THE PHYSICIAN
He was the first doctor jailed for assisted suicide. He spent time in maximum security. He does not regret it.
THE TORTURE THAT (MY PATIENTS) WERE GOING THROUGH …. THIS WAS GOING TO GIVE THEM PEACE OF MIND, KNOWING THAT THEY HAD THE POSSIBILITY OF DOING SOMETHING TO TAKE CONTROL.
After “surrendering” to Toronto’s notorious Don Jail and being stripsearched, Maurice Généreux was placed in maximum security. It was the safest place, he was told, for a “known gay.”
Along with three other inmates, his new home was a cell built for two. His neighbours were drug dealers, wife beaters and child molesters. No visitors were allowed.
He didn’t stay long, however. He was transferred to different jails twice. And when one of his guards at a correctional facility in southern Ontario recognized Généreux as the doctor who had once treated him at a Toronto AIDS clinic, he had him moved to “super max” — solitary cells normally reserved for the highest security risk offenders — for fear he would be “outed.”
Généreux remembers mentally disturbed inmates howling and screaming in middle of the night. He lost his yard privileges, and there was no unescorted movement, although he was still allowed to go to “work.” His job was making orange prison jump suits. Généreux was a trained surgeon, so he knew how to sew.
In fact, all he ever wanted was to be a doctor, until his career ended with the death of a patient and the near-fatal overdose of another.
In 1998, Généreux became the first doctor to be jailed for aiding and abetting suicide under section 241(b) of the Criminal Code — the very section that is set to become null and void June 6, when the Supreme Court of Canada’s deadline for new federal legislation governing physician-assisted dying expires.
Généreux, who spent nine months behind bars and was stripped of his privilege to practise medicine forever, says he wishes the ruling had come sooner. But he doesn’t regret what he did.
In an interview with the National Post, he says he was motivated by a desire to help ease the mental anguish his patients were experiencing in the days before triple-drug cocktails saved people infected with AIDS.
“The torture that they were going through — seeing their friends die slowly, often a very painful death — my feeling was that by giving them an option, this was going to give them some peace of mind, knowing that they had the possibility of doing something to take control,” he said.
To some, Généreux was an “agent of mercy” offering people a way out of their psychic and existential suffering. To others, he was “Dr. Death,” a reckless and manipulative doctor willing to prescribe enough Seconal, as ethicist Dr. Philip Hébert describes it, “to kill a moose.”
Either way, as doctors confront new euthanasia laws — and court rulings like this week’s decision granting a Calgary woman with ALS an assisted suicide in B.C. — Généreux’s story exposes the need for rigour in deciding who gets to make the final choice for patients.
Pro-euthanasia groups didn’t rush to make Généreux their poster child. In 1994, he pleaded guilty to sexually touching six patients and had his licence suspended for nine months.
Some of his colleagues in the AIDS community quietly urged him to resign. Instead, five months after his licence was reinstated, he prescribed lethal doses of barbiturates to help two patients in suicide. Mark Jewitt survived his 1995 attempt and is alive today. Aaron McGinn died in 1996, at age 31.
Both men had HIV but neither had fullblown AIDS. They were not in physical pain or in danger of imminent death. A forensic psychiatrist described Généreux as a man who over-identified with his patients and had trouble refusing their demands.
His sentencing hearing revealed he provided Seconal to 16 other patients in 1992 -96.
This was, however, during the early, bleak years of HIV, when many doctors openly refused to treat patients with HIV or AIDS. John Larsson, a longtime social worker and counsellor with the AIDS Committee of Toronto, remembers “there wasn’t much to hang your hat on in terms of staying alive in the long term. So people prepared to die, psychologically.”
That meant finding a way to control their death — getting suicide pills from empathetic doctors and, if the doctor “wasn’t all that cooperative,” stockpiling their medications. “They didn’t want to end up the way they saw so many other people die,” Larsson says.
