After weeks of debate, Canadian lawmakers have passed legislation to legalize physician-assisted death.

That makes Canada “one of the few nations where doctors can legally help sick people die,” as Reuters reports.

The new law “limits the option to the incurably ill, requires medical approval and mandates a 15-day waiting period,” as The Two-Way has reported.

The Canadian government introduced the bill in April and it passed a final Senate vote Friday. It includes strict criteria that patients must meet to obtain a doctor’s help in dying. As we have reported, a patient must:

• “Be eligible for government-funded health care (a requirement limiting assisted suicides to Canadians and permanent residents, to prevent suicide tourism).”
• “Be a mentally competent adult 18 or older.”
• “Have a serious and incurable disease, illness or disability.”
• “Be in an ‘advanced state of irreversible decline,’ with enduring and intolerable suffering.”

As a safeguard, the law also requires that two independent witnesses be present when the patient signs a request for a doctor-assisted death.

A headed debate emerged over whether to require patients to prove that their “natural death has become reasonably foreseeable,” as the law reads.

Some lawmakers wanted to broader eligibility criteria that would include degenerative diseases, Reuters reports. “The key amendment that senators had been pushing for was to broaden the criteria for who qualifies for assisted dying,” reporter Dan Karpenchuk tells our Newscast unit. “They had insisted that it includes suffering Canadians who are not close to death.”

Ultimately, the senators dropped the amendment and adopted the bill with the more restrictive language – but Dan says the law will likely be challenged in courts. He adds:

“Some senators say [the law] is immoral, adding that there could be people facing years of excruciating suffering, but not yet close to death. And in launching expensive legal challenges many who are desperately ill and their families could go broke from court cases to determine if they have the right to an assisted death.”

Justice Minister Jody Wilson-Raybould had opposed the broader criteria, arguing that it would mean that patients with “any serious medical condition, whether it be a soldier with PTSD, a young person with a spinal cord injury, or a survivor whose memory is haunted with memories of sexual abuse” could be eligible for a physician-assisted death, as CBC reports.

After the legislation was passed, Wilson-Raybould said in a statement with the Attorney General and Minister of Health that it “strikes the right balance between personal autonomy for those seeking access to medically assisted dying and protecting the vulnerable.”

Canada’s Prime Minister Justin Trudeau had backed the legislation, which was introduced after Canada’s Supreme Court struck down a ban on doctor-assisted suicide last year.

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Dr. Joshua Corsa, a senior surgical resident at the Orlando Regional Medical Center, operated on victims of the Orlando gay nightclub shooting. Abe Aboraya/WMFE hide caption

toggle caption Abe Aboraya/WMFE

A pair of bloodstained shoes has become a symbol of Orlando’s defiance in the face of extraordinary trauma.

The shoes belong to Joshua Corsa, a senior surgical resident at the Orlando Regional Medical Center. They were almost brand new when the hospital received scores of victims of the mass shooting attack on a gay nightclub Sunday morning that left 49 people dead.

Corsa tells reporter Abe Aboraya of member station WMFE that he worked in packed operating rooms for some 30 hours. He finally got a chance to try to sleep — unsuccessfully, he says — and returned to work on Monday morning.

There to meet him were his bloodstained shoes from the previous day — and “that’s when a lot of the enormity of it kind of struck me … that tangible reminder,” he says.

Corsa posted this image of his bloodstained shoes on Facebook Monday morning after hours of caring for Orlando shooting victims. Courtesy of Joshua Corsa hide caption

toggle caption Courtesy of Joshua Corsa

Corsa then sat down and wrote a Facebook post reflecting on the events, which was shared hundreds of thousands of times:

“These are my work shoes from Saturday night. They are brand new, not even a week old. I came to work this morning and saw these in the corner [of] my call room, next to the pile of dirty scrubs.

“I had forgotten about them until now. On these shoes, soaked between its fibers, is the blood of 54 innocent human beings. I don’t know which were straight, which were gay, which were black, or which were Hispanic.

“What I do know is that they came to us in wave upon wave of suffering, screaming, and death. And somehow, in that chaos, doctors, nurses, technicians, police, paramedics, and others, performed super-human feats of compassion and care.

“This blood, which poured out of those patients and soaked through my scrubs and shoes, will stain me forever. In these Rorschach patterns of red I will forever see their faces and the faces of those that gave everything they had in those dark hours.

“There is still an enormous amount of work to be done. Some of that work will never end. And while I work I will continue to wear these shoes. And when the last patient leaves our hospital, I will take them off, and I will keep them in my office.

“I want to see them in front of me every time I go to work.

“For on June 12, after the worst of humanity reared its evil head, I saw the best of humanity … come fighting right back. I never want to forget that night.”

