Op-ed: Expanding the right to die

A photo illustration shows a French general practitioner holding a stethoscope in a doctor's office in Bordeaux REUTERS/Regis Duvignau/File Photo

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It’s doubtful that most Canadians know how far and how fast our “right to die” has expanded.  Until 2015, assisted suicide and mercy killing (a.k.a. active euthanasia) were prohibited in the Criminal Code.  The Supreme Court of Canada Carter ruling in 2015 required both to be legal.  Canada is now one of the very few countries that allows actual killing by doctors.

It’s notable that other options for those suffering while dying already existed and continue to exist, including refusal of medical treatment and food and water, and palliative sedation.

The 2016 federal law passed after the Carter decision did restrict the right to “medical assistance in dying” or MAID to those whose death was reasonably foreseeable, but without the six month or less life expectancy requirement of most American states (all 10 of which only allow “self-administered” dying).

The result?  According to a Health Canada report (April 2019), there were 6,749 reported cases of assisted dying in Canada in just under three years of new Canadian and Quebec laws. Almost all of them were “clinician-administered.” “Self-administered” ones—assisted suicides—could be counted on two hands.

The right will almost certainly expand very soon.

That’s because the Quebec Superior Court used the Charter of Rights to invalidate sections of current Canadian and Quebec laws last month in a ruling involving two Montrealers with degenerative conditions.

The court ruled that people whose suffering is unbearable but not imminently facing death must be added to those eligible to receive “medical assistance in dying.”

Those people might well include not only those with cerebral palsy, post-polio syndrome, ALS and others in unstoppable decline, but also those who simply find their conditions unbearable, as well as the three already identified groups that there has been a major push to include: mature minors, mentally ill persons, and those with advance directives.

The federal and Quebec governments have four options: 1. Appeal the decision.  2. Accept the Court’s ruling and amend the laws within six months. 3. Use the Charter’s notwithstanding clause to overrule the Court.  4. Do nothing, leaving the details to the courts.

Whether the first or second option is chosen (the third and fourth probably won’t be), the question is once again very much before us: Who should be included?  What do we want our politicians, our lawmakers, to do?

We happen to have a federal election this month. As much as candidates may fear the controversies, criticisms and passions that go along with clear, non-evasive stands, we have a right to know their views.

Where should they stand?  Isn’t it simple?  Our bodies, our lives, our choices?  Well, yes and no.  It is true that each of us has a special claim on what happens to us. But we rightly impose limits for three reasons: our own protection from ourselves (paternalism), protection from others and consideration of the impact of our decisions on other people.

Those suffering, even if infrequently, do need protection from family members and others who exert undue pressure, and from medical personnel who are overworked, incompetent, or unethical or unprofessional.

Advocates of an extended right maintain that it is cruel to require people with degenerative conditions to be physically able and competent to make a second and final request. That can force people to choose to die prematurely, while still competent and able.

But physical ability is not required with “clinician-administered death.” And the idea that we only need to be competent at an earlier time also overlooks a main reason for the second request stipulation—we want to be sure that our earlier wish remains our wish at that crucial moment.  That is also relevant to advance directives.

There is a place for paternalism, now reflected in safeguards, such as the requirement that suffering be unbearable without hope of remedy, the waiting period, and the selection of drugs used.

We need to ask ourselves about the appropriate extent of paternalism and about MAID’s impact on our doctors and nurses asked to become active agents of death. We need to assess resources for, fears of and stresses on persons with mental health issues and physical disabilities. And aware of our messages to them and young people contemplating suicide.

The lists of disabilities is long; the list of mental illnesses is long, too, including anxiety disorders, addictions, eating disorders, depression, PTSD, prolonged grieving and many more.

To whom should we extend the right to “assisted death,” all things considered?

We need to establish policies and laws not only for ourselves and those close to us, but for all Canadians.  That’s a task for citizens, voters and our politicians, during and after the election.

Now retired, Tom Enders taught Philosophy, Applied Ethics and Political Studies at GPRC.

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