this is bbc news. we will have the headlines and all the main news stories for you at the top of the hour as newsday continue straight after hardtalk. welcome to hardtalk. i'm stephen sackur. in 2021, more than 10,000 canadians died at the hands of health care professionals. thanks to the country's legalisation of euthanasia. a handful of other countries have also legalised doctor assisted dying, but often with more restrictive rules.

so, canada has become something of a global testing ground for the complex ethical, medical and social issues raised by euthanasia. my guest, dr stephanie green, is a specialist in medically assisted dying, and has overseen more than 300 deaths herself. is canada at ease with its role as assisted dying pioneer? dr stephanie green in victoria, canada. welcome to hardtalk. thanks for having me. it's a pleasure to have you on the show, dr green.

now, you are an experienced medical doctor, but your particular focus for the last few years has been offering medical assistance in dying. so, in terms of your day to dayjob, what does that actually mean you do? mostly, it means i talk to a lot of patients. practically speaking, what it means is i meet with families and patients who are interested in talking about their end of life choices, specifically about the possibility of an assisted death. i do a lot of education and a lot of informing patients what that is, what it isn't, what other options might be. we talk about the process, the procedure. there's a very rigorous process that needs to happen if they want to go down that path. so, we work together through that process if necessary. and of course, ultimately, for some, it's a matter of offering the procedure itself administering the medications that will help somebody to end their life. right.

and i do want to delve into the detail of how choices are made by people at that end of life moment. but i'm also actually really interested in your choice. so, let's start there, because you were trained in obstetrics. you know, your work, before all of this, was with women about to give birth and delivering babies. in a sense, you were there at that moment of new life. why did you choose to make this dramatic switch in your medical career to focus on the moments of death? i'm actually trained as a family doctor, so everything from what we say is cradle to grave medicine. i did general practice for many years and always focused on maternity care. i've always had an interest in the intersection between medicine, ethics and law. and i... i found i was able to find that through women's health, maternity care, reproductive rights. and i very much enjoyed my work. and ifound, much to my surprise, actually, that my work, my 20 years working in maternity care, really, really prepared me well for end of life. there's a similar skill set

where you are dealing with families that one of the most intense days of their lives, a very emotional time in their lives, with a lot of family dynamics going on. and i'm there as a knowledgeable guide to help them through this incredibly intense and natural event. and all of those things can be said at the end of life as well. why did i make that change? i had a number of... it's not a very linear line... a number of issues. i wanted to be home a little bit more. i was finding after 20 years of providing maternity care and delivering babies, that being 2a hours in hospital and recovering from that time was becoming physically harder. i wanted to be around before my kids left. i was looking for a shift, and i'd been following the assisted dying debate in canada for 30 years since i was in medical school, and i believe very, very strongly in patient autonomy and what we call patient centred care. and i found that the idea of assisted dying was really focused on that. and i wondered who would do this work? and i felt that

i could do this work. the more i learned about it, the more i was drawn to it. that hippocratic oath which all doctors follow. i will use my powers to help patients i was sustained from harm and any man or woman. yourjob is to carry around a bag of toxic poisons and administer them, i'm not trying to be flippant, administer them them to people who are suffering grievously. i think there are two

words in your statement that are important. one is to help. we help our patients. we might do that in different ways. we care sometimes, we comfort always. i think helping is what the essence of what we do. the other where it is harmful i don't think i'm harming anybody. if you speak with the patients and families i am actually helping them with their illness and disease. that is what is harming them and killing them. i am there to help them at the time of great need and i think it fits perfectly with what clinicians do. it is clear this is a hugely complex, ethical and moral area. end—of—life care. before we get into the details of the cases, i wonder, when pope francis came to canada in 2022 and made of addressing the fact that canada has the highest number of euthanasia deaths in the whole world. he said we need to learn how to listen to the to listen to the pain of the poor and marginalised people

in place of affection. in relation to canada he said patients are administered death. that was a message, in a sense, directed at people like you. in place of affection, patients are administered death. how do you feel about that? it is not something the first time i disagree with something the pulpit said. i don't agree with that impression. i take issue with that. i think we offer affection. i think we offer caring and compassion. we do it's in a professional manner. a rigorous system with oversight. it's a legal framework. it's a rigorous framework. so i'm proud of what we do. i think everyone can think what they wish but that does not phase me. let's talk mechanics if we can, doctor green. when you meet someone who fits the bill, they want to die, they explain the reasons they want to die, how

