Amid a morass of bad news, there’s also some excellent news today. According to many Canadian sources, including the Globe and Mail and the CBC, the Supreme Court of Canada ruled unanimously this morning that terminally ill adults cannot be prosecuted for having a doctor help them end their lives. Assisted suicide had previously been a criminal violation. The ruling won’t take effect for a year, but that’s only to allow the provinces to develop regulations about the procedure. Quebec already has such a law, which was in some limbo as it violated Canada’s criminal code, but now it looks kosher.
Doctors do not have to comply with these requests, either, but I suspect that many compassionate ones will. How could they not—unless they were religious? The terminally ill people.
According to the CBC, the court ruled on a suit initiated by two women who were terminally ill, but the ruling came too late for both:
The case was brought by the B.C. Civil Liberties Association on behalf of two women, Kay Carter and Gloria Taylor, both of whom have died since the legal battle began. Both women had degenerative diseases and wanted the right to have a doctor help them die.
A lawyer on behalf of Carter and Taylor argued that they were being discriminated against because their physical disabilities didn’t allow them to kill themselves the way able-bodied people could.
Carter went to Switzerland with her daughter, Lee, to die. Taylor died of amyotrophic lateral sclerosis (ALS) in 2012.
There are those who object to this ruling, of course. I suspect the Anglican and Catholic churches will raise a fuss—after all, it was the Anglican Church’s refusal to give any credence to priest Eric MacDonald’s wish to help his M.S.-afflicted wife die with dignity that eventually made Eric (who used to comment here), leave the Church. And according to the Globe and Mail, an organization of Canadians with disabilities have also objected:
Critics of the ruling said it puts disabled people at risk. In a joint statement, the Council of Canadians with Disabilities and the Canadian Association for Community Living said they are “profoundly disappointed” with the ruling.
“As we each near the end of our lives, at the time when we are likely to be most vulnerable to despair and fear, we have now lost the protection of the Criminal Code,”the groups said. “Where shall we now find that protection? CCD and CACL caution that our collective response to this question must go far beyond the technical exercise of so-called ‘safeguards.’ ”
The protection, of course, will come with stringently written laws that require psychological evaluation, a terminal illness, and absolutely verified consent of the patient. It’s not as if anybody is going to pass laws allowing people to be killed willy-nilly! As far as I’m aware, places that allow assisted suicide have not had any cases of abuse, or even questions about abuse. One thing that I’ve learned from reading about assisted dying is that people who are given prescriptions that will end their lives painlessly—barbiturates—feel a great sense of relief that they have some control about how and when they die. And some don’t even use the prescriptions.
This ruling is very good news—another move upwards on the moral arc—and I hope that the U.S. courts will take notice of this, for assisted suicide is legal in only a few places in the U.S. Wikipedia lists them:
OR, WA, VT have legalized assisted suicide through the legislature or popular referendum; assisted suicide is de facto legal in Bernalillo County, NM and MT through court decisions; New Jersey’s House has passed legislation legalizing assisted suicide; bills in CT and CA are under review in the state legislatures.
That is not a lot of territory.
You can find the Canadian Supreme Court’s full decision here; I present just a few excerpts of how they nullified existing law:
Section 241(b) of the Criminal Code says that everyone who aids or abets a person in committing suicide commits an indictable offence, and s. 14 says that no person may consent to death being inflicted on them. Together, these provisions prohibit the provision of assistance in dying in Canada.
The trial judge found that the prohibition against physician‑assisted dying violates the s. 7 rights of competent adults who are suffering intolerably as a result of a grievous and irremediable medical condition and concluded that this infringement is not justified under s. 1 of the Charter. She declared the prohibition unconstitutional, granted a one‑year suspension of invalidity and provided T with a constitutional exemption.
. . . The appeal is allowed. We would issue the following declaration, which is suspended for 12 months:
Section 241(b) and s. 14 of the Criminal Code unjustifiably infringe s. 7 of theCharter and are of no force or effect to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.
h/t: Norm
Not only was the decision unanimous but, according to CBC news:
All nine justices share the writing credit on the ruling, an unusual action meant to signal particular institutional weight behind the decision.
Not only was the decision unanimous but, according to CBC news:
All nine justices share the writing credit on the ruling, an unusual action meant to signal particular institutional weight behind the decision.
