A Merciful Death

I grew up in the ’80s and ’90s and remember being fascinated by the controversy around Jack Kevorkian. He was a Michigan doctor who argued that sick people should be allowed to die on their own terms rather than suffer through a grueling illness. Was he a traitor to his oath to “do no harm”? Or was he an angel of mercy, letting victims of disease exercise one last bit of agency over their failing bodies? Kevorkian, who went to prison for helping dozens of people with “physician-assisted suicides,” seemed so radical at the time.

Now his ideas are commonplace. Ten states and lots of Western nations have assisted-dying laws. But they’re mostly built for people with a life-ending diagnosis.

Canada is trying something more. There, a patient can have a state-sanctioned death if she is suffering — but not necessarily dying — from an illness. For the cover story of yesterday’s New York Times Magazine, Katie Engelhart followed one woman’s journey to die. It’s a nuanced portrait of a person racked with pain and a tour of some controversial bioethics. I spoke with Katie about the difficulty in knowing what’s right and what’s wrong when people suffer.

Your story has so much intimate detail about the struggles of the main character, Paula Ritchie. How did you get her to confide in you?

Paula was, in her own words, “an open book.” The first time I called her, we talked for nearly three hours. She had applied for medical assistance in dying, or MAID, after suffering a concussion, which led to dizziness and insomnia and pain that never went away. I knew that Paula would be an interesting case study, in large part because of the complexity — the messiness, really — of her life. She was the kind of patient whom opponents of MAID worry about. Paula had a mix of physical and psychiatric conditions: chronic pain, chronic fatigue, bipolar disorder, depression. She had a history of childhood trauma. She lived below the poverty line. She was very lonely.

You watched Paula die. I was moved, reading about her last moments. What was it like to see that?

I was trying to be as small a presence as possible in the room. I sat in a folding chair at the foot of her bed. As a reporter, the experience was doubly intense: I was there to do a job — to gather information — but I was also experiencing the moment as a human being, sitting in a room full of suffering. I said very little to Paula and she said very little to me, although she did briefly reach for my hand as she was getting ready for her injections.