The Interview - The Doctor Who Helped Me Understand My Mom’s Choice to Die

Episode Date: November 16, 2024

Dr. Ellen Wiebe has performed hundreds of medical aid in dying (or MAID) procedures and is one of Canada’s most prominent advocates for the practice. David Marchese had questions — medical, legal and philosophical — about when it makes sense for doctors to help people to die, and also about how MAID might shape our thinking on what, exactly, constitutes a good death.

From the New York Times, this is The Interview. I'm David Marchese. All right. Today's episode is a little different. It's kind of more about a topic than it is a specific person. That topic is the controversial subject of medical assistance in dying, also known by the acronym MADE. That's the term for when patients legally receive help

from medical practitioners with ending their lives. Here in the US, MADE is currently legal in 10 states and the District of Columbia. Patients have to be terminally ill in order to be eligible. In Canada, where I'm from, the practice is legal nationwide and patients can apply for it in cases where they have a quote, grievous and irremediable medical condition, which does not necessarily mean terminal.

The episode is a little different for this reason, too. I have a very personal connection with the topic. Earlier this year, my mom died by maid. I have to admit, I didn't really have many questions about it beyond the basic hows. That is until a journalist friend of mine, somewhat provocatively and also astutely, sent me an article about a maid provider in British Columbia named Ellen Wiebe. Wiebe has performed hundreds of maid procedures and is one of Canada's most prominent advocates for the practice. As I looked more into Dr. Wiebe, who is 72,

I realized that actually I did have all sorts of unanswered questions, medical, ethical, and philosophical, about doctors helping people to die and about how made might shape our ideas of what a good death even means. Here's my conversation with Dr. Ellen Wiebe. with Dr. Ellen Wieb. Dr. Wieb, thank you very much for taking the time to do this. I appreciate it.

I just want to tell you upfront, my mom died from MAID in June in Ontario, and that's part of why I'm talking to you today. And I'm glad that she had made and it was the right decision for her. But I just wanted to tell you that so you know where I'm coming from. And also I want to apologize in advance

if I get emotional during this conversation. You know, it's probably not what I'm supposed to do, but there's not gonna be any way around it for me. Exactly. There's no easy way to say goodbye to your mother. So I assume that plenty of doctors support Maid, but I don't know how many doctors would want to be Maid providers.

What distinguishes you from other doctors? Well, human rights has been a major focus of my life and my other practice is abortion. And again, it has to do with basic human rights, people's rights over their own lives, their own bodies. And I'm comfortable with that. And I'm, you know, I feel honored that people trust me to help them through these difficult things that they're going through.

And that I can hand them that autonomy that they've lost. Do you ever have doubt or skepticism about your own work? Either on the level of how the system works or on a more personal level feelings of regret or sadness? Well, I mean, there's the intense grief that we see sometimes, but a lot of the deaths that we are dealing with aren't like that. The grief, the tragedy was elsewhere.

At that moment, they are celebrating a life. So last night, I was with a family who was celebrating the life of a 92-year-old father who was leaving. And there were tears, but there was laughter, and there were pictures of when he was an 18-year-old gorgeous young man. And, you know, that kind of thing that we've all gone through with saying goodbye to a loved one, where there's the good and the bad. And I'm so honored to be a part of these amazing experiences, like last night's. You know, as you're deeply aware, there are all sorts of different criticisms and skepticisms around medical assistance and dying.

There's the slippery slope argument, of course, you know, if you, you know, allow people to do this, then... Everybody's gonna want to die. Yes. Everyone's gonna want to do it or it's not so much that everyone's going to want to do it. I think the concern is that more people might feel compelled to do it or will do it who otherwise wouldn't choose to die.

So that's the concern. And I was being flippant there, but basically people want to live unless their life is unbearable. Well, so that's one concern. Another concern could be deemed religious to do with the sanctity of life and May devalues that. Another concern would be that people might end up choosing it for financial reasons or because they're pressured into it.