Worth repeating, lute. 🙂
Please notice that the Supreme Court of Canada’s judgement does not refer to terminally ill people, but to those who “have a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” This says nothing about terminality at all, nor should it. All laws regarding assisted dying should provide relief for anyone who is suffering irremediably, whether they are about to die or have many years to live. Canada’s highest court has recognise this, and it is the most important qualification in the judgement, and should not be missed.
I was hoping you’d appear in the comment stream, Eric. I wanted to say “congratulations”. I like to think your advocacy on this subject contributed to this victory Canada.
Here here.
Yes, indeed.
b&
Yes, I thought of you and your wife as soon as I read this. A victory for compassion. It’s about bloody time.
Thanks for that important detail, Eric!
Mission accomplished.
I’m glad you pointed that out. It should not matter. If anything, somebody with 40 years left to suffer is in more need of relief than somebody with three months. I have suffered chronic pain for 60 years, and NOBODY should be able to require me to keep suffering if I decide I have had enough. Unfortunately, the fundamentalist rulers of Texas don’t agree. (Don’t misunderstand. I’m not ready to end it yet. I’m not finished trying to make a few people think a little. I’m just saying it should be my decision.)
Ive “only” had 33 years of both acute and chronic pain, so I’m a baby compared to you, and I don’t want to die. But if I did, I should be able to make that choice. People have been trying to get legislation introduced in New Zealand for some years, but it’s never made it. We don’t have a constitution, so the Canadian route couldn’t be used.
People don’t realize how bad living with chronic pain can be and how much it plays into your quality of life. I find the medical establishment lacking in this area as well. It may be that a non life threatening ailment, like migraines, appear as something that is a low priority or something that should not be medicated with potentially dangerous drugs; but if it means the person is in agony every day and every night, it pretty much makes their life not worth living. I once told my doctor that I didn’t care if the medication destroyed my liver if it meant it stopped the pain. The restrictions on my medication is abominable!
Or they don’t care. They think that suffering shows good character, and that anyone who doesn’t want to suffer is substandard.
I think that one thing that those that claim that enduring suffering shows good character have in common is that they have never actually experienced true suffering.
As Ambrose Bierce described them:
“Christian, n.: one who believes that the New Testament is a divinely inspired book admirably suited to the spiritual needs of his neighbor.”
So suffering good enough for others but not for me.
I heard someone on CBC talking about how upset he was that the legislation was so broad because people who were not near death shouldn’t be allowed to end their lives. I said out loud to the radio, “have you never met a sick person?!” by which I meant, have you never really seen suffering – the kind that can’t be suffered in silence; the kind that can’t be medicated away? It really bothers me that such people feel justified in telling others to suck it up.
Two twisted things that I heard ‘compassionate’ pro-life Christians say:
1)it is most merciful to birth a 23wk neonate and watch it slowly die, because that neonate got to experience life for 12 hours. Also, it teaches those of us who are not suffering how to be compassionate.
2) only Jesus was born perfect, therefore, any woman with a disease that would kill her if she became pregnant should *not* be permitted to get a tubal ligation.
I think every legislator considering a “no” vote on such legislation should be required to spend a month with electrodes attached to his or her genitals before voting, with the voltage at the maximum amount that won’t cause permanent scarring.
Similarly, no politician should be able to send soldiers to war in a foreign country unless he or she has at least one close family member (spouse, parent, child) in active combat duty or agrees to do a complete tour of duty in a front-line combat role. Exceptions could be made for decorated veterans, especially those with war wounds, but those exceptions should probably be granted by popular vote of their constituents.
b&
I totally sympathize. Chronic pain is a night mare. I’ve had it with my back.
I hope your condition is now under control. Please say it is.
I get about 8 migraines a month that I can control with medication. I really want a neurologist who specializes in migraines to help me out but for right now I have other things to deal with so that will have to wait. I have a lot of muscle stiffness all over as well but I’m hoping all my pain is reduced with the high amount of walking I’m doing now.
Are you able to do light yoga stretches and massages for the muscle stiffness and pain, Diana? It’s tough when you don’t have enough meds on hand. I hope you get to the bottom of this problem. The hubby’s recurring migraines have abated for the most part since he had carotid surgery. The source of his problems were found ‘by accident’. The arteries to his brain were clogged.
