euthanasia – The Concordian

Almost a year into its legalization, medically assisted suicide is still something to be fought for

In June 2016, medically-assisted suicide, which is the act of suicide with the aid of a medical practitioner, was legalized in Canada. We are approaching the one-year mark of that decision, yet some people still strongly oppose it and feel that it should be illegal.

I think that in a civilized and democratic society, people should have complete autonomy over their actions so long as they don’t intentionally harm other people. Every major decision in a person’s lifetime should be up to the individual, since only they know what’s truly best for them. In a country that values freedom and individuality, a person’s right to death should be as sacred as their right to life.

A survey by the non-profit organization Dying With Dignity Canada showed that, in 2014, 84 per cent of Canadians supported assisted death. This includes euthanasia—when a patient agrees to die by the hands of a physician, and assisted suicide—when a patient dies by their own hands, but by means given by a physician. According to the Toronto Star, about 200 Canadians went through the process of physician-assisted suicide by October 2016, following its legalization.

However, The Euthanasia Prevention Coalition is a Canadian organization active in posting anti-euthanasia content on their website, in hopes of changing legislation to make it illegal again. A look through their website reveals anxieties around the possible abuse of power on the part of physicians, and the potential inability of those suffering to make a logical choice about whether to live or die.

Groups that are against medically-assisted death tend to think decriminalizing it is a slippery slope which leads to a society “where the vulnerable are threatened and where premature death becomes a cheap alternative to palliative care,” according to an article in The Economist titled “The right to die.” However, it is extremely unlikely this will happen because the essential purpose of legalizing medically-assisted death is to give people authority over their own lives. The idea that it could lead to people being unjustly killed is inconsistent with the movement’s core goals.

The current laws in Canada are extremely restrictive. The legislation around medically-assisted death puts a lot of emphasis on ensuring the autonomy of the patient. According to the End-of-Life Law and Policy in Canada website, patients must make “a voluntary request for medical assistance in dying that, in particular, was not made as a result of external pressure.” To say that legalizing medically-assisted death is a path towards injustice is incorrect because it is actually a step in the opposite direction.

According to the same article in The Economist, “places that have allowed assisted dying suggest that there is no slippery slope towards widespread euthanasia. In fact, the evidence leads to the conclusion that most of the schemes for assisted dying should be bolder.”

Canadian legislation ensures a patient isn’t able to go through with the whole process hastily. According to the End-of-Life Law and Policy in Canada, in Canada, in order to receive a medically assisted death, patients must submit and sign a written request to end their life in front of two witnesses, 10 days before death. Two physicians must also agree with the written agreement, which confirms the patient has an incurable medical condition that is in an advanced state and that death is foreseeable. Patients need to also be aware of other potential palliative care options.

In the end, adults should be allowed to make their own decisions, even if these choices have extreme consequences. The rhetoric around decriminalizing medically-assisted death shares many similarities with the debate concerning abortion laws. If we want to talk about slippery slopes, we should consider the ones lurking behind legislation that limits people’s autonomy over their own lives in relation to what they can and can’t do with their bodies.

In the February issue of their monthly anti-euthanasia newsletter, the Euthanasia Prevention Coalition cited an article by Metro News that claims many physicians are unwilling to perform euthanasia on their patients. Based on this article, they concluded, “killing another human being is counter-intuitive to our human nature … Death with dignity is not attained by a lethal injection—it is attained by dying comfortably within a community of caring and supportive people.” Aside from the fact that medically-assisted death can still be “within a community of caring and supportive people,” I think it is up to the individual to decide what dying with dignity looks like.

It is fine if physicians are uncomfortable with the idea of suicide since the desire to live is a personal issue. It is nearly impossible for someone who doesn’t want to end their life to understand the mentality of someone who does. We should offer as much help to people as we can provide—be it through medication, therapy or other treatment—but ultimately, people should be allowed to make their own decision regarding whether or not they feel like their life is worth living.

Not everyone’s views on death are the same. Some see it as the worst thing that could ever happen to a person, and as something that is to be avoided for as long as possible. This is a valid point of view, but it is by no means universal. If someone truly believes death is more desirable than suffering, then who are we to stop them? Everyone has had unique life experiences that contribute to their worldview and personal philosophy, and they should be allowed to act according to it. Just because others don’t agree with their choices is no reason to limit their ability to make these choices.

As long as someone is deemed mentally stable by a qualified psychiatrist to make such a weighted choice, then if someone definitively decides they want to end their life, we should take them very seriously and allow them to make that decision.

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.

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.