Striking down, as unconstitutional, the Criminal Code provision prohibiting assisted suicide, as the Gloria Taylor case does, in effect legalizing physician assisted suicide, is a very bad idea and a step backward for Canada and Canadian values, ethics and law. Not least because it will, inevitably, lead to legalizing euthanasia.
Legalizing assisted suicide or euthanasia raises issues, not only, at the level of individuals like Ms. Taylor who wants access to assisted suicide – the micro level – but also at the meso or institutional level – impact on health-care professions and hospitals; and at the macro or societal level – impact on some of our most important shared values that provide the glue that binds us as society.
Taking all this into account, the assisted suicide/euthanasia debate comes down to a direct conflict between the value of respect for human life, on the one hand, and individuals’ rights to autonomy and self-determination – the value of “choice” – on the other.
People who are anti-assisted-suicide/euthanasia give priority to respect for human life. That requires respect for each individual human life, and respect for human life in general. Even if we were to accept (which I do not) that helping a competent, consenting adult to die does not contravene respect for individual human life, it still contravenes respect for human life in general. Legalizing assisted suicide/euthanasia means crossing the line that we must not intentionally kill each other, the only exceptions being where that is the only reasonable way to protect human life, as in self-defence.
People who support legalizing assisted suicide/euthanasia simply assume that individual autonomy is the value that takes priority. But research shows that the most likely reasons people want assisted suicide/euthanasia are fear of being abandoned – dying alone and unloved – and of being a burden on others. Surely our response to such fears shouldn’t be to help them to kill themselves or to give them a lethal injection.
Strong arguments against legalizing assisted suicide/euthanasia at the individual level include a valid concern about their abusive use, especially in relation to old people, and particularly when paired with increasing disquiet about health-care costs. Two relatively recent Environics polls showed Canadians are very concerned about elder abuse if assisted suicide/euthanasia is legalized and that elderly persons could be pressured to accept euthanasia to reduce health-care costs.
I suggest that if we ask ourselves a series of questions about legalizing assisted suicide/euthanasia, many of us will conclude that it’s a very bad idea.
Why are we debating assisted suicide/euthanasia now when there is so much more we can do to relieve pain than was possible in the past? Would legalizing assisted suicide/euthanasia harm medicine and society? The answer is a clear yes. In a secular society, medicine and law are the principal institutions that carry the value of respect for life. They could no longer do so in an unambiguous way.
If we legalized assisted suicide/euthanasia would it become the norm? Abortion gives a clue in this regard. How do we want our great-great-grandchildren to die? This is probably the most important question of all.
So what do dying people need to make death bearable? Researchers are helping us to gain knowledge in that regard. It includes having access to good palliative care, including fully adequate pain management. But it also includes matters such as helping dying people to feel that they are respected, that they still have something to give to the rest of us, and that even when we are dying we can have a sense of hope and avoid the slough of despair.
Margaret Somerville is founding director of the Centre for Medicine, Ethics and Law at McGill University.