When I have a headache which is nothing compared to migraines, I first make sure to drink lots of water, in case I’m dry. Then I try eating hot pepper sauce, cayenne or wasabi and do a neck and temple massage on myself.
I stopped doing yoga because I found I got more stiff. This didn’t used to be the case. I suspect I have all over inflammation perhaps due to my nervous system’s reaction to migraines and possibly years of stress (which migraines don’t help). I have found that taking muscle relaxants – I take cyclobenzaprine – can help but I need to do this right away and I can only take at night and often half a pill because it knocks me out so much. If there is a weather change coming that is going to mean sudden pressure drops, I can get ahead of it by taking that medication. For some reason my doctor is cheap with those pills and doesn’t want to prescribe them in very big quantities.
Well said, and good work!
A crucial point. I’m glad you pointed it out!
Yes, thanks for the extra clarification. I wish America would learn something from our Northern friends. Our “exceptionalism” blinds us to other nation’s laws and regulations, whether they work well or not. I live in Washington, and though assisted suicide is legal, you can only do it in terminal cases, and you have to do it yourself. It’s not “assisted” by a professional or in a hospice or hospital.
Thank you for adding to this great news.
The other point that the media hasn’t communicated clearly is that if the government doesn’t enact new legislation to replace the current law, it will remove criminal sanction for anyone assisting someone with suicide, not just doctors.
While it will certainly be good to have structures in place to ensure consent and ability to consent, which may be best achieved by limiting this to health care workers, hopefully the new legislation will also protect friends and family who “assist” the person in indirect ways as well.
I recall there being concerns about Kay Carter’s daughter being charged for having simply travelled with her mother to Switzerland.
I wonder if the charges will lifted from those that were found guilty of manslaughter for assisting loved ones to end their lives.
After the Supreme Court of Canada decision in 1988 striking down the existing abortion law I believe that no legislation has been enacted that attempts to codify women’s access to abortion, and except for a few attempts by the current conservative government to do an end run around this by opening a “debate” on when life begins, Canadian women have pretty much unrestricted access to abortion.
Apparently the “slippery slope” crowd have ignored the Canadian experience with abortion when predicting that unencumbering end of life choices from religious dogma would lead to wholesale slaughter of the old and handicapped.
I’m quite sure that Canada will do quite as well in handling this new success in formulating social policy based on human well being and jettisoning legislation based on nomadic snuff porn.
Yes, there are no restrictions on abortion, even on when in the term you can have one. This is because Canada recognizes that this should be a decision between the woman and her physician and the state has not interest in that decision. This means late term abortions are very rare as they present a risk to the woman.
The abortion issue has been challenged by conservative politicians here and there but I think they are aware that doing so is political suicide.
We owe much to my hero, Henry Morgentaler and the prime minister I grew up under, Pierre Trudeau, who probably shaped a lot of my political and social views.
I heartily concur: Dr Morgentaler & PM Trudeau were two of the greatest Canadians we’ve had.
Just to be precise, there are restrictions on abortion, but not under criminal law. As a medical procedure it is regulated by the provinces and territories for better or for worse.
For example, PEI has not given the approval for anyone to perform abortions within the province, although Medicare will pay for them when performed in Halifax. New Brunswick until very recently required the consent of two physicians for an abortion to be performed in a hospital and covered by Medicare.
While there was the Morgentaler clinic in Fredericton, abortions performed there were not covered by Medicare, and this was the subject of a long-running legal battle that ended with Dr. Morgentaler’s death.
Outcry over the loss of the clinic forced the NB government to remove the two physician requirement, but the regulations still require the abortion to be performed in hospital to be covered by Medicare.
If assisted suicide were to be deemed a medical procedure, like abortion, then it would limit those who could perform it (else practising medicine without a license) without criminalizing it, just like the current approach to abortion. The one concern might be if a province put unnecessarily bothersome rules in place to hinder the process, but hopefully this wouldn’t be the case.
Yes, you are correct. (As you recognized, I was referring to the state of the criminal law, & should have been more precise). Thank you for addressing my oversight.