Treatments were evolving, “but we didn’t have the combination drugs that we have now, which have pretty well brought this epi- demic under control,” says Généreux, now 69 and running a bed and breakfast for gay and bisexual men in Victoria.
“At the time, physicians were in a very difficult situation. We were ethically obliged not to help our patients at the end stages of their life.”
Still, Généreux knew it was a crime. He falsified McGinn’s death certificate to prevent people from asking questions.
McGinn tested positive for HIV in 1989. In August 1995, Généreux prescribed the man, who had a history of depression and drug abuse, a quantity of Seconal that would be lethal. He gave him a second prescription a week later, when McGinn said he had lost the first.
Nine months later, as his partner later wrote, McGinn hung a crucifix on his bedroom closet door and swallowed the Seconal. He warned his partner not to stop him or call 911. But the man left McGinn’s side twice to call Généreux, who counselled him not to call an ambulance.
“This is what Aaron wants,” Généreux said, according to a Crown document. “You should let him do it.” Later, Généreux went to McGinn’s home, stated the cause of death was AIDS- related pneumonia and took away the empty Seconal bottle.
While he was the first to be sent to jail for it, Généreux was not the first doctor to be accused of helping a patient die. In 1993, an Ontario surgeon was charged with seconddegree murder in the case of a woman dying of cancer of the trachea and tongue. At her request, he removed her breathing tube and injected morphine to keep her comfortable. But he did not stop there. He also injected her with a bolus — a high dose of a drug given all at once — of potassium chloride, which stopped her heart. He received a suspended sentence after pleading guilty to the lesser charge of administering a noxious substance. (He could not be reached for comment.)
On reflection, Généreux says, “I would have taken more safeguards to protect my licence. I’m not saying that I would not have assisted. But I would have perhaps screened a little bit better, or been more cautious about how I approached it.”
Genereux mostly wants to put the past behind him; his prosecution and incarceration were demeaning, he says. But he adds that assisted suicide was an open secret — “It was common practice among physicians treating AIDS at that time” — and he feels his colleagues abandoned him when he pleaded guilty.
They say he was the one who abandoned his patients. Drugs such as AZT and protease inhibitors were available, and better drugs were on the immediate horizon.
Dr. Phillip Berger of St. Michael’s Hospital in Toronto is still treating people who were diagnosed with AIDS in 1992. “Just because one had AIDS didn’t mean their life was over,” he says.
Hébert, a physician and bioethicist at University of Toronto, devotes a chapter to Généreux’s case in his new book, Good Medicine: The Art of Ethical Care in Canada. He says Généreux was too eager to please pa- tients who were clearly depressed but didn’t refer them for counselling as he should have.
“He was described as a Pez dispenser of pills. And I think that kind of lackadaisical attitude of prescribing has to be not allowed,” he says.
“The one man who died ( McGinn) had his prescription for nine months, and he didn’t see Généreux in all that time. It’s like, ‘Here’s your lethal dose of medication and I’ll see you, whenever.’” Hébert testified for the Crown that the Généreux case was a textbook example “of how not to manage the despairing, impulsive, suicidal patient.” Even so, he feels some sympathy for Genereux. “There were people who supported him. He had some very powerful testimony in his favour.”
Généreux’s own college once described him as having made significant contribution to the treatment of HIV and AIDS. “He wasn’t a bad man,” Hébert says. “He wasn’t a bad person. I just think he made some very bad decisions.”
Still, lessons need to be learned. “If you think that there is any possibility of having a regulated scheme of assisted death,” says Hebert, who does support giving eligible patients the choice, “it has to be able to exclude cases like this. It has to be able to say, ‘ This is wrong.’”
Généreux says he’s happy “that finally we are permitted to be compassionate at the end stage. It’s sort of like an achievement, something that I’ve felt was needed for a long time and finally it’s here. My regret is that I’m not able to practise any longer and enjoy that freedom.”