A Vancouver Island man who “overtly and repeatedly” said he planned to kill his wife—who is 77, has advanced Alzheimer’s and lives in a care home—has been stripped of the power to make medical decisions on her behalf after the health authority took the case to court. A B.C. judge granted a number of orders last week in light of what the decision refers to as the husband’s “death plan,” which he framed as an alternative to medical assistance in dying and referred to as a “dignicide.” The husband, who is referred to as T.W. due to a publication ban also said he planned to kill himself. “The issue in this petition is whether the (health authority) should be granted declaratory relief and orders to enable it to provide protection to a vulnerable woman against the likelihood of death at the hands of her husband,” Justice Brandford F. Smith’s decision begins. The woman, E.W., was diagnosed with Alzheimer’s in 2017. She was removed from her home and taken to hospital in January of 2022 after the Vancouver Island Health Authority exercised its emergency powers because of “imminent risk of death or grievous bodily harm,” the decision noted, adding that E.W.’s condition was deteriorating to the point where she was unable to fully care for herself. The so-called death plan was a key factor in this decision. E.W. had been deemed ineligible for MAID in late-2021, and T.W. told the assessing physician—among others—about his views on MAID and his plans for his wife. “T.W. is a strong advocate for MAID and has expressed to various persons that if he and E.W. are eligible for MAID they intend to receive it. T.W. has also overtly and repeatedly informed family, friends and Island Health personnel that if E.W. becomes ineligible for MAID, he intends to end her life and then take his own life,” the decision said. “E.W. never expressed agreement with the death plan. On the contrary, E.W. was understandably upset by it. E.W. expressed to (the couple’s daughter) that T.W. was trying to kill her.” Concerns that E.W.’s advancing Alzheimer’s might hasten her husband’s execution of the plan became more pronounced when health-care workers monitoring the situation noted apparent preparations underway which included “paying for funeral services and grave sites; selling assets and distributing the proceeds; preparing obituaries; and creating memorabilia as part of their collective legacy,” the judgment said. E.W. has been in the care of the health authority since she was removed and lives in a long-term care facility, which is not named due to the publication ban. “Since arriving at the facility, E.W. has settled in well there and believes it is her home. She is comfortable, calm, and does not experience any distress when T.W. is not present,” the decision said. “She thrives in a low-stimulation environment. She interacts with the other residents and is generally able to navigate to her own room” Had the health authority not succeeded in court, a temporary order giving Island Health the power to keep E.W. in the facility without her husband’s consent would have expired, paving the way for T.W. to take her home. “The concerns regarding E.W.’s safety while in the care of T.W. associated to the death plan have not abated,” Smith wrote. ‘Unwillingness or inability’ to act in wife’s best interests T.W.’s plan to kill his wife was not the only factor cited as a reason why he was not an appropriate person to be making medical decisions on E.W.s behalf. His behaviour, as observed since his wife has been in care, was also a significant factor. Because of T.W.’s belief that physical activity would help stave off further cognitive decline, he “repeatedly engaged her in physical activities and exercise beyond what is reasonable for someone of her age and with her diagnosis,” the judge wrote. This included “incessant gardening” that left E.W. in pain, having her play catch and hockey, and insisting she walk 5,000 steps a day “all without regard to E.W.’s wishes,” according to the decision. T.W. also “insisted” his wife should wake up at 6:30 every morning despite her increased fatigue, leading him to phone her most days to rouse her, the judge said, adding that staff at the care home have said E.W. disconnected or hid her phone to try to avoid these calls. E.W.’s clothing and shoes, when selected by her husband, were also “tattered” and inappropriate for the weather, the judgment said. In one example provided to the court, care-home staff described how T.W. forced his wife to wear “worn-out men’s work boots” which resulted in “her feet deteriorating to the point that they required specialized nursing care.” When the boots broke, T.W did not replace them but duct-taped them back together and “insists” she continue to wear them when he visits, despite the fact she has another pair of shoes. T.W. also would not consent to a professional haircut for his wife, instead doing the job himself “very poorly.” E.W.’s ability to connect with people—including her daughter—has also been “hindered” by her husband, the court heard. For the first two years E.W. lived in the care home, her husband did not allow their daughter to visit. “Facility staff have observed T.W. telling E.W. that they no longer have a daughter, or that their daughter has ruined their marriage and their lives, and that E.W. should refuse to see her,” the decision said. He would