Skip to playerSkip to main contentSkip to footer
dmdmdtvs
  • 2 days ago
Assisted Dying The Final Choice (2nd Apr 2025)
Transcript
00:00Assisted dying is one of the biggest ethical questions facing society.
00:07This is the medication that somebody will take to ultimately end their life.
00:12It can be as short as 30 minutes.
00:15Is it a fundamental human right? Or does it put lives at risk?
00:20I think it's just robbing our people of hope.
00:24Without that safety net, I would have made that choice to end it myself.
00:29Long ago.
00:32We'll meet patients and doctors in California and Canada on both sides of the argument.
00:39I have God and I have good medicine.
00:42For the patients at the last moment, they're always looking in my eyes
00:45and giving me the heads up and ready to go.
00:48What lessons could there be for Britain from how Assisted Dying works in North America?
00:54Canada has fallen off a cliff. I wouldn't even call it a slippery slope.
00:59We just saw people who were at the end of their lives suffering the way they didn't want to suffer.
01:05That's not slippery slope. That's due diligence.
01:09And we witness the death of a man who says he wanted to end his life on his own terms.
01:16I just don't see any merit to dying slow and painfully. I want none of it.
01:22I want none of it.
01:23Good night.
01:24Good night.
01:25Good night.
01:26Good night.
01:27Good night.
01:28Good night.
01:29Good night.
01:30Good night.
01:31Good night.
01:32Good night.
01:33Good night.
01:34Good night.
01:35Good night.
01:36Good night.
01:38A few of us want to think about death.
01:42Especially when we're fit and healthy and the sun is shining.
01:50But California is one of ten US states where assisted dying is now legal.
01:58In some respects, it's a model for how the practice might work in Britain.
02:05Aid in dying is available to those who are terminally ill and expected to die within six months.
02:13Patients must self-administer the lethal medication, the same as what's proposed in England and Wales.
02:25We're in San Diego to meet a couple who form an important part of this story.
02:35Wayne and Stella have been married for over 50 years.
02:40They've led a very active life together and travelled widely.
02:47Wayne worked as a landscape architect but is now too ill to go further than his front porch.
02:55He's terminally ill with heart failure and sepsis has severely damaged his spine.
03:02How much pain are you in?
03:04It varies but it varies from being very painful to excruciating beyond, almost beyond tolerance.
03:13Wayne has applied and been approved for an assisted death.
03:18He wants to die before his health declines so much he might not be able to swallow the lethal medication.
03:25I've watched two relatives go through the slow death, natural death, and it was heinous.
03:36Bad for them.
03:38And I felt bad and decided I'm not going to go through that one way or the other.
03:43I just don't see any merit to dying slow and painfully.
03:46And hooked up with stuff and intubation and all this, feeding tubes and all this stuff.
03:52I want none of it.
03:54Where have you decided you want to die?
03:56Right here.
03:58Here.
03:59Why is that?
04:01Just because I like the setting.
04:03Hospitals are miserable.
04:05I hate hospitals. I'll never go to another one.
04:07I'll die in the street first if I go to a hospital again.
04:10He would probably insist I wheel him out to the street.
04:13Yeah.
04:15Wayne is 80 while Stella is 78 and they have two grown-up children.
04:22The family know Wayne's mind is made up.
04:26Stella, do you support Wayne in his decision?
04:32Yes, I mean I've known him over 50 years.
04:35He's a very independent man.
04:38He always knows what he wants to do and he's always fixed things.
04:40If something's not right, he can fix it and he does.
04:45And that's how he's operating now.
04:50Including the manner and timing of his death.
04:53Right.
04:55He'll do it his way.
04:58Okay Wayne, so I'm going to do my exam now.
05:01I'm going to listen to your heart and your breathing.
05:03Dr. Donnie Moore will be present when Wayne takes the lethal dose.
05:09Although it's not compulsory for healthcare staff to attend.
05:14He showed me the drugs that are used, which arrived the previous day at the house and are now kept out of reach.
05:21So, these are two medications that we use to prevent any kind of nausea once somebody has drank the mixture.