There's a long list of concerns. Do any of the arguments against Maid hold water for you? Do any of them give you pause? DG So it is our job as clinicians who assess people for Maid to determine some of these issues you've just brought up. So for example, I met a man in residential hospice, and he was late stage, confined to bed, and he said, the reason I want made is because I don't want to be a burden to my family. They keep coming into the hospice, and they should be working. And, you know, I mean, I have to deal with that. Like, you get, sorry, that's not good enough reason. You can't, but in fact, of course, he also

was very distressed at the fact that he had, he'd been a person who had taken care of his family, who had taken care of others. And now he could lie in bed and have people take care of him. And it was unbearable to him that he was in that state and he wasn't getting better. He was just going to do more and more of it until he was dead. And so I had to determine that his suffering also included that and not merely doing it to protect his family from having to come to the hospice to see him because they loved him so much and wanted to be there.

What determination did you make in that instance? Oh, he was most definitely eligible. His family gathered around him and it was a very moving, comfortable death for him and his family. I want to ask about where the line should be for eligibility. In, I think it's 2027 in Canada, people for psychological reasons will be able to access maid. And I know in other countries, there's been broader discussion about maid in instances of early dementia. able to access made. And I know in other countries, there's been broader discussion about made

in instances of early dementia. People saying, I want to go before the disease gets too far. Or I think it's the Netherlands. They've talked about made in instances of, they call it completed lives. You know, when an elderly person just has reached a point

where they say, I've lived my life. I don't, you know, it's not that they're ill or depressed or suffering. They just feel like their life is done. And those are all pretty, in a way, different circumstances. And I just want to know where you think, societally, we should say the line is for someone being able to access medical assistance and dying. I don't have the answer. I mean, again, I come from human rights.

People should have control over their own lives. And they should be able to have help at the end if they so desire. But there's the situation of a quadriplegic. Generally it's young men who do risky things who become quadriplegic. And they are horrified at the idea that they're going to live totally dependent for the rest of their lives and want to die early. And then years later, they maybe they've got university degree, career, family, and they love life and feel that it would have been terrible if they had had the choice to die early because they would have taken it.

And that's a problem. How long should you force somebody to put up with quadriplegia before they can make the decision that that's not acceptable life to them? And there isn't an answer because people should have the right to control their lives. Have you ever helped someone with made and then regretted it?

No. I don't agree with all of my patients' choices, you know? I mean, I never, sometimes I struggle when I see a young, beautiful person choosing to leave earlier than they needed to because it's hard, especially on their parents. And I'm a parent of adult children. But I mean, as I said, I believe so strongly in basic human rights. If that person says that they can't live with this condition, then once we've gone through the whole process, I will honor their wishes. It's hard for me to get the words out.

Now, I want to ask some questions that directly come out of my mom's experience. Just for more context, she had ALS, she was seven years old, she was suffering physically and mentally. There's no doubt in my mind that it made was the right thing for her, it's what she wanted, my family's all in agreement about that.

And yet it raised questions for me. And so this part is just for people who don't know the process. So in Ontario, one of the steps is that you have two independent assessments from a doctor or nurse practitioner who help determine whether or not a patient is eligible for MADE. There's a bunch of other steps, but this step is the one that I'm thinking about now. So I was at one of those assessments. You know, and it's sort of a surreal experience

to be in the room while your mom is talking with a doctor explaining why she wants to die. It's just a strange thing. But another aspect of it that was surreal for me was, like, so I'm sitting in a room listening to a conversation between my mom and a doctor who's never met my mom, trying to assess my mom's sort of material,

physical and psychological situation. And then, you know, sort of, we all know that this person is gonna give a thumbs up or thumbs down at the end of it. And I don't think anyone was dishonest or negligent or anything like that. But I still thought, what does this doctor really know about this situation?

There's this strange dynamic of, my mom wants something from this doctor. The doctor knows that, is asking questions that clearly have, for lack of a better term, correct answers in the situation. Just something about the whole thing seemed both totally insufficient to determine what my mom actually thinks and feels. And then also, on some level, just an example of medical hubris.

