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The Current Transcript for December 11, 2017

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

[Music: Theme]

SOUNDCLIP

To the men and women of Christians United for Israel, the day will come when President Trump moves the American embassy [loud cheers] from Tel Aviv to Jerusalem. IT is not a...

ANNA MARIA TREMONTI: It was more than an election promise from the Trump campaign. It was a pledge from his running mate - now Vice President Mike Pence - to the evangelical Christian groups to which he himself belongs. As important as Jerusalem is to Jews and Muslims, it is also full of symbolism and significance for Christians, especially evangelical Christians with a literal interpretation of the Bible. No one group put its clout behind Donald Trump in the U.S. elections more than the evangelical Christians of the United States. As Israelis and Palestinians clash over the U.S. recognition of Jerusalem as the capital of Israel, we're looking at the power of the third religion in this political equation. Also today, we are 18 months in to medically assisted death in Canada.

SOUNDCLIP

I'm really someone who loves many many things and finds life a great joy. Yes I really adore living.

AMT: Will Pegg loves his life but he hates the death that awaits him from the cancer that has taken over his entire body. His choice to have a doctor help him die has created events and relationships that have enriched the life he continues to live. In half an hour, Kristen Nelson brings us the living side of a man awaiting his medically assisted death. And after that the doctors in that equation.

SOUNDCLIP

I sleep very well at night. I've only experienced gratitude from people and feel like I've really... It sounds weird I feel like I've done a good thing.

AMT: We will hear from three doctors who have confronted major obstacles in their choice to assist those patients who want to die. From the paperwork, to the travel, from hospitals that shut them out, to those who judge them even while others beg for their help. That's in an hour. I'm Anna Maria Tremonti. This is The Current.

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'Christians are thrilled': American evangelicals embrace Trump's recognition of Jerusalem as capital

Guests: Jerry Johnson, Stephen Spector

SOUNDCLIP

Jerusalem is Israel's capital. No one can deny it doesn't obviate peace. It makes peace possible because recognizing reality is the substance of peace. IT is the foundation for peace.

AMT: Israeli Prime Minister Benjamin Netanyahu today in Brussels steadfast with his opinion on Jerusalem, even while European foreign ministers have made it clear they do not support U.S. recognition of Jerusalem as the capital of Israel. Leaders around the world, from Moscow to Paris, have expressed concern about President Trump's decision and what it means for the prospect of peace. In an emergency session yesterday the Arab League called on the White House to reverse its decision. And the pope urged world leaders to work together to avoid what he called a new spiral of violence over Jerusalem. The announcement by US President Donald Trump has sparked days of unrest among Palestinians in the West Bank and Gaza. Angry crowds also took to the streets of Jakarta, Dhaka, Cairo and Beirut where Lebanese security forces used tear gas and water cannon on a crowd outside the American embassy. But one group was very pleased with President Trump's announcement. For years evangelical Christians in the U.S. have been pushing their government to recognize Jerusalem as the capital of Israel. And they are applauding the president who they say finally had the courage to do it. Jerry Johnson is the president and CEO of National Religious Broadcasters a Christian media organization. And Jerry Johnson is in Washington D.C. hello.

JERRY JOHNSON: Hello Anna Maria. Thanks for having me on.

AMT: How did you react when you learned Donald Trump would recognize Jerusalem as Israel's capital?

JERRY JOHNSON: Well we were thrilled. I mean this is something that President Clinton, President Obama, President Bush have all promised. So it's not a novel idea but no one else came through on the promise. We're very very pleased that the Jewish people in the Jewish state could have a capital. The capital they wanted the capital that Israel had 3000 years ago.

AMT: How important is this to American evangelicals?

AMT: Well it is important. I mean as a matter of human rights and history, I think particularly coming out of the 20th century. I mean if we care about genocide you've got six to 10 million Jews slaughtered in the Holocaust. I think Christians particularly are sensitive because Christians maybe didn't speak up and speak out as much as they should have to protect Jews. And I think with the Western world and the U.N. supporting a Jewish state, a place for the Jewish people to be safe, to have a home is very important. And it's very important for them to have the capital. And this is their capital. And it's been a matter of U.S. policy for years. So Christians are thrilled about this.

AMT: What's the religious significance of the city of Jerusalem to your faith?

JERRY JOHNSON: Well as a person of the book I mean it really goes back about 3800 years ago in Genesis 12. God made a promise to Abraham and it was really twofold. He told Abraham you're going to have a seed, descendants, a race, a people group and this people group will be a blessing - the Jewish people and for Christians. This is about the messiah it's about Jesus. I mean here we are Christmas he is the Jewish Messiah and this is the region where he lived and the region where he died and rose again - and we're told a prophecy - where he's going to return. So this is the epicenter for the Christian story. It's also interesting Anna Maria of it, in Genesis 12, the other promise was to Abraham that you would have a land that they would have this race and they would have the land. And that goes back again 3800 years ago and you know starting with David it really was the capital for the Jewish people. It really we call it Palestine but that didn't happen till about 2000 years ago when the Romans - it was called Judea before that. You couldn't say the word without hearing the word Jew essentially. Titus wanted to wipe out Jews, wipe out their memory renamed the area of Palestine. We don't think that's right and we support Israel.

AMT: And you make the point that according to the book, according to the Bible. What's the significance of Jewish control of Jerusalem for the second coming?

JERRY JOHNSON: Well I've heard a lot of Anna Maria from you know I have [unintelligible] I have a Ph.D. in theology. I've taught at two colleges and two seminaries. I've not heard one evangelical theologian in my camp say that Christ is waiting to return on the U.S. president declaring or recognizing Jerusalem as the capital of Israel. He's not... we don't believe that the return of Christ is contingent on what the U.S. says or does.

JERRY JOHNSON: No but isn't it not what the U.S. says or does. But just in terms of the Jewish control of Jerusalem.

JERRY JOHNSON: I don't think that their control... I mean what is obvious and biblical prophecy is that that is the epicenter, as it has been for history will be to the end of history they're going to be there. The nations, the world is going to be opposed to them. Of course that's been part of their history as well. And so you do certainly get the sense that the Jews are there and that the Jews are persecuted and are being attacked. And so this is part of the big in-time scenario. But I mean they're already there. They've been there. So I don't see that a legal declaration of the capital- I mean that's really not the issue. I do not know the Bible verse to support that.

AMT: So what is the issue if they've been there? Why? Who needs the legal definition then? Why is that so important?

JERRY JOHNSON: I guess what I'm trying to emphasize Anna Maria, is looking back is the issue not looking forward. That is 3800 years, particularly 3000 years ago, David - It's just it's never been the capital for any of the people group. No other people group, no other government has said this is our capital. This is a Jewish city founded by Jews. There was I mean [unintelligible] two thousand years ago by the Romans and the renaming of the area and the cause of the human rights tragedy of the 20th century. They needed that state. The world gave them that Jewish state. Essentially they had to fight for it you know, in the end get it. Protect it. And this is just the next step of saying this is the capital city. That is mainly looking back not looking forward for Christians. I think that's the way I would talk about it.

