With the tabling this week of Bill C-14, Canada has officially become a country where grievously ill adults can be killed by the state at their request. Voluntary euthanasia, in which a doctor or nurse administers a fatal substance to a person who has requested it, will be a defining characteristic of our nation. So will physician-assisted suicide, in which people kill themselves with substances provided by the state.
The enormity of this moment cannot be overstated. As compassionate, progressive and sensible as state-sanctioned death can be under the right medical circumstances, it is an extreme action that leaves no room for second thought. The Supreme Court has ruled that denying medically assisted death to a consenting adult is a violation of his or her Charter right to security of the person, but no one would argue that Canada ought to normalize such a thing in a casual manner.
Thus, taking into consideration the obligation of the government to reinforce the value of human life even while sanctioning its premature end, the government's proposed assisted-suicide legislation is well thought out, for the most part. It signals that Parliament will respect the Supreme Court decision but won't compromise the need for the utmost caution.
The bill restates the inherent and equal value of all lives and works hard to counter any impression that the sick, the elderly and the disabled have less to live for. It does this by creating proper protections for the vulnerable, who might be coerced by unscrupulous family members into requesting their own deaths, and by clearly defining the kind of informed consent a person must give when requesting his or her death.
The bill also avoids creating unintended consequences by stubbornly advancing the right to medically assisted suicide and voluntary euthanasia in an incremental fashion. The bill meets the court's June 6 deadline for having legislation in place, but it puts off the most complicated issues – children, people who suffer from a mental illness but not a physical one, and advance consent – for further discussion.
There are many who disagree that this is the proper course. For them, the right to a medically assisted death of a person suffering from "a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual," as the Supreme Court put it, is absolute and needs no further discussion.
They see the bill as too risk-averse, partly because they consider the only true stakeholders in this issue to be the people who would legitimately and uncontroversially benefit from immediate access to medically assisted premature death.
But in fact the stakeholders are far broader than that. There are the vulnerable, there are the pharmacists, doctors and nurses who must assist in patients' suicides, there are the patients' families, and there are Canadians who want to mix compassion with a proper measure of caution. Confirming the constitutional right to medically assisted suicide and legislating it into practice are two different things. It requires a great deal of faith in human nature, and in Canada's overburdened health-care system, to believe that Parliament can simply translate the court's ruling into law without the possibility of unintended consequences.
The ruling, for instance, didn't differentiate between mental and physical ailments. That led an all-party parliamentary committee to advise in February that psychiatric patients in Canada should be given the right to assisted suicide as long as they are mentally competent.
But in Belgium, which has among the most relaxed right-to-die laws in the world, a similar provision led doctors last year to grant a 24-year-old woman the right to be killed by lethal injection because she suffered from depression and had suicidal thoughts. Her appalling case caused an uproar, as it should have. At last report, the woman hadn't acted on the doctors' decision and was still alive.
Ottawa has avoided this troubling scenario by stating in its proposed bill that only those who are suffering from a grievous and irremediable medical condition and whose "natural death has become reasonably foreseeable" have the right to request medically assisted suicide or euthanasia. For the time being, people suffering from terrible and punishing psychiatric diseases are unlikely to be allowed an assisted death, although it is conceivable that someone with anorexia might qualify.
This clause appears to mean that only people with terminal illnesses will be allowed an assisted death. That contradicts the wording of the Supreme Court ruling, which made no distinction between fatal and non-fatal ailments, and did not limit the new right to die to the terminally ill.
The government should refer this question to the Supreme Court for clarification. There are without doubt people in Canada who are suffering terribly right now from diseases, disabilities and illnesses that do not pose an immediate, or even mid-term, threat to their lives. It would be cruel to force them to go through the agony of a court case challenging the new law when the government, and the court, could settle the issue quickly.
But for the most part, Canadians should be relieved the government is moving slowly. The balance Ottawa needs to achieve is one where no one is left needlessly suffering as the result of undue caution, but no one is hurt by undue haste. The government must be open to amendments during the extended debate it has promised for the bill. And it must follow up on its promise to study the difficult issues left out of the law for the moment.