Like, why would this doctor think she can understand the fullness of the situation based on a one-hour remote call. The whole thing felt a little bit like a charade to me or a game we're all willingly entered in. Why isn't it? Interesting. Okay, so first of all, the clinician who assessed your mother reviewed her medical history, and it was extensive, I'm sure. So there was not only a description of the diagnosis of ALS, but also her deterioration over time and her reaction to that, her reaction to the medications that

were given to alleviate her suffering. And so the doctor had a lot more information than what she got from that one hour. And secondly, our job during those assessments is to make sure that the person understands their condition. I mean, remember, some of the ALS patients we assess can't talk. And when somebody is nonverbal, it's more of a struggle. But your mother was still verbal, right? Yeah.

So being able to understand that she understood her condition, that she understood her options. That probably wasn't very difficult for the assessor. And that was the basic thing that we want because we have eligibility criteria that we have to go through. There's the easy ones, over 18 eligible for Canadian medical insurance. That's equivalent of residency status. And so those are all the easy ones we check off. And then the more complex ones are capacity to make decisions and the understanding.

So yes, that is the main thing that we are assessing, is do they understand this decision they're making after we know that they have checked all the other boxes? I have to admit, you know, I was wrestling with what I thought were the epistemological problems of mate assessment, where I was just thinking, how can these people really know what my mom is thinking? But I guess your point is it's not their job

to know what my mom is thinking. Your mother had rights. Maid applicants have to be of sound mind. You have to determine that they're being rational and logical. And this is something that I struggled with a little bit when it came to my mom's decision to use maid. She was physically suffering, but then was also depressed. And depression, as I understand it, the medical definition is that it's a mood disorder. So how can we say with certainty that someone experiencing a disordered mood or disordered

state of mind is making a rational choice? Exactly. So this is something that we have to work on. In that kind of situation, instead of asking somebody if their mood is low, which hers was, of course, and many of my patients who are dying, because they're losing so much. I mean, they're, it's, they, they, and often, like your mother, have one loss after another, after another loss. And that's really depressing. And so how do you figure out whether they have a mood disorder that disorders their thinking so that they can't think clearly

about making a logical decision? So what I look at in someone like that is when people are clinically depressed, they tend to believe that they are bad people, that the world's a bad place, that it's their fault that things are going wrong. And that is disordered thinking that might respond to therapy, even in a dying person who's suffering physically. But if a person like your mother says,

I'm losing everything. The things that used to give me joy, I can't do anymore. What's the point in going on just to get worse and worse? That's pretty logical. She's recognizing the truth of the situation. I'm also curious about the subject of maid and grief. My best friend five years ago died from suicide, not medically assisted.

And that for me was a real, was a complete surprise to me, totally out of the blue. And it... I'm so sorry. I really felt like a rupture that I still feel like is not closed, you know, five years later. And I think the closest I've gotten is that, accepted that like, it's just always gonna be a bit of a painful question mark there.

That's as far as I can take that. But with my mom, I don't have any of those feelings at all, the feelings of rupture and emotional discombobulation. And my hunch is that Maid had a lot to do with that. It was, it was her choice. It was a clear choice. You know, we knew when she was gonna die, we had time to spend just with her. I asked her everything I needed to ask her and said everything I needed to say to her.

And I think as a result, I felt prepared for my mom dying. Do you have any sense of the connection between made and grief? Yeah, yes. We need to know more. But there are clear differences between grieving after made versus grieving from sudden deaths like your friend or expected but natural deaths. or expected but natural deaths. And they have to do with the planning. So for a lot of people, the planning for an assisted death allows for people to do exactly what you said, say the things that need to be said,

ask the questions that needed to be asked, and people say that it makes it easier. But the harder thing for some people is that this person left earlier than they needed to. They could have gone on longer. And that can feel like abandonment and rejection in a way that is very hard on the survivors. In terms of suicide versus maid, you described it beautifully. I mean, the suddenness of a suicide, the violence, the fact that they have to do it alone and

