By Howard Schneider
Washington Post Foreign Service
Tuesday, July 15, 1997; Page A13

By early November, Paul Mills had undergone 10 operations over six months associated with his throat cancer and was, according to officials at the Queen Elizabeth II Health Sciences Center, in "tremendous discomfort." Life support had been withdrawn at the request of his family. He was wracked with infection and likely within hours of death.

It was then that intensive care physician Nancy Morrison took a step that her supporters contend was well within a doctor's province given the patient's condition, but that others say went too far. On Nov. 10, she administered a dose of potassium chloride, a drug that can be therapeutic under certain conditions but that, in sufficient quantity, stops the heart so efficiently that it is authorized as a lethal injection drug for executions in some American prison systems.

Mills died, and Morrison was charged with first-degree murder, in a case that may prompt Canada to address medical, legal and ethical issues it has so far skirted. Unlike the United States, where the suicides assisted by physician Jack Kevorkian and other cases are leading state governments to set rules for how and when the life of terminally ill patients can be ended, Canada is only beginning to confront those questions.

Canadian federal law prohibits assisting in a suicide, and conviction carries criminal penalties of up to 14 years. But when it comes to managing the end of life, Morrison's lawyer and others say, Canadian doctors practice in a gray area where some drugs, including morphine, are considered acceptable palliatives, even in doses that arguably accelerate the moment of death, while others, like potassium chloride, are taboo because they accelerate it too much.

"Euthanasia and mercy killing are not terms known in Canadian law," prosecutor Craig Botterill told Maclean's magazine. "This is a first-degree murder charge, and I'm arguing that she killed him."

There have been other cases in Canada involving similar issues, but none as potentially pointed as Morrison's, and none that has yet caused the country to clarify its laws.

Vancouver resident Sue Rodriguez, crippled with Lou Gehrig's disease, asked the Canadian Supreme Court to sanction her suicide in 1993, but the judges said that would require a change in the country's criminal code. She eventually took her own life with the help of a doctor, but no charges were filed. Twice in Ontario, health care professionals have been charged with murder for using potassium chloride on terminally ill patients, but in both cases prosecutors reduced the charge to the less serious "administering a noxious substance."

Morrison's lawyer, Joel Pink, said no such deals are being offered in her case, and even if they were, Morrison feels she did nothing wrong. Putting her on trial for murder, he said, will call into question practices in intensive care units throughout Canada, and in so doing help lead the country to clarify policies governing the terminally ill.

"The doctors should be shuddering in their shoes" over the implications, Pink said. The case likely will not go to trial until next year. In the meantime, the 42-year-old physician resigned her intensive care post at the Victoria General unit of the health sciences center, the largest medical complex in eastern Canada. She is still practicing medicine and remains on the staff of Dalhousie University's medical school.

The case will be a touchy one for both sides.

Mills was recorded as having died of natural causes related to his infections, and no autopsy was performed. Pink said it may be difficult for prosecutors to convince a jury that the injection of potassium chloride is what actually ended the life of a man whose system was already shutting down, let alone prove that his death amounts to a planned and intentional killing.

"Everybody had said their goodbyes" to the 65-year-old man, Pink said.

Working against Morrison, however, is the fact that she did not consult the family before deciding on the injection.

Mills's widow, Dorice Lastowski, said in a telephone interview that the family had agreed to end life support but that she would never have sanctioned a life-ending injection. She said Mills had been on life support at a New Brunswick hospital the previous summer and that doctors told her then he was within a few days of dying. He recovered enough to live a while longer without the machines.

"I am still shocked by it," Lastowski said. "We took it for granted that they would take him off the life support and let nature take its course, but that did not happen.

"I know he was a very sick man," she said, but "if God was ready to come and get him, He would have come and got him. . . . Even if it had been a mercy killing, you have no right to take somebody's life."

Within the hospital, some of Morrison's colleagues also questioned her judgment. An internal review was commissioned, and she was suspended for three months from practicing in intensive care. One colleague, dissatisfied with that punishment, triggered the murder investigation by notifying police.

Whatever the outcome of Morrison's case, the broader debate is already beginning over issues that a Canadian Senate committee tried to tackle two years ago. No legislation was approved as a result of that study, but it concluded that Canadian politicians will, as they have in the United States, soon have to clarify the rules for treating the terminally ill.

"There is a line between acceptable medical practice and unacceptable medical practice, but the line is gray and it is a foot wide," said Peter Spurway, public affairs director for the hospital center. "It has been ignored, because it is politically difficult. . . . The [baby] boomers are going to stand up and say, 'I am not going to die an ugly, agonizing death.' "

After charges were filed against Morrison, Halifax police and hospitals received calls from around the country from relatives of people who died in intensive care.

"People see the details and say, 'The same thing happened to my mom,' " said Halifax Police Constable Gary Martin. He said police are looking into 23 other cases involving Halifax area physicians and hospitals.

John Butt, the province's chief medical examiner, is reviewing other cases as well. He said he has already found some that, given the charges leveled against Morrison, he feels should be reviewed in more detail by police and prosecutors.

With murder charges pending against one doctor, he said, Canada is by necessity going to have to start making distinctions between types of drugs and treatments for the terminally ill, the effects of which are partly a matter of degree. Administered as an injection, in sufficient quantity, potassium chloride disrupts the electrical conduction that keeps the heart beating, Butt said. The sedative effects of morphine, by contrast, may occur more slowly, but can shut down the cough reflex or other functions and so accelerate the moment of death.

The line that separates what a society considers compassionate from what it considers criminal, he said, is one that Canada must now draw.

"The amount of narcotics that are used in palliative medicine would not fit into those sorts of cases where one was more concerned with the preservation of life," Butt said. "The decision is on the knife edge."