05:28And then obviously the key bottle.
05:31What about this?
05:33Yes, so this is the medication that somebody will take to ultimately end their life.
05:37It has five medications at very high doses that work in concert to make sure that somebody's in a very deep sleep.
05:43And then if they're breathing and their heart is suppressed.
05:47And how quickly do they fall asleep?
05:49Once somebody has drank the medication, within two to five minutes, they get very tired and they fall asleep.
05:56Once they're asleep, it's much harder to predict exactly how long before somebody will die.
06:02It can be as short as 30 minutes.
06:05Sometimes it can take several hours.
06:06But I think it's important to know that the person is in a very, very deep unaware state during that time.
06:15I still believe that with good palliative care and good hospice care, we can provide good deaths to the majority of patients.
06:23But for those who want more control or those whose suffering is irremediable, I believe this should be an option that's available to them.
06:29Wayne asked if we'd come back a few weeks later once he'd picked a date and to witness his death.
06:43He said people in Britain should see what assisted dying involves.
06:48It's an invitation we accepted.
06:51And we'll come back to Wayne later.
06:59Assisted dying was introduced here in 2016 and some remain passionately opposed.
07:10Like Dr. Vincent Nguyen.
07:13He believes medical aid in dying is both morally wrong and dangerous.
07:19He's a palliative medicine specialist in Newport Beach, south of Los Angeles.
07:24His opposition is based on his medical experience and his Catholic faith.
07:31I worry that physicians are no longer seen as a healer as we are, but rather than participating in the death of a person by killing them.
07:40And we come from a healer to a killer.
07:42The way that a society cares for its most vulnerable is the measure of its humanity.
07:49So instead of ending people's lives, let's put programs together to care for people, let them know that they're loved, they're wanted and they're worthy.
07:59Right there, see? He's right on the green. See that?
08:05Michelle Carter is one of Dr. Nguyen's patients.
08:09She's 72 and has been married to Mike for 43 years.
08:14Both are being treated for cancer.
08:17Mike for prostate and Michelle for ovarian.
08:21Michelle is terminally ill and has already been close to death twice.
08:26She knows that at one point her immunotherapy will stop working, but she has no intention of having an assisted death.
08:36Suicide, dying, is not for me because, first of all, my faith informs my daily life.
08:44And I also believe in nature and the way there's a natural progress and way of things.
08:53And so for myself, it has never been an option.
08:57It was something that I held my mother's hand when she passed.
09:00I held my father's hand when he passed.
09:03I understand what it means having those two times that I, you know, was almost close to death.
09:08But no, I just want to go ahead and go the natural, the natural way of things.
09:15I think palliative care has enough options and has proven to me that there's enough options there that you're not going to find, I will not mind myself alone and in a freefall.
09:27I have God and I have good medicine.
09:29Michelle is a retired psychologist.
09:34She says she doesn't want to stop others choosing assisted dying, but knows it's not for her.
09:39I believe there's freedom of choice.
09:41However, for me, I choose palliative care and I stand by it with my faith and some great doctors.
09:47And also you don't want medicine to go to the other extreme, but just keeping you alive.
09:55Absolutely not. That is unfair to my family.
09:58It's unfair to all those that I love.
10:00And so when that time comes and I start to fade away, then I simply do want to do just that.
10:10There are others who feel under threat from assisted dying.
10:13Ingrid Tisha, who's 59, has muscular dystrophy and chronic respiratory failure, which means she's at high risk of infections and needs oxygen.
10:27She was part of a lawsuit which failed to get California's aid in dying laws overturned.
10:33I think it's strong and it's dangerous because it lowers the standard of medical care for people who are the most vulnerable and the least able to advocate for themselves.
10:48It makes me feel unsafe in the medical care system.
10:54She feels that comes with potentially chilling consequences.
10:57The message that it sends to people with disabilities in California is that you deserve suicide assistance rather than suicide prevention when you voice a desire to end your life.
11:12It's like people have just said, I give up. I'm not going to get what I need. I'm not going to get taken care of. And the best solution for me is to get out of this world as fast as possible.