not have anybody with them, that it is unsanctioned, police have to be involved, et cetera. It makes it all more difficult on the survivors. I just want to pull back again for a few minutes. One of the recurring fears around MADE has to do with the idea of coercion or people feeling forced into it because they don't want to be a burden or maybe they don't feel like they can get proper care to alleviate their suffering. How does a maid assessor make determinations in those kinds of examples? Because I don't know that somebody's going to say, I'm going through this because my kids think I'm being a burden or my partner thinks I'm going to be a burden or I'm pressured into

this or I don't have the money. So how do you figure it out? Yeah, I learned this early on my first year. I had two patients around the same time who both had progressive neurological diseases, and one of them was rich, and she was rich in every way. She had not only a beautiful home and money, but she had a loving husband and children and friends, and she had this rich life, and she needed full care care and she had her staff, she called them her staff, who did her caregiving. The man, on the other hand, lived in a horrible housing situation and he was poor in every

way, he had no money, he had caregivers whom he fought with all the time. And I thought, you know, like, okay, so this guy got a million dollars and was able to afford staff and a home. Would he want to live longer? And you know, I came back thinking they said the same things to me. The woman who was surrounded by this loving family in this beautiful home said, all I can do is get put into my recliner and sit there all day and then get put into bed and lie there all night. And that's all I can do.

That's not good enough. And the man said exactly the same thing. Life isn't good enough when all I can do is get put into a chair and sit there, and then get put into bed and lie there. That's not life. And so, you know, we all struggle with this when we see that part of the suffering is the poverty, or at least that the poverty makes their suffering worse. But maybe I am misunderstanding the story a little bit,

because didn't you just describe an instance where people were explicit with you about what they wanted? I mean, the material circumstances might have been different, but do you feel like you're able to determine whether or not people are being fully honest with you in those moments? People can lie. Of course they can lie and I can be duped, absolutely. But I still have to go through my entire checklist and I have to know that they truly have the grievous and

irremediable medical condition, that they do understand their condition and its prognosis and the treatments and the alternatives. And I explore the suffering. You know, I don't just accept when people say the pain's too bad, but of course people can lie. Have you ever experienced situations where the family was unhappy with the made decision? Oh, yes. What were the ripples from that?

Well, anger, of course. So, I've had a number of my patients who said, I'm not telling mom. You get to tell her after I'm dead. Really? So you... So I remember one family, the wife and brother were with my patient. He was only in his 40s, but he was at the end stage of a horrible, horrible cancer, death, and suffering dreadfully. And so his brother was there and he says to my patient, you've got to tell mom.

And he said, I'm not telling mom. Well, I'm not telling mom. So you've got to tell mom. So we're dealing with complex family dynamics sometimes and we try to negotiate a little and say, I've said to many people, listen, you're going to be gone, but they're left behind. What could you do to make it a little easier on them?

So we talk about that, and how could you write letters, could you do videos, could you do something to make it a little easier on them? You know, I feel that some of the critics of Maid, I just think they're making some bad faith arguments. You know, you can sometimes get the sense when you watch certain videos or read certain arguments that they think doctors are out here, you know, champing at the bit to sign more people up for made and in sort of like a willy nilly fashion.

And what do I know? But my sense is much more the doctors take these decisions very seriously and are following the rules and are not cavalier about it. So I think there's just some kind of bogus arguing going on. But are there any arguments on the more liberal, pro-made side that you think are maybe made in bad faith? Sorry, I can't think of one that is like that. Yeah.

For me, one is sort of the pushback against the slippery slope idea that, if you allow people to do it, more people will do it. And it seems to me that that's obviously true. I think anywhere medical assistance in dying has been allowed, then gradually the numbers go up. Yeah, there's a real change in the culture. So now when I meet a new patient, they often tell me, oh, I know my aunt had made or whatever.

