Agency, Autonomy and Will: Who Decides?
Photojournalist Ian Willms on Assisted Suicide, Mental Health and Journalism Ethics By Kimberly J. Soenen | January 30, 2024
(An image from the project “We Shall See.” Photo by Ian Willms)
Canada announced on Monday that it is postponing a plan to offer people suffering from mental illnesses the option of a medically assisted death.
The New York Times reported just hours ago that an “announcement by Mark Holland, the health minister, and Arif Virani, the justice minister, came after a special parliamentary committee looking into the plan concluded that there are not enough doctors, particularly psychiatrists, in the country to assess patients with mental illnesses who want to end their lives and to help them do so.”
I have been in conversation with photojournalist Ian Willms about this bill since the fall of 2023. Willms is a Toronto-based highly-accomplished professional photographer who is especially skilled as a lyrical photo essayist. He is dedicated to long-form, in-depth visual reporting about health, culture, conflict and the human experience.
We started our conversation with what attracted him to the legislative debate and how covering the assisted suicide issue has impacted him professionally and personally.
Soenen: Were you assigned the story of assisted suicide for mentally ill persons or did you pitch it out of interest? Meaning, were you interested in this legislative debate in Canada or was it new to you to explore journalistically?
Willms: I was assigned to the story, but I was also personally interested in the issue because my mother has volunteered for Dying With Dignity in the past. She became an advocate for Medical Assistance in Dying (MAID) after caring for my grandfather at the end of his life in 2005. My grandfather suffered horribly in his final months and would have been a likely candidate for the MAID program.
In 2015, I lost my father after he endured months of pain and suffering in an Intensive Care Unit, a time which I photographed as a means of coping in the moment.
Those experiences left me dealing with Post-Traumatic Stress Disorder and severe anxiety for years afterward. Most recently, someone very close to me disclosed that they were wanting to access MAID because they could no longer cope with their treatment-resistant depression. I was deeply torn between the need to support someone I love and not wanting to let them go.
My first photographic encounter with MAID came in 2022 on an assignment for The Globe and Mail. I photographed a doctor who was concerned that the rollout of the program was premature. I suppose that doctor was right because the deadline ended up being pushed back by the federal government.
Soenen: When you began on the work, did you have preconceived notions about what you would feel and who you would speaking with? Or, were you surprised by the “types” of persons you met?
Willms: On this most recent assignment for The New York Times I photographed Jason French, a man who was seeking MAID for his treatment-resistant depression. My lived experience with MAID informed my empathy for Jason's circumstances. Many people don't realize that treatment-resistant depression can be like a mortal wound. When people say things like "you just need to do this" or "get over it" or "try to stay positive" they're totally missing the potential severity of the illness.
“I always approach stories of this nature with the camera down and my heart open. I think that's pretty essential whenever someone is trusting you to photograph them at a time when they are vulnerable and in pain.”
—Ian Willms
Soenen: Is assisted suicide a medical issue or a moral issue?
WIllms: As a photojournalist I have photographed several people with terminal ailments and I remember every one of them. That said, the impact of Jason French’s story didn't just hit close to home—it tore right through me. This is not a bad thing, though. I'm grateful to have felt as much as I did and to have had the opportunity to photograph him from a perspective of care and understanding.
Soenen: How can we navigate that line between being deeply torn between the need to support someone and not wanting to let them go? Can we capture those complex feelings of internal dissonance with our cameras and pens?
Willms: I wish I could answer that, but I can't.
Thankfully, the person I mentioned earlier in our conversation decided they didn't want MAID anymore so I did not need to navigate that complex and intense process.
The photographs I made around the loss of my father were my best effort of communicating such a personal loss in a visual way. At the time it was a very instinctual process. If the feeling came, I took a picture. It didn't matter if the photograph made sense to me at the moment of capture. I could only find that narrative thread in the editing stage afterward. I wrote at that time, as well, mostly on my Instagram feed. It was a similar process. Very stream of consciousness and raw. Sometimes it was maybe a bit too raw. I'm not sure the project was successful because ultimately, I needed to take space from the work to heal myself. In time I'll come back around and organize it into a final form.
Soenen: Now that the Canadian government has paused assisted suicide legisltion, will there be a follow up story about Jason French and other subjects?
Willms: There are no plans that I am aware of, but it's possible. What matters to me most is how he would feel about it.
Soenen: Were there moments when reporting on this legislative debate where you had a Camera Down moment and engaged with your subjects on a personal level off the record? And if so, what did you learn about persons who suffer from treatment-resistant illness and the lonely depths of bipolar disorder and chronic clinical depression?
Willms: Yes, absolutely. I always approach stories of this nature with the camera down and my heart open. I think that's pretty essential whenever someone is trusting you to photograph them at a time when they are vulnerable and in pain.
“Trust, respect, consent, transparency and integrity are more important than any photograph in these kinds of situations. There are inherent power dynamics at play in photojournalism which favour the photographer. It is critical that we do our best to be aware of, and mitigate that imbalance whenever possible. The best photographers are often deeply empathetic people. Unfortunately, that makes them vulnerable to mental injury when documenting the pain and suffering of others.”
