I am Wanda Morris, the Executive Director of Dying With Dignity, Canada's largest Right-to-Die organization. I believe that someone who is sick and dying must have the option to hasten her death with medical assistance. AMA!

How long do you predict before medically assisted suicide becomes legal in Canada? And if soon do you think the United States will be close to follow? Edit: accidentally a word

Thanks for the question. I prefer to use descriptors such as medically assisted dying, or physician assisted death or end of life choice. Suicide has a very negative connotation and I think it should. When we think about suicide, we generally think about someone suffering from a deep depression and acting in a way that if they lived, they would regret.

In contrast, our clients and the general population who support legalizing physician assisted dying are people who love life. It is just that they have been unfortunate enough to be afflicted with a condition or illness that is killing them. They are dying - that is not a choice they are making. The choice they want is to how they die - preferably peacefully and gently rather than through the horrific death that might otherwise await them.

In terms of changes in Canada, we are at a very exciting time. The province of Quebec has announced that they will introduce legislation by the end of June that will legalize physician assisted dying in that province. The legislation will of course have to go through various readings - but it could in fact be passed by the end of the year.

Quebec's situation is particularly intriguing as they are going down a previously untried route. Rather than trying to challenge the criminal code, they are side-stepping it. They've announced that this is essentially a medical matter and are going to address it through healthcare legislation.

The court case in the province of BC continues. We've now heard the appeal and are waiting for the decision. Whoever loses will then appeal to the Supreme Court of Canada who (we hope) will strike down the existing law and give parliament a year to write a new one.

With respect to the last part of your question, I think that all the jurisdictions in the world are eyeing what is happening in other places. This is such a topical issue in so many places! Vermont has just seen a bill passed by the senate this past Tuesday. The UK has just reintroduced a bill from a labour peer. The Green Party in Australia has introduced a bill to legalize choice.

However, in terms of the US, I do think that what happens here will have a particular bearing on the climate and appetite for change. Some of the laws (say in The Netherlands or Belgium) can been seen as coming from countries who are pretty different, but I believe (speaking from my Canadian perspective) that activity in Canada will have the biggest impact in the US - aside from changes happening within the US.

The other interesting twist in the Canada / US impact is that all US legislation and the court decision out of Montana have focused on giving a terminally ill person (with 6 months or less to live) a prescription that they can take themselves.

Here in Canada, we believe in a model that is closer to that typically used in Europe. For example, we believe that individuals with an incurable condition and unbearable suffering should be eligible for support. There is no specific time frame around the person's life expectancy.

We also support not only the right of an individual to obtain a prescription that allows them a gentle death, but also the right of sick and dying individuals to request and receive voluntary euthanasia.

Sue Rodriguez, a woman with ALS who took her case to the Supreme Court of Canada 20 years ago was instrumental in increasing Canadian support for assisted dying. We don't believe that we should accept a solution which would not have provided the support Sue Rodriguez (and now Gloria Taylor) required to have a peaceful death.

These principles were supported in both the decision from the Carter Case (featuring Gloria Taylor) at the BC Supreme Court and in the report from Quebec which is the basis for the legislation being prepared in that province.

How can you know if the person is capable of making such a decision by themselves? The decision to end a life is a very heavy one that has an effect on many people around them and people in such positions may not understand what exactly they are doing.

What kind of assistance do you offer the family of a patient who chooses to end their life in such a way? How can you reassure them so that they understand what the patient wants and why they want it to be that way?

Thanks.

One of our fundamental rights as healthcare patients is the right of informed consent. No medical practitioner can perform any test, diagnostic or procedure without first obtaining this consent.

This means that medical professionals are very experienced at assessing capacity because if an individual doesn't have capacity, they can't provide informed consent.

One of the reasons that our process is somewhat long and involved is to give us a chance to interact with our potential clients and assess their capacity. If we have any reason to doubt their capacity we would either refuse them outright or require them to complete a capacity assessment.

Our support is typically offered to individuals and their families. If someone makes the decision to end their life, we continue to support their family members afterwards.

We encourage our clients (or potential clients) to talk to their family members, and we can provide support to help them do so. It is generally this dialogue and discussion that allows family members to support the choices that their loved ones want to make.

The other thing to keep in mind is that the people who we help are facing the prospect of horrific deaths. People don't want their loved ones to die, but they also don't want them to suffer. Given the opportunity for reflection, most family members will support the choices of their loved ones.

There was a very lovely and very moving series conducted by CBC's White Coat Black Art program with Dr. Brian Goldman. He conducted three separate interviews. The final interview with Nagui's widow, Jan Crowley (and DWD President Meg Westley) provides a wrenching inside look into how someone faces the planned death of someone they truly love. You can listen to it here:

http://www.cbc.ca/player/Radio/White+Coat+Black+Art/Full+Episodes/ID/2279230574/

Would you ever accept a client who has a degenerative cognitive condition such as Alzheimer's? Someone who decides they don't want to be a burden on their family? Or do you only accept terminally ill individuals?