So it has become part of the culture. They understand the whole issue, the process, because we've had it for nine years and so they know somebody. And the other thing that makes it just part of the culture now is that when somebody gets a diagnosis, and three of my close friends had these diagnoses in the last nine years, instantly when you have that horrible diagnosis, you also know your options right from the beginning. And of my close friends who had, one had made, one didn't, had an actual death, and the other

is living way beyond this prognosis quite amazingly. But it was there. Like, for the one who didn't have it, he talked about it. He said, if it ever gets too bad, that's what I want. And he kept deciding that it wasn't that bad and he went through a natural death. So that's what our culture is like now. It helps the people who don't have made, the one who's still living quite well, I mean, he knows it's there.

He knows that should his cancer lead to really unbearable suffering, he's got a way out. Another thing that I was really thinking about with the experience with my mom was why doctors are involved in this decision at all. If we accept that people have a right to bodily autonomy and can make their own decisions about their own lives, why are doctors the ones who my mom had to go to and say, let me do this? I mean, I understand why we need doctors to administer, in my mom's case, the injection, but isn't there something sort of paternalistic

about doctors in this instance? Maternalistic. Why? Why are they involved? So I think that it's reasonable that our country decided to use doctors as the gatekeepers. It's not perfect. It's not necessarily even a full sort of human right, but in general, our country trusts doctors to make decisions on the basis of patients' rights and the good of the patient.

And so we are the trusted gatekeepers, and it's not perfect at all. I mean, another country like Australia, they give it to a committee. So you have to, the doctors prepare the documents for the committee, but it's a committee with an ethicist and lawyer and doctors and so on who actually make the decision. So that is another way of doing it that would not be just doctors. Why do you think it's reasonable that in Canada, doctors are the arbiters? We help make assisted dying more accessible to patients than the Australian system, where it takes many weeks to get through that complex process.

So access is better. And we're not a faceless committee. We are people with faces and empathy, and we're humans. I want to go back again for a minute to my mom's situation. The doctor who helped my mom to die, who was great. She just came in and made the family all feel comfortable, and it was very clear and made my mom feel comfortable. I thought she did an amazing job. But after she asked my mom whether everything was clear to her or if there were any questions,

my mom, she was so brave. She just said, let's do it. But that's who my mom was. But after the drugs were injected and my mom was non-verbal, the doctor in a very caring way, sort of softly under her breath said, looking at my mom, she's so in control. It was just such a moving thing to hear in that moment,

what I was really wanting to hear. But I also don't fully know what she meant when the doctor said that. I wonder when you are in that situation, do you feel like you are seeing things in the non-verbal patient or understanding something about what they're going through in that moment? Well, remember that the drugs we give in Canada are general anesthetic, and most people have had an experience with a general anesthetic so they know exactly what it's like.

We start with a sedative, so you just feel kind of sleepy and maybe a bit woozy, and then you're asleep, and then you're in a deep coma and you know nothing. We know that in that process of going into coma, hearing is the latest thing to go. And so a lot of us would tell the loved ones around the bed, she can still hear you, and she probably can still hear you. And they'll say their last, you know, I love yous and that sort of thing

in case they can still hear. But our method, it makes it very quick. As you noticed, it's only minutes. Yeah. Yeah. Do you think anything happens after people die? No. No. I talk about this with all my patients, ask them what they think.

So I know whether they're expecting an afterlife, but no, I don't personally expect an afterlife. We know that most maid providers and most maid recipients tend to be not very spiritual. Why do you think that is? Part of the entire attitude towards having control of your life. The kind of people who aren't religious, are well-educated, et cetera, are more likely to have choose made, whereas highly religious people, people very connected within certain ethnic groups, certain cultures, are less likely to? You know, I suspect my spiritual or religious beliefs are in line with yours. I don't think anything happens after we die and I don't really believe in a higher power. But there was something profound for me with my mom and really seeing somebody's alive,

alive, alive, and then a second later they're dead. And I just hadn't in any meaningful way been forced to confront the fact that the line between life and death is a heartbeat, it's a split second. And that was, I mean, maybe it sounds naive, it was kind of mind opening for me. Do you feel sort of wonderment or awe or a matter of factness about that transition

