Northwest Arkansas Democrat-Gazette
Scheduled to die
The rise of Canada’s assisted suicide program
This piece originally appeared in Common Sense (commonsense.news)
On Sept. 7, Margaret Marsilla called Joshua Tepper, the doctor who planned to kill her son.
Marsilla, 46, lives outside Toronto with her husband and daughter. She had known that her 23-year-old son Kiano Vafaeian, was depressed — he was diabetic and had lost his vision in one eye, and didn’t have a job or girlfriend or much of a future — and Marsilla asked her daughter to log onto Kiano’s account.
That was when Marsilla learned that Kiano had applied and, in late July, been approved for “medical assistance in dying,” aka MAiD, aka assisted suicide. His death was scheduled for Sept. 22.
In a Sept. 7 email from Tepper to Kiano and Tekla Hendrickson, the executive director of MAiDHouse, the Toronto facility where Kiano’s death would take place, the doctor mapped out the schedule on email:
“I am confirming the following timing: Please arrive at 8:30 a.m. I will ask for the nurse at 8:45 a.m. and I will start the procedure at around 9 a.m. Procedure will be completed a few minutes after it starts.”
Marsilla was terrified. She had tried to do everything for her son, but it had been rough for him. She and his dad had gotten divorced when Kiano was a kid. On his 16th birthday, she had given him a BMW. When he was 17, he had been in a bad car accident. He wasn’t up to college. He smoked a ton of weed. He’d lived with his dad, then with his mom, and now with her sister, Kiano’s aunt.
Whatever he did, he was unhappy. Going blind in his left eye this past April was the tipping point.
The day after she discovered the email, Marsilla called Tepper. She pretended to be a MAiD applicant and said she “wanted to go through the whole process in general, from A to Zed, before the Christmas holidays — if you know what I mean.” Tepper indicated he understood.
Tepper ran through the list of requirements: “You have to be over 18. You have to have an OHIP card.” (He was referring to her Ontario Health Insurance Plan.) “You have to have suffering that cannot be remediated or treated in some way that’s acceptable to you.”
Marsilla, who recorded the conversation and shared the five-and-a-halfminute recording with Common Sense, told Tepper that she was diabetic and blind — more or less her son’s condition.
Then, the doctor said, “If you wanted, I could do a formal assessment with you.” Marsilla asked if she should come in. Tepper replied: “We do them remotely, often by video of some type: WhatsApp, Zoom, FaceTime, something like that.”
A few minutes later, Marsilla hung up. She had just over two weeks to stop her son from dying.
When we think of assisted suicide or euthanasia, we imagine elderly people with late-stage cancer or advanced ALS in severe pain. The argument for helping them die is clear: Death is imminent. Why should they be forced to suffer?
In 2015, Canada’s Supreme Court ruled that assisted suicide was constitutional. In June 2016, Parliament passed Bill C-14, known as the Medical Assistance in Dying Act. Anyone who could show that their death was “reasonably foreseeable” was eligible.
The Netherlands, Switzerland, Belgium, Spain, Australia, and New Zealand, among others, allow assisted suicide. So do 10 states in the U.S.
In 2017, the first full year in which MAiD, administered by provincial governments, was in operation, 2,838 people opted for assisted suicide, according to a government report. By 2021, that figure had jumped to 10,064, accounting for more than 3% of all deaths in Canada that year.
There have been a total of 31,664 MAiD deaths; the large majority were people aged 65 to 80 when they died. In 2017, 34 MAiD deaths were in the 18- to 45-year-old category. In 2018, that figure rose to at least 49. In 2019, it was 103; in 2020,118; and in 2021, 139.
Today, thousands of people are applying successfully to kill themselves.
In 2021, the province of Quebec reported that 4.7% of deaths in the province were due to MAiD; in British Columbia, the number was 4.8%. Progressive Vancouver Island is unofficially known as the “assisted-death capital of the world,” doctors told me.
Over the past few years, doctors have taken an increasingly liberal view when it comes to defining “reasonably foreseeable” death. Last year, the government amended the original legislation, stating that one could apply for MAiD even if one’s death were not reasonably foreseeable. This second track of applicants simply had to show that they had a condition that was “intolerable to them” and could not “be relieved under conditions that they consider acceptable.” This included applicants like Kiano.
Next March, the government is scheduled to expand the pool to include the mentally ill and “mature minors.” According to Canada’s Department of Justice, parents are generally “entitled to make treatment decisions on their children’s behalf. The mature minor doctrine, however, allows children deemed sufficiently mature to make their own treatment decisions.”