Also, from what I gather, many (most?) physicians decline to perform third trimester abortions in the absence of serious genetic or other medical issues. In practice, this constitutes another (non-legal) restriction.
Maybe I am being uncharitable, but it would not surprise me to see conservative provinces erect onerous barriers. I would like to see such disparities addressed somehow, but attempting to do so could be a constitutional nightmare.
Such is the hassle of having provinces administer health care instead of the feds. It makes more sense to me if they shared some of the load. If I’m a Canadian, I should be able to get consistent health care wherever I go, not have to get one province to bill my home province or deal with varied legislation.
That is an excellent, telling parallel. We are the only western nation with no abortion laws (i.e., no restrictions on when &/or why a woman can obtain an abortion). Moreover, since 1988, the Supreme Court has repeatedly strengthened this position in a variety of ways (often indirectly, e.g., Dobson vs Dobson found that women cannot be negligent towards their own fetus).
Yet our abortion rate is very low, & continues to decline (by approx. 1% per year). From what I gather, it is currently below 15 per 1000.
Of course, we also have good sex ed & no restrictions on contraception. (Québec does not have consistent sex ed programmes, & their abortion rate is significantly higher than the rest of Canada). Perhaps we should look at adding some form of ‘death & disability ed’ to primary & secondary education.
Dobson vs Dobson, [1999] 2 SCR 753. http://scc-csc.lexum.com/scc-csc/scc-csc/en/item/1716/index.do
You would think that one of the primary functions of an education system would be to ensure that upon becoming adult members of a secular democracy, children would have the necessary intellectual toolkit to make informed choices about all aspects of their lives.
This seems to be lost on the religious, for example here in the provence of Ontario, Canada the taxpayer funded Catholic school boards are still busy using public funds to ensure that women and homosexuals are denied basic human rights and have unequal access under the law.
We see the same thing happening in Catholic hospitals, which are primarily taxpayer funded as well, working diligently to force their disgusting anti-human ideology on women who have no other easy access to basic medical services.
Hopefully the current provincial government (the premier Kathleen Wynne is both female and homosexual) will have the guts to kick these nasty theocrats out of our education and medical systems.
Absolutely! I live in Ottawa (moved here from Halifax for grad school) & I am with you on this 100%.
(On a related note, did you see the recent report? http://news.nationalpost.com/2015/02/06/despite-lack-of-evidence-20-of-ontarians-believe-some-vaccines-cause-autism-new-poll/#__federated=1
Apparently 1 in 5 of our neighbours shouldn’t be allowed to use ‘big kid’ scissors unsupervised. Scary).
I’m of an age where I remember some of my childhood friends striken down with polio, rheumatic fever and rubella.
I never thought I’d see the day when these diseases would make a comeback.
Rex Murphy, who angered me over his anti-atheist remarks, makes very good points about vaccines.
Who knows, eventually we may have a comprehensive program for those who choose to capitalize on it. I see studies in psylocibin are coming along nicely in relieving the sense of despair of death for sometimes up to six months from one session. But the US seems unparalleled in its capacity to retard its own progress wherever religion gets its grubby hands in on it, under the guise of “ethics.” Just saw this article today. We are concerned this might be a slippery slope towards healthier, more intelligence and attractive kids. Heaven forbid!
http://www.scientificamerican.com/article/when-will-3-parent-babies-come-to-the-u-s/?utm_source=twitterfeed&utm_medium=twitter
I saw a similar complaint in the British press. It’ll mean less people with disabilities are born, which is apparently a bad thing. I don’t get the logic. It means there will be less suffering, more healthcare money available for those who need it, more money available for research to help those with the conditions and I really can’t imagine that less people being born with avoidable conditions will make me any less sympathetic to, or aware of, the needs of those that are. This argument is also used by anti-choice campaigners who think people shouldn’t be able to abort a foetus with a congenital condition. They seem to think there is a moral equivalence between aborting a foetus with a congenital condition and the death of a self-aware, thinking, feeling person with hopes and dreams with the same condition. It’s ridiculous.