from life to death? No, it's an amazing transition for the person and for the family. Earlier in my career, I delivered over a thousand babies and I was involved in families welcoming a new person into their lives. That is also an incredibly profound experience. And here people are saying goodbye for the last time to somebody who's been so important to them. Last night, you know, the new widow said, 57 years, I don't know how I'm going to go

on without him. So, you know, a profound change for this woman to now be a widow instead of a wife. And so it's a profound experience. I'm thinking of a doctor I was talking to told me this anecdote about a palliative care physician, and that doctor said, you know, you should stop when the decisions you make don't bother you anymore. You feel so, or seem to me so comfortable and at ease with your work. Do you think your work is the kind of thing that a doctor can get too comfortable with?

Well, remember, we're doctors, so we're used to tragedies, we're used to being in other people's crises. So in order to do this, you have to be able to protect yourself. And you learn that in medical school, how to set boundaries and not take home other people's tragedies and make them your own. Or you couldn't do the work and you couldn't enjoy the work and find meaning and value in the work and find meaning and value in the work. It's different for every person how they take that. For example, I spent 20 years working

in the sexual assault service here in Vancouver. That meant that I was spending time with women who had been assaulted, just assaulted, you know, and traumatized in a terrible way. And I was able to do that without taking on a lot of secondary trauma. And a whole lot of people can't. You know, one of my friends joined the service a whole lot of people can't. One of my friends joined the service briefly and said, I can't get back into bed with my husband after I've come away from a sexual assault case,

so I better quit. And she did, and she's still married, which is great. So you have to know yourself. You have to know what you can tolerate and what you can do. But if you set boundaries so strongly that you no longer have empathy and you no longer care about the people, then you've gone too far. After the break, I called Dr. Wiebeck

to ask about the dangers in all the different works she does. Well, I must say that the anti-abortion people are worse. They shoot and stab my colleagues and threaten me with death, whereas the anti-maid protesters are more likely to pray for me. [♪ Music playing. Fades out. Fades in. Fades out. Fades out. Fades in. Fades out. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. Fades in. are you? Good. So in addition to your work with Maid, you've been an abortion provider for a long time. That's right. You touched on this a little bit earlier,

but I want to know more about the connection between that work and your Maid work beyond the fact that they both have to do with bodily autonomy. I mean, you're dealing with patients at two such different phases of life. What is the emotional interplay there for you? Oh, I love going between, you know. I'm dealing with young women in the morning who are, you know, planning their lives around, you know, having children, not having children, having the choices over what they want to do.

And then in the afternoon, I might be seeing somebody who's planning their death. It's a wonderful balance for me. So besides bodily autonomy, the social constructs are very interesting because in Canada and the US, the majority of people are pro-choice. The majority of people believe that women should have the right to control their bodies and people should be able to control their deaths. And yet, there's still a lot of stigma. There's a difficulty with access for both. And there's difficulty with finding enough providers, finding spaces, finding

all these things. So it's very interesting. And, you know, the same people are against me. I've had lots of anti-abortion people against me and now anti-made people against me. So, yeah, there's quite a few similarities. Do you find that opponents of abortion and made demonize the work in similar ways? Well, I must say that the anti-abortion people are worse. They shoot and stab my colleagues and threaten me with death.

Whereas the anti-maid protesters are more likely to pray for me, which is fine. So they are less violent, which is good, but their rhetoric is similar. I mean, I'm of course called a serial murderer. There was a colleague of yours in Vancouver in around 2000 or so who was shot. And stabbed. Same colleague. Can you tell me that story? He was having breakfast in his home and someone shot him through the window and hit his groin.

He almost died of blood loss and had to have a number of surgeries and did recover and did go back to work. And then a few years later, someone stabbed him at work. Did that give you pause about doing the kind of work you do? Yeah. I mean, I had to look around me. I still had young children. And I had to look into myself and decide, you know, if I'm going to be anxious all the

time, that's not a good thing. But my anxiety dropped and I was able to continue the work. And now it's much less, there's much less violence against abortion providers. So there was a time when I was wearing a bulletproof vest to work every day. And did that those feelings of anxiety just ebb over time because you weren't getting threats in the same way or did you just acclimate to a higher level of anxiety? No, I mean, it just it just went away. I'm not an anxious person.

