In these circumstances, where there is a conflict between the attending doctor and parents or legal guardians of the patient, and the patient is incompetent, the conflict is settled by the health care consent board. This is a brilliant solution.
What about people in persistent vegetative states?
Should health care professionals be permitted to withdraw care from people in persistent vegetative states? During the first two years, they have a fair shot of coming out of a coma, but then the likelihood goes down really rapidly. They are lying in hospital beds and you can keep them alive forever. To the best of what we know, they do not suffer. This is why in some places when you say treatment is withdrawn, it really means they are no longer fed. Doctors believe that after 10 years, there is no way they will come back. It becomes a resource issues and it is very stressful for the family.
What about terminal sedation?
This has become a big topic; lawyers are looking at it, and so are ethicists. When someone sedates a patient, they cannot request food. So you can give an advanced directive saying “don’t provide me with nutrition and sedate me for pain.” This is an end-of-life choice. You refuse intake of nutrition and you’re sedated so you don’t suffer. The law in this country isn’t clear on this.
What about other examples where the law is unclear?
It is legal in Canada to provide a patient with symptom relief or palliative care that is life-shortening. They have split a hair here, which is bizarre. The logic here is that the intention matters. Your intention as a doctor is you want to prevent the patient from suffering but you don’t want to shorten their life. An example of this would be giving someone a lot of morphine or painkillers [which could hasten their death]
What about the slippery slope argument?
This is crucial to this debate, but it turns out not to be true with assisted dying. This argument was used in the Sue Rodriguez case [who lost her case to have the right to assisted suicide when the Supreme Court ruled against her] They were concerned at the time because the evidence was far from established, that you would you end up with involuntary euthanasia, especially with resource constraints.
I was concerned about this. But it turns out not to be true. Today, we know what has happened in all those places where assisted dying is legal: Montana, Oregon, Washington, Belgium, Switzerland, the Netherlands, Luxembourg. You can see, after decriminalization, you have a spike in people requesting and using assisted dying. But then year after year the numbers go down. The reason I believe is that people once they know that if all else fails this is an option, most people won’t make that call. The stress is gone so they die of natural causes.
What about the issue of abuse?
Look at the Netherlands, there is evidence abuse is taking place. People are getting killed who haven’t requested it. However that doesn’t establish a slippery slope. There were 550 cases where people haven’t asked to die in a year but they did. But it turns out that the people didn’t sign the forms but made their views known to doctors. As well, in countries where assisted dying has not been decriminalized, involuntary euthanasia does also take place. So you need to show more that that there is involuntary euthanasia taking place to build an argument against decriminalization of assisted dying.
Any other concerns about assisted suicide?
I have trouble with the issue of incompetent people being denied access to assisted dying even though their quality of life may no longer be acceptable. I have no answer to the dilemma. People don’t feel comfortable with incompetent people with a poor quality of life having the right to euthanasia. As well, what do you do with the increasing number of dementia patients? They might suffer a poor quality of life and in those circumstances if they were competent, they could request euthanasia. This is an issue Canadians will have to face.
What impact does the aging of the boomers have?
It goes in waves. In Quebec they have a big consultation under way on this issue because more than 80 per cent of the population supports assisted dying. They are ahead. You cannot escape the fact that the population is aging, resources are dwindling, and also there are a much larger number of people who no longer say, “Doctor knows best”. Baby boomers are always rebelling. Now they are going towards the end of their lives and they’re used to getting their way. They will put pressure. They have the sophistication, money and education to make a lot more hay of this.