Our laws have not kept pace with Canadian views on assisted death

old hands

Editor’s Note:  This author was a guest panelist on CARP’s  medically assisted dying panel which will be televised Monday October 20th, 2014.  For more information about the CARP panel, click here.  This article was published by the Globe and Mail on October 8th, 2014.  To go directly to the article on the Globe and Mail website, please click here.  Andre Picard is the Globe and Mail’s healthcare correspondent and one of Canada’s top policy writers.  He has written extensively about assisted death and a variety of other important health issues.  To see all of Mr. Picard’s recent articles on the Globe and Mail website, please click here.

If I cannot give consent to my own death, whose body is this? Who owns my life? Sue Rodriguez famously asked.

The Supreme Court rejected her attempts to strike down the Criminal Code provisions making assisted suicide a crime, in large part because the prohibition was deemed to be consistent with Canadian values.

Twenty-one years later, as the top court prepares to revisit the issue, Ms. Rodriguezs whispered question has become a coast-to-coast shout. Our values have changed. So have our expectations. Our laws, and our lawmakers, have not kept pace.

As a new poll commissioned by Dying With Dignity Canada shows, the overwhelming majority of Canadians believe people should have the right to end their own lives, and they should be able to ask for assistance from a physician to do so.

The message in the poll is clear: We should no, we must do everything possible, medically and legally, to facilitate the right of people to die with dignity.

What that means, first and foremost, is that we should be alleviating the pain and minimizing the suffering of those who are dying.

About 250,000 people a year die in Canada, and most die in hospital and, depending on their life-threatening condition (cancer, heart disease, COPD, dementia, pneumonia, etc.) they do so in a fairly predictable manner. Everyone who dies of a terminal illness deserves good palliative care, and, generally speaking, we do a poor job of providing that care. Thats not a reason to decriminalize assisted death; thats a reason to improve palliative care.

But, in some instances, the pain is unbearable; in others, the medical interventions merely prolong suffering rather than extending life.

What we do now is do pain relief as best we can, up to and including palliative sedation. Patients sign do-not-resuscitate (DNR) orders so, for example, if their heart or lungs stop working, cardiopulmonary resuscitation is not performed. Dying patients also routinely refuse food and water and starve themselves to death.

These are all passive forms of euthanasia (a loaded word that’s best avoided).

What striking down s. 241(b) of the Criminal Code, with its maximum sentence of 14 years in prison, would do is allow the accelerating of death, for example, with the injection of a combination of barbituates and muscle relaxants.

Some argue that physicians should not be involved in accelerating death because their job is to heal ,not kill. That’s a false dichotomy: The role of physicians is to provide humane care. In exceptional circumstances, ending a persons suffering is appropriate medical care.

The principal fear with decriminalization is the slippery slope argument the notion that, without a law, well start injecting old people and those with physical, developmental and psychiatric disabilities willy-nilly.

Well, not all slopes are slippery.

What people want, and deserve, is control over their own bodies, their own lives. That is a fundamental right in a democratic society.

There have to be practical and reasonable limits to providing care which is why care is sometimes discontinued but no one is going to impose assisted death on anyone.

And the reality is, if assisted death is decriminalized, very few people will actually exercise the option.

What the experience from other jurisdictions, such as Oregon, the Netherlands and Switzerland, also tells us is that, where assisted death is legalized, palliative care services are excellent. (Quebec’s Bill 52, for example, allows physician-assisted death, if a number of strict conditions are met, but also makes palliative care at end-of-life a right.)

The likely reason is that when right-to-die legislation is proposed, it forces a societal debate to occur and underscores the importance of good end-of-life care.

In Canada, the who owns my life? debate is long overdue. Its a discussion that needs to happen in the courts, in Parliament and, above all, around all our kitchen tables.


© The Globe and Mail