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Dr. Ellen Wiebe has never shied away from speaking publicly about the act of ending someone’s life.

For Wiebe, medical assistance in dying (MAID) is “incredibly rewarding” work. She hasn’t faced nearly the same sort of stigma she once faced as an abortion provider and says that while she and her MAID colleagues “all work within the law,” she’s also not as “conservative” as some.

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What she isn’t prepared to share publicly is how often she has administered a fatal substance upon a patient’s request.

“I know the exact number,” the Vancouver doctor said, “but I don’t want to do that, no. It’s become a weird thing, people talking about their numbers, or criticizing people who talk about their numbers.”

“Hundreds is good,” she said. About 430 as of May 2022 alone, as she then testified before a special parliamentary committee on medical assistance in dying, or MAID.

In addition to her MAID work, Wiebe runs a contraception and medical abortion clinic in Vancouver. She is one of the most prominent and prolific providers of assisted dying in Canada, the “pro-choice doctor providing peaceful deaths,” Canada’s “de facto ambassador” for the right to die. She wasn’t part of the activism that led to the decriminalization of doctor-assisted death but she was the first doctor outside of Quebec to perform a court-approved, patient-requested euthanasia, a term she dislikes. “In Canada we don’t use the word euthanasia,” she once told podcaster Mikhaila Peterson. “That’s what we use for our pets. Here, we call it assisted dying.”

It’s hard to even be in the same room as somebody who’s suffering so severely. But then… I get to end that suffering

Dr. Ellen Wiebe

Most recently, Wiebe was featured in the BBC documentary, Better off Dead?, an exploration of the assisted suicide debate by British actor and comedian Liz Carr, an international disability rights activist who doesn’t believe assisted suicide is safe for the likes of her or other disabled people. In a clip that made the rounds on social media, a camera pans over a black leather sofa in Wiebe’s office, a recliner so that people can “snuggle up with their loved ones if they want.” For some people, it’s a good place to die, Wiebe told Carr. Her face lights up as she describes MAID as the most fulfilling work she’s done since doctor-assisted death became legal in Canada in 2016. “People ask me why and I think, well, doctors like grateful patients, and nobody is more grateful than my patients now and their families,” she tells Carr, though that’s not always necessarily so. “We know that angry family members are our greatest risk,” she once told a Scottish pro-MAID group, because angry family members are more likely to bring formal complaints forward.

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A board member and research director for the Canadian Association of MAID Assessors and Providers, a member of the clinician’s advisory council for the MAID lobby group Dying with Dignity Canada and clinical professor in the department of family practice at the University of British Columbia, Wiebe has accused Canada’s politicians of being “wimpy” for waiting for the Supreme Court of Canada to sweep away the laws prohibiting doctor-assisted dying on constitutional grounds, and not through government-led legislation. She learned from Dutch colleagues which drugs to use, and in what order, how to avoid complications like prolonged time to death, and how to choreograph the procedure day. “So, who wants to sit on (the patient’s) right side, and who on her left … and the dog, where the dog goes,” she told National Post. “And then I try to get out of the way. I can do that if I’ve got an extension tube for my IV.”

She’s published numerous papers in the assisted dying space, mentoring other doctors and hosting MAID training webinars, but has also been accused of bullying and sneaking her way into faith-based facilities. She’s faced multiple complaints against her to the College of Physicians and Surgeons of B.C. but has always been found in compliance with the rules.

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She identifies as disabled herself. Diagnosed with heart disease at age 40, she hasn’t been able to walk more than 10 metres since, and uses a wheelchair and electric scooter. “Now I’m aging (she’s 72) and doing even less,” she told National Post.

What she isn’t prepared to do less of is MAID. “It’s the last thing I’ll give up.” In many ways it’s akin to her abortion work, she said. “It’s about honouring people’s wishes, empowering people to have control over their own lives. It’s wonderful that I have the opportunity to do that.”

Wiebe can seem “oddly cheerful” when discussing MAID, viewers of the BBC documentary remarked. She grinned at peculiar moments during an interview with National Post, laughing as she described how, when getting final consent on the day of death, “I come in and say, ‘Are you sure this is what you want to do today?’”

Laughter can be a response to emotionally uncomfortable situations, like talking about death, said Helen Long, CEO of Dying with Dignity Canada. “You suddenly realize what you’re in the middle of discussing.”

“Laughing often is just part of my personality,” Wiebe told National Post.

“I love life.”

She also loves her job, and is “so glad, so glad” to live in a country where people aren’t condemned to unbearable suffering, telling Carr assisted dying is “the best work I’ve ever done.” In Canada, all but a handful of MAID deaths involve euthanasia, where the doctor pushes the syringe. With assisted suicide, the person swallows a lethal amount of drugs prescribed by the doctor.