We have the same sort of idiocy here in NZ. A group of Downs Syndrome parents – assisted by ‘Right to Life NZ’ (and guess where they come from) – are agitating against pre-natal screening for Downs Syndrome as ‘genocide’. I think they have less brains than their Downs Syndrome kids. http://www.bioedge.org/index.php/bioethics/bioethics_article/down_syndrome_screening_is_genocide_says_new_zealand_group
To these people, and all self-centred disability groups who oppose the ability of others to alleviate their own suffering, I respectfully say: Go fuck yourselves. Any sympathy I have for your problems evaporated instantly the moment you tried to deny relief to others in case it somehow, in some obscure and paranoid-fantasy way, impaired your interests at some point in the future.
(I hasten to add that not all Downs Syndrome parents are in that group).
There was a guy on Patheos blogs who was arguing the same thing. He was from NZ, and the father of a DS child. His argument was that DS was just another variation, like hair or eye color, and that it was always totes wonderful and joyous
I think they have to try to convince themselves that looking after their – what’s the politically correct term these days, ‘disadvantaged’? – disadvantaged children must have some compensating redeeming features. If it helps them to get through the day, fine, I can forgive that much self-deception. But they can’t expect everyone else to agree with it and particularly not if it impacts other people’s lives.
What was it that Winston Churchill said? “Ah- the Americans- they always get it right, after they’ve tried everything ELSE, first.”
Let us all make sure our passports are in order. Go to Canada for health care, pills you can’t get in the U.S and now to finish it off. I would say Canada will get sicker of us than a pile of draft dodgers.
Nah, Canada took in a bunch of people during the Bush years (not to mention the Vietnam War) and those Americans fit in quite nicely here because they tend to be very liberal. However, I’d like to see liberals in America be able to change their country as well without having to be driven out, so to speak.
You might say we will have to look north for enlightenment.
We are retiring to WA state. And we were before either of these:
1. Legal recreational marijuana(!!)
2. Legal assisted suicide
It is a wonderful place.
My best friend is dying from ALS. He’s only 40 years old. It’s an unspeakably horrible disease, with no hope of a cure. He’s very scared and doesn’t want assisted suicide or even a living will, but that decision should be his and his alone. I have utter contempt for self-righteous religious prigs who think they have the right to impose their warped sense of morality on suffering people.
I am so sorry to hear this. My condolences to you and your friend.
It did not happen for “a reason.”
Indeed it anyone for that matter including the group that Jerry references who fear disabled people will be harmed. There is no evidence of that elsewhere and should they tell others how they should live and die? Hell no!
I am sorry to hear about your friend.
So sorry, Stephen. It’s a heavy lot to bear.
That is so sad, Stephen.
I’ve never before experienced something like this. My pain of watching him fade away hurts, but it’s made more difficult by feelings of guilt because it’s so much worse for him, so what right do I have to feel bad? It’s confusing. He’s fortunate to have a devoted wife and family and many friends who take care of him and will treasure his memory.
Please don’t feel bad about feeling badly for him. It’s a very human response and all because you love and care for him, and think of yourself as sharing a difficult journey with him. I don’t mean to be presumptuous, but I suggest that you just continue to show your regard for him, maybe write him notes or send him a recording of your voice and share any little joy you experience in life with him, and tell him how cherished he is and what his friendship have meant to you.
..*his friendship has meant to you*
I am proud to live in a province, British Columbia, whose Civil Liberties Association started the process which resulted in this decision. It is a well-aimed kick in the nuts for our born-again Prime Minister, Harper, whose pet hate has always been “activist judges”. Dare I say – Thank Zeus et al !
What is interesting about this case is the Supreme Court actually revisited its prior ruling which is unusual.
For those interested, <a Dying with Dignity Canada has been following this closely and advocating for this type of change.
It is unusual for the SCC to revisit their prior ruling in that it happens very rarely; it is not, however, unusual in the sense of being theoretically abnormal or in conflict with established doctrines in Canadian constitutional interpretation.
“[O]ne of the most fundamental” principles of constitutional interpretation in Canadian law (Same-Sex, para. 22) is the Doctrine of Progressive Interpretation, often referred to as the Living Tree Doctrine/Théorie de l’Arbre Vivant. It became entrenched via the seminal ‘Persons Case’ (Edwards v. Canada) wherein Lord Sankey L.C. indicated that courts must not approach interpretation so as “to cut down the provisions of [an] Act by a narrow & technical construction, but rather to give it a large & liberal interpretation” (Edwards, 9).
