THIS IS ASSISTED DYING

A Canadian physician recounts a still-evolving practice of allowing people to end their own lives with medical help.

In 2016, Canada was ahead of the curve in passing a law that allowed for doctors to assist terminally ill people to choose when and how to die, by which “the fear of an unknown ending is replaced by a semblance of control.” The law had a few gray areas that were later addressed: At what point can it be determined that death is imminent? Can someone who is beset by incurable depression or some other mental disorder be considered a candidate for medically assisted suicide? Green addresses such questions with case studies from her own practice. She also investigates the moral and ethical challenges placed on her and her fellow physicians by the sheer task of determining when a patient qualifies for the application of the law. “It turns out all these emotions go somewhere,” she writes, “and every once in a while, a crack forms in the retaining walls, and the feeling slips out.” Her allowance that doctors are humans, too, is welcome. With a few years of practice in medically assisted suicide, which in Canada is accomplished through the ingestion of lethal drugs by mouth or intravenously, Green has a notion of trends. For example, the number of people who choose that avenue is growing, and it is especially prevalent around the holidays. Even so, she recounts, it’s a small fraction of the number of Canadians who die each year, in part, she suggests, because medically assisted suicide is not widely advertised. Canada bests its southern neighbor in favoring science over religion, but, Green also notes, medically assisted suicide is allowed in several U.S. states, if with somewhat tighter controls, with states requiring “that the patient be terminally ill with a prognosis of six months or less.” Green predicts that these controls will be loosened as more people learn about the option.

A humane, cleareyed view of how and why one can leave the world by choice.