Although medically assisted dying has been law for more than a year in Canada, Dr. Scott Anderson is one of only two physicians in the London area willing to help his patients die.

Anderson, an emergency intensive care specialist at London Health Sciences Centre, is one of only 74 doctors in Ontario and 11 in the South West Local Health Integration Network registered with the province's 1-800 number to help connect patients seeking the procedure with doctors willing to perform it.

Anderson suspects that, of those 11 doctors in the London area, he and only one other will actually perform a medically assisted death (a third is being trained). He believes the others are only willing to provide the patient consultations required for a medically assisted death.

Helping patients end their life isn't easy work, but Anderson sees it as necessary.

"Ultimately, it's about allowing the patient to have an autonomous decision about their own health care," he said. "When somebody is asking for your help to die, I don't see how the answer can be no."

So why is a medically assisted death so hard to access despite being law? The reasons why are complex.

In June of 2016, Parliament passed Bill C-14, which lays out the rules that allow doctors and nurse practitioners to legally end the lives of terminally ill patients who are suffering and whose deaths are "reasonably foreseeable."  

To access a medically assisted death, patients have to be 18, must be assessed by two doctors and must wait 10 days (in most cases) before getting a life-ending procedure.

In theory, the law allows patients who want a pain-free death to avoid needless suffering at the end of their life. But in practice, Anderson said there are too many barriers for what he believes should be a care option available to every Canadian who wants and qualifies for it.

One hitch: Doctors and hospitals aren't required to provide patients with a medically assisted death if they're opposed for religious or personal reasons. In London, faith-based institutions like the Catholic St. Joseph Health Care London won't allow staff to perform end-of-life procedures. 

This can be an issue in rural areas and smaller towns where the main hospital won't perform end-of-life procedures. 

Anderson said there are other barriers to medically assisted dying.

For example, he believes the phrase in the legislation that says a patient's death must be "reasonably foreseeable" in order to access an end-of-life procedure is problematic.

What about a patient in terrible pain with a disease that will eventually end their life, but whose death may not be imminent? 

Doctors sometimes face a backlash

There are other barriers.

The law requires that patients get two witnesses to their written request for medically assisted death. But those witnesses can't be anyone mentioned in the patient's will or involved in their care. This requirement can be a problem for a 98-year-old-care home resident who has outlived her friends and relatives.

Medically assisted deaths must also be reported to a coroner. That means faxing pages of medical information and consent forms.

Also, Anderson said doctors known to perform the procedure can face a backlash. He's public about providing doctor-assisted deaths, but the other London-area doctor who does them would rather stay anonymous. 

Urgent requests for a doctor-assisted death can come suddenly on weekends or evenings.

A few weeks ago, Anderson drove to two hours to Leamington to help a patient die there. In another instance, the patient wanted a medically assisted death but his family was against it. With his main responsibility to the patient, Anderson performed the procedure while the family was away from the residence.

Another time, he had to visit a patient at a filthy apartment filled with cat feces. 

But to Anderson, the ability to end a patient's suffering is well worth the trouble. He said his patients are often grateful to have control over their own death after losing everything to a devastating illness.

"I know no one whose witnessed one of these deaths who has thought of it as anything other than a dignified death," he said.