According to the Living Tree doctrine — adhered to from our constitution’s inception (see B.C. Motor Vehicle Act, para. 53) — a constitution is fundamentally organic in nature. It is “a living tree capable of growth & expansion” — & thus must be interpreted in broad & “progressive” fashion, “accommodat[ing] & address[ing] the realities of modern life” (Edwards, 9). Or, as it was put more recently,
“A large & liberal, or progressive, interpretation ensures the continued relevance &, indeed, legitimacy of Canada’s constituting document. By way of progressive interpretation our Constitution succeeds in its ambitious enterprise, that of structuring the exercise of power by the organs of the state in times vastly different from those in which it was crafted” (Same-Sex Marriage, para. 23).
Strict textualist & originalist approaches to constitutional interpretation (such as that espoused by Scalia et al.) are anathema & explicitly rejected by the SCC since they hinder the law from keeping pace with the evolution of Canadian society & the plurality of diverse groups comprising it.
Thus, this was bound to happen sooner or later. Revisiting prior decisions is unavoidable for the SCC, & not regarded as problematic, but as natural, normal. Society changes & law must change with it — whether conservatives like it or not.
Regardless, I am glad it happened now! It’s such a mature, compassionate, well-reasoned judgment.
References
Edwards v. Canada (Attorney General), [1930] AC 124 (PC); 1929 UKPC 86. BAILII. Web. http://www.bailii.org/uk/cases/UKPC/1929/1929_86.html
Reference Re B.C. Motor Vehicle Act, [1985] 2 SCR 486. LexUM. Web. http://scc-csc.lexum.com/scc-csc/scc-csc/en/item/100/index.do.
Reference re Same-Sex Marriage, [2004] 3 SCR 698. CanLII. Web. http://canlii.ca/t/1jdhv.
Great explanation of things. I think this shows the court working as it ought to work. When the original ruling came down, there were many unanswered questions about assisted suicide and there were few reference points to draw on, so the Court handed down a cautious decision that indicated what were the points of concern.
Now, in this case, there are decades of evidence from other jurisdictions, and the plaintiffs constructed a strong case that addressed the concerns in the Rodriguez ruling, and this new ruling was the result.
Much like medical or technology testing will err on the side of caution when there is significant possible risk, and then open things up once trials present a more accurate picture of risk, that’s what the Court has done with these two decisions.
Thank you. (^_^)
Yes, it is similar, in some ways, to certain types of STEM-field trials, isn’t it? (I hadn’t thought of it in those terms). You adopt a position based on available evidence; when the evidence changes, you change your position.
Now if only we could determine why so many people seem to have difficulty with that approach…
Not merely revisited, but overturned. Unanimously. And with such strong agreement that the written opinion wasn’t signed, indicating all justices supported it. Pretty amazing to see such a big reversal in such a relatively short period of time. Quite amazing. Hearty congrats to the years of hard work from groups like Dying With Dignity Canada, I’m sure it must have felt hopeless at time.
Gives one a little extra faith in humanity.
This has personal meaning for me, as I had a friend whose ALS-afflicted spouse had to go to Switzerland to die with dignity, rather than be able to end his life according to his choice in Canada. This is a hugely important decision, and a victory for both rationality and compassion.
I just hope the conservatives don’t effectively destroy it via poor legislating. 😒
Yes, when you look at how they’ve botched legislation promoting things that they favour, you have to wonder how they’ll manage with something they don’t like.
They could create huge barriers to access (onerous assessment requirements, excessive documentation & other red tape, etc.). It’s a tough call: I feel uncertain as to whether their previous legislative gaffes are deliberate / calculated, or manifestations of genuine ignorance. Perhaps, with an election approaching, & high public support for assisted suicide, they might decide to play it safe.
Also, since health is ostensibly a provincial matter, one might find that it is difficult to create *federal* legislation on the concern.
The same people who oppose abortion also oppose assistece suicide.
I think that they are projecting their existential angst onto the rest of us.
Good point. Makes good psychological sense. Projection is the problem.
“The same people who oppose abortion also oppose assistece suicide.”
And support the death penalty.
It’s perfectly all right to kill people who _don’t_ want to die. (i.e. presumably, most people on Death Row).