AMT: Do you believe Mr. Trump is a good role model for Christians?

JERRY JOHNSON: Well I don't think that's the question. I know that as I travel around the world, international sort of sensationalise the Trump relationship with evangelicals and make that the question. The question is about policy and Christians have been pleased with his pro-life policy, with his economic policy, with his policy towards Israel. So were pleased with his policies. I guess his being a role model is not the way we think of the U.S. president.

AMT: There was broad support for this move amongst evangelical Christians in the United States. According to a Pew survey, a couple of years ago 80 percent of white evangelicals believe that Israel was given to the Jews by God. Only 40 percent of Jews held that belief. Why do you think that is?

JERRY JOHNSON: Well, being a Jew is a complicated thing. Very interesting to know the number of atheist and agnostic Jews and that that makes some real questions about God. It's not about whether the land was given to them by God you know that probably tracks pretty closely to the number of agnostics.

AMT: So this recognition that Mr. Trump has given, what's your feeling about Mr. Trump, politically now that he's done this?

JERRY JOHNSON: Well I mean he's shown again that he's got some courage to do what other candidates have pledged to do. He's finally done them. And this was a matter of U.S. And I have got to say Anna Maria, I think it will actually help in negotiations because this Israel will have a greater sense of security. And from that position of security I think they can go into negotiations feeling not as threatened as they were before. I think it could actually help them be more co-operative and not having to defend themselves quite so much and it might be surprising that you get something you wouldn't have gotten otherwise.

AMT: Well we'll be we'll be watching. Mr. Johnson thank you.

JERRY JOHNSON: Thank you Anna Maria.

AMT: Jerry Johnson president and CEO of National Religious Broadcasters. He's in Washington D.C. As he mentioned Donald Trump is hardly the first U.S. president to make big pronouncements about the status of Jerusalem.

SOUNDCLIP

RONALD REGAN: We remain convinced that Jerusalem must remain undivided but its final status should be decided through negotiations. And make no mistake the United States will oppose any proposal, from any party, and at any point in the negotiating process that threatens the security of Israel.

BILL CLINTON: Jerusalem is still the capital of Israel and most remain are not divided city accessible to all.

G. W. Bush: As soon as I take office I will begin the process of moving the United States ambassador to the city Israel as chosen as its capital.

BARACK OBAMA: And Jerusalem will remain the capital of Israel and it must remain undevided.

AMT: Despite those words from Presidents Ronald Reagan through to Barack Obama, President Trumps move to actually give Jerusalem official recognition represents a significant break. And that's being attributed in part to the significant presence of evangelical Christians in Mr. Trump's political base. There are an estimated 50 million evangelicals in the United States making them a formidable political force. Stephen Spector is the author of Evangelicals in Israel: Ihe Story of American Christian Zionism. He's in Long Island, New York, hello.

STEPHEN SPECTOR: Hi Anna Maria.

AMT: How much did the evangelical Christian lobby influence Mr. Trump's decision to recognize Jerusalem do you think?

STEPHEN SPECTOR: Well according to Johnny Moore, who is one of the actually the de facto spokesmen for the evangelical advisory group that Trump has put together, there would have been no Jerusalem move without evangelical pressure. Mike Huckabee - who is the father of Sarah Huckabee. Sanders said that his group conducted an e-mail campaign. Gary Bauer, who is also on the evangelical Advisory Group, had his followers sent letters and a number of the Christian right leaders said they met on a regular basis, almost a daily basis, with the White House and almost always raised this issue.

AMT: Now my last guest kind of soft pedaled the belief. But what is what is the significance of Jerusalem for the evangelical Christian faith?

STEPHEN SPECTOR: Well Mr. Johnson was right. There's no biblical precept about recognizing Jerusalem as the capital city. The whole notion of the capital as a later idea and certainly there was no concept of embassies. But what is important to any of angelical faith and to anyone who is the Bible believer is the fact that God is Jerusalem. It says in Second Chronicles that he chose Jerusalem for his name and for his home. And Jerusalem is mentioned over 800 times in the Bible. So for evangelicals in particular Jerusalem is a sign that the Jews are God's chosen people. In a more specific way, it's also the site where Jesus lived and it's also for many of them - who read the Bible literally - it's the place that Christ will return and therefore it has to be undivided. And that's the real issue. For the people that I've interviewed, evangelical leaders and lay people, it isn't so much a question of official recognition as a capital city but the fact that it has to be a place where the Jews will populate and be in charge, in order for this temple to be rebuilt for example and there were biblical prophecies about the fact that that's where Christ will return.

AMT: What about the timing of this? Why do you think Mr. Trump made this announcement now?

STEPHEN SPECTOR: I think from his point of view it's hard to say that this is religiously motivated. He certainly has the most evangelical group of advisers and cabinet members in the history of the country. He also knows that the evangelical Christian are the essence of his base and he knows what they believe. It happened to be coincidental with the fact that there was a 17 percent decline in his favor ability ratings among American evangelicals. It was just announced recently. But I'm not sure that that anything to do with it. The president runs a transactional presidency and he was fulfilling a promise that he made to an important voting group. Also he was courting conservative Jews and particularly Sheldon Adelson and actually there was a Hanukkah party at the White House last week which only supporters of President Trump and this movie were invited. One of the evangelicals who attended said "look he is an investor and he knows where the best return is. So he is rewarding the people who supported him and will support him in the future".

AMT: So the best return. There's also a vote tomorrow in Alabama, a Senate race, evangelical vote is crucial in that race is it not?

STEPHEN SPECTOR: It is. I'm not sure that this decision will have much influence on that. There are other more pressing considerations but it certainly can't harm the chances of [unintellligible].

AMT: But you make the point that this had to do with then his supporters. Are you suggesting it has less to do with the Jews of Israel and actual Middle East politics and more to do with his own base back home and the lobbyists?

STEPHEN SPECTOR: I think if you talk to diplomats who've been working on this issue for a long time. They all say this was not a diplomatic move. The timing was not great considering that in the Middle East that the Saudis were beginning to align themselves more closely with Israel and now they're more on the defensive. The Islamists, the Iranians will be more critical of anyone who aligns himself with America. The Tom Friedman had an article a column in The New York Times saying that this was not made part of a package, that the president Trump gave this away and got nothing in return. It certainly is a reward to Netanyahu, the prime minister of Israel, at a time when he embattled but I don't know that diplomacy was a key issue and I don't think the president Trump necessarily thinks of himself as operating within traditional diplomatic traditions.

AMT: Not everyone sees Mr. Trump as a devout Christian. He's been married three times, he rarely goes to church, yet 81 percent of evangelicals voted for him. Why is that?