First off, we only accept people with the capacity to make their own healthcare decisions.

Some support groups, such as Final Exit Network in the US, will support people in the early stages of Alzheimer's, while they still have capacity. Because of the difficulties of assessing competence (which can change quickly) and because we have limited resources, we've made the decision not to support people with Alzheimer's in our Client Support Program.

We wouldn't support someone because they were worried about being a burden - whether it was a financial or some other kind. This concern needs to be addressed by providing better medical and social support - not by providing different end of life options.

In the US legislation, to qualify as having a terminal illness, an individual needs to have two doctors agree they have six months or less to live. This can be problematic as it is tricky to know exactly what someone's life expectancy will be.

Instead, our Client Support Program Committee (the group of healthcare professionals who review all individuals who wish to be clients) assesses whether the person has an incurable illness or condition and unbearable suffering.

We do accept people with longer than 6 months to live, many people with ALS or Huntington's can have a fairly lengthy life expectancy. This is also consistent with the legislation that we would like to see introduced.

What sort of consent do you need to get before assisting someone in ending their life?

In Canada, our program at Dying With Dignity works within our existing laws. This means we don't assist anyone, but we do provide information and emotional support to those at end of life. To be eligible for our support, an individual has to have an incurable condition and unbearable suffering. Our clients are typically those with cancer, ALS or other horrific illnesses and conditions.

In jurisdictions where choice is legal, the consent varies by the jurisdiction. Typically there needs to be repeated requests for support along with two doctors who agree with the diagnosis.

Requests are also scrutinized closely. For example, in The Netherlands, only 1/3 of requests for assistance to die are granted.

I don't have any questions, but I fully support this idea and wish you the best of luck at getting those laws more in your favor.

Thanks! Support is great. If you haven't already done so, you could like us on facebook, follow us on twitter or make a donation :) there are links to join and donate on our website:

www.dyingwithdignity.ca

Has a family member every confronted you after someone took their own life? I still don't know how I feel about this topic yet myself, but what do you tell someone in that situation? You pretty have have to explain a very deep and controversial issue to someone who is probably distraught over losing a family member, what do you tell someone like that?

Through our Client Support Program we work with individuals and their families. It would be really rare to have this situation arise after someone's death because for the most part, the discussions have all been held beforehand.

One of our clients, Nagui Morcos was also a volunteer for our organization and a wonderful spokesperson. Nagui had Huntington Disease, a particularly cruel way to die. He also knew what awaited him and his family as he had nursed his own father through to his death of the same disease decades before.

He did encounter people in his family who were opposed to his decision. Some of them challenged him directly and others tackled his wife.

At Nagui's memorial service, his uncle read a very moving letter from Nagui which explained in his own words the reasons for his actions. You can read Nagui's letter here:

http://www.thestar.com/news/gta/2012/09/07/huntingtons_disease_sufferer_nagui_morcos_explains_his_suicide.html

This part of his memorial service was particularly moving as the uncle who read the letter introduced it with reference to the suicide of his own son, and made very clear the world of difference between the two choices.

Why did you become involved with the organization? What are the side effects (in your personal life) of being involved with the organization? Would you give examples of patients that suffered unnecessary pain in the months/years before their death that have contacted your organization, but current laws made it impossible for you to help them?

Like a lot of our members, I got involved because of the horrific death of a loved one. My father-in-law (in England) had dementia and became increasingly violent in its final stages. He never would have wanted to be in a care home, but that's where he ended up.

He also had become very weak in his legs so was in a wheelchair. As the dementia progressed, he lost his sense of boundaries and would run the wheelchair into furniture, and then into the staff and other residents.

To protect the staff and residents, and himself, the staff took the arms of his wheelchair and placed them on a windowsill, so that no matter how much he tried to move the chair, he was stuck.

When he tried to then crawl down from the chair, the staff ended up strapping him in.

That is how he spend the last weeks of his life. My husband came home after his final visit to his father and was tormented by what he'd seen. He asked me to make sure that whatever happened, I wouldn't let that happen to him.

I'd long been a supporter of the cause in principle, but this personal experience prompted me to volunteer which eventually led to my current role.

The primary side effect is a heavy travel schedule! We do a lot of our work through education and I speak across the country. I'm also juggling the reality of living on the West Coast and having our national office in Toronto.

I think the toughest part from an emotional point of view is debating the religious right. I have been absolutely astounded at their willingness to just make s**t up. They fund our opposition heavily and hide behind a smokescreen of fear and misstatement.

For example, it was really heart breaking to see the recent citizens ballot initiative in Massachusetts lose because of outright lies in advertising - primarily funded by the Catholic Church. With the spending happening in that race at a rate of 5 to 1 (against vs supporting) it becomes very challenging to get the truth out and dispel the myths.

There are lots of horrific stories out there. Because of the state of our current laws, people either have to go too early (while they can manage everything unassisted) or face a terrible end.

