Audrey Parker was assessed and approved for medically assisted death, but because federal law requires that she be lucid at the time of death her plans were derailed

For weeks, Audrey Parker had been organizing what she called her “beautiful death”, carefully planning every detail of her final days, and even writing her own obituary.

Parker, a television makeup artist, was in excruciating pain as cancer crept from her breast into her bones and brain, and intended to end her life before the suffering became too overwhelming.

But because Canadian federal law required that she was lucid at the time of death – and fearing that the combined effects of cancer and medication could rob her of that clarity – Parker was forced to end her life months before she had intended to die.

With the help of a nurse, Audrey Parker passed away on 1 November, surrounded by friends and family in her Halifax home. She was 57.

Parker’s lost battle for greater autonomy in medically assisted death has reignited a debate over Canada’s legislation on medically assisted death, which critics say forces terminally ill people to choose two equally unpalatable choices: a death that is premature, or one that is painful.

Sign up for the new US morning briefing

Parker was not the first to use Canada’s medically assisted death laws – more than 3,700 already have done so since the country’s supreme court paved the way for physician-assisted death in 2015 – but she quickly became one of the country’s most prominent advocates for changes in the law.

“The world lost a person that had such spirit, who kind of always knew she was going to do something really, really important,” said Kim King, a close friend who was with Parker during her last moments. “And in the end, she did.”

Legislation passed in 2016 allowed anyone above the age of 18 with a “grievous and irremediable medical condition” to apply for physician-assisted death. Individuals must undergo consultations and be examined by two clinicians in order to gain approval for the process.

Parker was assessed and approved, but a key provision in the law – that she be of full mental capacity when the decision to terminate life is made – derailed her plans.

“When we realized the implications of the late-stage consent, it was very disturbing,” said King. “She was so courageous to face her death head on.”

If she wanted to die on her own terms, it would have to be when she was still mentally sound. While she wanted to live to see another Christmas, she told friends she couldn’t run the risk of waiting too long.

“She was worried about how this cancer had ravaged her body so aggressively that if she waited too long, she would lose capacity and then she would be completely denied the right to have an assisted death,” said Shanaaz Gokool, head of Dying with Dignity Canada. “And then she would die in a manner she knew will be horrible.”

For clinicians and bioethicists, Parker’s fight encapsulates an ongoing debate within the medical community surrounding how to best help patients in their final days.

“A lot of us knew when the legislation came down, that this would be one of the next battle grounds,” said Chris Kaposy, a bioethicist at Memorial University. While the law has produced troubling situations like Parker’s, it also aims to protect vulnerable people, said Kaposy.

Clinical ethicists often grapple with instances of patients with late-stage dementia, some of whom have requested physician-assisted death – but later forget these wishes and go on to live contented lives, he said.

“You have to walk that line between honouring legitimate directives, where people are suffering … But also you want to be able to avoid situations where you’re obligated to essentially kill people who are happy.”

Only three countries permit people to plan their death beforehand, and do not require competency at the moment of death: the Netherlands, Luxembourg and Belgium.

But according to King, “[Parker] didn’t suffer from dementia, she wasn’t vulnerable. And she was very clear about what she wanted.”

Parker’s death has prompted a fresh debate on end-of-life planning in Canada, said Dr Jeff Blackmer, vice-president of the Canadian Medical Association. “If you agree with assisted dying or not, one of the silver linings to this has been a more open discussion about death and dying in Canada – and about the choices that we make at the end of our lives,” he said.

A government panel which is studying the existing legislation will release its full report in December, but will not make any recommendations, and the government will not be required to act.

The day after Parker’s death, the federal justice minister, Jody Wilson-Raybould, expressed no intention of amending the current law. “We’re not considering changing something in the legislation,” she told reporters, adding that she and the government were “confident in the legislation”.

While the minister’s position disappointed King and other friends, they see it as a reason to keep pushing hard for changes in the law, continuing the battle Parker fought to the end.

“Until she took her last breath yesterday, she never wavered,” said King. “It was just so beautiful.”