STEPHEN SPECTOR: I spent the last year researching that question. I spoke to evangelical [unintelligible] leaders who are baffled by it. Much of the answer may have to do with the fact that white evangelical Christians are also white Americans and that there were many of them are white working class. There were a lot of issues that had to do with economy, that had to deal with a despair for the future, the pain that much of the country has. And there was enormous hostility to Hillary Clinton that her supporters didn't fully appreciate. And all of those factors came together in kind of a surprise. Much of the country was shocked, much of the country was jubilant. But it wasn't always true that evangelicals supported Trump. During the primaries, they really had other candidates they preferred. But in the end many of them said it came down to abortion that President Trump had sided with him on the question of pro-life and Hillary Clinton had said things that were more liberal than other presidential candidates had said before. There were also doubts about her character. And as a politician Trump was able to find a voice to reach people and excited them in ways that Hillary Clinton didn't. A lot of that came together and produced one of the most shocking outcomes in history of the American experience.

AMT: You have said that some evangelical Christians see him as a Cyrus. What does that mean?

STEPHEN SPECTOR: Evangelicals recognize Trump's historic history and his character for what it is and many of them say on the other hand he is giving us what's good for Israel and what's good for Christians. And therefore likes Cyrus, who was a Persian king who returned the Jews to Israel and help them rebuild their country after the Babylonian exile. They feel that God uses people who are not good people. For example a lot of evangelicals will not let President Trump date their daughter but they do love the fact that he's doing things that no other president has done, even though they promised it. So they speak about Trump as a Cyrus or a King David who also had moral flaws but god used him as his instrument and that's how they find the kind of theological justification for their support.

AMT: And just before I let you go then, how do you see the influence of the evangelical movement evolving with Mr. Trump? Very briefly.

STEPHEN SPECTOR: Well I think that 81 percent of them voted for him. Even though he had that loss of support recently, I think he is solidifying his base and his calculation is with a solid base. He has a good chance for re-election and he's got such a good press among the more conservative Christians right now. And they're the largest group. They're not all of the evangelicals. There is a progressive group and they would most likely vote against him. But overall I would expect that his support among evangelicals remains solid.

AMT: Stephen Specter we have to leave it there. Thank you.

STEPHEN SPECTOR: Thank you for having me.

AMT: Steven Spector author of Evangelicals in Israel: The Story of American Christian Zionism. We reached him in Long Island in New York. Let us know what you think of what he had to say. You can tweet us @TheCurrentCBC. Find us on Facebook. Go to our Web site cbc.ca/thecurrent. The news is next and then we're talking about medically assisted death. One and a half years into it being legal in Canada I'm Anna Maria Tremonti. This is The Current.

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Will Pegg will die an assisted death. He couldn't feel more alive

AMT: Hello I'm Anna Maria Tremonti and you're listening to The Current.

[Music: Theme]

AMT: Still to come we're dedicating our next hour to a weighty topic today: Medically assisted death. First with the story of one man's journey into the reality of ending his life with a doctor's help. And then we'll hear from medical professionals who are adapting to the new reality. As much as patients and their families. But first our documentary One More Moments.

[Music: Adaptation theme]

SOUNDCLIP

VOICE 1: Today, the Supreme Court of Canada confirmed that seriously and incurably ill Canadians have the constitutional right.

JUSTIN TRUDEAU: Plan we put forward is one that respects Canadians choices.

VOICE 2: Late today Bill C14 passed in the Senate and was given royal assent. that means Canada has a law on assisted dying.

AMT: A year and a half ago it became legal for doctors to help people die in Canada. The result of years of legal challenges and public debate. According to Health Canada at least 2000 Canadians have died with medical assistance since that became legal. About one third of those deaths have occurred in British Columbia. The majority took place on Vancouver Island where people chose assisted death at a rate five times higher than the rest of Canada. It's a big societal change. Doctors, patients, families have all had to adapt to the reality of someone wanting to take their own life with doctor's help. As part of our yearlong project Adaptation, The Current producer Kristin Nelson has the story of a 58 year old man in Victoria B.C. and his journey with medically assisted death. This is her documentary: One More Moment.

SOUNDCLIP

[Chatter]

KRISTIN NELSON: It's the Sunday night sit, a regular meeting of this Victoria meditation group.

[Music]

VOICE 3: Welcome everyone to the Sunday night sit.

KRISTIN NELSON: Dozens of people are gathered in this yoga studio. They're settling in; some with crossed legs on pillows, others on chairs wool socks brushing the hardwood floor. The windows are cracked slightly to lead in the crisp evening air.

[Music]

VOICE 3: Just settling in, arriving in this room, in this posture, in this body, in our body andmind.

KRISTIN NELSON: The meditation leader sits at the front of the room. A small statue of the Buddha on one side of him a bell on the other.

[Bill ring]

VOICE 3: They all beings everywhere. Be free from suffering.

WILL PEGG: Welcome everybody.

KRISTIN NELSON: There are more people than usual at this meeting. Many of those gathered are here to support their friend, Will Pegg.

WILL PEGG: The glass broke for me this January. I was driving home and I stopped in a Vic general and ten hours later a very ashen faced, young internist came into the room and said that I had prostate cancer, and then mentioned that I had some growths on my pelvis.

[Music]

KRISTIN NELSON: Those growths turned out to be metastatic bone cancer. By the time the cancer was found he had over 200 metastases or Mets on his bones.

WILL PEGG: On my spine, pelvis, every rib, skull, the left eye that's looking at you right now has a mat just above and behind it.

KRISTIN NELSON: Will is under no illusions about what his future will be.

WILL PEGG: Over time my rib cage will fall apart, my vertebrae will fall apart. The nerves that are in those areas will be crushed, my neck may break to be various forms of paralysis and the opioid load that's needed to control that degree of pain would be stunning.

KRISTIN NELSON: He knows what's coming because that's how his dad died.

WILL PEGG: My dad had the same type of cancer. He was on no pain medication. The people who were present on site told me he was screaming with pain.

KRISTIN NELSON: We all knew he didn't want to die that way. And so almost immediately he started inquiring about medically assisted dying.

WILL PEGG: It feels like the ability to go with the ways of nature instead of against the ways of nature that there'll be a point where the body's carrying capacity for me to live well versus the inputs it's required to keep that going will be fairly negative cost benefit analysis for both myself and my loved ones. And for me it seems beautiful that we can end our time together on this planet, potentially somewhere that's beautiful for me and beautiful for them. And with a lot less drain on the resources of myself, my family, and the Canadian medical system.

KRISTIN NELSON: He'd like to die on a beach on Clayuquot Sound on the far west coast of Vancouver Island, but when and how that will happen is still unclear.

WILL PEGG: Having never died before, at least not that I'm aware of, so it's a bit hard to envision, but this whole process for me has been about trying to embrace wellness for the people around me. So whatever it looks like it would be without drama hopefully, without a lot of footprints left under hearts and there should be singing.

[Group singing]

KRISTIN NELSON: When Will talks about the people around him, he's talking about a huge community of friends that came together after his diagnosis. There are Quakers, Buddhists, environmentalists, nurses, counselors. They set up committees and got to work when it became clear that we'll needed help.

WILL PEGG: The symptoms came on very quick. After my diagnosis, about a week later, I had become unable to manage large parts of my life because the illness was taking up so much energy every day.

KRISTIN NELSON: He was in a lot of pain and living alone in a house outside of Victoria. On bad days, he would have to crawl to the bathroom.

