Margaret Somerville, the founding director of the Centre for Medicine, Ethics and Law at McGill University, says legalized assisted suicide opens the door to legalized euthanasia. Arthur Schafer, the director of the Centre for Professional and Applied Ethics at the University of Manitoba, says it entrenches our rights as humans.
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.
Friday's decision by the British Columbia Supreme Court was a victory for a dying 64-year-old ALS patient. Gloria Taylor won her right to physician-assisted suicide at a time of her choosing. But, just as important, the decision is a victory for civil liberties in Canada and for the rights of the disabled.
For more than 20 years, Canadians have been telling pollsters that we favour a change to the Criminal Code that would make it legal for patients with incurable physical illness to opt for assisted suicide. Just before Ms. Taylor began her legal challenge, a Forum Research poll showed that more than two-thirds of Canadians favour the right to physician-assisted suicide.
The reason why most Canadians will cheer this decision is that individual autonomy is a core value of our society. The right of competent adults to make important decisions for themselves – including life and death decisions – is part of what defines us as citizens of this country. Autonomy is a cornerstone of our culture, as it is of other liberal democratic societies. It is also enshrined by the Charter of Rights and Freedoms.
You and I have both a moral and a legal right to make important choices based on our beliefs about the good life. But this does not mean that our right to autonomy is absolute. When the Supreme Court decided in 1993, by a 5-4 vote, to deny Sue Rodriguez's challenge to the criminal prohibition of assisted suicide, they acknowledged that the law violates her right to autonomy. But the majority argued the violation was justified because, without a complete prohibition, there was a danger of error and abuse. They feared that vulnerable members of society – minorities, the disabled, the sick, the elderly, the poor – might be victimized by a more permissive law.
In 1993, doctor-assisted suicide had not been legalized anywhere, so it was plausible to invoke a slippery slope on which the vulnerable could become victims. Today, however, we can trade speculation for evidence gathered from jurisdictions where it has been decriminalized.
After reviewing the evidence presented by both sides, including evidence based on experiences in Oregon and the Netherlands, the B.C. court concluded that none of it supports fears that mistake and abuse are more likely in a permissive but regulated regime. Mistake and abuse can and do occur in Canada as well as in Oregon. But in Canada, there are virtually no safeguards around end-of-life decision-making: deciding, for example, when to "pull the plug" or when to put a patient into "terminal sedation." In Oregon, decisions are regulated and monitored; there is public accountability.
None of the critics' dire predictions have come about: Palliative care did not suffer because it would be cheaper to hasten people's deaths rather than to relieve their suffering. In fact, palliative care in Oregon and the Netherlands is excellent – and it improved because of decriminalization. Nor did the doctor-patient relationship suffer. On the contrary, there is evidence that patients in Oregon feel alienated from physicians who oppose assisted suicide.
Nor is there evidence that respect for the value of life has diminished in jurisdictions that have opted for safeguards rather than a ban. Respect for the religious doctrine of "the sanctity of life" may be waning, as more people favour individual liberty; but respect for quality of life (and for the right of each individual to decide when life has become more burdensome than beneficial) has increased.
As the court noted, Ms. Taylor's right to life is protected, not imperilled, by decriminalization. She can now wait until she's ready to die instead of killing herself prematurely, in order to do so without assistance.