One of Canada's most prominent MAID providers reflects on divisive decade

Dr. Ellen Wiebe has never been one to shy away from risk.It started with the very first patient she provided with a medically assisted death: Hanne Schafer, a 66-year-old Calgary psychologist diagnosed with amyotrophic lateral sclerosis three months before retiring in 2013.MAID was three years away from legalization, but Schafer was quickly losing her ability to talk, walk, eat and drink and wanted the procedure as soon as she could get it. On Feb. 29, 2016, a judge approved her request, more than three months before MAID would become legal on June 17.The next hurdle was finding a doctor prepared to do it, recalls Schafer’s husband Daniel Laurin. He credits Dr. Wiebe with helping his late wife when no one else would: "It was a very humane thing to do.”On the cusp of Canada's 10-year anniversary of legalization Wednesday, the Vancouver family physician is dogged by controversy but undeterred from her original path.“I'm willing to take risks for my patients,” Dr. Wiebe says.With her first case, there was no nurse to insert the IV, nor a pharmacist to dispense the necessary drugs because their colleges wouldn't yet allow it, she recalls.“I had to lie on the prescription,” Dr. Wiebe says with a shrug, “because I wrote a prescription for a month of palliative care drugs and of course used them all at once.”Repeating the story another day for an on-camera interview, she sits in a wooden chair at her dining room table as the last of the day’s light creeps in. Her speech is slower and her tone is softer. In this telling, she doesn't mention the prescription.Now age 74, Dr. Wiebe is a divisive figure, oft-regarded as either a patient-oriented champion of autonomy and human rights or a doctor too willing to provide the procedure.Families who believe their loved ones should not have qualified for MAID have tried taking Dr. Wiebe to court or have complained to the College of Physicians and Surgeons of British Columbia. But Dr. Wiebe has never been found guilty of violating the law.Some legal and medical experts say it's exceptionally difficult to prosecute a practitioner accused of wrongfully administering MAID, in large part because the law gives physicians leeway to interpret and stretch its boundaries.“If you look at some of the cases, it tells us more about the failure of our system,” says Trudo Lemmens, a professor specializing in health law and policy at the University of Toronto.The federal government’s eligibility criteria for MAID is split into two tracks. For Track 1, a person’s death must be reasonably foreseeable. Lemmens says that’s interpreted by some to mean the patient is dying, while others would argue it includes someone with an incurable illness, but also many years left to live.Track 2, introduced in 2021, allows people with disabilities who have a serious and incurable disease to apply. Plans to extend eligibility further to a person with a mental illness have been delayed until March 2027.Dr. Wiebe has faced legal and regulatory challenges almost as long as MAID has been law.In 2017, Dr. Wiebe’s practice was reviewed by the college after she provided MAID to a 56-year-old woman with advanced multiple sclerosis who was ineligible until she starved herself to make her death “reasonably foreseeable."That same year, a Jewish long-term care facility complained to the B.C. regulator after Dr. Wiebe snuck in after hours at the family’s request to provide MAID to their 83-year-old father.In 2024, a family tried to sue Dr. Wiebe after they said she provided MAID to a 52-year-old father of three on a day pass from a psychiatric hospital in 2022. The family said in the civil claim that he had chronic back pain, but it was “neither grievous nor irremediable.”College records don't list any disciplinary measures and Dr. Wiebe says no allegation of MAID misconduct has stuck.“Every one has been ruled in my favour for the obvious reason that I actually obey the law and I obey the regulations,” says a matter-of-fact Dr. Wiebe.However in 2024, a judge issued an urgent injunction to stop Dr. Wiebe the day before she was scheduled to provide a medically assisted death to a 53-year-old Alberta woman. In the ruling, a B.C. Supreme Court judge said the woman appeared to have a mental condition, not a physical one.“There is a serious question to be tried in B.C. about whether there should be judicial oversight when someone chooses to die pursuant to the MAID exemption provisions in the Criminal Code,” Justice Simon R. Coval said.Lemmens says the injunction shows there is judicial concern about Dr. Wiebe's practice and the absence of criminal prosecution doesn't mean there are no problems.“It may simply be that it's too difficult to prosecute these cases,” he says.Dr. Wiebe does not appear easily shaken by the scrutiny of judges, regulators or the media. She's quick to point out that courts and colleges side with her every time.“Because I obey the law every single time,” she says, sitting taller in her wooden dining room chair.That hasn't stopped public attacks, including an ongoing petition signed by more than 15,000 people who demand that her practice be reviewed.The mother of Kiano Vafaeian has been especially vocal in her criticisms of Dr. Wiebe, accusing her of granting her 26-year-old son MAID in Vancouver, after he was denied by doctors in Ontario. Margaret Marsilla alleges her son "shopped around" until he found a provider willing to do it.“Dr. Ellen Wiebe took my son from this world before he had the chance to heal, grow, and live the life that was still waiting for him,” Marsilla posted to social media in March on what she said would have been her son’s 27th birthday.Marsilla went public with her son’s story in January, saying in news stories and on social media that he had Type 1 diabetes and partial vision loss, but that it was not grievous. She says he sought death because he struggled with mental health, which should have made him ineligible.Dr. Wiebe says she has never provided MAID to somebody for mental illness, apart from a patient with a mental condition that resulted in physical pain, approved by a judge in 2016.“I'm a mother. I know that she grieved the loss of her son, and I understand that some grief is pretty complicated and can come out in anger,” Dr. Wiebe says, unshaken.Asked for her emotional reaction to Marsilla's allegations, Dr. Wiebe pauses for several seconds."I mean it's expected," she says. "This is something I thought long and hard about and I believe it's the right thing to be doing."Dr. Wiebe says she knows how to identify if a person's request is driven by mental illness. She consulted a psychiatrist on her early MAID cases but says she now does those assessments on her own.She says people who are depressed tend to feel guilt and remorse. To tease this out, she says she asks questions like, “Do you feel that you deserve to suffer?”The patient's answers will dictate her next move.“If somebody is saying, ‘I need to die because the world would be better off without me,’ then we'd like to have them work through some of that depression beforehand, so that they are choosing MAID as a reasoned option considering their medical conditions,” she says.Endorsement for Track 2 can come from any physician who feels qualified to assess the patient. That means a mental health specialist is not required if the doctor feels they have enough expertise.To psychiatrist Dr. Sonu Gaind, that’s like allowing a doctor who believes they have the medical expertise to treat a very complicated gastric cancer to go ahead and do it, despite not having the years of specialty training required to get certified.As long as the MAID practitioner believes a person's condition is irremediable it is “very difficult, if not virtually impossible” to prosecute them, he says.“It's a bizarre sort of thing where frankly, it ends up being something that is largely self-monitored, and then we're relying on that self-monitoring to also be our adjudication system, which is absolutely remarkable,” says Gaind, former chief of psychiatry at two Toronto hospitals.Dr. Wiebe says she has been called a killer for decades and faced death threats, but never wavered. She was an abortion provider for 40 years before MAID, and similarly adamant then that her patients had a legal right to the procedure.“I was doing the right thing so I had no issues with being treated like that,” Dr. Wiebe says, leaning her head against her hand.When one of her sons was seven years old he was scared to walk to school alone for fear someone would come after him because they were after her, Dr. Wiebe recalls.“I didn't like the fact that me being targeted could hurt them, but I was able to rationalize that part because there were a lot of patients who needed help,” she says.

One of Canada's most prominent MAID providers reflects on divisive decade

Register for free access or login.

Related Topics