WILL PEGG: One terrible night in February I had managed to get into the bath tub but I couldn't get out of the bath tub. And because the house was wood heated the fire went out, the house got cold and I was stuck in there just running more and more bathwater.

KRISTIN NELSON: It looked like he was weeks away from dying.

WILL PEGG: I think of it as being sort of in the antechamber of death. I was in the waiting room.

MARGA ST. JAMES: Will was having a lot of symptoms you know I just said this "he looks like he's dying right in front of my eyes".

KRISTIN NELSON: That's when Marga St. James stepped in.

MARGA ST. JAMES: I could see him you know losing colour and weight and you know he wasn't sleeping, he wasn't eating. He was just totally in a lot of discomfort.

KRISTIN NELSON: Marga has spiky grey hair and rainbow striped eyeglasses. She's been friends with Will since the 80s and she put her life on hold to help him, signing 'do not resuscitate orders', registering for palliative care and calling hospice. Then she moved on to the more practical matters of his home and business.

MARGA ST. JAMES: Just like packing up his house and closing up his business and getting his financial affairs in order. We didn't know what the timeline was and we just felt like - and he did too - that selling the house and moving into town was the best option.

KRISTIN NELSON: Margaret admits that the way Wills closest friends were making decisions was a bit radical but they agreed that the good of the group should be paramount. And they felt that it would be easier to support him if he was in the city, even though it was hard for Will to leave his house.

WILL PEGG: It was incredibly disorienting but Quaker's generally try to do things by consensus. So it seemed reasonable that they should operate by a principle whereby a good decision would be a decision that benefited the whole, and the consequence of that of course was that they made a lot of decisions that were very difficult for them in terms of relieving me of my possessions, my business, my home and other things but their vision turned out to be a beautiful one.

KRISTIN NELSON: And then, after all those intense decisions were made and Will was settled in an apartment in the city close to his community of supporters, the treatments started working and Will's health improved.

WILL PEGG: And I got a temporary day pass to get out of the antechamber and I've been living full throttle ever since.

KRISTIN NELSON: But Will still has terminal cancer and living full throttle is possible in part, he says, because he knows he can get a medically assisted death when the time is right. But for a small number of people in his large multi-faith community, the idea of him ending his own life is just too much.

MARGA ST. JAMES: I know of a couple of people who who he was friends with you know before his diagnosis and they just weren't - they weren't able to accept his choices and they have just kind of moved away and he doesn't hear from them.

WILL PEGG: Groups that have deep cultural and religious belief in reincarnation and the Karmic implications, if you like, the rebirth implications of how one spends one's last moments on earth have been amongst those people who've had a bit of a struggle with this new opportunity to end one's life.

KRISTIN NELSON: Even though some people fell away and were unable to adapt to the idea, others came forward.

[Chatter and Cross talking]

MULTIPLE VOICES: He is as good at this as you are, Will. It feels very awkward. You are great.

LOUISE TAKEDA: Hi my name is Louise Tekada.

LOUISE TAKEDA: Very intimidating after watching him go right.

KRISTIN NELSON: Louise and Will sit beside each other on a couch, in a room filled with house plants. Afternoon sun streams in through a nearby window.

LOUISE TAKEDA: At one point I got an email from Will saying that he had this terminal cancer diagnosis.

LOUISE TAKEDA: Curly Locks of dark brown hair frame Luisa's small face. She's wearing jeans and a down vest. There are reading glasses propped on top of her head.

LOUISE TAKEDA: It was very shocking it was very saddening and it kind of realize at that point "Gee" you always think you have more time. That's too bad that I didn't get to know him better you know he is such a - such a great person and felt very sad about that. And then I thought. There's still time like there is still time to get to know him.

KRISTIN NELSON: Louise began volunteering to stay with well after his chemo treatments.

WILL PEGG: She really saw me at my completely lowest and most vulnerable. My body aged 10 years in a few months, my hair fell out. My skin fell part. In the course of those visits, I don't know about falling in love but in Buddhist terms we somehow entered into that place of love, being in the place of love, together, completely surprising, stunning both of us really.

KRISTIN NELSON: For Louise. Falling in love with someone who is dying, who's planning to end his own life was hard.

LOUISE TAKEDA: You open yourself to a lot more pain just even in thinking about these things. You really have to find a love that's greater than that pain. And be willing to make that space in your own heart to have pain and to have fear and to be okay with that. So that's definitely a process.

KRISTIN NELSON: A process that led to a wedding in November. It was an intimate Buddhist ceremony in a room full of flowers, tears streaming down their faces as they exchanged vows.

LOUISE TAKEDA: I feel incredibly honored and privileged to be able to spend this time with him. You know whether that's three months or three years or longer. And the fact that it is more time limited makes all the time that we spend together very precious.

WILL PEGG: It takes a lot of clear mind and wise heart and some crying. I do all the crying.

[Laughter]

WILL PEGG: You're more private about that.

KRISTIN NELSON: Most newlyweds don't have to think about preparing for their partner's death so soon. But Louise has had to come to terms with Will's decision to end his own life, and visits like this one to Dr. Stephanie Green helped. Stephanie Green is used to needing a lot of chairs in the room when she meets with Will. He often brings at least a few people from his care committee.

DR. GREEN: Louisa. Aaron, I forgot the name.

KRISTIN NELSON: When the time comes, Dr. Green will be the one who helps Will die.

DR. GREEN: Yes it's months probably since we've met.

[Cross Talk]

KRISTIN NELSON: Will stood out to Dr. Green early on.

DR. GREEN: Will is a unique guy. He's got a lot of love around him. He's got a huge community around him and they're really really incredibly supportive. So I was experiencing it that the first time I went to meet him.

KRISTIN NELSON: For many years Stephanie Green worked in maternity. But after the law changed she began taking on patients at the opposite end of life.

DR. GREEN: I may feel quite privileged to be in a position where I can actually give someone the gift of compassion that they're asking for. There's very few people in our society who've been given that honor really. I don't take that for granted I am enthralled with it. I am rewarded by it and it's been an amazing year.

KRISTIN NELSON: Medical assistance in dying or MAID was only legal for six months before Will's cancer diagnosis.

WILL PEGG: I mean Stephanie gave me my life back. The perception might be that MAID is about dying but as far as my personal experience of it, it is about living. Rather than me spending my energies worrying about clear torment to come. In my situation it's allowed this year to flower. Stephanie is in the position to accord me mercy which is an incredible gift in the midst of dire circumstances .

DR. GREEN: I just want to add to that. I think Will has hit a really important point. I mean I've been able to see through this year the effect of telling someone "okay I think you're eligible for this care in fact I know you are. It's now up to you." To be able to give that power to someone at the end of their life is not just empowering for them it's truly therapeutic. I mean clinically I've seen people react to that news that they now have that control, even if they never asked for this care later, they feel better. Planning for a good death allows for good life. I really believe that.

KRISTIN NELSON: Today Dr. Green explains how a doctor assisted death unfolds.

