physician-assisted suicide. That lawsuit gained steam on June 29, when 63-year-old Gloria Taylor, who has battled crippling symptoms of ALS for nearly a decade, added her name as a plaintiff in the case.

In the first of this two part series, we meet three B.C. men who faced down immense opposition and social taboo while fighting for the right to die with legal help, and the drugs to help them do it.]

I cannot tell you Stephen Gardiner's real name or where he lives because, if I did, well-intentioned friends might try to stop him from killing himself. And he doesn't want them implicated.

I can tell you Wolf Obgielo's name, because the details of the assistance he'll get when he decides to die won't be revealed here.

Both men are terminally ill with cancer and both want to choose -- without the interference of authorities -- the time and circumstances of their death.

I can also tell you about Vancouver's 66-year-old Ken James, whose chronic back pain and heart condition are so debilitating, so unrelieved by daily morphine tablets that he says, half-laughing: "If I were a horse, they'd shoot me."

To avoid authorities that could charge anyone who helps him with murder, he's been researching the best methods for killing himself with minimal evidence left behind.

None of these B.C. men can access the prescription drug pentobarbital, which is the lethal drug-of-choice for most of the 38 or so people in Oregon who annually find release under that state's physician-assisted suicide legislation, Death with Dignity. And Nembutal, the lethal, fast-acting drug that Exit International's Dr. Philip Nitschke recommends, isn't as simple to acquire as it once was.

But there is helium-inhalation. It's a quick and easy-to-use option that New Westminster's Russel Ogden, Canada's leading researcher on right-to-die issues, knows is currently filling the assisted-suicide gap -- until this country joins the growing number of international jurisdictions where dying people can legally get help ending their lives.

In the decades ahead, no issue will be more contentious -- as Boomers age and Medicare costs go ballistic -- than the fundamental right-to-die question: Whose life is it?

No place in the nation's 'deathbeds'

These words were first spoken to me by Sue Rodriguez in the late winter of 1993, while I was researching a story on assisted suicide for Chatelaine. Rodriguez was dying of ALS then, and had decided to mount a legal challenge to the law, seeking permission to receive medical assistance when -- incapable of any movements because of the paralytic effect of ALS -- she finally chose to die. "Who should decide when I die?" she asked.

She lost the case in a famous Supreme Court of Canada 5-4 split-decision later that year. The Court ruled that no one could legally have help dying, despite terminal disease, intractable pain, prolonged suffering, or an expressed desire for relief.

So, the issue remains the proverbial elephant in the room: big, looming, and -- because of the profound ethical questions involved -- dangerous.

Few politicians are brave enough to say, paraphrasing Pierre Trudeau, that the state has no place at the deathbeds of the nation. Few doctors, nurses, or those involved with hospice care are prepared to risk careers saying aloud what everyone knows: assisted suicide happens -- discreetly -- all the time in Canada.

But were it made visible, by admitting that, the police might intervene. So instead, fear and silence reigns.

As one of Vancouver's leading palliative care authorities said to me last month, requesting anonymity, "Everyone told me not to talk to you. I could lose my job. Talking about assisted suicide is taboo." And yet, according to a February 2010 Angus Reid poll, a large majority of Canadians (75 per cent in B.C.) favour the establishment of a medically-regulated system of euthanasia; and a slightly smaller percentage favours the decriminalization of assisted suicide.

The pain of dying

In January 2007, Wolf Obgielo, then 53 and newly unemployed after decades in forestry management, left his Pritchard, B.C. home east of Kamloops to find out why his persistent flu wasn't going away. When the medical assessments were done, an oncologist informed him he had aggressive Stage 4 cancer in his lungs and lymph nodes, and had six to 12 weeks to live.

It hit him, he says, "like a sledgehammer." He'd watched his uncle dying, slowly suffocated by lung cancer. His father had hung himself in a closet in the face of prolonged chemotherapy. But for three years, Obgielo fought the disease. This past spring, however, wasted by the cancer drugs' effects, he decided to give up, and began looking at how he would end his life.

As he sits amid dozens of equestrian knickknacks and scores of wall-mounted photos of himself, his wife and two sons -- many of them of the family on horseback, riding the sagebrush-covered rangeland above Pritchard -- his breathing is laboured and words slow.

