In Conversation with Dr. Ellen Wiebe – Physicians Advisory Council, Dying With Dignity Canada

by | January 31, 2018


By Scott Douglas Jacobsen

Dr. Ellen Wiebe is a Clinical Professor at the University of British Columbia in the Department of Family Practice with over 30 years of full-service family practice. She developed Hemlock Aid, is on the Physicians Advisory Council for Dying With Dignity Canada, and the Medical Director of the Willow Women’s Clinic. Here we talk about medical assistance in dying and abortion.

Scott Douglas Jacobsen: So, what is the relationship between abortion and MAiD’s work?

Dr. Ellen Wiebe: I have been a family doctor. I have been doing family practice for over 30 years. For the first three decades, I had a full family practice, but I did a lot of women’s health including delivering babies and doing abortions.

I was an activist in reproductive health rights and access to abortion and medical abortion as well we surgical abortion, etc. When our law changed, only then did I become active with medical assistance in dying.

I was not part of the activism prior to it or to getting the law changed. But what happened was that palliative care doctors, people who are dealing with end of life all of the time were not as a group not going to be doing any medical assistance in dying.

I immediately thought, “Oh my heavens, that means there will be a lack of providers. I can do this. I better get myself trained and up and ready to help.” I recruited a friend and we went to the Netherlands to get trained before our law changed, so I could provide.

I connected with Dying With Dignity Canada and became active in the field as well. I was struck by how many parallels between the two kinds of work. First of all, in the deep connection we have with our patients, even though they are short relationships compared to regular practice where I see people for decades; in an abortion, I meet a woman, talk with her, discuss the options, and then we go into the problem. I fix it.

If she has other issues, I can refer her to somebody else, but we deal with it. But there are so many overlays with an abortion compared to other work. There are protestors that I have to deal with. There are things like her having to go through protestors to get to me.

There are all of these overlays and political issues. People don’t keep it a secret when they want to have a baby and have one, but when they don’t want to have a baby and don’t have one they keep it secret.

But why do they keep it a secret, it is because of the shame and the stigma and so on. That is involved. There are the societal things. There is the political stuff of political groups being against it.

I got into this. I discovered again that I was providing medical care to people in very intense relationships, where they were dying and wanted to choose to have some control over their deaths.

I was able to help them provide for that. It was really good work. In both fields, I get intensely grateful patients. I get hugs from people I have only know a short while; I may get hugs from people in family practice, but these are after long relationships.

Whereas, these ones were short relationships. I feel privileged to be part of a family saying goodbye to a loved one. I used to be delivering babies and watching a family saying hello to a new loved one. There are so many parallels there.

Then the political stuff [Laughing] with all of the anti-MAiD people and the pro-MAiD people and the media and so on. The intense personal connection I have with patients as well as the political stuff as well as the sociological stuff, where some people who want to tell the world.

Some of my patients have gone public and made national news wanting to tell their story. Others wanted to keep it a secret. So, we have to work around that. I tell them that by law I have to report everything, but that we can try to keep it a secret from the other people around.

It can be a problem if you saw the news about the patient who was at the Louis Brier Care Home who wanted to have a private death and not have let anybody else around know; I, of course, got accused of being unprofessional by not talking to them, even though my patient told me not to.

The patient has a right to privacy. Those issues around they want things to be private, how and when they are dying. It is something they keep private. You have that kind of stigma associated for some people.

The political stuff is there too. We are lucky in Canada that abortion is not in the Criminal Code. Almost all of my colleagues all over the world who are abortion providers are providing abortion in a situation where abortion is in the Criminal Code with the exception that ‘if you are a doctor and if the patient is under this and that, then you are allowed to provide.’

We are practically the only country that has decriminalized. For MAiD, we have it in the Criminal Code, which means I am guilty of murder if I don’t follow the rules with 14 years in jail [Laughing], so I follow all of the rules and we have to interpret the rules.

It is hard because some are vague. One lawyer can interpret one way and another can interpret another way. I have got to deal with telling my patient that they are eligible or not and if I will provide or not.

There are some of those big differences. For me, if someone wants an abortion and I will provide it for you, I am not risking criminal prosecution if I am interpreting the law quite right. All of my colleagues all over the world do.