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“It’s hard to even be in the same room as somebody who’s suffering so severely,” Wiebe told the Post. “But then, of course, you know, I get to end that suffering, which is good.”

But others like Trudo Lemmens are troubled by the small number of providers dominating the practice and the “pseudo-spiritual language” some use to describe doctor-administered death.

“When MAID was legalized, it was framed as a practice that was exceptionally required to ease the dying process or give some control at the end of life,” Lemmens, a University of Toronto professor of law and ethics, wrote in an email.

I come in and say, ‘Are you sure this is what you want to do today?’

Dr. Ellen Wiebe

“We have veered very far from that and now uncritically accept the most aggressive provision of MAID and see growing attempts to describe this as the most meaningful form of medical practice.”

In one study, MAID providers with between 12 and 113 assisted deaths each described the delivery of a medical death as “heartwarming,” “the most important medicine I do,” “an ultimate act of compassion,” “liberating” and “almost an adrenaline rush. I was surprised at how good I felt.”

Narratives like these make Lemmens concerned that MAID is being promoted as a medical therapy with a “quasi-religious zeal.” Others like Christopher Lyon, a Canadian social scientist at the University of York in the U.K. have remarked that pleasure from euthanasia is deeply disquieting, “because death is usually a deeply painful or difficult moment for the patients and their loved ones.”

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Lyon’s 77-year-old father died by MAID in a Victoria hospital room in 2021, over the family’s objections. (Wiebe was not the provider.) His father had bouts of depression and suicidal thinking, but was approved for MAID nonetheless. Lyon wonders what draws some providers to MAID “and what happens to a person when killing becomes a daily or weekly event.”

“Some providers have counts in the hundreds — this isn’t normal, for any occupation,” he said. “Even members of the military at war do not typically kill that frequently. I think that’s a question that we’ve not really ever asked.”

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Wiebe rejects the suggestion some providers seem overly enthusiastic. “My patients were all people who were suffering unbearably and chose this,” she said.

“Remember that we work in tragedy all the time, right? My whole career has been being with tragedies. When somebody gets the diagnosis of cancer, when somebody gets the diagnosis of a chronic illness like multiple sclerosis — I mean, it’s just one tragedy after another,” she said.

“Why do we want to be doctors? Why do we want to care for people who are suffering tragedies? Because we can help. Because we feel like we can help. And that’s why we get a good feeling about it.”

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Canada has a strikingly high assisted death rate, reaching 4.1 per cent of all deaths in 2022. At 5.5 per cent of all deaths, B.C. had the second-highest percentage of MAID deaths, behind Quebec, outpacing assisted-suicide pioneers like Belgium and the Netherlands. Sporadic reports have emerged of people being driven to MAID because of poverty, debt, a lack of decent housing or food. Lyon and others are concerned with what they see as the looseness of the safeguards and eligibility criteria, and the way assessors are able to interpret them.

However, Ottawa palliative care and critical care specialist Dr. James Downar said the metaphors, the expressed feelings of “joy” and “love,” fit with the experiences of those working in all aspects of end-of-life care. “When someone says it’s highly rewarding, those are exactly the words that people use when they’re doing palliative care” or providing end-of-life care in the ICU, Downar said.

It’s not death-glorifying, he said. “It’s absolutely not a celebration of the act of ending someone’s life. It’s a reflection of the intense emotional bond you form with families and patients.”

“Nothing in the data lines up with the story that there are doctors pushing this,” said Downar, a former MAID provider. Wiebe isn’t ashamed to be involved in MAID and she’s not afraid to talk about it publicly, he said. Most providers, and there were over 1,800 in 2022, tend not to advertise that they’re involved in MAID, given the stigmatization and temperature of the discussion, he said. “Ellen is not hiding anything. I have tremendous respect for that.”

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She’s also “warm and funny,” blunt and straightforward, a straight-shooter with a determined streak, said Long from Dying With Dignity.

How many patients is too many patients? Wiebe specializes in MAID, Long said. “How many palliative care patients do palliative care clinicians have? How many times is palliative sedation (using drugs to render the dying patient unconscious) delivered?” MAID is a legal process, Long said. “If a smaller group of clinicians has opted to make this their full-time practice because of the need that they see, does that make it wrong? I don’t think it does.”

Why do we want to be doctors? Why do we want to care for people who are suffering tragedies? Because we can help

Dr. Ellen Wiebe

In the BBC documentary, Wiebe describes the option of MAID as an insurance policy, an escape hatch. “Liz, right now, you love life, and you want to live. But there’s lots of nasty illnesses you might get,” she says. “And if you got terminal cancer and you had to go through chemotherapy and radiation, wouldn’t you be thrilled that you had the choice to say, ‘I’ll go this far, and not further’?”

Wiebe has attended many non-MAID deaths. “I know what the ends are like, and I’m not interested in that,” she told National Post. MAID means people can “skip out when you’re still you,” she said.