[Music]

DR. GREEN: ...One more time but once that last verbal 'go ahead' is there then I'll begin the procedure itself. And the nuts and bolts of that are that I start administering a series of four medications. The first one is...

KRISTIN NELSON: The whole process only takes about 10 minutes. It's somewhat incongruous considering this most profound existential moment through the lens of a sanitized medical procedure.

DR. GREEN: The patient will go from a light sleep down into a much deeper sleep and then down into quite a deep coma.

KRISTIN NELSON: And hearing it explained in such detail, somehow brings Will's death closer into the room even.

DR. GREEN: Breathing will slow down if not stop. But even if that happens we go ahead and complete our protocol which is a fourth medication to make sure that's final. And of course I'm with the patient the entire time making sure things are going as expected and I won't let any gather guest know when we are complete and the heart has stopped.

WILL PEGG: I feel incredibly comforted. And to me it's a great relief to hear about the process. Very comforting indeed.

KRISTIN NELSON: We'll has no problem talking about his own death and Dr. Green says that's common, that patients often accept the idea of dying this way well before their loved ones do.

DR. GREEN: They have come to a place where they want to have the discussion about the possibilities of this care usually much sooner than their family members, because they're the ones dealing with the situation personally, the symptoms, the psychology of it, the fallout, their sense of burden on others. They're the ones who've been sitting in this.

KRISTIN NELSON: The medical profession is adapting to. Dr. Green says she's in touch with her colleagues all the time debating how the laws should be interpreted? Who is eligible? What are the best practices. But the one thing she isn't struggling with is the moral question.

KRISTIN NELSON: [To Dr. Green]Is there any weight on you to be the one taking a life?

DR. GREEN: That's an interesting question. Is there any weight on me?

KRISTIN NELSON: Do you ever go home and "Oh my God.

DR. GREEN: You know, no. I don't have to think too hard about that. I worry that that might be the case. My family worried that might be the case. Many colleagues expressed worry about whether that would be the case. I sleep very well at night. I always feel like I've done something good. I will never assist someone who I don't think meets the criteria of the law. So I don't put myself in a position where I'm worried about going to jail that's never been an issue. And with that aside I've only experienced gratitude from people and feel like I've really. It sounds weird. I feel like I've done a good thing. I really do. I don't feel karmic weight. In fact good karma breeds good karma. I think this only breeds positive things.

[Chatter]

KRISTIN NELSON: After that meeting with Dr. Green Will's friends gather for a dinner of takeout Thai.

[Chatter]

KRISTIN NELSON: Erin Munro was one of Will's dearest friends someone he thinks of as a daughter.

ERIN MUNRO: He's kind of like an adopted family member in a way like he is definitely part of my inner circle of closest people and most part of people for sure and definitely seen me through some really tough times.

KRISTIN NELSON: Before he got sick, Will ran an organic gardening business. He mostly hired young people who were recovering from addictions and often trauma. Erin was 24 when she first met.

ERIN MUNRO: Well it was like such amazing therapy to me gardening and... I don't know was just really healing like it just sort of expanded my sense of myself, my sense of like the world in a way like I don't think I'd really experience that other places.

KRISTIN NELSON: Erin was in the room earlier in the day when Dr. Green described Will's death. She has mixed feelings.

ERIN MUNRO: I think I have kind of maybe a slightly naive perspective that I just I worry that... I just wouldn't want him to do it too soon. You know and I feel like, I don't know, if this is a weird parallel to draw, but like I feel like a lot of the time with animals we do it too soon. You know what I mean and there's all this kind of dogma around it being a kindness. And I actually have some conflict about it like where I'm kind of like... 'huh'.

KRISTIN NELSON: It's complicated because Aaron supports assisted death and Will's right to choose it.

I just don't want to miss any moments I guess. I don't know. I just have that comes up for me like 'this is so final'. I mean the end is the end of it. Like you can't be like 'wait one more'. You know like Hang on. I had one more one more good moment. You know like I want to have it. That's the I guess my job as his support version is to like work through whatever I have to work through to get to the point where I'm 100 percent comfortable with him making that call for himself. You know what I mean so that I'm not dealing with that stuff by the time it comes you know. It's great that Stephanie is able to meet with people kind of a little bit earlier on the path right. So it's like yeah like, if I'm a little slow I've got a little bit of time which is nice.

DR. GREEN: It's going to hurt like hell when he is gone.

ERIN MUNRO: Yes but in an odd way I feel - I've told this to him too - like I don't know if it's trust or love or what but it's like I feel totally sure that I will still carry him and like his spirit and his support like I don't feel like I'm going to lose that kind of life. I get it. And so and that's the piece where I'm like 'oh just one more moment'. But the work is done at the same time, do you know what I mean? So it's like it's all there anyway.

[Music]

WILL PEGG: When one is experienced whatever we would call out with our loved ones; great love, great beauty to have one more minute of it is not necessary. And therefore to artificially extend my life at great suffering for all involved seems counter-intuitive.

KRISTIN NELSON: Today Will is on his way to Salt Spring Island, embracing the moments. C.

WILL PEGG: Coming here. Is a reminder of the bigger picture.

KRISTIN NELSON: Will has been coming to Salt Spring since the early 1990s. Lately he's been coming back to Salt Spring more regularly to see a holistic doctor and to visit Seed Spirit farms.

WILL PEGG: We're looking out over many acres of seed fields stretched across the Cranberry Valley.

KRISTIN NELSON: This is the home of Will's friend Dan Jason.

DAN JASON: We're going down to plant some garlic and this time of year. Is it okay to walk all the way down there?

WILL PEGG: I am I'm going to get you to take my arms. Walking for me is getting to be a little hard. Cancer is more advanced than the last time I saw you. That is a lot of clothes Dan.

DAN JASON: Two ladies out will first and then....

WILL PEGG: Any particular [unintelligible] the cove lands in the bed down for you?

DAN JASON: Pointed side up because that's where it's going to grow from and the roots are going to come out at the bottom just fall.

KRISTIN NELSON: How hard is it to think that you may not be here when that garlic comes out?

WILL PEGG: It's heartbreaking to think. But I remember that my pain is part of a larger pain and kind of a contract that we make with life when we're born that some of us are going to see the other ones go. And so yes, but I can definitely feel a deep sadness in my chest as we talk about this and I see the there's finches sitting on the post behind us. Looks like they were it just came out of licorice patch. And I want to hear them sing next spring holiday.

[Music]

AMT: We have been listening to the documentary one more moment produced by the current Kristin Nelson and documentary editor Liz Hoath. Stay with us in our next half hour more on adapting to the reality of medically assisted dying. We will bring together a panel of doctors to hear their perspectives, including the physician we just met in the documentary Dr. Stephanie Green. I'm Anna Maria Tremonti. This is The Current on CBC Radio One, Sirius XM, online on cbc.ca/thecurrent, on podcast and on your radio app.