So it's not surprising that my anxiety that particular, you know, the day Gary was shot, you know, that I was anxious. Do you think an anxious person could do the kind of work you do? Well, each of us handle our anxieties in our own ways. In your work as an OBGYN, you know, I imagine that you've dealt with maternal death or sort of unexpected infant death. Have those experiences sort of colored your understanding of your made work? Well, being a doctor means you work with tragedy.

I was so lucky to be involved in delivering babies and did over a thousand. And almost always there's great joy in the room. But of course, when it's the parents who are crying and the baby is not, then it's horrible tragedy and grief. And so that's part of being a doctor and I've been a doctor for a long time. I don't know that every doctor necessarily accepts that. I mean, there are all kinds of doctors who I think not only don't often deal with tragedy but maybe even are wanting to avoid having to deal with tragedy.

So I wonder if you have a perception of what medicine is fundamentally about that also has something to do with why you do the kind of work that you do that is maybe not shared by all doctors. Well, for example, not all doctors want to do palliative care even though most specialties have people dying. But you know, what I couldn't tolerate and was so grateful I didn't have to deal with hardly ever was the dying children. So I really admired the pediatricians who could work with these very, very seriously

ill children and dying children because that one just freaked me out. So we all have our limitations. I could deal with adults and their tragedies, but when it came to the children, I couldn't. So that was a little too hard. Yeah. You know, my mom's death and the bravery that she showed, she seemed to me lacking in fear. Thinking about it since she died just made me realize there's just so much bullshit in my life that

I need to be braver about. Like, if she can be brave about that, I certainly need to be braver about some of the basically inconsequential things that I feel like I'm not brave enough about in my life. And that's something that I feel like I'm now carrying with me that I wasn't before. So for you, a person who's around death so much, has your experience with death taught you anything about what makes a good life? Oh, yes. I mean, my patients teach me so much about that. And, I mean, at my age, obviously, I've lost loved ones, not just

my parents. So that helps to make you realize what's important in life. We just had Canadian Thanksgiving and so I saw all my kids and, you know, these are the really important things, and spending time with friends, and being with patients, and everything I do, I mean, I feel like everything I do should be worthwhile or fun, preferably both. I mean. I mean. I mean.

I mean. I mean. I mean. I mean. I mean. I mean. I mean. I mean. I mean. I mean. I mean. That's Dr. Ellen Wiebe. In the weeks following my conversation with Wiebe, a judge in British Columbia issued a rare temporary injunction preventing the medically assisted death of a 53-year-old

woman who had been approved by Wiebe for maid. This was in response to a civil claim from the woman's partner that Wiebe had wrongly approved the procedure because the patient's partner that Wiebe had wrongly approved the procedure because the patient's condition was mental, not physical. The case is still pending, and Wiebe declined to comment. This conversation was produced by Seth Kelly. It was edited by Annabel Bacon, mixing by Afim Shapiro. Original music by Dan Powell, Pat McCusker, and Marian Lozano.

Photography by Devin Yalkin. Our senior booker is Priya Mathew, and Wyatt Orm is our producer. Our executive producer is Allison Benedict. Special thanks to Rory Walsh, Renan Borelli, Jeffrey Miranda, Nick Pittman, Matty Masiello, Jake Silverstein, Paula Schumann, and Sam Dolnick. If you like what you're hearing,

follow or subscribe to The Interview wherever you get your podcasts. To read or listen to any of our conversations, you can always go to nytimes.com slash The Interview. And you can email us anytime at theinterview at nytimes.com. Next week, Lulu talks with Rosé, a member of the group Blackpink, about the making of a K-pop star. I felt like we were trained to always present ourselves in the most perfect, perfect way.

Um, in making sure that I'm a perfect girl for everyone. I'm David Marchese, and this is the Interview from the New York Times.