If their law says you can go to 12 weeks only, which is a lot of European countries and someone is 12.1 or 12.2, will you tell them, “Yes, I will do it,” and then call it 12? Or do you say, “Sorry, you have to travel to the Netherlands”?

We may have to tell people, “Your disease may not be something where your death will be in the foreseeable future.” The parallels are amazing.

Jacobsen: These are highly difficult circumstances that you have been dealing with, whether more than 30 years as a family doctor, especially with the potential for legal action to be taken by some, or a patient or someone holding picket signs outside.

Wiebe: You’re right. Talk about legal and illegal actions, I have had my life threatened many times as an abortion provider by somebody who had a history of convictions for aggravated assault and a license to carry a gun.

My colleagues have been shot and stabbed around me.

Jacobsen: That is very pro-life, of course.

Wiebe: [Laughing] very pro-life [Laughing]. So, I have had my life at risk by illegal actions. Now, I have my freedom at risk by legal actions. Cool, eh [Laughing]?

Jacobsen: You have pressure from either side with regards to illegal action, such as death threats or threats of violent action against you as a person, as well as legal action against you as a professional person.

In a sense, you, to some people, cannot win because you’re doing work that in any case, they will try to find a way to demonize, stigmatize, prosecute, or kill you!

Wiebe: Yes.

Jacobsen: So, that leads to questions about provisions for the doctors in terms of protection from the legal actions and the illegal actions. Are there any?

Wiebe: We have our organizations that are helpful. We have Dying With Dignity Canada that is an activist organization that is working hard to support us in some really important ways. We have our own professional organization called the Canadian Association of MAID Assessors and Providers.

They are working hard to help. I am a member of both organizations. That is important. As a professional, I have my own organization called Doctors of BC and Canadian Medical Protective Association.

I pay lots of money to our organizations and they protect me [Laughing]. I have all of those protections. I mean, I am obeying the law. I am following the rules. I am providing legal and medical care. I am in both of those situations.

I am helping Canadians exercise their rights. In one case, their right over their own body and their right to choose if and when to become a mother; also, the choice of how and when to die if it falls under our law.

It is really good work. I love my work. I love both sets of patients [Laughing].

Jacobsen: From my own observations, the individuals who tend to be against women’s choice to have a child or not, in other words to be a mother not, as well as against an individual’s choice to do their ‘final act’, when and how to end their life, are often the people arguing for a high form of individualism.

Wiebe: The right to bear arms, right?

Jacobsen: It is an illogical juxtaposition of them. You are for individual rights as one of the highest values if not the highest value, but you’re against an individual woman’s right to choose to be a mother or a person’s with regards to death.

Wiebe: Those are such deep innate rights, over the integrity of your own body and your own death. They are such integral rights compared to some of the rights that they talk about: free speech and so on. Of course, we also agree on those.

It is fascinating to me, when you think of someone like Trump espousing individual rights, except for those people.

Jacobsen: What are some myths about abortion and physician-assisted death or suicide?

Wiebe: I haven’t actually thought about this in this way. But you’re so right. The argument is that if you make abortion legal then everyone will have one [Laughing]. The same with assisted dying. You make it legal and everybody is going to want it [Laughing].

Jacobsen: Society will implode.

Wiebe: Guess what? It doesn’t happen. In mature societies such as the Netherlands, which have had assisted death for decades, we’re talking about 4% of all deaths. 96% of all deaths are not assisted.

So, that is after decades. It doesn’t take over. What happens with legal abortion if it comes along with access to contraception and sex education, the abortion rate drops. It tends to come together with those things. Legal abortion tends to happen in the same place as contraception and sex education.

Those are real myths. Another is vulnerable people being pushed into things. You’ve got abortion available and a boyfriend or a mother is going to persuade someone to have one when they shouldn’t because they really want to have a baby.

That is rare. We have certainly seen it. We watch for it all the time in an abortion clinic. A young girl comes in with her mother and separate her to make sure she is not being coerced into this – likewise with non-English speaking wives who are in there with the translating husbands.

We want to make sure that they are, but it is a rare situation that someone is being pressured hard into it. Vulnerable people are not forced to have abortions in our society. In MAiD, there is this myth that vulnerable people will be pushed into it because we don’t want any severely disabled people. We want to get our money faster.