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Doctors frustrated with lack of clarity for medically assisted dying practices in Canada

Guests: Stephanie Green, Gary Rodin, Scott Anderson

AMT: Hello I'm Anna Maria Tremonti and you're listening to The Current. As we heard in our last half hour, it is not just patients and loved ones who are adapting to the idea of medical assistance in dying - also known as MAID - it is a shift for medical professionals across the country. And it should be noted, there's quite a variation across the country in the rate of medically assisted deaths since it became legal, a year and a half ago. I'm joined now by three people who are closely involved in providing medical assistance in dying. Stephanie Green is a physician and the co-founder and president of the Canadian Association of MAID Assessors and Providers. You heard her in our documentary she is Will Pegg's doctor. She joins us from Victoria, B.C. Gary Rodin is a professor of psychiatry at the University of Toronto. He's head of the Department of supportive care at Toronto's Princess Margaret Cancer Center and he is also the academic director at the Kensington Hospice in Toronto. He's in our Toronto studio. Scott Anderson is an emergency and intensive care physician who also provides medical assistance in dying. And he's joining us from London, Ontario. Hello everyone. Good morning.

STEFANIE GREEN: Good morning.

SCOTT ANDERSON: Good morning Anna Maria.

AMT: Stephanie, let's start with you. Your province in B.C. is leading the way when it comes to the number of people dying with the help of a doctor, why do you think that is?

STEFANIE GREEN: I think there's probably a number of reasons. I think British Columbia, in particular Vancouver Island, attracts certain retirement communities So our demographics are such that we have a little bit of a more elderly population. People who've had the independence and ability to move here to retire, generally people who have not just the means but a certain will to live a certain way their life and have carried that with them. I think a number of things have come together to kind of have that the population that typically asks for assisted dying lives here on Vancouver Island, in particular in British Columbia in general where people are a little bit more progressive than other areas of the country.

AMT: Scott Anderson how many doctors are providing medically assisted death in your part of the province of Ontario.

SCOTT ANDERSON: In Ontario, there were approximately a hundred at the beginning of the year and right now it's hard to know exactly how many but I think it's it's down to around 50. And there's a difference between assessors and providers. There are a lot more assessors out there than providers - people willing to provide the medications at the time of the death.

AMT: How often are you getting these requests?

SCOTT ANDERSON: I have been getting a lot of requests. My requests come from as far as Toronto, Windsor, Chatham, all over the province because people have had limited availability or access where they live.

AMT: So how much travel are you doing?

SCOTT ANDERSON: I travel quite a bit. It depends on where the need is but if there is a need I will go. And there's different areas of the province where - for example the Greater Sudbury area - they've provided MAID to less than 5 people and that's a very large area of the province which has a medical school and is a referral base for that area. So there are areas of the province where access and availability to providers is very difficult for patients.

AMT: Gary Rodin and how easy is it for someone in Toronto to get medically assisted death if that is what they want?

GARY RODIN: I think there is probably much more access in Toronto. Much of it is going on in institutions in Toronto and also in home palliative care. Now of course that's probably true for many aspects of medical care that there's greater access in larger urban centers.

AMT: I should clarify Gary wrote and you don't perform medically assisted death but you are involved with the team that does, am I right?

GARY RODIN: The assessment and yes we've created a structure for it at the University Health Network which has four hospitals in Toronto.

AMT: Do you see a problem with access?

GARY RODIN: I think what we've heard is that there is a probably a problem with access in the larger community. I think it's probably complicated it's related to the availability of medical - trained medical staff but I think it's also the lack of a support system for people in the community you're providing. It's a difficult thing to do as a sole provider.

AMT: We reached out to Dr. Timothy Holland who is a family doctor who assists patients to die. He's in Truro, Nova Scotia. He sees a problem with how doctors are being compensated for the work that they're doing around this listen to him.

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As it stands now in Nova Scotia, the payment system is completely inadequate. I mean I still am waiting for my first payment on the medical assistance to a dying procedure and it's been about a year and a half. I don't think it's ill will on the part of the government it's just trying to figure out the best way to deliver pay for physicians about this procedure and do so in a way that allows access for all patients.

AMT: Stephanie Green, are doctors who do this work generally being properly paid?

STEFANIE GREEN: There's a huge variety across the country. I think Dr. Holland and his very small crew of assessors and providers in Nova Scotia should be lauded for their incredible efforts to set up the program. You know make infrastructure and still go on providing care despite the fact that they have not been paid for 18 months. Here in B.C. we're also struggling where our structure here is such that we're actually paid but the amount we're paid is less than 50 percent of what the average physician would make just by staying in their office doing less emotional and less burdensome work. So there's a huge variety across the country and it's definitely one of the obstacles going forward.

AMT: According to the Nova Scotia Health Authority two thirds of those who request assisted dying in that province did not get it. Do you think physician compensation has something to do with that?

STEFANIE GREEN: I'm absolutely certain it is. Here in British Columbia we have a passionate group of assessors and providers and even with that we've lost several a significant number of them due to inadequate compensation. If that's happening in a passionate group you can imagine why new providers may not want to step forward and if there's no providers there's no care.

AMT: Scott Anderson do you feel properly compensated?

SCOTT ANDERSON: No this is not the type of work you do for the compensation. That's said, the legislation has come in faster than the governing bodies could regulate it. In Ontario there are no special codes for MAID and no acknowledgement of MAID. But there's a lot of other reasons that physicians are shying away and I wouldn't say money is the main one.

AMT: And what is the main one?

SCOTT ANDERSON: I think there is a variety of reasons. One of them is there's no other area of medicine where if you were to make a mistake or you made a judgement to provide MAID to a patient and the coroner's office after the fact chooses to criticize the management of that case, you're facing potentially criminal liability. And there is a massive degree of oversight on these cases. Not that it's inappropriate, but at times you're made to feel that you shouldn't have done it or it wasn't appropriate and the legislation is written intentionally vague. It talks about a natural death is reasonably foreseeable. Well that depending on the interpreter that can change.

AMT: Have you faced this from the coroner's office?

SCOTT ANDERSON: Yes yes. The coroner's office has provided a degree of oversight after the fact that - I know they're trying to do their job and they're trying to make sure that all the cases that go forward have been properly considered in that. But I've even tried to call the coroner's office ahead of time to say what will you say about this person's death, if I were to call you after the fact because not all these cases are clear cut cancer deaths. Sometimes there is ambiguity and when you call them ahead of times they say they don't provide advice ahead of time. And so you can call our legal authority - the Canadian Medical Malpractice association - and they will try to give advice but ultimately the doctor is the one who bears the responsibility of the patient's death.

AMT: Gary Rodin in a little over a year ago you told CBC that one out of 10 people who asked for the procedure are approved for it. Is that still the case?

GARY RODIN: Well you know I think when we give a figure like that it really depends on what we think is a denominator. The figures now we could say that we see about one a week at the University Health Network, one request. And if you look overall, only about a third of those people who make a what we could call a serious inquiry only about a third of those going on to have MAID. We don't think that's necessarily a bad thing. We've developed a very extensive educational program and we want people to feel free to inquire about it. Many people reflect on it. It's a thought that many people with cancer have. It's a thought that many human beings have about 'is life worth living in its present form?'. Of those people that actually apply, fill out the application, 60 percent of them go on and have MAID. I don't think there's one right number though. I think the criteria is: Are those people who are eligible and who want to die in that way able to die in that way?