does the process work? from that wish to die to end point itself and your delivery of death? so every case is really individual. that sounds a little bit flippant to say but it is true. there is no standard path that anyone will take, but generally speaking the process is that the patient needs to be the one to make the wish. no one else can ask for that on their behalf. the patient expresses their wish in a written form it is signed and dated and witnessed. it is an official form. two clinicians need to see the patient separately and have an independent assessment to make sure that the medical and legal criteria are met. it is a rigorous system and i won't go through all the details but there are approximately eight or nine things that need to be found to be true. the prime ones that your audience might be interested

in, the patient has to make a voluntary request and have the capacity to meet the request. they need to be suffering intolerably and other issues need to be found to be true. 0n on top of that, there are a number of procedural safeguards that need to be met. if all of that happens, there is the matter of empowering the patient and saying that you are eligible. that doesn't mean you would have an assisted death or that you must, but that you may. that in itself is therapeutic. is there a in—built time lag? from the expression of wish to the end. are there time restrictions or controls put in to ensure the issue and is fixed and that minds have not changed? how does that work? 0ur original legislation required about a ten day period from the time that the wish was made in writing until the event could happen.

we found that created a lot of anxiety in all our patients who were close to the end of life and concerned that any to retain capacity. there were refusing the medication and intervention in order to ensure they could make that final decision which was another safeguard in our system. that ten day wait has been removed from our law found to be because it was detrimental. now we have two objects. the two first step is that's which are reasonably foreseeable. they can make their wish, go through the process and plan their death in whatever timeline works for them. for patients whose death is not reasonably foreseeable, track two, there is a minimum assessment of rather 90 days to make sure it is fulsome. i find that is a low bar those cases can be complicated and can take months and months

of time but there's a minimum of 90 days for those whose debts aren't foreseeable. doctor green let me ask you a blunt and personable question. what is it like for you to be physically with the person at the time of their death, and for you to be the person administering the lethal cocktail of drugs that kills them? you are killing them, unlike in certain situations, like california and countries in europe where assisted suicide is allowed. where medical professional can be present, but they have to administer their own drugs. you are administering the lethal drugs and you are killing that person. i was concerned when i began the work and wondered what that would be, but after some thought, the most accurate thing i can say to describe this work is privilege. i feel incredible privileged to be invited into that intimate time

for a patient who is at the end of their life, to be asked to facilitate their final wish. to be trusted in that time and journey with them and witness their suffering and help them choreograph this very important event. it is, i find very privileged worked and ifound it to be profoundly meaningful. people express a lot of gratitude for this possibility, and a lot of relief they can have the open and honest conversation. i have been overwhelmed by the gratitude expressed by the patients and their families for this work. that is a powerful way of putting it. i wonder, whether at that last moment as you are about to begin the administration of drugs, have you ever had somebody say "i can't go through with this?" "this can't happen. " i've never seen that, personally. i have had a significant amount of experience.

in that time, i think in think of two patients who changed their mind when i showed up. we give them, i give my patients opportunity to change their mind and we give them the opportunity right up until that moment you describe. i had two patients who said they weren't ready and one of them died that night from their own medical complications, and the other call me back the next day and asked me to come as soon as possible. other than that, i have not seen that personally. people do not enter that decision lightly or spur of the moment. they speak months and years and they come to me when they are ready to make this choice and they are frustrated the process takes time to go through. but i have not seen personally a lot of people changing their minds. i think, i see they are very much ready on the day of the event ourselves and very much

at peace and ready to move on. theirfamily and friends are grieving and it is harder for them than the patients in my experience. as you alluded to in our conversation, there are rules regarding those who are terminal and those who are suffering unendurable long—term pain but are not actually terminally ill. the canadian law has expanded its scope over the period from 2016 to the present day. many canadians it seems are worried that as it stands, the rules around assisted dying essentially give it a signal to the country that enduring disability is now a sort of qualifier for euthanasia. is that a fair comment? i think that is inaccurate, to be honest. i think context is important. the original high court decision, the change in our laws didn't come

