A desire to control their future, not depression or fear of pain, is the main reason people seek physician-assisted suicide or euthanasia, the Supreme Court of British Columbia has heard in a right-to-die case.
Helene Starks, an associate professor at the University of Washington School of Medicine, told court that a groundbreaking study she was involved in showed that terminally ill patients sought the right to die only after long periods of reflection – and that they were primarily driven by a desire for control over the place, process and timing of death.
Madam Justice Lynn Smith, who is hearing the first constitutional challenge on the issue in 18 years, was so intrigued by the evidence that she asked Prof. Starks if she hadn't found signs that some patients had other reasons, such as depression or continuous pain.
"Aren't there outliers?" she asked.
"There were no people in our study who didn't fit this pattern," replied Prof. Starks, whose research project, Insights into Hastened Death, examined the experiences of 35 patients and their families in Washington and Oregon between 1996 and 2001.
At the time of the research, physician-assisted suicide was legal in Oregon, which approved the practice in 1997, but not in Washington State, which passed its Death With Dignity Act in 2008.
Some of the patients Prof. Starks studied, however, managed assisted suicides in Washington even though it wasn't legal.
Prof. Starks said when people decide they want to hasten their own deaths, they usually find a way to do it.
"Where there's a will, there's a way," she stated in her affidavit. "Opinion polls consistently find that public and physician support for physician-assisted dying is between 50-80 per cent. This means that patients who are serious about finding allies are likely to eventually meet a physician who is willing to write a prescription for barbiturates. ...In our study, only 2 people were unable to obtain medications and in both cases, it was because they started late in their illness and then suddenly died from exacerbations, thus they literally ran out of time."
In 1993, Sue Rodriguez, a Victoria woman dying of Lou Gehrig's disease, went to court in an attempt to strike down Criminal Code sanctions against physician assisted suicide. She lost in the Supreme Court of Canada, but subsequently took her own life with the help of an anonymous doctor.
In the current case, the B.C. Civil Liberties Association and a group of individuals, including Gloria Taylor who is dying of Lou Gehrig's disease, are arguing that it is unconstitutional to deny Canadians the right to have an assisted death.
Ms. Taylor will not testify at the trial but expects to attend Dec. 1.
In her affidavit, Prof. Starks states that the planning phase for patients seeking an assisted suicide "was often long and unfolded over months and years."
Depression was not a primary factor and the overwhelming majority of patients made their choice at a point when they still had full mental capacity.
"Our findings demonstrate that the decision to seek PAS was not impulsive, and patients openly communicated their intent with family members," stated Prof. Starks.
"Almost two-thirds of the patients pursued PAS because they felt dying was eroding their sense of self. Several patients did not want to [be]remembered as ill and frail," she said. "Those most likely to be interested in a hastened death . . . are adamant about being in control and remaining independent."
Prof. Starks said even though assisted suicide is legal in Washington and Oregon, there are still considerable barriers. Patients must make three separate requests for a hastened death. The requests must be witnessed by two people not related to the patient and who do not stand to gain from the estate. And the patient must seek independent assessments from two physicians.
Typically, she said, those who obtain the right to assisted suicide tend to be people who, over the course of their lives, achieved the things they wanted.
"They are organized and know how to get what they want, and are willing to do whatever is necessary to achieve their goal," she said.