There are evil people. There must be people like that. But it is so rare. It is our job to find them. It is our job to make sure that each person who comes in trusting an assisted death is not pressure in any way.

But what we find in abortion and MAiD, and I had not thought about this before, Scott, is that the vulnerable people and the most marginalized people have the least access to healthcare of all kinds including abortion.

The poorest people who have the least agency – the ability to speak for themselves and get what they want – are the ones who just don’t get good healthcare in our societies. They have less MAiD and less abortion.

When people talk about the slippery slope, “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.

You know who wants MAiD? It is me. It is white, educated, rich people. People used to being in charge of their lives. People who get cancer and say, “Huh! I am not going down that route” [Laughing].

Jacobsen: In some ways, in a larger context or in a larger societal institutional analysis, these two topics for whom the protestors see as the most important thing to do. It’s important! They go out and picket on a cold day often. It’s Canada.

These seem like red herrings to more important problems that resources could be devoted to, e.g. financial, emotional, intellectual, and human power resources.

Wiebe: Whose resources are you talking about? Could it be the Catholic Church?

Jacobsen: It could be the Catholic Church or it could be the individual citizens.

Wiebe: Yes, so, you have an agency or an individual who has resources and using them to fight abortion and MAiD, when they could be helping end of life care and helping disadvantaged youth who want to have children.

Jacobsen: It could be either of those cases. It could be even a larger context, where it is the preservation of the environment. The potential for environmental catastrophe.

Wiebe: Isn’t it funny how the people who are against us on these issues aren’t for the environment, even though it is their own environment too? [Laughing]

Jacobsen: Often, it tends to be obscurantists. People obscuring real issues, muddying the waters of real topics that deserve debate: what are we going to do about climate change? What are we going to do about energy policy to transition into a non-hydrocarbon producing economy?

These people are around. No need to name names. But people like this focus on these things as red herrings – smelly old fish that would throw off a dog, a philosophical term. It is a similar way you can apply to things seen as political issues, abortion or reproductive health rights, and physician-assisted death or end of life rights.

These become red herrings by being against them because the more important issues of the day are things such as climate catastrophe [Laughing] via global warming as well as pollution.

That could be of the oceans, of landfills that we’re not really dealing with, and so on. In the long-term, there is obviously going to be an energy transition. Renewable energies every year get cheaper for the same unit of energy compared to oil, gas, or coal.

So, if that is the case, and it is, even on an economic argument, the transition should be done. But even on a moral argument, what world do you want to leave for your grandchildren? So, economically or morally, the arguments seem aligned in terms of the long-term view. That’s why I see these as red herrings.

That’s why I see these people as often obscurantists going against it. It is the similar relationship between many American televangelists and followers. The televangelists are the charlatans; the followers are decent people most of the time.

That may be hurt in some way and hoping for a magical solution. You’ve seen the videos. I’m sure. I’ve seen these YouTube clips of these old videos. Where there are individuals throwing their diabetes medication and glasses on the stage saying, “I prayed and had an ecstatic experience seeing pastor so-and-so, and my diabetes and glaucoma were cured.”

These sorts of things. These people don’t deserve ridicule. These are not people who are powerful. They are victims. I think in the same way with the people are who mobilized through red herrings, political red herrings.

Wiebe: That is an interesting issue. So, one of the uncomfortable discussions we can have is about what is acceptable to talk about and so on, as opposed to what people actually think, e.g. we’re in every way a non-racist society, except we’re all racists and behave as such.

It is good that we live in a non-racist society, but we have to recognize that we’re racists and racism occurs everywhere. That is the same with some of these other basic human rights issues, where there is lots of intolerance of other people’s viewpoints in general.

Those of us who say and it is acceptable to say now that everyone has their own right to their own ideas. We can accept these, but are intolerant of people saying out loud that they are intolerant of others.

Jacobsen: Thank you for the opportunity and your time, Dr. Wiebe.

Image Credit: Dr. Ellen Wiebe.

Scott Douglas Jacobsen founded In-Sight Publishing and In-Sight: Independent Interview-Based Journal.

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