11:27What does that say about who we are as a culture?
11:31And a key argument against assisted dying is that it will lead to this coercion of the vulnerable.
11:42I worry that there's a group of people who are vulnerable to this silent coercion, such as the people who are disabled, the elderly and people with mental illness such as untreated depression and anxiety.
11:54They will feel that the only option to relieve them of their suffering is to opt to die by intentionally end their life by taking medications.
12:07That argument is rejected by doctors involved in assisted dying in California.
12:13Dr. Ryan Spielvogel trains physicians in end of life options, including assessing patients for aid in dying.
12:23I would like to say unequivocally that I have never seen a case of coercion in the hundreds of cases that I have been a part of.
12:32The patients are always driving the process. Sometimes they have supportive family members and other times they have to drag their family members kicking and screaming to the doctor's office with them.
12:42If anything, I would say coercion goes the other way. I have unfortunately seen many cases where families have coerced their loved ones out of doing this because they have ways to make it difficult for their loved ones to do it.
12:56In California, there was initially a mandatory 15 day cooling off period between patients making their first and second request. That's been reduced to 48 hours.
13:09Dr. Spielvogel says it was a sensible move as many patients were dying during the waiting period.
13:16We didn't see it actually enhancing patient care. We didn't see it catching people who were indecisive. We just saw people who were at the end of their lives, the very end, who were suffering the way they didn't want to suffer, end up dying the way they didn't want to during the waiting period.
13:36But critics would say that reducing the cooling off period from 15 days to 48 hours, that's an example of the slippery slope.
13:47I think that's a false argument. So when we introduce something like an assisted dying bill and then we see what worked and what didn't, and then we take out the things that didn't, that's not slippery slope. That's due diligence.
13:59That's due diligence.
14:06Across California, around one in every 300 deaths is now medically aided.
14:16We'll be returning to San Diego later to see Wayne and his family on the day of his death.
14:22In Canada, aid in dying accounts for around one in 20 of all deaths, 15 times the rate in California.
14:44More than 15,000 adults a year in Canada have a medically assisted death.
14:55Introduced in 2016, it's open to those with an incurable medical condition which causes intolerable suffering.
15:05Initially, it was just for the terminally ill, but that requirement has been dropped.
15:12This theatre feels like the most special, unique place on earth for me, and it just feels fitting that I should take my final breath here.
15:33This is where performance artist April Hubbard wants to die.
15:44She's on stage at her local theatre in Halifax, Nova Scotia.
15:50April is just 39 and is not terminally ill.
15:55Why do you want to end your life?
16:04I want to end my life because the balance of being able to live and enjoy life is no longer outweighing the pain that I'm in.
16:14And there's many days where I can't lift my head off the pillow and I can't eat anymore.
16:19And it's not a way I want to live for another 10 or 20 or 30 years if I can't have the quality and enjoyment in my life.
16:29A serious spinal condition means April has been on strong opioid painkillers for more than 20 years, including these fentanyl patches.
16:47So these four medications are my core meds that I have to have all the time to function right now.
16:54April has been approved for medical assistance in dying, which Canadians call MADE.
17:01They're never designed to be used for long term, so for me it's done a lot of damage to other parts of my body.
17:11To qualify, adults must have a grievous, incurable condition which causes suffering which they consider intolerable.
17:19It took April seven months to get the MADE paperwork approved by two doctors.
17:28Terminally ill adults can get it done in 24 hours.
17:33MADE is very much another medical choice for me, it's another type of medical care.
17:39But that ability to have autonomy over my own body has been the leading factor for me in choosing MADE.
17:50So how did Canada come to have some of the most liberal assisted dying laws in the world?
17:56It stems from a Supreme Court ruling a decade ago, which said the ban on medical aid in dying breached human rights.
18:06That's unlike the situation in Britain, where momentous social changes are left to Parliament rather than judges.
18:14In two years, Canada plans to extend assisted dying to adults with a mental illness and no physical ailment.
18:28For critics, it will be a further slide down an already slippery slope.