He still rides, he says. His wife helps him. He's a cowboy at heart. It's his last real pleasure. But it's getting harder now. The cancer's in his bones. His lower back. His left hip. Left ribs. His lungs and lymph nodes.

"Pain?" I ask.

"Oh, yeh!" he replies emphatically. "I've got a horror vision of me gasping like a fish in the bottom of a boat. Just flipping around, you know. People who are against assisted suicide don't know the pain of dying, the mental torture," he says. "You could live longer, drugged up. But what the hell do you live for? It's not the quantity of time, but quality of life that matters. When I can't ride my horse anymore... I'll get the help I need. The SPCA could have you charged for cruelty to animals if you have a dying animal and you don't put it down."

Canada's death dilemma

Few people in Canada knows more about the practicalities of suicide and euthanasia than Russel Ogden, 47, an instructor of criminology and sociology at British Columbia's Kwantlen Polytechnic University. If you Google "How to Kill Yourself," his name is among the first of 4,300,000 entries. On Feb. 12, 1994, the Vancouver Sun ran a front page story on Ogden, which reported he'd found 34 Canadian cases of illegal assisted suicides while researching his Master's thesis. It was, by coincidence, the same day B.C.'s Sue Rodriguez, accompanied by a still unknown physician and B.C. MLA Svend Robinson, defied the 1993 Supreme Court of Canada ruling against her wish for assisted suicide by having a doctor help her die. This was international news. Ogden instantly became an authority on the dilemma society faces when terminally-ill or chronically-pained individuals wish to end their lives, and governments prohibit it.

In Ogden's thinking today, there are four or five central issues concerning assisted suicide that will, in the coming decades, force politicians and the public to resolve the ambiguities that now govern how a sane and terminally-ill person, wishing death, dies. The first is the question of civil rights. Over the past 50 years, laws against everything from choice in abortion to gay equality have fallen. The last great taboo, to Ogden, is the right to die under the circumstances of one's own choosing. "The right to be -- or not to be -- is the ultimate civil liberty," he says while sitting in his neat suburban home with the tools of assisted suicide -- for demonstration purposes only -- in the basement below. "Suicide used to be a crime," he says. "But we no longer bury suicides at the crossroads. Suicide's legal. The quarrel now is getting assistance to die. I can't think of a single place in criminal law where helping someone do something is unlawful, although it's otherwise lawful to do it yourself."

In tandem with these steps toward the expansion of civil rights within Canada, there has been, Ogden points out, a dramatic shift in public opinion toward approving right-to-die legislation. Polls now show almost twice as many Canadians favour legalizing assisted suicide and/or euthanasia today -- permitted now in three U.S. states and a half dozen countries -- as when Sue Rodriguez raised the issue 18 years ago. It's not simply Canada's 9.8 million Boomers are getting their first whiff of Eau de Eternity. It's that Boomers have lived with choices. They've grown used to being in control. And, says Ogden, they're unlikely to accept quietly the dictates of medical professionals who remind them assisted suicide is illegal.

Furthermore, Ogden argues, the Boomers realize -- as do those in Generation X and Y -- the cost of providing a whole generation of aging Canadians with end-of-life health care is staggering. Tens of billions of dollars annually. In fact, 50 per cent of an average person's lifetime health care costs in Canada are incurred in the last year of life. This is because physicians, by and large, are fixated on prolonging life -- even among the most elderly and the dying -- through myriad Hail Mary medical procedures that stand very little chance of long-term benefit.

Ogden is not without critics. His research over the past 20 years has regularly involved both terminally ill people who seek assistance in dying, and those who are willing to assist them in that effort. However, since aiding a suicide in Canada is a criminal offence, Ogden has had to protect his sources by refusing to name names or publish revealing details. This has inevitably produced scholarly questions -- not to mention legal threats -- towards his work

It's ironic, Ogden believes, that despite most Canadian doctors' reluctance to support right-to-die legislation, the courts have taken a different approach toward the illegality of assisted suicide. In almost every case in B.C. where there have been allegations of assisted suicide amongst the terminally ill, crown prosecutors have recommended -- following a lenient, in-house protocol -- no charges be laid. And in the 44 assisted suicide legal cases in Canada since 1940 where Ogden has found charges were laid, 12 people have been jailed, including a two year term handed Dr. Ramesh Sharma of Vernon, B.C. who prescribed lethal medication to an elderly patient in 2007.

