Home CommentaryOpinions YES to a right to die, but NO to having your doctor do it

YES to a right to die, but NO to having your doctor do it

by Milos Kovacevic November 5, 2013
YES to a right to die, but NO to having your doctor do it

 The Quebec government is one step closer to amending end-of-life care with the successful second-reading vote on Oct. 29 of Bill 52. The Bill, if ultimately passed, will usher in some big changes for end of life care. It will make Quebec the first and only Canadian province legalising a patient’s right to die.

Assisted suicide by itself is nothing ground-breaking in our part of the world. Four U.S. states, including neighbouring Vermont, have provisions for it, some going back all the way to 1997. Canada, by comparison, lags in that it considers it a criminal offense similar to homicide. What Quebec’s Bill 52 hopes to do is not only make it attainable, but expands the list of those who can administer it.

Flickr photo by Mark Cloggins

In the U.S. states that allow it, a doctor can carry out a patient’s desire for assisted suicide by prescribing a lethal dose of medication, to be taken by the patient at their own volition if the patient suffers from a terminal condition.

Bill 52, on the other hand, suffers from vagueness in the wording of the eligibility criteria. The relevant clauses state only that the patient must “suffer from an incurable serious illness,” while another requires that the patient must also “suffer from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.”

What exactly is an incurable and serious illness, and how is it different from a terminal condition? Paranoia of slippery slopes aside, who’s to say a debilitating case of arthritis or Alzheimer’s, amongst others, won’t be grounds for assisted suicide? What are the reasonable bounds of tolerability, if any? Terminal is a firm term with strong boundaries. A “serious illness” isn’t.

Additionally, how does one judge unbearable psychological pain? Yes, the bill requires “repeated requests” from individuals, provides psychological testing if needed, and needs the affirmation of a second physician. Yet this isn’t enough. What if a patient is in the throes of the prolonged effects of a depression and related psychological anguish (which often come on the coat-tails of medical prognoses)—is such consent valid?  Depression can come and go. Death, by contrast, is permanent. One may wish to die today, but what of tomorrow?

The right to die is a controversial one, but at the very least one largely confined, for good reason, to a single person: the patient. Death should be a private, personal choice under reasonable circumstances, and while the doctor may disagree or agree, the final decision it is quite literally out of his or her hands. Bill 52’s proposed outline will make it not only possible for doctors to carry out assisted suicide, but make it obligatory. Doctor-assisted will become doctor-administered, keeping it equally out of their hands (in making the choice) but in their hands (to carrying it out). A doctor’s refusal to carry out the patient’s wish to die would be considered a denial of proper medical care. Is this the responsibility we should be pawning off on our physicians?

Thankfully we have an example of a system like Quebec’s in Europe. Belgium, the Netherlands, and Switzerland all allow some form of assisted suicide, and the numbers of procedures are now into the thousands each year. Yet the worrying fact isn’t that the numbers are growing but who is doing it. While the majority are still terminal patients suffering from illnesses such as cancer, a steadily increasing amount are electing to go through with it because of such conditions as blindness, depression, or complications from sex-changes, amongst others.

It is a doctor’s duty to do best by the patient. In cases of terminal, painful conditions, this opens up the possibility of giving in to the patient’s desire to end their life. However, expanding the criteria to allow any condition the patients themselves see as ‘unbearable,’ and instituting it as a professional duty, is going too far and amounts to a lackadaisical effort to keeping individuals alive.

Quebec is doing an admirable thing by giving patients the right to die, but they’re acting hastily in implementing it. Not everybody who wants to die should have the avenue to do so, and the wording of the Bill must make this clear. Before we go too far, we should go slow, and institute policies similar to America’s.

All parties involved must admit a certain ethical line is irrevocably crossed when doctors go from overseers of death to active agents in carrying it out. Canadians (foremost Quebecers) are now asking themselves if they are ready to cross this line, and all the moral weight that comes with it.

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