AMT: Does the law give doctors a good guideline?

GARY RODIN: Well there is ambiguity in the law and I think one could be regarded in different ways. The law says things like 'Irreversible Decline Death and the reasonably foreseeable future'. We think this is not such a bad thing in the sense that it gives room for judgement between the doctor and the patient. I think it is clear however that it's meant for the terminally ill. This is controversial some people would like to extend the guidelines, the boundaries for it. I think actually that's what the Canadian public had in mind. And probably the Supreme Court had in mind when this legislation is passed.

AMT: Why might someone not be approved?

GARY RODIN: There's a number of reasons a person firstly needs to be competent and needs to be able to understand the procedure, to understand treatment alternatives that are available to them. And they need to be able to make an informed decision and they need to have a terminal illness.

AMT: Dr. Green how difficult is it to interpret the legislation?

STEFANIE GREEN: I think there is ambiguity in the legislation and there is some benefit to that. But it's been holding people back. Some of the assessors and providers that make up our membership at CAMAP have expressed difficulty and confusion. And when there's confusion there's fear, and when there's fear there's inaction. And I think it's fair to say that there's probably a number of people who've applied for this care who do qualify who haven't been able to access it because of ambiguity in the law. And I think it goes to show the importance of CAMAP and the community of providers we've created so that we can learn from each other and grow from each other. There's great power in collegial support and interpretation together.

AMT: What proportion of requests do you approve of the people you assess?

STEFANIE GREEN: I don't have the exact number but I would say it's probably close to Dr. Rodin's number. It's probably 60-70 percent. Again it depends on who comes forward and the reasons for coming forward. But of those who filled out an actual request, it's at least that high. I have a self-selecting population that comes to see me.

AMT: Do you ever feel concerned about being too liberal in your interpretation of the law?

STEFANIE GREEN: No I'm quite careful actually I think I consider each case very very carefully and when there's cases that I'm sure I ask colleagues. And when my local colleagues are also unsure we ask colleagues across the country. We've established a really good network of communication amongst the providers.

AMT: Have you had any concerns raised from the coroner's office.

STEFANIE GREEN: Not personally no.

AMT: I have another perspective I'd like you all to hear. This is Catharine Schiller assistant professor at the University of Northern British Columbia's School of Nursing. She has been speaking to doctors who practice medical assistance in dying. This is what she hears.

SOUNDCLIP

In very small communities, everybody knows everybody. So everybody knows who the practitioners are who are involved. What that has meant is that some of these practitioners have felt that they've been the recipient of very negative comments. Their families have been recipients of many negative comments from people in the community or family members of the person who accessed MAID and who don't agree with made and who don't agree that the person should have accessed it. And so the practitioners are feeling as if they're they're wearing it, that they are involved in this. And as a result some of them are choosing not to be involved because they don't want to put that mark on themselves.

AMT: Stephanie Green how big of a problem is that sort of thing for you?

STEFANIE GREEN: For me personally it's not been an issue here in British Columbia The support for assisted dying is enormous. I have had one colleague who's had some personal backlash in the hallway of a hospital, but it's the only one I know of.

AMT: Scott Anderson?

SCOTT ANDERSON: Oh I think it is a more prominent problem around where I am. I've had a physician who was opposed to it. She had a patient ask her about it, she read about it, went to a seminar on it, felt more comfortable. I helped her through it and she said it was an incredible experience for the patient and herself. But when she got back to the office on Monday her co-worker, another physician, asked her how it how it felt to have murdered her patient. And that's not the first or only example I have of that. I've personally experienced it as well.

AMT: Tell us a little bit more of what you've experienced.

SCOTT ANDERSON: I assisted a patient who was young, had multiple scleroses, had no quality of life, was living in a nursing home and was in severe decline. And he asked for medical assistance in dying. He had two assessors and he qualified and I went to provide it. And on the day of the procedure a nurse ran into the room and said "you need to read this". And it was a it was a letter from his family physician basically suggesting that we were murdering the patient.

AMT: How did you react to that?

SCOTT ANDERSON: I mean it was very difficult. It was very challenging. I sought some counsel and advice from other people. I felt like complaining to the College of Physicians and Surgeons, given how inappropriate that was and. But ultimately it's clearly that person's views. It wasn't about the patient at that point. And I chose to not complain about it.

AMT: You have also faced institutional objections to what you do. Have you not, Scott Anderson?

SCOTT ANDERSON: Absolutely. Two of the institutions that I work with very closely are Catholic based institutions. And faith based institutions in the province have taken a strong stand that they do not want to participate in this and sometimes it becomes actually obstructionist and that becomes a problem. Because when patients go to hospitals they used to go to hospitals based on where they where they lived as well as what their religious belief is. But patients can now find themselves in a institution that is faith based because that institution provides the regionalize resources. For example a rehabilitation hospital might be affiliated with the Catholic Church. And if you find yourself in a rehabilitation hospital that is affiliated with the Catholic Church and they don't agree with or will not assist you in obtaining MAID it can create a very difficult situation for the patient.

AMT: You had a patient a couple of weeks ago who was across the street in a hospital what happened?

SCOTT ANDERSON: The patient was requesting MAID. He qualified but the institution would not allow me to assess the patient in the institution. So we had to transfer him by ambulance to another hospital where he could be assessed for MAID. And it was all done very hush hush and very secretive. And I don't think there's anything that should be hush hush or secretive about this. The patient is simply asking for medical assistance in the dying process and that's really what it's all about.

AMT: When you say hush hush what happened?

SCOTT ANDERSON: Well the patient and his wife were asked by nurses "are you going for a MAID assessment? What's going on? What's happening?" And they felt like they couldn't be honest with their nurses and care providers because of fear of retribution or retaliation.

AMT: Do you think most people of faith are opposed to this?

SCOTT ANDERSON: I think there are some but an incredible situation occurred with my second patient who requested MAID and he was a Catholic priest. And he told me that the institution that he is affiliated with does not agree with it. And up until recently he didn't agree with it. But when you find yourself in the very situation where you are dying sometimes your views change. He had reckoned and reasoned with it and he said "My God is not going to judge me for asking for assistance in dying. My God is going to judge me for how I conducted myself and my life.

AMT: Scott Anderson do you think that enough doctors are ready to have frank discussions about medical assistance in dying and to refer patients to a doctor who can assess them?

SCOTT ANDERSON: I think there's just like anything in medicine. I think there is a variety of comfort with this. I think we're going to start to introduce these programs in the medical schools and this will become a much more comfortable discussion to have. What we really lose track of or understand in this process is that this gives patients control back in their life, the disease process that has affected them, has robbed them of their dignity and their control. And they all feel relief. None of these people want to die. But when you are facing death they want to be in charge. They want to be able to make decisions on who's going to be there, when it's going to happen. And that's been my experience that that an incredible sense of relief and control comes over the patient.

AMT: You actually had a patient who recorded a conversation with a doctor dissuading him.