The powerful post has since been made private. You can listen to Corsa read it here:

He says he is still wearing the shoes — now wrapped in shoe covers, because of the blood.

To him, they serve as a reminder, “not of the terrible things that happened, but of the good that came from them … how the city came together, how the hospital came together.”

He adds: “These patients are some of the nicest people I’ve ever met and I think it’s good to have a tangible reminder to look at every day, remind yourself that there’s still good out there even in the face of this.”

Corsa started his medical training as an Army medic, an experience that he says “helped me to stay somewhat calm” as he treated the victims of the deadly attack.

He adds that he hasn’t had time to process the events. “You almost enjoy the work in that it keeps you from having to sit down and deal with it,” he says. “You’re able to focus on the patients, which is what’s truly important.”

Corsa says that the situation at the hospital is becoming calmer. “We finally started a turnaround where it’s less damage control and more starting to think long term, down the road,” he says.

And five days after he posted the viral photo, he is still vowing to continue wearing the shoes until the last victim of the Pulse nightclub shooting is discharged.

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Stanford law professor and bioethicist Hank Greely predicts that in the future most people in developed countries won’t have sex to make babies. Instead they’ll choose to control their child’s genetics by making embryos in a lab.

On KQED’s Forum program, Michael Krasny spoke with Greely about his new book, The End of Sex and the Future of Human Reproduction. Greely highlights the ethical and legal questions that might arise in the future’s reproductive paradigm.

This conversation has been edited for length and clarity.

Krasny: There are a lot of new advances, technology and so forth. We reached the point where you get some sperm donor and a little piece of skin and you’re in business because of stem cells.

Greely: My book argues that two different biomedical innovations coming from different directions and not really propelled by reproduction are going to combine here. One is whole-genome sequencing, and the other is what I call easy PGD, preimplantation genetic diagnosis, [that] is, getting rid of egg harvest … which is unpleasant, dangerous and really expensive.

This ties in with in vitro fertilization also being not as onerous as it has been in the past.

What I think is going to happen, we’ll be able to take some skin cells from anyone and turn them into any cell type. Make these into eggs or sperm and that is going to make IVF much easier, cheaper and less dangerous.

You [can] decide, “Well, I want these traits,” and it becomes a selective process.

Yes, I think we will see an increased and broad use of embryo selection. I would be careful to set the time frame at 20-40 years. I think we’ll actually see a world where most babies born to people with good health coverage will be conceived in the lab. People will make about a hundred embryos, each will have its whole genome tested, and the parents will be [asked … “Tell] us what you want to know and then tell us what embryo you want.”

This could bring down health care costs, and it is also good for same-sex couples, isn’t it?

Well, yes and maybe. I think it should bring down health care costs, and, in fact, one of the advantages to it is that it would be so beneficial for public health care costs that I think it would be provided for free. If it costs say, $10,000 to start a baby this way, 100 babies is a million dollars. If you avoid the birth of one baby with a serious genetic disease, you’ve saved $3 [million to] $5 million. The same-sex issue, I think that’s going to work, but that’s another jump. That would be taking a skin cell … from a woman and turning it into a sperm. I think [it’s] probable, but that hasn’t been done yet.

This is not the end of sex — because recreational sex will always be with us — it’s the end of sex as a way of procreating.

I think it will not be the complete end. I think people will still get pregnant the old-fashioned way, right, sometimes for religious reasons, sometimes for philosophical reasons, sometimes for romantic reasons, sometimes because they are teenagers and the back seat of the car is there.

A lot of people talk about playing God, but before we get into that, there’s the rubric of consumer eugenics. And there is a eugenics fear when we start talking about selection.

There certainly is. Eugenics is a slippery word; it means many things to different people. To some, it’s state-enforced reproductive control. To some … what we had was state-enforced sterilization. To some, it’s any kind of reproductive choices, but those are different things. For me, I think the coercion is much more important than the issues of selection. The concern about the state or the insurance company or someone else, forcing you to pick particular babies, worries me a lot more than having parents make choices, though that raises its own set of questions.

What do you see as the biggest question here?

I worry about the dilemma of Republican legislators in very conservative states. They want to spend as little money as possible on Medicaid. I could imagine a state saying, “We’re not going to pay for this via Medicaid,” which would mean that the roughly 40-50 percent of babies born in that state who are paid for by Medicaid wouldn’t get to go through this, and although they are not “superbabies,” adding another 10-20 percent health advantage to the babies of the rich over the babies of the poor is a bad thing.

Listen to the full interview here. Greely shares his thoughts on cost, socioeconomics, gene editing and the ethics of designer babies.

This story was produced by KQED’s daily health and technology blog, Future of You. The blog’s host and editor is Jon Brooks.

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