Canadians want to live good, long lives. And for most people, that includes an ending-of-life that is as dignified, peaceful and comfortable as possible.
Time and again, opinion polls show a large majority of Canadians support the idea that the terminally ill should be able to decide when and how they die. They believe that competent adults in unbearable pain, suffering from an illness that will never improve, have the right to die with dignity.
And yet the Canadian government is no closer to resolving how – or if – to reform the law against euthanasia; no politician is brave enough to champion such a contentious cause, or even to launch a national debate probing public opinion.
The issue remains divisive and morally fraught. Critics of euthanasia, including some Christian groups and advocates for the disabled, fear it could lead to “mercy” killings of the vulnerable and the elderly.
As baby boomers age, experts believe they will lobby for a change to the section of the Criminal Code that makes euthanasia illegal (and punishable by up to 14 years in prison), in the same way they advocated for the legalization of same-sex marriage, and for other momentous social changes.
This year, two people with amyotrophic lateral sclerosis, more commonly known as Lou Gehrig’s disease, one in Quebec and one in British Columbia, launched legal challenges for the right to die, in an echo of the Sue Rodriguez case from 1993. The legal challenges will be heard this fall, and the issue is likely to end up – once again – before the Supreme Court of Canada.
The government should address the issue of euthanasia head-on, instead of allowing expensive, time-consuming and ultimately inconclusive legal battles to ensue. Legislators should consider accepting assisted suicide as an option of last resort, and frame its legalization narrowly, so that safeguards are in place to prevent abuse, and to ensure that euthanasia is restricted to all but the most extreme cases.
Parliament could debate and pass into law principles that define a legal, doctor-assisted death. Then it could be up to the colleges of physicians in the various provinces to decide whether to include them in their codes of ethical practice. The decision could be made between a patient and a physician.
It has been almost 20 years since Sue Rodriguez, who also suffered from Lou Gehrig’s disease, passionately and eloquently argued for the right to assisted suicide. Unable to walk or talk, she finally took the step illegally, after the Supreme Court ruled against her. The 5-4 ruling found that Parliament, not the courts, should decide this issue.
Since then, assisted suicide has become legal in several jurisdictions, including Oregon, Washington, Montana, Belgium, the Netherlands, Luxembourg and Switzerland. Canadian legislators can learn by example. In the U.K., the Director of Public Prosecutions recently published revised guidelines detailing factors that make the prosecution of family members who help relatives die less likely.
It is of paramount importance, clearly, to ensure that those requesting assisted suicide are competent, and are certain of their choice. Those who sign an advanced directive should be allowed to change their minds, even if they develop dementia, and come to fiercely oppose their earlier decision. The law needs always to err on the side of life.
The Dutch law offers a six-part test, which must be met for a physician-assisted suicide to be legal. The patient’s request must be voluntary, they must have a lasting desire to die, and their suffering must be unbearable. The attending physician must assist the patient to weigh the alternatives, must consult with another doctor and ensure there is no chance of recovery. And a report must be filed with the coroner. Each year, many requests for euthanasia are rejected, especially in cases of depression.
Research shows that, in places where assisted suicide is legal, there is an initial spike in requests. However, the number then diminishes. “Many people, once they know that if all else fails, this is an option, they won’t make that call. The stress is gone,” says Udo Schuklenk, a Queen’s University professor who chairs the Royal Society’s committee on end-of-life decision-making in Canada. The committee will release a report this fall.
“Often when people talk about end-of-life decision-making, the assumption is, it’s about pain,” he adds. “But it’s not. The concern is more about losing control over the quality of their lives.”
As well as retooling the law on euthanasia, the government should expand the use of palliative care, so that people with terminal illnesses can be less fearful of an agonizing, protracted end, and less drawn to assisted suicide as a last option.
There must, however, be a way for society to grant the wishes of mentally competent adults who do not want to live with unspeakable pain, lose their ability to swallow, walk and talk, lose their selves. Surely this is the most compassionate way for them to end to their journey, and to have the good death they deserve.