A secret death

In Stephen Gardiner's thinking -- he requested a pseudonym so he could tell me his story -- the prohibition against assisting a suicide and the uncertain nature of court actions have created for him, as for many others, a terrible lottery. He cannot seek help in ending his life -- he has terminal cancer -- without jeopardizing his friends.

So, at age 62, a year after he got the bad news, he sits in his Lazy-Boy recliner in an un-nameable Okanagan town, recording the music that will be played, and listing the friends who'll be invited, and talking about the self-activated device that will gently kill him, at the death ceremony -- seated in the very chair he now occupies -- he will soon attend.

He'd seen first-hand the problems of dying in his father's failed efforts to kill himself after a stroke. He knew he'd find a route to elude the struggle his father had faced. "There are a lot of messy ways to kill yourself," he tells me of those months last fall searching the Internet. "But if you want to kill yourself in a way that's... well... graceful, it usually requires help."

He knew he didn't want to die, oblivious to friends, in a physician-administered morphine coma. Unmarried, self-sufficient, a computer technician before his illness and a man with practical, problem-solving inclinations, he'd searched the web for spiritual advice, the legal ramifications of assisted suicide, and the various options available to him if, as he came to realize, he were forced by law to kill himself unaided.

There was Nembutal, recommended by the Australian founder of Exit International, one of 44 organizations worldwide fighting for right-to-die legislation. The problem was that this veterinarian drug -- used for putting down animals -- is only publicly available in Mexico, and even there at great difficulty. And whoever got it for him could be charged with abetting murder.

There was, as well, the fatal inhalation of inert gases like helium or argon. This method has been explored by the Swiss-based right-to-die group Dignitas. Helium is, of course, available at party balloon stores, and argon at welding shops. But the apparatus needed -- the same equipment Russel Ogden has in his New Westminster basement -- means you die with a plastic bag on your head and a pressurized tank at your side and tubes and valves in between. And that didn't fit Gardiner's idea of a "graceful" death.

Gardiner gets up from his chair, returns from his bedroom, and hands me a black, neoprene air-purifying face mask, the kind used by workers sand-blasting. It's the first time, he informs me, he's shown anyone his suicide invention.

Since the frightening feeling of suffocation comes from a face-masked person's rebreathing carbon dioxide, he explains, by attaching a carbon dioxide absorber to the exhalation valve and a closed-circuit air loop, means that with the mask on, he'll fall unconscious from oxygen deprivation within 2-3 minutes and be dead 10 minutes later.

He tells me he's thinking of getting a patent, marketing it as a "Debreather," and making a million dollars. At this, he laughs ruefully. "As long as my quality of life is good," he says, "I want to stay alive. It's up to the individual to decide when they go. Not the police. Not the medical profession. Not the law. A huge public debate is needed. But when I finally want to die, I'll die." And he holds the mask to his face and inhales.

Tomorrow, the similar "slippery slope" arguments of both Canadian doctors and Christian pro-lifers against assisted suicide. And the surprising frequency -- and intense pushback -- of assisted suicide in the few U.S. states and countries that made it legal.  [Tyee]

12  Comments:

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  • alive

    45 weeks ago

    Let's stop the hyprocracy

    During the prohibition period, smart entrepenours made the ingredients available with a warning that it is against the law to mix them together!

    Maybe it is time for similar packages of various powders to be promoted (for whatever purpose) with a similar warning that if ingested they will result in a quiet peacefull death?

  • rantnic

    45 weeks ago

    FOLLOW THE MONEY

    With half of a persons total health care expenses being spent in the last year of life one need not wonder why there is such a large lobby to prevent the use of assisted suicide. Should the " dieing" market be reduced by even 10% we are still talking billions a year lost in Canada alone.

  • joanieL

    45 weeks ago

    changing laws puts seniors at great risk

    There's another side to this coin. If we change our laws to make it legal for people to "help" kill other people, we open the door even wider to abuse by people who have the means, motive and power to do so. It happens, perhaps more often than we suspect. Here's one recent BC example:

    In February this year, a Victoria woman was given an end-of-life morphine dosage even though she was not terminally ill nor in great pain. In fact, she was a very vital, though elderly, woman as a YouTube video taken of her shortly before her death shows. She was resuscitated by paramedics and taken to Emergency. The nursing home is under police investigation for this incident.

