Suicide is not the answer, generally speaking. But we are not speaking generally when we talk about drafting a law legalizing and regulating physician-assisted suicide – a law the Supreme Court of Canada has told Parliament to enact by June 6.
The new law will ease and enable suicide, normalizing what in most circumstances is a harmful, undesirable act by fitting it into a compassionate health-care system through the exculpatory power of legislation. As such – as a necessary exception to all the rules and norms that constitute our traditional sense of collective good, which focuses on extending life rather than ending it – the coming law on physician-assisted dying needs to be extremely specific and tightly defined.
Assisted suicide should be legal – but only under carefully circumscribed conditions. The right to assisted suicide, as the Supreme Court has said, is not a right open to all comers. It is not a general right available to all Canadians at all times. It is a right that exists only in those rare but very real circumstances where medical reality is such that hastening death is more humane than trying to forestall it a little longer.
If we see someone wavering on a high bridge, threatening to end it all, the correct response is to intervene and prevent death. It is legal to kill yourself but, unlike other rights – religious freedom, speech, sexual autonomy – it's not a right whose exercise should be celebrated or promoted. It is not a right where, the more widespread the practice, the better off society is. Quite the contrary.
If you stop someone from committing suicide, you will not normally be accused of having violated their fundamental rights. Medicine, law and our common humanity all recommend against standing by while someone attempts to bring about their own demise. And so, except in the special instance that the Supreme Court has carved out, the law makes it illegal to counsel and assist someone who wants to kill his or herself.
The reason is that suicide is usually a mistake for the individual, and a loss for society. Mental illness, shame, depression and despair are behind so many suicides, but it is not the answer for any of that. That's why the law and our best impulses are normally about discouraging and preventing the ending of a life.
But suicide may be the answer in some exceptional and exceptionally difficult circumstances, namely medical conditions that reduce a person to suffering intolerable and enduring pain for which medicine has no cure. That is why the Supreme Court found that the Constitution contains a right, under these exceptional circumstances, to not be prevented from seeking medical assistance in ending one's life.
And that's why Canadians and their elected representatives find themselves in a quandary as they study the recommendations of the joint parliamentary committee that has presented the federal government with a blueprint for physician-assisted suicide. The committee's report, which goes even farther than the Supreme Court says the Charter demands, raises worrying questions.
The Court said a blanket ban on medically-assisted death violated Canadians' rights, limiting their autonomy, dignity and liberty. It said that mentally competent people with "grievous and irremediable" medical conditions, whose suffering was intolerable, should be able to end their lives with the help of a doctor. We agree.
However, though physician-assisted death should be legal and available, it must be carefully limited to cases where it is the right choice because there is no humane alternative – which makes it even more crucial to improve Canadian standards on palliative care, pain relief and mental-health treatment, limiting the attraction of suicide as a last resort.
Questions are rightly being raised about granting children and the mentally ill legal access to an expedited death. The parliamentary committee recommends opening this door, but that is a mistaken approach, born of confusion about the nature of the right the Supreme Court discovered, and when and how it should apply.
Seeing assisted death as a right like other rights puts pressure on lawmakers to open the door ever wider: Who wants to be the MP in favour of restricting rights? But the assisted-death right is a unique right. It only comes into existence when the need for it weighs more heavily in the balance than the harms its exercise can cause. It is only a right in cases where it is clearly the lesser evil.
There are situations, particularly with painful, terminal illnesses, where death is a blessed relief, and even people who might be considered vulnerable by age or status should have the right to assistance in ending their lives, if that is their sincere wish.
That is what Canada's new assisted death law should be about. The goal is not to expand the right to as many recipients as possible. It is to confer it only on those whose medical condition is such that they can truly benefit from it.