because patients demanded it, or the government thought it was a good idea. this was a rights issue in canada which is quite unique. it is determined that the blanket prohibition of assisted dying was infringing on certain peoples rights in certain circumstances. in that decision it is important to note that the court decision did not require a link with end—of—life or a terminal illness. the government imposed what they called reasonably foreseeable death, which was never meaning terminal illness. it was never an eligibility criteria in canada. it was put in place by 2016 by the government and was felt to go against the courts decision and challenged in the courts. the court in 2019 verified it was constitutional to chanel he invited and removed it from our law.

so we never required terminal illness and we don't now, but we do have a path for those whose deaths are reasonably foreseeable with a time frame around it. that in mind, it doesn't mean that because your enduring disability that you qualified for assisted death. there are many things that need to be true. serious illness, disease or disability is one factor. patients also need to be in advanced stage of decline. you are outining it very clearly but people in canada today say that the fact is some people, severely disabled, with different kinds of conditions that are given their lives enormous pain and difficulty they turned to assisted dying, simply because the health care and economic situation they are living in in canada today is not able to improve their lives to a point where life would be endurable. they say, rather than offering these people a chance to die, what we should really be doing

is entirely focusing our attention on fixing the problems on health care and economic situations which would give them a better quality of life. yeah, i think that we absolutely need to recognise that there are social inadequacies. we have done terribly, like many countries. canada has not lived up to his promise in terms of community mental health services, disability support. some areas don't have palliative care. we need to do better in housing and income stability. these are real problems. i stand loudly and proudly with anyone demanding better. i can't do myjob probably if i can offer these things to my patients. federal law requires me to make patients aware of the means to reduce their suffering, including those resources. and to make sure that they seriously consider them. if they don't exist, it's very

difficult for me to do myjob. 0n the other hand, if those things don't exist we can't hold individuals hostage to societies failings. we need to do better in those issues, but that doesn't mean we shouldn't allow assisted dying for people who are suffering intolerably and a system inadequate to help them. there is a difficult question about prior association prioritisation. one case about the four canadian veterans who in the autumn of 2022, it seems, were offered the possibility of assisted dying by a caseworker who looked at their individual circumstances. one of them was a well—known para—olympian who said she was offered the option of dying by this health care employee after she said that she didn't have a ramp, a wheelchair ramp in her home, and was struggling

to get one installed. that is terrible. that is so shocking. how can that happen in canada? it is ludacris, i agree. you mention it was a caseworker. i don't know why a caseworker in veteran affairs would be bringing up assisted dying with someone. clearly, someone has stepped out of their lane. it is not theirjob or ability to do so. they don't have a professional responsibility to do so. that is a ludicrous error. in some countries, where euthanasia is legal, there is a rule where no professional involved in care can initiate a conversation about assisted dying. but that is absolutely not the case in canada, is it? so, and i agree it shouldn't be the case. where going talk about that. no

caseworker should ever be bringing it up. i agree with that and it was clearly a ludicrous error someone made. in the circumstances, when a clinician is dealing with a patient it is my professional obligation to offer all options to a patient when they are available. if i have a a patient that requires chemotherapy and i know of three regimens and i only offer one i am professionally liable for not doing myjob. if a patient is in a specific situation and talking about end—of—life choices and exploring their goals of care and discussions about what they want and don't want, and talking about palliative care and what is available, it would be professionally obligated for me to say, something along the lines of some people in canada are interested in hearing about assisted dying, it is newly available, is it something you want me to discuss with you? i think you can ask

a question and raise an issue in a compassionate way and the patient can guide that conversation. for me to not do so would be not doing myjob. but outside of that it is something that should not be happening. in numbers, canada has the highest number of deaths by different forms of assisted dying in the whole world in 2021. some doctors involved in this are now getting worried. i'm talking about doctor lee for example who also works in this field as you do who is now worried. she says the laws are too vague and "i don't think death should be the societies solutions for its own failures. i think the canadian populace and maybe legislators are not now all aware of who is qualified and who has been dying in this way." she is beginning to get very worried. are you? i very much respect doctor lee.