18:33Opponents of MADE argue it's being used as an alternative to social or medical support.
18:46Ramona Coelho, a family doctor in London, Ontario, says it's far quicker to get aid in dying than specialist care.
18:55Canada has fallen off a cliff. I wouldn't even call it a slippery slope.
18:59When people have suicidal ideations, we used to meet them with counselling and care.
19:05And actually for people with terminal illness and other diseases, we could mitigate that suffering and help them have a better life.
19:13And yet now we are seeing that as an appropriate request to die and ending their lives very quickly.
19:19How do you feel about people being able to request MADE in the morning and be dead by the evening?
19:27I find it very distressing because suffering is complex.
19:32The idea that you could actually understand someone's suffering in one day and actually try to mitigate it or remediate it, I feel is very improbable.
19:41And so likely we're ending the lives of people who might have enjoyed the rest of their lives with their family if they were given time.
19:48I don't see that as a mercy.
19:51Sharon Scribner's family say she was repeatedly offered MADE when she was dying of lung cancer in hospital at the age of 81.
20:01We had the nurse come in saying you should fill this paper out Sharon before you go so you can get on the list to see the MADE doctor.
20:13And my mum said no, no thanks.
20:16They really did not want us to leave until my mum had signed these papers.
20:20You brought your mum home to die. What was her death like?
20:26Beautiful. We had the palliative care team in the community came in and I knew we could have a beautiful at home death for mum and I wanted that for her.
20:38And my sister got to experience the most beautiful death with her. So it was amazing. It gave all the family time to visit her.
20:48They came from far and wide and she had the best last day of her life. So it was special.
20:56What do you think MADE is doing to Canada?
20:59It makes us think that we can't endure and we can't suffer a little bit and that somehow now they've decided that dying needs to be assisted.
21:11Where we've been dying for years and our bodies know how to die, you know, and it's like all of a sudden now we're telling people that this is a better option.
21:22This is an easy way out. And I think it's just robbing our people of hope and of just a sense of accomplishing a beautiful life.
21:37In Canada, nearly all medically assisted deaths are carried out by doctors, what's also known as voluntary euthanasia.
21:45Dr. Konya Troughton is president of the Canadian Association of MADE Assessors and Providers.
21:54I do think MADE is working well. I think people are incredibly relieved to have an option.
22:00I think that we have good oversight and I think that the clinicians who do this work see it very seriously.
22:06We see it as a sacred obligation, as a sacred duty.
22:08She's helped hundreds of people to die since the law was introduced.
22:15Strangely, these days I use my stethoscope more to determine if someone has no heartbeat than if they have a heartbeat.
22:22So then I'll listen to you for a full minute.
22:24Dr. Troughton agreed to demonstrate what's involved on me.
22:29So I'd start an intravenous probably there, start it through there, okay, and then I'd secure it in place.
22:35Injecting the drugs means it usually takes only a few minutes to die.
22:42That's where the drugs would go in?
22:44Yeah, the drugs would be threaded through here, so each of this just has a little barrel that I can attach a syringe to.
22:50This is not what's planned for England and Wales, where patients would need to self-administer, usually drink, the lethal dose.
22:58Dr. Troughton says it's more effective for doctors to carry it out.
23:02For the patients, at the last moment they're always looking in my eyes and giving me the heads up and ready to go.
23:09They are directing the process.
23:11That gives me an honour and a duty and a privilege to be able to help them in those last moments, with their family around them, with those who love them around them, and to know that they've made that decision thoughtfully, carefully and thoroughly.
23:24The Westminster bill would restrict assisted dying to those expected to die within six months.
23:33In Canada, 19 out of 20 made deaths are among those whose death is reasonably foreseeable.
23:41But this has a huge range.
23:44So it could be someone, for example, with rapidly onset Alzheimer's, who might have five or seven years to die.
23:51It might be someone who has advanced rapidly spreading cancer who has only two weeks to die.
23:58So both of those categories would fit because they would die sooner because of their disease process than their natural predicted death.