—Ian Willms
Soenen: Was documenting the ICU and End of Life experience of your father a way to distance yourself from feeling all of the emotions those situations present? It is not uncommon for writers, artists and photojournalists to use a lens or pen as self preservation armor. The camera and pen can serve as a walled fortress for emotions. That is, while documenting stories for journalism we are acting solely as vessels, but when it’s family, it’s difficult to immerse halfway as a family member and a documentarian at once. Does it have to be either/or?
Willms: Yes, absolutely. My camera was something I could control at a time when I had almost no control on what was happening to my father. By documenting and conveying the horror that was unfolding I was able to delay much of the emotional burden until later when other people would be more able to help with his care. Once we reached that stage I promptly burned out.
Soenen: Were you able to get therapy or help to guide you through the loss of your father?
Willms: Yes, thankfully. I worked hard to find treatments that worked for me and it has definitely paid off. I'm very fortunate to live in a place where these kinds of services are accessible. I'm also immensely grateful to my friends and family for their support.
Soenen: How long did it take you to look at the photos of your fathers End of Life experience? It’s often necessary to get distance.
Willms: I was only really able to work on the photos while the whole situation was still unfolding. When my father was still in the hospital and enthusiastically pushing me to work on the project, Olivier Laurent (Currently the International Photo Editor at The Washington Post, and former Editor of Lightbox at TIME Magazine) and I prepared two posts on the TIME Lightbox. One written by him, and one written by me.
After that, my father died. I had an exhibition of the photographs in Toronto and began editing the work into a book. The process was very difficult by that point and I was feeling the burnout catching up to me, so I stopped. I tried again after a year. Then again after another year. Eventually, I kind of gave up. I look at the book dummies I created these days and I still feel a strong desire to finish the book. It will happen eventually.
Soenen: Do you have advice for young journalists and editors who are taking on medically-complex stories who may be in need of mentoring related to the best way to honor individual subjects while reporting on extremely difficult health conversations?
Willms: Trust, respect, consent, transparency and integrity are more important than any photograph in these kinds of situations. There are inherent power dynamics at play in photojournalism which favour the photographer. It is critical that we do our best to be aware of, and mitigate that imbalance whenever possible. The best photographers are often deeply empathetic people. Unfortunately, that makes them vulnerable to mental injury when documenting the pain and suffering of others. So, keep that in mind and always try to care for yourself like you would care for a close friend.
Soenen: One name: Kervorkian.
As we advance compassionate End of Life conversations and debate, it’s clear what was considered a felony then, now has a legitimate chance to be legalized not only in Canada but also the United States. As Europe is already moving on legislation and practice in this medical field, what is the progress you’d like to see in North America going forward?
Willms: I think about Kevorkian a lot these days. I remember his case playing out in the news when I was just a child. After the conviction, he became a punchline for the world. Even today, I see his name being used to make fun of death. It's heartbreaking to think about the systemic disrespect he endured for doing what is now known to be morally and ethically sound. The fact that he went down in history as "Dr. Death" is an ironic injustice because ultimately, he lost his freedom for offering us the choice to live on our own terms.
Soenen: Up for some non-photojournalism interrogation?
Willms: Always.
Soenen: For readers who aren’t familiar with how photographs and news reach their screens and front doors, can you tell us a little more about the legendary Panos Pictures Agency?
Willms: Panos is an agency that was built around the goals of pushing boundaries, challenging assumptions and inspiring change. When I look at the work by my colleagues at Panos, I'm always inspired and motivated to continue telling stories with photography.
Soenen: Favorite band?
Willms: If I had to pick one it would have to be the White Stripes. They had a big influence on my approach to art and storytelling.
Soenen: Leica, Sony, Canon, Nikon, Hasselblad or…and why?
Willms: Leica. I often photograph people in very difficult and vulnerable moments, so using a camera that's as small and quiet as a Leica M can really help put folks at ease. Also, the sheer quality of image you can get from such a small footprint is pretty much unbeatable. They are a company with a long history that they are still very much connected to, but they are also constantly developing new approaches to design and function. And, finally, I appreciate their emphasis on making products within the European Union, with high standards for labour and environmental care.
Soenen: Most influential photojournalists in your work and life?
Gary Winogrand taught me to speak; Mary Ellen Mark taught me to care; Larry Towell taught me to love; Donald Weber taught me to think; Harry Gruyaert taught me to compose; Stanley Greene taught me to fight; Eugene Smith taught me to commit.
Soenen: Currently reading?
Willms: I'm about to start “Shelterbelts” by Jonathan Dyck.
Soenen: How do you relax?
Willms: I play guitar and I ride BMX.
Soenen: Favorite meal?
Willms: Unfortunately, it's bacon and eggs.
Soenen: Will photography survive AI, and if so, why?
Sure, why not? It survived Television. Film survived digital. The ways in which photography is practically utilized won't be the same, but photography as an artform will continue and there will always be a need for reliable, visual evidence and documentation. I also think there's something to be said for the fact that a human being chose to take a picture of a certain thing in a certain way. AI can mimic that, and maybe even copy it, but the result will never be a truly human perspective.
Soenen: Best advice you’ve ever received?
Willms: As mentioned earlier, care for yourself like you would care for your best friend.
Learn more about the work of Ian Willms here>
TIME Lightbox
Canadian Assisted Suicide Legislative update>