i work with her and i respect her point of her view and disagree with it. i think we have a rigorous system with a number of safeguards and eligibility criteria that are being exceptionally well adhered to. i know the colleagues in my country that do this work do it carefully and conscientiously and are aware that if they get it wrong they are liable for jail. we have been careful in the past 6.5 years. there has not been one charge against a clinician for doing this work in an abusive way or in any way out of the system. i think there are people who are concerned about the role of government in supply and the social needs, but that is different than the main programme. quickly before we end. the canadian government is wrestling about whether to go with another expansion of the parameters of assisted dying to include severe forms of mental illness. do you support that expansion?

it's not whether i support it. it's up to the constitutional experts in our country and they have i spoken about that for some this is a measure of inclusivity. not an expansion of our law but a restoration of the rights of those with severe mental health disorders in rare cases. so they also have the access to this care should whatever the law says, i will follow. it is not whether i agree or not. the question is not whether it would happen but how to do it safely and we are grappling with how to do that. canada is seen across the world as the place with the most liberal assisted dying laws in the world. do you think that is something that canadians should be proud

of, or something right now canadians need to think hard about or worry about? i think we need to remember that canada has learned from otherjurisdictions. we saw what was working in europe and what wasn't, we saw what was working in the us and what wasn't. we have clinicians who can administer the medications and taking that has allowed us to create models that has allowed us more to the point what patients need and require with still a very rigorous system. i think canadians are supportive and proud of the opportunity to have this care available to them and are grateful for that, and i don't think there's anything to be particularly concerned about in that. doctor stephanie greene it has been a pleasure talking to you. thank you for being on hardtalk. thank you for your time.

hello. it was a very mild weekend and it looks as though monday is going to be every bit as mild. but how about the week overall? here's the summary. that mild start monday and tuesday. we're expecting a cold front to reach us on wednesday. so there will be some rain midweek. and then after that, it's going to turn a little bit colder. so here's the forecast. and starting with the satellite picture, you can see the clouds are still streaming in out of the southwest. so a mild direction, hence those higher temperatures. and the weather map also shows isobars and plenty of them across northern scotland. and that means those strong winds will continue through early monday. so the forecast then shows lots of cloud through the early hours, but a few clear spells as well. wet in western scotland, and the early morning

temperatures will be typically around double figures across the board, maybe a little fresher in the south where we will have had a few clear spells. so lots of cloud first thing, but clouds will break to give way to sunny spells, maybe to the east of the high ground around the midlands to the south. temperatures could actually reach 16 degrees celsius in eastern parts of the country. but where the clouds persist, more typically around 11 to 13 degrees. so that's monday. how about tuesday? a weather front is approaching which will introduce eventually colder air, but it's still to the west of us. we're ahead of it and ahead of it. we've got that southwesterly airstream and a lot of cloud around on tuesday and the cloud will be thick. i don't think there'll be many sunny spells developing on tuesday. temperatures still managing to reach around 11 to 13 degrees celsius. and then a change happens on wednesday. a cold front sweeps across the country and pushes the milder air towards the east. but it's not desperately cold air. in fact, we're expecting the temperatures to return to the seasonal norm.

so, yes, it's a northerly from a cold direction, but it's not all that cold. i think it's going to feel colder because of the cloud and the rain and the stronger wind on the north sea. so the temperatures even as high as ten degrees in one or two spots. and yes, there is a chance of a few wintry showers, but that's mostly across the scottish mountains. so midweek, yes, a mixed bag with outbreaks of rain. here's the summary with the outlook. a mild start to the week rain midweek with that slightly colder air arriving and then end of the week, it could actually improve once again. bye— bye.

welcome to newsday reporting live from singapore. i'm karishma vaswani. the headlines: north korea is accused of firing ballistic missiles into the sea of japan just a day after a similar launch. police looking for nicola bulley, the woman who disappeared in the north—west of england, say they've found a body. nearly two weeks on from turkey and syria's devastating earthquakes, the search for survivors is to come to an end. will russia soon be buying chinese weapons for its war in ukraine? that's what the us says, and they're warning beijing not to do it. and going with a bang — the film about the first world war that's proved to be a big winner at the baftas.