She didn’t set out playing such a conspicuous role in doctor-assisted dying. Born into a Mennonite family in Abbotsford, one of four children, Wiebe wanted to be a doctor ever since she was a kid. “I know my Bible pretty well,” she told Maclean’s in a 2016 profile. “I could quote it, no problem.” Her parents — her mother, a homemaker, her father a teacher with CIDA, the Canadian International Development Agency — were “wonderful people who loved life,” and held deep Christian beliefs. But by 17, Wiebe had “lost all my religiosity,” she told Maclean’s. “It was just part of being in university, questioning and wondering and learning who you are.”

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What she became was a family doctor, graduating from medical school in 1975 with the goal of being a “full-service, cradle-to-grave” doctor. She delivered babies (more than 1,000 over her career), attended house calls and took care of the dying. As she got older, she focused on women’s health, pioneering work on medical abortions and bringing trials of the abortion drug, mifepristone, to Canada.

As an abortion doctor she faced down death threats and attacks at her clinic, but it wasn’t until a colleague, fellow abortion provider Gary Romalis, survived two attempts on his life — one via a sniper’s bullet, the other a 15-centimetre knife — that Wiebe felt compelled into becoming an abortion rights crusader. The glued locks on the clinic she could ignore, she told The Province, “Until Gary was shot, and then I couldn’t ignore it.” Gary (Garson) Romalis died of pancreatitis in 2014, at age 76.

Even when the Supreme Court of Canada ruled in 2015 that the Criminal Code provisions prohibiting medical assistance in dying would no longer be valid, giving Parliament one year to draft legislation, “I had no clue this was the way my life was going to be,” Wiebe told the medical journal The Lancet.

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She assumed palliative care doctors would provide the assisted deaths, but in the beginning, national palliative care organizations wanted no part of medically administered death. “So, I called up a friend who was also an abortion provider and said, ‘Palliative care is not going to do the work. We better figure out how to get trained and get in there,’” she told National Post.

The pair travelled to the Netherlands in 2016, meeting with four providers to learn what they could about assisted dying. “Now it’s half my clinical work, and very, very important,” Wiebe said.

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She sees similarities between MAID and abortion. Both are legal medical procedures that most Canadians believe people should have the right to access. “All the polls have said that, and yet, it still has some stigma and shame,” Wiebe said. Seventy-seven per cent of surveyed Canadians expressed support for the country’s current assisted death regime, a Leger poll found in February.

Most people who choose MAID have cancer, followed by cardiovascular, respiratory and neurological conditions. In 2021, the law was changed so that death need not be “reasonably foreseeable,” so-called Track 2 cases involving people with a chronic, but not terminal illness or disability, like fibromyalgia or chronic fatigue syndrome. Such cases account for “a tiny percentage of assisted dying,” Wiebe said, about 3.5 per cent (463 people) of all MAID cases in 2022. Still, many MAID providers are profoundly uneasy with euthanizing the non-dying, though Wiebe isn’t among them. She told parliamentarians in 2022, “I also have a lot of experience with our new group of patients, who we call ‘Track 2.’”

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When asked how she personally processes providing more than 400 assisted deaths, Wiebe said most involve “completed lives, (older) people who have had cancer for years. They tell me that they’ve lived a long, good life, and they’re ready to go.” Those tend not to involve severe grief, she said. More challenging to witness is the “raw grief” of a middle-aged or younger husband saying goodbye to his wife. “You feel it, you know? You feel that kind of deep grief.”

But MAID has also allowed for “fascinating talks” about how people want to die, she said. “We’re asking questions that I never asked before we had assisted dying: Where would you like to die? When would you like to die? Who are you going to invite to your death?”

Wiebe has described deathbed scenes featuring poetry, champagne, hors d’oeuvres and opera music. But families have also described the procedure day as surreal and unsettling. “It’s what my mother wanted, but it was kind of, like, ‘What just happened?’” one participant reported in a survey of 18 family caregivers of people who received an assisted death at two large urban hospitals in Toronto. Many described being alarmed by the number and size of pre-filled syringes. Others weren’t prepared for the speed of death, leaving them “overwhelmed and concerned about whether the patient was ready for such a sudden death,” the authors wrote.

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“It’s hard for me to realize the fact that I have a bunch of syringes, as opposed to one, is scary for some people,” Wiebe said. “So, I might not think of that.” At the time of death, she likes to be “part of the wall,” she said. Inconspicuous. Out of the way.

There’s a rhythm to how things generally unfold she said. “When everybody is ready, I say, ‘Okay, ready to go to sleep?’” The first injection is a sedative, followed by general anesthetic that puts people into a deep coma, and finally a third injection that stops the breathing and the heart.

