Why Canada never had a Dr. Kevorkian

The following is an excerpt from A Good Death by Sandra Martin.

Late on a June afternoon in 2014, Petra de Jong, wearing a bright pink suit and black pumps, was nonchalantly describing how she had tried to help a patient die back in 1989, and how abysmally she had botched it. With her short blond hair, wide smile and round open face, she looked so harmless and friendly it was hard to imagine her as an agent of illegal death. "As a lung physician you meet a lot of people who are dying. And they die in an awful way," she said in a matter-of-fact tone as we sat on either side of her desk in the Amsterdam offices of the Dutch Voluntary Euthanasia Society (NVVE), where she had been the director since 2008.

In 1989, long before the Netherlands passed legislation in 2002, legalizing euthanasia under prescribed conditions, de Jong was thirty-five, recently qualified and working in a hospital near Utrecht. One of her patients had a tumour that had almost completely obstructed the passages that conduct air into the lungs. His breathing was very difficult and when he began coughing, he had a great deal of trouble stopping. Instead of gasping until he died, as though he were being asphyxiated, he wanted to commit suicide. He asked de Jong for a prescription for enough drugs to kill himself. She complied, guessing at the quantity of the barbiturate, and reassuring herself that her patient would never fill the prescription or consume the drug.

She was wrong. He took the medicine despite its bitter taste, but it didn't kill him right away. "It was awful for everybody," de Jong said, but especially for the patient's wife, who watched her husband struggle for nine hours. The family doctor reported de Jong to the police, who questioned her about her actions and her motives. "In the end," she "didn't have a trial" and "wasn't put in prison" because everyone "was aware that this man was suffering very, very much and he was terminally ill."

Most doctors would have turned away from death requests after that, but de Jong was undeterred. She resolved that the "next time" she must "be more careful and do it myself and stay with my patient." Within the year she had another terminal patient who wanted an early exit. Again de Jong wrote a prescription – a larger dose this time. She informed the patient's family doctor and alerted the attorney-general that she was going to assist a suicide. This time the process went smoothly.

"It wasn't a problem any more," de Jong said, referring to the series of failed prosecutions in Dutch courts in the 1970s and 1980s that made it virtually impossible for a doctor to be convicted of murder or manslaughter for killing a suffering patient so long as a prescribed list of due care criteria was observed. "After that, when I had a patient who asked me to help him die, I gave him an injection in the hospital," she said.

Only in the Netherlands, I thought to myself, would two strangers – one of them with a tape recorder – talk so openly about mercy killing. Such a candid conversation was unthinkable in Canada in 2014 and is still a contentious subject today as doctors, other health-care providers and even publicly funded institutions parse the definition of "suffering," "do no harm," and the philosophical depths of their conscientious objections.

Why were Canadian doctors unwilling to step forward and admit helping their patients die, the way Dutch doctors did? Partly the explanation lies in the tradition of tolerance in the Netherlands, the strong bond between family doctors and patients and the medical profession's openness. But there's another factor: There was no renegade Canadian doctor, such as Jack Kevorkian in the United States, who was willing to risk his licence or his freedom to challenge the laws against assisting a suicide. Or, to use a different example, as Henry Morgentaler had done in offering illegal abortions. He endured police raids, criminal charges, incarceration, death threats, even the firebombing of his Toronto clinic in a defiant campaign to change the law. And it worked. The abortion law that forced a woman to see the approval of a hospital-based committee before terminating an unwanted pregnancy, was struck down by the Supreme Court of Canada in 1988 because it violated the Charter of Rights and Freedoms.

Five years after de Jong openly helped two patients die in 1989, Sue Rodriguez ended her life in Canada, in what remains one of the deeper mysteries of the right-to-die movement. She had cried after the Supreme Court of Canada upheld the laws prohibiting physician-assisted death in a 5-4 decision on Sept. 30, 1993. Then she composed herself, turned to her friend, NDP politician Svend Robinson, and said: "The court may have spoken, but I have the last word."

As the fall turned into winter, Rodriguez's enunciation deteriorated so much that broadcasters used subtitles in her last interview. She admitted that she had set a date for her death, but instead of revealing it, she gave viewers one last radiant smile – an ethereal image of an ordinary woman transformed into an icon for the right-to-die movement.

The date was Feb. 12, 1994 – two days before Valentine's Day. Rodriguez was alone in her split-level house when Robinson arrived through the backyard. He went downstairs to her bedroom, handed her a potion of secobarbital and turned on some of her favourite music, Land of Enchantment by the German new age musician Georg Deuter. Then he climbed into bed and held Rodriguez in his arms until her heart eventually stopped beating.

Robinson openly admitted he had been with Rodriguez when she died, but he was never charged with anything, least of all assisting a suicide. One of the people who came under police suspicion was Scott Wallace, a prominent physician, politician and board member of the Right to Die Society in Victoria. Like so many others, Wallace had been charmed by Rodriguez as a person and deeply affected by her plight. After attending the hearing at the British Columbia Court of Appeal early in 1993, he had publicly stated that he would be willing to consider helping her die.

Wallace himself died in 2011, so I asked his daughter, Anne Wallace, a provincial court judge in Kelowna, B.C., why her father would make such an offer. "He was the kind of doctor who was always there for his patients," she said, and after "meeting Rodriguez and talking to her, he was convinced she was right in what she wanted to do."

Wallace said her father saw the suffering of many patients at the end of life and he thought that if people were well informed they shouldn't have to endure such painful and protracted deaths or to leave their friends and loved ones with such horrible memories. At the same time, doctors faced a dilemma. They didn't want to violate the Hippocratic oath or be sued or criminally charged and risk prison and the loss of their medical licences. "My dad thought that people who were dying wanted to be in control of their own deaths and it bothered him that we weren't being honest about it," Wallace said.

Her father was questioned for "four or five hours by the police," but he had "an ironclad alibi," she told me, because he wasn't even in Victoria the day Rodriguez died. The quality of her father's alibi makes her think that "he did know what was going to happen, but he wasn't involved." As she pointed out, "It wasn't like my mother and father to just take off for a day of vacation."

There have always been a few doctors willing to quietly nudge a patient over the brink to eternity, but hastening a death depended on the physician's compassion, not the patient's choice, and required the family to be complicit in maintaining a shroud of secrecy. Britain's King George V is a famous example. The royal physician, Lord Dawson, gave the terminally ill monarch a fatal injection of morphine and cocaine just after midnight on Jan. 20, 1936, to ease his patient's suffering but also to ensure a dignified announcement in the Times, rather than a blaring headline in an afternoon tabloid. And yet that very same year, Dawson stood in the House of Lords and argued against a bill legalizing euthanasia.

This sort of rampant hypocrisy made some Canadian doctors, including Wallace, speak out after Rodriguez raised the issue of physician-assisted suicide in the 1990s – not that it made a difference. It would take another 20 years, the evidence from permissive regimes elsewhere and another group of heroic and suffering patients, including Kay Carter and Gloria Taylor, to bring a new and successful Charter challenge to the Supreme Court.

Excerpt from A Good Death by Sandra Martin © 2016. Published by HarperCollins Publishers Ltd. All rights reserved.