It’s just not alright to help or allow people who do want to die, for whatever reason.
Isn’t that how morality works? Getting what you want is immoral and must be prevented?
Right Wing Nut Job Heuristic No. 43: The least compassionate choice is almost always the best choice.
Despite the opposition of disability groups, one of the chief advocates of assisted suicide, or right-to-death as I prefer, is Steven Fletcher, a Member of Parliament and former cabinet minster who was himself paralyzed from the neck down in a 1996 car accident. And he’s a Conservative MP, which means he differs entirely from PM Harper. This is going to be a difficult issue for politicians, because no matter what stance they take, they’ll have fierce resistance. But the court’s 12-month deadline give them limited waffling room.
The statistics in Canada show an overwhelming desire for assisted dying even among religious groups so the politicians can’t say much and besides the Supreme Court made the ruling so….
The CACL is a good organization of wonderful people, but their take on this issue is exactly wrong. Although they are not for the most part self-righteous religious prigs (@6) their position resembles the faitheist position on morality (in which only faith in god can prevent depravity). CCD and CACL assume that, without laws against assisted suicide, the disabled in my country would be completely at the mercy of their predatory care-givers and mendacious family members. Like my elderly parents, who have cared for my disabled sister for 50 years: CACL thinks that my mom and dad are just waiting for a legal opportunity to put my sister out on an ice floe somewhere. And assisted suicide laws are the only thing standing in their way. It’s really insulting (as well as being on the wrong side of helping those who are “enduring suffering that is intolerable.”)
I’m a little curious to see how the government will draft the legislation. When the courts forced them to offer medical marijuana it spawned some laughably passive-aggressive lawmaking, disclaimers, and PSAs. Last year the government spent $7 mill on ads about the harms of marijuana which were more than Health Canada spent on all public awareness campaigns combined! (And for fun, the courts have already struck down aspects of their legislation – couldn’t get it right, even after the courts slapped them the first time.)
Let’s see them whine & complain their way through the whole affair, acting like the world will end without their brand of stuffy paternalism.
This is great news. I hope it starts the snowball rolling.
Definitely a proud day; makes me glad to call Canada home. More importantly, we soon won’t be forced as a society to perpetuate barbarity and inhumanity against people who are suffering intolerably. A huge win for empathy.
Here’s my opinion, with some background first. I do hospital care as well as an office practice, and it commonly involves palliative care. I’ve known my patients in this rural and under-doctored area for up to thirty years and I’m not going to forsake them at the end. Assisted suicide has not been legal here, but now we have a Supreme Court ruling that gives us 12 months to figure what to do. In general, the emphasis in end of life care in Canada is much more humane than that which I read about in the US – quality of life prevails over quantity. We simply don’t do heroics on dying people, and it may be that’s because there is no financial incentive to do them (and perhaps even a disincentive as their extra costs are paid for in our taxes). Proper palliative care can diminish the need to think about assisted suicide, but of course it doesn’t eliminate it.
If we had passed legislation on assisted suicide before the Supreme Court was involved, we could have made judgements about who might qualify, given that beyond the straightforward case of the terminally ill, there are some difficult groups to consider:
1. There will be people who hate their lives, but who aren’t terminally ill. Should they qualify?
2. How about the depressed, especially those who have been resistant to treatment. They may be rational and simply feel it isn’t worthwhile.
3. Physically disabled people, perhaps in great pain or having dreadful quality of life, but with their life-expectancy undiminished?
4. Who shall speak for those unable to speak for themselves, but who suffer?
But now the Court has ruled that there is a right for all citizens with severe illness, disease and disability, and includes both physical and mental disorders in that ruling, to be assisted in ending their lives. So we have lost the opportunity to have a law that pre-screens the kind of illness and individual that might qualify. OK, that’s what the Supreme Court is for – and we will cope.
In other jurisdictions where these things have been enacted, it is generally left to a physician to prescribe a lethal dose of medication, and it is up to the patient to self-administer it. There is no expectation that a physician must do this on demand; they have the option to decline and allow some other doc to do it as a matter of conscience.