We’re asking questions that I never asked before we had assisted dying: Where would you like to die? When would you like to die? Who are you going to invite to your death?

Dr. Ellen Wiebe

She warns the family they can expect the colour in their loved one’s face to change. “But, generally, (death is) very calm and peaceful.” She takes a neck pulse to determine when to call time of death. “But that is, of course not the actual time of death, because when people die, it’s a slow process,” Wiebe said. “Some cells die before others. So, the whole process for me, from the time I start injecting until I call that it’s done, is about five minutes.”

Failed IV’s can be a problem, she said, just getting the needle in, in the first place. “If you’re doing it at home, we don’t have a backup IV team to call in like we do at the hospital.” Doses have had to be adjusted as doctors gained more experience. “But, no, I wouldn’t say we’ve had bad reactions in our patients.”

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“I just get so many thank yous and hugs.”

And pushback. Wiebe has had several complaints lodged against her, including her provision of death in the case of “Ms. S,” a 56-year-old woman with advanced multiple sclerosis who, in 2017, starved herself to meet eligibility criteria that her death was “reasonably foreseeable,” a case with eerie echoes to the 27-year-old autistic Calgary woman who stopped eating and drinking in May over a judge’s order blocking her access to MAID.

In 2017, Wiebe was accused of “borderline unethical” behaviour for entering Vancouver’s Louis Brier Home & Hospital, an Orthodox Jewish long-term care home, and providing MAID to 83-year-old cancer patient Barry Hyman, despite knowing the facility did not allow assisted deaths on its site. Hyman’s family had invited Wiebe in to honour his wish to die in his room. As Wiebe assembled her prepared syringes, “My heart was racing that someone would open the door,” Hyman’s daughter Lola told The Globe and Mail.

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The same year, the chief medical officer and coroner with B.C.’s coroner’s service raised questions about Wiebe’s provision of MAID to a woman with dementia.

Wiebe was found not guilty of breaching college standards in all three cases. An inquiry committee found that Hyman had consented to MAID and that Wiebe had followed proper procedures. Complaints have “always resolved in my favour,” Wiebe said. “But still, that’s the kind of thing that the anti-MAID people have done to me, as opposed to threatening to shoot me, which is nice.”

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She’s well-versed in the law, ticking off in interviews how the request must be voluntary, witnessed by an independent person, approved by two clinician assessors. In 2018, she told journalist and writer Peter Stockland she provides “what is right up to the edge of the law, and never beyond, of course. I’m working beyond where some providers would work … it varies on how risk-averse people are.”

“Some people are more conservative than I am,” Wiebe told National Post. “We all work within the law.”

It’s about honouring people’s wishes, empowering people to have control over their own lives

Dr. Ellen Wiebe

In general, people who choose MAID are like her, she said: White, educated, wealthy, privileged. The vulnerable and most marginalized have less MAID, she said in an interview with Canadian Atheist. “When people talk about the slippery slope, (they say), ‘When you start offering it, people will start pushing those marginalized people to have assisted deaths, so we don’t have to pay for them anymore,’ but marginalized people don’t get much good anything, much less MAID.”

She has no religious beliefs, but understands the need some have for ceremonies, she told the Post. “I have been privileged to be present for Jewish, Muslim, Sikh, Indigenous, Catholic, United Church, Pentecostal” and other ceremonies at the time of MAID. Her patients are referred through the MAID coordination centre and other doctors mostly. Her youngest was in her 20s, “one of those horrible, horrible cancers.

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“The death itself was beautiful. She had a big party with her family and friends outdoors in the backyard. There was poetry, there were flowers, there was food. She didn’t eat it. It was an amazing event. Again, incredibly grief-stricken parents and spouse.”

She’s performed over 800 MAID assessments, more than half of them virtual and almost all patients from B.C., some of whom she found ineligible. Others died naturally “before they got around to setting a date.”

Wiebe has a supportive husband (together they have five sons and seven grandchildren) and supportive colleagues she can call up and say, “Oh, I just had a hard one,’ and I blurt it all out.

“Luckily, I’ve got people to debrief with.”

She fully anticipates that MAID will be extended to mature minors. “I’ve always been assuming for eight years that a 17-year-old with terminal cancer is going to say, ‘I have the right,’ and of course any judge in the country will say, ‘Yes, you do.’”

She also expects some form of advance requests for MAID in cases of dementia, which would allow a person to make a written request for euthanasia that could be honoured later, even if they lose their capacity to make medical decisions for themselves. Support for advance requests is strong, according to polls. But if someone is unable to express how they’re feeling, who decides if they are suffering unbearably — and what if they changed their minds? MAID doctors may be asked to “provide” for someone they have not met before, and with whom they will not be able to communicate, Wiebe said.

“That’s going to be hard for us as providers,” she said.

“This will be a new challenge. And I’m up for challenges.”

National Post

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