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What’s so difficult about the right to die?

The Supreme Court of Canada has spoken. The public has spoken, emphatically. Canadians should have the right to die, without further delay. They already have this right in Quebec. So why all the foot dragging? "Allowing assisted suicide isn't complicated," opined one editorial. "Just do it, Ottawa."

On the face of it, the issue seems straightforward. Most of us believe in personal autonomy, especially for ourselves. People want to die and we should provide the means. The end.

In fact, it's complicated. To start with, the Supreme Court decision of February, 2015, is maddeningly vague. It says that people with "grievous and irremediable" suffering are entitled to assisted death. How are we supposed to interpret that? "The court was negligent in not telling us where the line is," one person who is deeply involved with the issues told me.

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That opinion is shared by many. The Supremes say it's not up to them to work out the details. That's the job of elected politicians and "qualified" professionals. But the issues are so fraught that no one wants to take the lead. A few months from now, assisted dying will be legal across Canada. Yet essential questions about the scope of the law have yet to be addressed.

Here are some. Should we allow euthanasia (which means a doctor kills you, as in Quebec), or what's known as assisted death (which means a doctor gives you the means to kill yourself, as in Oregon), or both? Should we consider right-to-die requests from people who would otherwise have years to live, or only from those who are already close to death? What about psychiatric patients who find the burden of life unbearable? (Psychiatrists are divided on this one.) What about three-year-olds with terminal cancer? (Some pediatric doctors argue that children also have the right to be spared needless suffering, even if they are too young to consent on their own behalf.)

Most of us haven't given any thought to these moral headaches. Few of us are even aware of them. Whether Parliament can sort them out remains to be seen. A much-awaited parliamentary committee report will land this week, after which we can expect an avalanche of new debate. That's not all. Each province will have to work out the implementing details for itself. The result could be a dog's breakfast of different laws and guidelines across the country.

Our biggest choice is whether we want to be more like Oregon, or more like the Netherlands and Belgium. Oregon's law is highly restrictive. People who request assisted dying must be no more than six months away from death. Euthanasia is not allowed. Instead, patients are given a prescription for a fatal overdose. (Interestingly, a third of them never use it.) A move last year to extend the window of life to 12 months was rejected as too radical.

The Netherlands and Belgium take a far more expansive approach. Psychiatric patients can request euthanasia, and although they make up only a small percentage of the total, their numbers are growing. One woman was euthanized a year after her husband died because she didn't want to live without him. People who want to die can shop for an opinion from doctors who work in mobile euthanasia clinics. Canada should not (and probably won't) go there.

In the middle is Quebec. Unlike Oregon, it offers euthanasia, but not the means to kill yourself. As in Oregon, you must have a serious and incurable illness and be near death. Psychiatric patients, people under 18 and non-residents of Quebec aren't eligible. Ten people have received euthanasia since the law took effect two months ago.

Quebec will likely be the model the rest of Canada will follow. But that won't end the story. The right-to-die lobby is vocal and persistent. It will likely push for the broadest possible interpretations of the law, whatever it turns out to be.

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Recently, I spent a few hours with people who are steeped in the issues – doctors, psychologists, ethicists, lawyers and judges, advocates for children and disabled people. The only thing on which they all agreed is that we have reached a watershed moment for society. "These are not private decisions only," one observed. "It's about the worth of people's lives, and whether we think those lives are worth living."

Ultimately the buck stops not with the legislators, the professionals or the courts, but with us. The laws we make reflect the kind of society we are. For now, I think we should be modest. A law that some people think doesn't go far enough is probably the one we want.

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