Dr. Ellen Warner is an oncologist at the Sunnybrook Research Institute in Toronto and a professor at the University of Toronto’s medical school. “My objection to MAiD was that there was no way we would be able to avoid this slippery slope, because these aren’t black and white cases,” she said. “I’m 100% against MAiD. I’m an old-fashioned Hippocratic Oath kind of doctor.”
But Dr. Derryck Smith, a psychiatrist at the University of British Columbia, views the rise in MAiD deaths as progress. “MAiD is about relieving suffering, respecting human dignity, and recognizing the inherent right for individuals to make decisions affecting their health and even their death,” Smith told me.
Many of the people thinking about killing themselves in Canada are relieved that the government has made it easier to die.
“The nightmares have always been a problem,” Mitchell Tremblay, 40, told me. “Since I was 6 years old, when my cousin molested me.”
The MAiD-curious, like Tremblay, were lonely and scared, and had coalesced into a growing online community and through the spread of death cafés. There were more than 1,300 death cafés in Canada and 14,000 worldwide.
In 2012 or 2013, people mostly met in other people’s homes to talk about the emotional and philosophical complexities of death. They ate cake and had coffee or tea. Since then, the number of virtual cafés had grown considerably.
Tremblay was from outside Toronto, and had been homeless off and on for more than two decades. He had spent years in and out of psychiatric facilities, prostituted himself, done tons of drugs, and shuttled between dingy apartments and halfway houses. He planned to apply for MAiD as soon as it opened up to the mentally ill in March 2023.
“MAiD is going to give me dignity,” Tremblay said. “I need to go now, because I know it’s gonna get worse.”
Victoria Cowie, 21, was a third-year engineering student from LaSalle, Ontario. She suffered from epilepsy and had anemia, getting three or four iron infusions intravenously every week. She took care of her mother, Joan, 53, who was battling ovarian cancer and had been confined to a wheelchair by Guillain-Barré syndrome.
Both women received disability support from the provincial government in Toronto — that brought in $1,361 every month. After paying rent and utilities, they usually had a little more than $70 to pay for food.
Sometimes people would send them groceries or other essentials; sometimes they’d get some canned goods at local food banks. Often they’d get by on only one meal a day.
They couldn’t go on like this for long. “Mom,” Joan recalled Victoria telling her, “I don’t think we can survive. We have to apply for MAiD.”
It had not been lost on government officials that MAiD could save them a good bit of money.
In October 2020, the Office of the Parliamentary Budget Officer issued a report stating that MAiD would cut health-care costs by over $66 million. In 2017, Aaron Trachtenberg, a research fellow and a doctor at the University of Manitoba, and Braden Manns, a health economist and nephrologist at the University of Calgary, published a paper predicting that MAiD could slash health care costs by as much as $100 million yearly.
On Sept. 8, the day after Margaret Marsilla called Tepper, she took to Facebook to post about her son. “Can you F….. believe it!!! The doctor literally has given him the gun to kill himself,” Marsilla wrote.
Dr. Kristen Creek, in Winnipeg, messaged her. Creek was a family physician and provided MAiD. She was surprised to hear that a young man with diabetes had been approved for it. She urged Marsilla to call Tepper back and be up front about who she was.
Marsilla did. Soon after, Marsilla, Kiano, Kiano’s aunt, and Tepper spoke on the phone. That call led nowhere, Marsilla said. By now, a right-wing Canadian Catholic news site had picked up on Marsilla’s post, which mentioned Tepper by name, and the doctor was getting pummeled by outraged readers.
On Sept. 16, Tepper texted Marsilla to say that he’d postponed Kiano’s death until Sept. 28. Five days later, the doctor texted her again to say that he wasn’t going through with it.
Recently I managed to FaceTime with Kiano. He said he’d applied for MAiD a few years back, then dropped it. Then, in May, after learning that his eyesight was going to get worse, he decided he did want to die.
“I was so ready,” he said. “I was actually very looking forward to ending my pain and suffering.”
Kiano told me he was “baffled” by everything that had happened the past three weeks: his mother’s social-media campaign, Tepper’s decision not to help him die. “I didn’t know what to say,” Kiano said. “It’s how she knows how to love me.”
Still, he was furious with her. He didn’t know what came next, whether he’d find another doctor. The MAiD people didn’t want to touch his case.
“KIANO I love u,” Marsilla wrote in a text.
“No you don’t,” he wrote back. “You were adding to my pain and suffering, and for that I curse you.”
“I love u And I want to talk to u,” Marsilla wrote. After a moment, he texted back: “You know what I need.”
If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingOfSuicide.com/resources for a list of additional resources.