A Good Death: Making the Most of Our Final Choices

Sandra Martin

HarperCollins, 2016

Reviewed by Johny Van Aerde,




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The release of this book could not have been more timely. With facts updated to February 2016, it was published two months later in April, quite unusual for a book to be so up to date.


This book is, without any doubt, a must read for physicians, if not every Canadian citizen. One may think that it is about Bill C-14 (the medical assistance in dying bill). After all, author Sandra Martin is the journalist who wrote in the Globe and Mail, “Bill C-14... has far too little heart and far too much head. It is lodged firmly in the mindsets of risk-averse bureaucrats and politicians.”1


The book goes much further than that; it is a compilation of philosophical, historical, legal, and international issues related to assisted death, assisted suicide, palliative care, and euthanasia. It is based on facts and hundreds of interviews with people close to the issue — doctors, patients, ethicists, activists, and underground suicide aides. The opposition to decriminalizing assisted suicide and death is powerful and sometimes moralistic, with religious groups, “experts,” and palliative-care doctors sometimes raising a true panic. Martin parses through the arguments in a balanced way, without hiding which side of the argument she is on.


She gives an outstanding overview of the recent history of death, detailing legal skirmishes in Belgium, Luxembourg, Switzerland, the Netherlands, and parts of the United States that have drawn new boundaries in the battle for legalized death and euthanasia. However, it is Canada’s struggle that dominates her book.


The evidence is clear, not only that Canada is not an international leader in the domain of assisted death, but also that there is no nationally united health care system, even in death. As in so many components of the Canadian health care system, this has resulted in each province dealing with palliative care, assisted death, and assisted suicide differently.


Quebec is the most advanced province, legislatively, thanks to Veronique Hivon with her nonpartisan and unrelenting efforts during and after her political career with the Parti Québecois. On the other side of the country, British Columbia was first off the starting blocks, going back as far as 1993 when Sue Rodriguez, a courageous woman, challenged the law. A few years ago, there was the now famous case of Kay Carter, another BC woman, resulting in the decisions by the Supreme Court that have led to the present struggles of our government with drafting appropriate legislation. Top


Indeed, in February 2015, based on the Carter case, the Supreme Court of Canada legalized physician-assisted death and gave the government a year to implement legislation. A handful of Canadians have already pursued physician-assisted death in the interim, but they had to present their cases before the courts. In that kind of legal limbo, the rights of both patients and doctors under the Canadian Charter of Rights and Freedoms are at issue, and doctors are wary of the uncertain consequences. Top


In 2015, Adam Gopnik2 wrote in the New Yorker about radical reform as it pertained to gay marriage and argued that radical reform needs the underpinning of social consensus if it is to succeed peacefully and permanently. He submitted that an impossible idea becomes possible first, then it becomes necessary and, finally, all but a handful of diehards accept its inevitability. Making an impossible idea possible requires time, patience, and reasonableness. “The job of those trying to bring about change is... to move it into the realm of the plausible, and once it is plausible…, it has a natural momentum toward becoming real.”2 Martin makes the point that this is exactly what is happening with the assisted death issue.


Whether we like it or not, this pressing social issue is about to reshape Canada. Death must be allowed to evolve in tandem with our medical and demographic realities. Perhaps there was a time when assisted suicide or death did not reflect the moral or spiritual realities faced by most people. The issue has reached a tipping point, and Martin urges Canadians to get involved in the national dialogue on death with dignity. Reading this book is one way to start our fight for our final human right.



1.Martin S. The heart of dying: a personal journey. Globe and Mail 2016;April 16. http://tinyurl.com/ha9aosy

2.Gopnik A. Trollope trending. New Yorker 2015; May 4. http://tinyurl.com/lvzvmxj


Johny Van Aerde, MD, MA, PhD, FRCPC, is past president of the Canadian Society of Physician Leaders and editor of the Canadian Journal of Physician Leadership.


Correspondence to: johny.vanaerde@gmail.com