AMT: Yes. This patient was dying of prostate cancer and he asked the oncologist about having MAID and the oncologist said "well you don't need to worry about that. That's not a concern we'll deal with that when it comes up". And he said to the oncologist "Well I guess I'm not understanding this correctly, last week you told me that there are no more treatments and that I was going to die from this disease." And he said "that's correct". And so the patient said "well how long do you think I have?" And the oncologist said "between two and three months". And he said "Well would this not be the time to talk about that then?" It wasn't it wasn't an adversarial relationship it was an amicable friendly relationship. But I think the comfort level of the oncologist was lacking there.

AMT: Gary Rodin you're involved with all aspects of this, including palliative care. How did doctors have those conversations so to kind of look at all angles of that?

GARY RODIN: I think more and more the medical community, the public and the medical community become much more comfortable with conversations about death and dying. You know one of the concerns originally was that the introduction of something like assisted dying would distract or detract attention from palliative care. And I think that hasn't happened. In fact it's if anything attracted attention toward the problem of end of life and dying, that is to a large challenge for us to begin to educate doctors nurses and healthcare providers about how to engage comfortably in these conversations .But I think we've made enormous progress. Although we're focusing today a lot on the problems and difficulties in access to MAID, I think if we stood back and took an overall look at it, I think it's actually remarkable and dramatic that this legislation is introduced. And with all its flaws and imperfections that has become so normalized in a country like this that it's now seen as part of end of life care by the large majority of health care providers and by Canadians. Now we need to work out a lot of the problems. But I think there's been enormous and much more progress I would have thought in the last year than we might have expected.

AMT: Stephanie Green what do you think?

STEFANIE GREEN: While we've made some great strides I think we shouldn't forget two things. Number one, there's actually a general awareness in the Canadian public which is a little bit lacking. There are still large amounts of people that don't know that assisted dying is not just legal in this country but available in every province and territory. And I think we need to address that. Like as Dr. Rodin says through good education. And I think just to touch on Dr. Anderson's point, it's not just faith based institutions that are opting out of providing this care. We have a number of secular publicly funded institutions in this country - many actually - who've decided not to offer this care and I think that's probably unacceptable to the public and it needs to be documented and shown.

AMT: And who does the documentation, the patients or the doctors?

SCOTT ANDERSON: Well we're talking about a very vulnerable population. I think quite honestly if if people have experienced being turned away or been having trouble accessing care in certain institutions, I think my good friends over a dying with dignity would be very happy to hear from them as they're documenting all these cases.

AMT: I was also struck Dr. Greene that in our documentary, after choosing MAID, Will Pegg's life continues. That this was as much a story about his life as anything else.

STEFANIE GREEN: I think Will made the point beautifully in the documentary. And I have found and I'm sure my colleagues have found that when someone is given the permission to go ahead and have an assisted death, when they are told they are eligible, it's very clear to me that their life is no longer about dying. They stop focusing on dying and they truly embrace living. I think Will expresses it beautifully in the documentary and I see that all the time.

AMT: Dr. Rodin you're nodding.

GARY RODIN: Well I think that is really our major task is to help people live life as well as they can until the end of life. I love that phrase full throttle. And to be able to plan for the end of life and to live life as well as you can in the meantime I think it's ultimately our goal.

AMT: We have to leave it there. Thank you all of you for being part of this discussion today.

STEFANIE GREEN: Thank you.

SCOTT ANDERSON: Thank you.

GARY RODIN: Thanks very much, Anna Maria.

AMT: Dr. Stephanie Green is the co-founder and president of the Canadian Association of MAID Assessors and Providers. She's in Victoria, B.C. Gary Rodin is a professor of psychiatry at the University of Toronto and the head of the Department of supportive care at Toronto's Princess Margaret Care Centre as well as the academic director at the Kensington Hospice. Scott Anderson is an emergency and intensive care physician who also provides medical assistance in dying. He is in London, Ontario. If you have a comment or a story to tell about medical assistance in dying please send us an e-mail. Send it from our website cbc.ca/thecurrent, click on the contact link. You can also find us on Facebook or tweet us @TheCurrentCBC. That's our program for today stay with Radio 1 for Q. Benny Anderson from Abba joins Tom Power to talk about his latest record. I want to tell you about another important story about medically assisted dying coming up tomorrow night on the world at 6:00, here on CBC Radio One, and on the National on CBC Television. It's the story of a 64 year old Toronto woman who was diagnosed with Parkinson's disease in 2005. She was determined to have a doctor assisted death and while she was initially encouraged by the new federal legislation, she came to see it as part of the problem. So keep your eyes and ears open for that. Kas Roussey. We'll have a report on Nancy Vickers who died at home earlier this month. Finally will end today with a little bit more from Dr. Stephanie Green. She was part of our panel discussion about medical assisted dying. We heard her earlier in our documentary because she is Will Pegg's doctor. And in that we heard a bit of her description of what it's actually like to be there for the procedure at the end of her patient's life. So we leave you with Stephanie Green once more describing that procedure. I'm Anna Maria Tremonti. Thank you for listening to The Current.

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So on the day of someone's scheduled death I go to the location where this is going to be and I will immediately speak one on one with the patient about whether they want to proceed, how they feel about things, how their night has been, whether they really want to do this. It's an extra step of making sure there's consent basically. And after that fulsome discussion actually get written consent. When that's been done, I spent time with any guest they've invited. It's usually family or close friends and I make sure that I go through all the steps that they're going to witness. What's going to happen. I explain what's going to happen. And I explain it in enough detail that there's no question about what's going to happen and answer any questions they have. And once that's complete we gather back in the space that the patients chosen. And and I always provide opportunity for last words. And I always give the last word of course to the patient themselves. So offer them an opportunity to do that. And if there's any planned ritual or ceremony we can incorporate that in in any way to this timeline. So this is without any of that happening. And then once the patient themselves has decided they're ready to begin. You know I'll ask them verbally one more time. And up until that moment they can always change their mind. But once that last verbal 'go ahead' is there then I'll begin the procedure itself. And the nuts and bolts of that are that I start administering a series of four medications. The first one is an anti anxiety medication. So just relaxes the patient and often makes them predominantly symptom free and very comfortable. And nine point nine times out of 10 patients will fall asleep with that medication a nice light sleep. A little bit of a snore possible. Everybody knows patient is comfortable. That's lovely. Second medication is a local anaesthetic just to make sure the veins we're using aren't irritated although I don't think the patient really feels much after that. Third medication is an anaesthetic that is often used to put someone to sleep for an operation but a much larger dose. So the patient will go from a light sleep down into a much deeper sleep and then down into quite a deep coma over the course of a couple of minutes. And usually respiratory effort or breathing will slow down if not stop during that medication. But even if that happens we go ahead and complete our protocol which is a fourth medication to make sure that's final. That process of medication administration on average is between maybe 10 and 11 minutes. And of course with the patient the entire time making sure things are going as expected. And and we'll let gather guests know when the were complete and the heart had stopped.

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Monday December 11, 2017 Full Episode Transcript

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