    In May, this woman died in that same nursing home, and the circumstances of her death are being investigated by the coroner's office, and there are calls for a public inquiry.

    Read Kathleen's Demise - Focus magazine July/August 2011:

    http://www.focusonline.ca/?q=node/249

    We should be very, very careful before we make it even easier for people to end another person’s life. Or, conversely, we need to make it much, much harder for medical practitioners and health care providers to administer end-of-life drugs.

  • mgailthiessen

    45 weeks ago

    Who's Life Is It?

    I guess my first question is, "WHY is it illegal to assist a terminally ill person to die?" When I was younger, and this was talked about, I was led to believe that the reason was that "someday, there MIGHT be a cure" for ALS, all types of cancer, or any other terminal illness, and that it would be a "crime" if a week after someone did commit suicide, whether assisted or not, someone shouted "Eureka, I've found it", and the person's life could've been spared. Well, to my knowledge, this has not yet happened -- at least in very many instances. I just cannot wrap my head around keeping someone alive against their will, living in total agony, unable to draw a breath without help, or without excruciating pain, not even being able to attend to their "most personal needs", because "the law" says to do otherwise is "A Criminal Offence". Where is the dignity in having to rely on someone else for those basic needs? Where is the dignity in spending your last days moaning and writhing in pain that leaves you almost
    unconscious? When there is NO hope for recovery, why is it so terrible to let that person leave this world in peace, and with some of their personal dignity intact? (And by the way, yes, I call myself a Christian!)

  • John Greg

    45 weeks ago

    Theism

    Considering Canada's ongoing swing toward a more theist culture, thanks to Harper and his ideologues and a lot of our immigrant brothers and sisters "in the Lord" of one kind or another, it is probably going to become even more difficult to move toward making assisted suicide legal.

    I find it reprehensible that some butt-stuffed bureaucrat is able to prolong my life into sheer agony just 'cause he/she says so.

  • Alan Abel

    45 weeks ago

    joanieL

    I don't doubt the passion behind your pro-life position, but the fact is the health care system is a human system and thus mistakes, along with medical acts of heroism will always be par for the course. None of this should infringe on my overriding right to control my own body, my life and eventually my death.

    There is a very unfortunate, prevailing religious tenet out there that life must be prolonged at all cost, including the cost of the dying person's rights and wishes. I say no way. I hope and pray that when my time comes, it's quick and painless, not prolonged and in agony. If I get to a point when I am merely being kept alive with medicine and hospital machinery, I want someone to listen to my final request that I be given quick passage to the other side. I resent the idea of some medical establishment, a family member or a hospice official to be making this decision for me. In the event that I am unconscious and can't decide exact timing of my death, well, that's what a living will is supposed to be for. I have made explicit, detailed instructions in my will for when, and under which circumstances, I am to be allowed to die. I encourage all of you to do the same.

  • alive

    45 weeks ago

    oh please!

    look joanieL, murder is murder, regardless of the age of the victim.

    What you describe is terrible, but has nothing to do with this discussion!

    Only when and if a very sick person asks for assistance to die, will any of this be an option.

  • joanieL

    45 weeks ago

    Alan Abel you have misconstrued and misunderstood

    Mr. Abel, I'm not a pro-life person, and never said I was. I'm not objecting to your wishes to end your life either, if you so choose. I'm just against people taking the life of another person who doesn't want to die.

    The key thing is that the woman depicted in the article that I linked to in my earlier post DID NOT ASK TO DIE. Nor did she have a terminal illness or pain. Nor was her life being prolonged “at any cost” or even no cost. She wasn't "being kept alive by anything but her body". She was just an ordinary, if elderly, woman.

    Maybe you didn't read the article, so I’ll repost it: http://www.focusonline.ca/?q=node/249.

    Another point is that this Victoria woman absolutely did not have control over her body, or her life. Quite the opposite. She was being administered drugs to end her life -- without her knowledge or consent. The decision was made by the nursing home, nurse, doctor... not by the woman.

    This woman’s experience was not about mercy at all. We're talking people trying to put a person to death for some other reason. So, there is a need to strengthen safeguards and punishment for people who abuse their powers (e.g. doctors, nurses), as appears to be the case in this Victoria nursing home.