24:05The number of Canadians choosing a medically assisted death is increasing every year and is now one of the highest rates in the world.
24:19Does that represent liberty or a threat?
24:22Hello, hello, friends. Welcome to the show, friends, and thank you so much for clicking on this brand new episode of Disability After Dark.
24:35I'm, of course, your deliciously disabled host.
24:38Andrew Gerza is a podcaster and disability awareness consultant in Toronto.
24:44He says assisted dying is putting the lives of people with disabilities at risk.
24:50It sends a message to them that you shouldn't fight for more, you should just die.
24:58And so it's really scary to me because if my disability declines, I'd still want to be here.
25:06If my care needs got higher, I'd still want to be here.
25:10I fought to be here, to live my life the way that I live, and to know that there's a law that's saying you could easily end it.
25:16It's just really scary.
25:17Do you think it's easier to get medical assistance in dying here than it is to get decent disability support?
25:25Yup. It took me 10 to 15 years to get housing like this, and it would take me months to apply for MAID.
25:32I agree that suffering can be compounded by social circumstances, and it's tragic that, absolutely, it's sad that people would opt for an assisted death because we don't have adequate housing.
25:47I think that it doesn't happen very often. It's very rare that that happens. But the suffering also comes from their disease state. It comes from their neurological condition. It comes from their chronic pain. It comes from those conditions.
26:02Supporters of MAID say that without it, many people would turn to suicide.
26:11Without that safety net, I don't think I'd have the courage to keep taking the risk of living, and I think I would have made that choice to end it myself, and alone, and without the support of the people I love long ago.
26:27And my fear is that that's what will happen for many folks around the world who don't have the ability to have a peaceful and supported death.
26:41April has not set a date for her death, but says it'll be sometime in the coming months, surrounded by family and loved ones.
26:51It's nearly four weeks since we met Wayne and Stella at their home in San Diego.
27:12We've been invited back, as today is the day Wayne has chosen to die.
27:24Hi Stella, how are you?
27:27Good, thank you.
27:28Yeah.
27:29Hey.
27:30We're here.
27:31Great to see you.
27:32Yeah.
27:33We wanted to be sure that our presence would not be a burden on the family.
27:37Oh yeah, it was nothing like it, but…
27:40It was good to see the couple again, and be introduced to their children, Ashley and Emily.
27:47Wayne looked more frail than the last time we'd met, but was in good spirits.
27:53So, have you decided absolutely that this is the day you want to take that medication?
28:02I'm all in.
28:03I've never had any question about it.
28:05I was determined and decided weeks ago.
28:09And what have you been doing the past few days with your children here?
28:15Well, kind of getting some things done, and eating stuff that I don't normally eat, because
28:22I can now, and that's been fun.
28:24Apple pie, I really love apple pie, but I'm supposed to not have carbohydrates, but now
28:29who cares?
28:30I mean, what the heck?
28:31You know?
28:32And pizza, and what else?
28:34I even had a glass of tequila, which I'm not supposed to have either, but it was great.
28:40It's like having a prolonged wake ahead of time, which we feel is a gift to be able to
28:49have done this ahead of time instead of something sudden or traumatic ending.
28:54It's been, like Mom said, a gift to be able to be here with him.
28:59We won't have to spend our last days with him, like in some horrible hospital where he's
29:05just not aware of everything.
29:06So this is, well, it's been really hard.
29:09It's also been nice to know we're getting to share this time with him.
29:13I think it's been a great opportunity to maybe do some of that grieving or at least
29:17pre-processing that ahead of time, coming to terms with it.
29:20At the same time, getting to spend the last few weeks with my father.
29:24It's now 10.30am.
29:31Wayne takes three anti-nausea tablets.
29:35These are to prevent vomiting of the lethal medication.
29:43Dr. Donnie Moore is on his way to the house.
29:47He's one of two doctors who've had to confirm that Wayne has less than six months to live
29:53and so is eligible for an assisted death.
29:56Good morning.
30:05Good morning.
30:06Good to see you.
30:07Good to see you.
30:08Good to see you.
30:09Good morning.
30:10Hey, doctor.