In my introduction I've posted stories about Nagui Morcos and Susan Griffiths, and the Huff Post blog about Dr. Greg Robinson also provides more details.

If you check out our website, we also profile stories on our blog and in our newsletter (you'll find these under the resources tab).

The biggest problem we find, even with folks where we could provide information and support, is that so often they leave it too late. By the time they call our Client Support Program to find out about their options, they don't have the stamina to go through our eligibility process or do everything they need to secure themselves a peaceful death without assistance.

If a patient could simply ask their doctor for assistance, this would make it so much more accessible and thousands of Canadians who suffer at end of life would have another option.

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Our opposition comes primarily from two places, the religious right and the disability community.

The disability community is not united in opposition - we have members and supporters who have disabilities. However, those who do oppose it usually point to the discrimination they've already experienced and worry that availability of this choice will result in coercion of individuals with disabilities to die. (We believe the best safety net for them is a legal system with robust checks and balances.)

The religious right opposes our position primarily on religious grounds. They believe in the sanctity of life and that if God wills suffering - then it must have some kind of benefit.

The best way I've heard that argument articulated is as follows:

"I'm like a piece of carbon, if I endure suffering, it can transform me into a diamond. (And God would never give me more than i can handle.)"

Of course the idea of redemptive suffering doesn't play a large part in the decision making of the majority of Canadians, so groups like the Euthanasia Prevention Coalition (EPC) tend to couch their arguments in terms of fears for the disabled and elderly.

Dr. Will Johnson, the BC Chair of the EPC and I have been toe to toe in a number of debates. He will always say that "it's not about religion". I think the facts clearly indicate otherwise.

We recently had a rally outside the courthouse in Vancouver, our members and supporters came out in support of choice, and the EPC's supporters were there taking the opposite position. When asked about whether their position was religious, they all said no. However - they'd obviously created multi-use signs. While the front of the signs said things like "assisted suicide is elder abuse" the back-sides were filled with anti-abortion slogans!

I actually have another question if you don't mind. Are you concerned that the increasing attacks on abortion and birth control in the US (I'm not sure of the situation in Canada), and the ideology (religion etc.) underpinning those attacks, makes physician-assisted suicide less likely in the foreseeable future?

I think what we are seeing is increasing polarization. Whether we're talking about abortion, same-sex marriage or end of life choice, the arguments tend to come from the same base of religious fundamentalism.

Yet in Vermont, the successful governor campaigned on the promise of introducing death with dignity legislation.

The rise of Christian Nationalism is also becoming an increasing problem in Canada. Marci McDonald's outstanding book on the subject is I think a must read for all Canadians who are concerned about freedom from religious coercion.

http://www.amazon.ca/The-Armageddon-Factor-Christian-Nationalism/dp/0307356469

One very interesting fact though, is that at least in Canada, there is support for legalizing physician assisted dying legislation across all political parties. In the run up to the last Federal election, there was a Vote Compass Poll which asked people their views on a variety of subjects. The one and only statement which people from every political party agreed with was that physician assisted dying should be legalized.

No questions, just a thank you for fighting this fight.

• diagnosed with Renal Cell Carcinoma in Nov 2012.

I'm so very sorry to hear this news.

If you aren't already aware of all your legal end of life options, you might wish to contact us or a similar organization in your country.

If you are in Canada, you may wish to contact our client support program. There is more information about our program on our website here:

http://www.dyingwithdignity.ca/learn/index.php

Our sister organization, Compassion and Choices, runs a free end of life support program in the US.

There is more information about their program here:

http://www.compassionandchoices.org/what-we-do/end-of-life-counseling/

Does Canada, or any other government, provide a rationale for why it's legal to end your own life, but illegal to be assisted in doing so? There seems to be an obvious tension, where on the one hand, the government is saying that consenting to your own death is enough not to make ending your own life illegal, but consenting to someone else helping you end your own life is not enough to protect that other individual.

It is certainly a legal anomaly. There is no other situation where it is legal to do something, but illegal to assist someone to do that legal act. In the recent case for the right to die being appealed in BC (called the Carter Case and featuring Gloria Taylor) the Federal Attorney General basis its stated opposition on concerns about abuse for Canadians who are weak and vulnerable.

What did you have for lunch today?

Mostly butterflies in my stomach! Actually I had a shrimp salad with bean sprouts, spinach and celery - and a lovely cup of green tea. Mmmmm.

why are you encouraging people to KILL themselves? This is not a decision for you or anyone else. When we reach the end of our natural life, the good Lord will call us home. Until that day, llife is a precious gift tobe valued and not destroyed.

Sigh.

What we support is a legal framework with checks and balances that allows people to make their own choices.

It sounds like you have particular religious beliefs and asking for assistance to die would not be a personal choice for you. Great that you have such clarity.

What our members and supporters, and the 80% of Canadians who support physician assisted dying, want is the right to make their own choices.

It is not right or fair or just that individuals with particular religious viewpoints use the coercive power of government to impose their views on the rest of us!