also “monopolize” available visiting hours, staying for the entire time meaning his wife could not be alone with any other visitors. For over a year, T.W. did not approve social or community outings for his wife, meaning the only times she left the care home was for two dental appointments. The one outing he did approve, was for his wife to attend a court hearing on the health authority’s application to renew a temporary order allowing them to keep her in the facility without her husband’s consent. “At the hearing, T.W. insisted that E.W. read from a script he had written for the court,” the decision said. While refusing to consent to outings or activities arranged by the care home, T.W. has planned things of his own. “T.W. has involved E.W. in overwhelming social gatherings, such as hosting a large group gathering for their anniversary, at which he made her read out letters and speeches that she did not write or understand, having her wear her wedding dress, despite her reported discomfort,” the decision said. “Visits and behaviours like these are not therapeutically beneficial to E.W., who is happier and more at ease when she is not overstimulated.” When T.W. visits, he often wears a homemade T-shirt or sandwich board saying “Free E.W.,” tells his wife she is being “jailed,” and “openly” accuses the care home of elder abuse, Smith’s decision said. “T.W.’s open expression of his loathing of the facility and its staff in E.W.’s presence has also caused her unnecessary upset and confusion,” the decision continued. T.W. also removed “all personal effects” from his wife’s room, including all family photos. The judge also noted that despite privacy laws and court-ordered publication bans, T.W. operates at least two websites and one YouTube channel through which he disseminates his wife’s personal, confidential, medical information and levels accusations against the health authority. All of these things, combined with the so-called death plan, demonstrated T.W.’s “failure to fulfill his duties and obligations” and showed an “unwillingness, or inability, to act in E.W.’s best interests,” according to Smith’s decision. Ultimately, Island Health’s win in court means T.W. is barred from acting as his wife’s representative and decision-maker for medical matters, removing his authority to provide or withdraw consent on her behalf. The health authority declined to comment on the case, citing patient privacy. “In general, as a designated agency under the Adult Guardianship Act, Island Health works to fulfill its obligations concerning the protection of vulnerable adults from abuse and neglect. This can include court proceedings,” a spokesperson wrote in an email. “Island Health is pleased with the court’s decision.” ‘The death plan is contrary to our murder laws’ Isabel Grant, a law professor at the University of British Columbia’s Peter A. Allard School of Law, said while the case had a potentially life-saving outcome—the decision itself is problematic. She points to the judge’s reference to the Criminal Code MAID provisions as one reason why. “T.W. formulated the death plan. As far as Island Health is aware, E.W. never expressed agreement with the death plan, which, in any event, is contrary to the Code provisions governing medical assistance in dying,” the judge wrote. Speaking about the potential criminality of T.W.’s so-called death plan as simply a violation of our MAID law and not as a potential murder is, in Grant’s opinion, a glaring oversight. “He is talking about murdering a disabled woman who does not have the ability to protect herself,” Grant said. “The death plan is contrary to our murder laws. And I think it’s really important not to have us talk about the murder of elderly people as some slightly improper form of MAID. That’s not what it is. It’s murder. Just because she has a disability does not transform this into something else. This case demonstrates how our MAID regime has normalized death as a response to disability for the elderly,” Grant said. Grant also said she finds it troubling the decision does not indicate that any moves were made by any authorities to limit or prevent T.W.’s contact with his wife in light of his seemingly unabashed professions of his intent to kill her, or that there was any discussion about how or whether his actions would warrant a criminal investigation or charge. The relationship between T.W. and E.W. is also one with all the hallmarks of coercive control—a form of intimate partner violence that Canada is taking steps toward criminalizing, Grant pointed out. In that context, Grant said the repeated references to T.W. advocating for MAID for his wife, his apparent attempts to find a way consent to it on her behalf, and his plan to kill her if MAID was not available are particularly troubling. Cases like this one, with a stark power imbalance and troubling pattern of coercively controlling behaviour highlight the risks of the MAID regime in the context of intimate partner violence and coercive control which puts overwhelmingly disabled women at risk, according to Grant. “He’s describing the planned and deliberate murder of his wife,” she continued. “There is no indication that E.W., even when capable, wanted her life to be ended. To the contrary she has expressed fear of this ‘death plan.’ He has made the judgment for her, and it is not his to make.”