30:11How are you doing?
30:12Doing well.
30:13Good morning.
30:14Good to see you, my friend.
30:15Good to see you.
30:16Uh-huh.
30:17Well, this is the big day.
30:18This is the big day, yeah.
30:21You're still feeling like today is the day.
30:23Oh, no, it is.
30:24No, I haven't, I haven't wavered.
30:26It's up.
30:27Okay.
30:28You know, I don't have any feeling of trepidation or anything, so it's like, okay?
30:31It's something, it's what we're doing.
30:33Yeah.
30:34Okay, I'll get everything ready and then you just let me know when you're ready, okay?
30:39Let's go.
30:40Let's go.
30:41Let's go.
30:42Let's go.
30:43Let's go.
30:44Let's go.
30:45In the kitchen, Dr. Moore prepares the medication.
30:49He adds cherry and pineapple juice to the lethal powder, which should make it easier for
30:55Wayne to drink.
30:57It's a powerful combination of sedatives and painkillers, each up to a thousand times the
31:04normal dose.
31:10And so, this is the medication and this is just some extra juice if you'd like it for
31:27afterwards.
31:28Okay.
31:29Okay, I guess.
31:30And when you're ready, just take the biggest sip as possible of this.
31:35I don't know if you can drink it in one big sip, that's usually best.
31:41All right.
31:46I'm just going to be here with you.
31:49Good night.
31:52Mmm.
31:53The taste is bitter, so Wayne has some more juice to wash it down.
31:58One more puffs here.
32:01Mmm.
32:02Yeah, I'm getting sleepy.
32:05Yeah?
32:06Okay.
32:07It's okay, just close your eyes and relax.
32:12I want you to think of walking, walking in a vast, vast sea of flowers.
32:20Within three minutes, Wayne is asleep.
32:24Beautiful roses and tulips, daisies, lilacs.
32:30Dr. Moore has been present at 150 assisted deaths.
32:35He says most patients die within two hours of drinking the lethal dose.
32:41On one occasion, it took 17 hours, though the patient remained unconscious throughout.
32:48I think that he's passed.
32:53I think that he's passed.
32:55Yeah, there's no matter.
32:57No matter what, you know what, you can get to see.
32:59I don't know.
33:00I don't know.
33:01I think that he's going to go outside.
33:02I don't know.
33:03No matter what, he'll have to dixen like him.
33:04I don't know.
33:05And I know, but I think he's going to walk the eel in a few minutes
33:07before he's been able to walk.
33:08He's been able to walk.
33:09He's been able to walk inside.
33:10He's been able to walk.
33:13Wayne fell asleep within three minutes of swallowing the lethal medication and he never regained
33:34consciousness. He was pronounced dead after 35 minutes. It was really hard to watch him drink
33:43the medicine just seeing how comfortable with it he was and how ready he was and it was just
33:52drink it and drink some juice like it was he was ready for it so that really helped. And how would
34:00you describe your dad's death? It was peaceful yeah it was peaceful it was exactly what like the
34:09best version of what I could have anticipated. What about you Ashley? Well it was a bit of a
34:15relief when I saw him fade off into sleep because I knew at that point he was no longer or would soon
34:24no longer feel you know miserable and the pain that he was experiencing.
34:33It was so peaceful I know it's exactly the way he wanted to go and it went just like he hoped for.
34:41Yeah it went smoothly and I know it was what Wayne wanted. It was so much better than it could have
34:49been in other circumstances. It was just so peaceful. I'm so glad that he's no longer in such pain. He could
34:58yeah that the last couple of weeks have just gotten daily worse and worse as far as being able to move
35:07around and breathe and yeah it was not too early and not too late. It was just right.
35:25More than 300 million people around the world live in jurisdictions which have legalized some form of
35:33assisted dying. It's not yet clear if England and Wales or indeed Scotland will join that growing list.
35:42For critics any change in the law would be dangerous and put the vulnerable at risk.
35:52For supporters assisted dying is a fundamental liberty which allows people like Wayne to end their lives
36:01on their own terms.