In the comments at WEIT the last time this was discussed, there was a good deal of ‘it’s about the patient, not about you’ directed at docs who raised even mild objections to being given this role, to the extent in one case of a thoughtful doc being told he needed to change career. Well, I’ve some sympathy with him/her, despite my long history of supporting assisted suicide, and my liberal exploitation of the ‘dual-effect’ of narcotics in the terminally ill. The first reason is that as a professional, I owe my patients something that is central to my job – my best opinion. I don’t do my job if I give people what they want, I only do it if I give them what my professional judgement says is right. I have to justify it to myself, which I assess by imagining all my colleagues looking over my shoulder and second-guessing me. If I think they would agree, I can go ahead. There is no such thing as just writing a prescription that somebody requests without some judgement being applied; anything else is an abnegation of duty. It’s not always popular, but it is the difference between seeking a professional opinion and hiring a tradesman. It’s nothing to do with arrogance, but is a basic expectation of fulfilling the duty of care and any licensing body would come down hard on a doctor who didn’t take it seriously. Consequently, I have to approach a lethal prescription the same way. This is a matter that should be up to the patient, but by involving a doctor you invoke his judgement. I’ll repeat that to be clear, this is a matter that should be the patient’s decision and not the doctor’s, but in asking a doctor provide assistance, you cannot help but get the doctor’s sense of ethics involved, and that will always involve an internal debate about whether this particular case is justified. Am I ready to take on that role – trying to write a lethal prescription whilst attempting to withhold my own judgement? I’m not sure yet, and it is something that ought not to be done without much thought. There’s something else too, and that is that I will carry another burden afterwards in that I would feel some responsibility for that death. We all have a metaphorical bag of bones that we drag around after ourselves, filled with our mistakes that we wish we could do over. None of us need to make it heavier than it is. Now it’s likely that 90% of requests wouldn’t trigger any difficult ethical decision, but even then I still get the burden of responsibility. At some point the bag of bones gets too heavy.
The second reason is a logistical one. I’m in a rural area. There isn’t another doctor always available to step in when the first doesn’t want to do it. There would also be the strong expectation (and a reasonable one) that a patient who has trusted me for thirty years would want me to be in on this very important matter. There would be pressure to conform, whatever my conscience said, or whether or not I agreed in that particular case (again, I know it’s not my decision, but you can’t get me involved without me having an opinion.) I’m already the only doctor in the area willing to be involved with abortions . Others keep their consciences clean by telling their patients to see me for this purpose, though how that is morally superior I’m not sure. I may have the reputation of being not only ‘the abortion doctor’, but also the one who is willing to ‘finish off’ patients? Doesn’t sound very nice.
So all in all, I am in favour of assisted suicide being available, and I’m probably more willing than most to include ‘rational suicides’ outside the traditional terminally ill applicants. I’m not sure we need to include a doctor in the process, beyond certifying that a patient has no hope of cure in the latter cases, and that the patient understands the nature and implications of his decision in the former. I’m sure I’m being influenced in this by a couple of factors. One was the decision made to withdraw fluids from my father after a devastating stroke. It’s common practice to treat big strokes palliatively when there seems no hope of any quality of life, and I don’t know how many times I have led a family through the decision making process. I never knew I would still be questioning myself as to whether I and my family had done the right thing 16 years later. The other thing is that it seems likely I now know how I shall die myself, having developed leukemia. Naturally I have been thinking on it a lot, but I’m still confused as to how I should proceed mentally. Yes, I would want the right to die, but I suspect decent palliative care will make the process comfortable enough that I don’t exercise that right. Complicated.
So to summarise: a good decision, and one I applaud as a patient, whilst having qualms as the physician expected to assist. It probably just means I have to think about it to the point where the doctor in me is on the same page as the patient in me. If I can be comfortable with a complete transfer of decision-making to the patient for an abortion, I can probably do it for this. I just need, say, 12 months or so…
This is very helpful. Thanks for sharing your perspective.
If I were in your shoes, I’d ultimately ask myself what I always ask doctors, “What would you do if this were your sibling, child or parent?”
I think everyone should have access to humane assisted suicide if they want it, whether they’re terminally ill or in chronic pain or not. We can try to talk them out of it and give treatment for whatever may be the problem, but it should be their decision. It’s not like there aren’t many ways for people to kill themselves that they may botch horribly.
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