    By the way, living wills have no force in BC, not yet anyway. And the hospitals and doctors and nursing homes often don't respect the laws that already exist. That's another thing you would have seen if you'd read the article in the link. Lastly, putting instructions in your will about how you want to die is useless, because a will cannot be brought into effect until after a person's death. Please check your facts before you offer advice of such a serious nature.

    Also, you seem to presume all "old people" want to be put to death (and to have that decision be made by someone else). Shouldn’t that be their choice? My position is that people should be protected from predation by others who may stand to gain by the death of an older person or an ill person.

    To end a person's life without their knowledge or consent is just plain murder. Surely that is taking the ultimate choice away from a person, isn’t it?

  • joanieL

    45 weeks ago

    Not "only" if/when requested by "very sick"

    “alive”, you are quite wrong when you say that this will happen “only when and if a very sick person asks for assistance to die”.

    This Victoria woman never asked to die. By all accounts she was full of life, and wanted to enjoy more of it. The woman recovered completely after paramedics treated her, confirming she was not in the last few days/hours of her life nor “very sick”. The only thing that had made her “very sick” was the morphine/narcotic drug.

    I have great sympathy and support for people who wish to die if they so choose. My concern is that people with ulterior motives will take advantage of a situation more readily if we make it legal to “help” another person die. People say there will be safeguards, but that hasn’t worked in real life.

    In Oregon for example, the statistics show that, even though their law says that the person must consent, that in a great number of Oregon’s “assisted deaths”, no other person was present beyond the person put to death and the person administering the medication. In other words, there was NO WITNESS PRESENT during the administration of the drug to confirm if it was indeed the person’s choice to have their life ended. Those Oregon stats are available to anyone who wishes to research them. This is a real red flag because the lack of independent/credible witnesses is an open door to abuse.

    In the Victoria woman’s situation, had she died instead of being resuscitated by paramedics, staff could easily have claimed she was on her death-bed, or whatever. Many people are too willing to accept verbal claims from medical staff without proof (“oh, he just slipped away...”), and to believe the myths and perceptions about the elderly, i.e. that they’re just drooling nobodies who can’t communicate and aren’t worthy of being treated with the same respect and consideration as other people.

    Making it legal to (help) end someone else’s life will put the elderly and the ill or disabled in greater danger of predatory actions by other people. We need to ensure that whole categories of the public are not put in harm’s way by making it legal for one person to take the life of another, for however good a reason.

  • Alan Abel

    45 weeks ago

    joanieL

    You are correct, I have misrepresented your position and made wrong assumptions in my previous response to you. And for that, you have my sincere apology. These Internet comments forums are often not conducive to careful, considered thought, at least for me.

    I also wrongly used the terms living will and will interchangeably, which you correctly note is wrong. A few years ago, I did do up my own living will (aka advance health care directive), and I agree that under current legislation it may be worth no more than a symbolic gesture to my immediate loved ones. But I do think it's important to put down in writing, for your self and those closest to you, what you want if you reach a point where you can no longer decide for yourself. I also fully agree with your point about "offering advice of a serious nature." My hope is that readers of these comments sections wouldn't put more value than a grain of salt into anything they read here, especially with regards serious advice.

    Having said all this, your concern regarding end-of-life / elder care is more than valid, and the Focus article serves as a disturbing reminder that issues like this are not always what they appear. However, I don't think we can let cases like the one raised in the Focus piece deter us from seeking proper right-to-die legislation. Perhaps with comprehensive legislation, more tragedies can be avoided.

  • Cat Amadeus

    45 weeks ago

    To prevent abuse...

    In Switzerland, a procedure has been adopted years ago by Exit International to prevent the kind of abuse seniors might be exposed to if assisted suicide was legalized. The "Swiss Model" is both compassionate and accountable and includes cooperation with the local authorities. In BC, the Farewell Foundation is challenging the constitution in order to legalize assisted suicide, with the purpose to implement the Swiss Model in Canada. You can read about this model in their newsletter at: www.farewellfoundation.ca

  • alive

    45 weeks ago

    I mean, really!

    frankly joanieL, I am not interested in arguing with you, if you insist that wrongdoing as you illustrated is a cause to stop help to whose who so desire.

    I can grant you that any such law will require some guarantees, and you can be sure that enough people will contribute to that end.

    Any law can be scrutinized and loopholes found, but there are always remedies!

    Let's concentrate on the urgent need for a solution for those of us who may need this kind of help!

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