It is hardly surprising, but nonetheless disappointing, that legislation concerning physician-assisted suicide is almost certainly going to be delayed. This legislation is way past due.
Before 1972, it was a criminal offence to attempt suicide with or without help. The result was that, until this law was reformed, many physicians humanely documented suicide attempts as “accidental.” In retrospect, it boggles the imagination that a person trying to recover from a serious mental illness would have to face a police interview, and possibly appear in court.
In 1993, Sue Rodriguez, a patient with ALS, lost her second bid for an assisted suicide. This was in the Supreme Court of Canada in a slim 5-4 decision.
In 2011, the British Columbia Civil Liberties Association filed a right-to-die lawsuit in the B.C. Supreme Court on behalf of Gloria Taylor, another patient with ALS. In June 2012, the court ruled in favour of the BCCLA, and one month later, the federal government appealed this decision. In March 2013, the B.C. Court of Appeal overturned the lower court decision.
The case was then taken by the BCCLA to the Supreme Court of Canada, which, in February 2015, came down with a unanimous decision in favour of physician-assisted suicide. The court was realistic about the significance of this decision, and gave the federal government, provincial governments and physicians’ licensing colleges a year to prepare appropriate legislation.
It is now nine months from that decision and little seems to have been achieved. It is my opinion that, in a large part, this was active passive opposition to this legislation.
Polls indicate that 85 per cent of the population of Canada supports the concept of physician help at the end of life. The 15 per cent who do not support it are quite vocal in their opposition. I think many of their concerns are understandable, but not insuperable.
• Physician-assisted suicide is euthanasia. It’s not — it’s entirely different. The former is a choice to die with a considered request for this. The latter is killing a person with neither their awareness or consent — isn’t that murder?
• The disabled will be culled in the name of economics. I think this argument disabuses itself.
• The frail elderly will be persuaded to commit suicide by their “loved ones” to avoid being a burden or delay an inheritance. I think this is possible, though unlikely. This is where the legislation is going to need to be carefully drafted.
• Palliative care will not be practised to its full extent. Palliative care has come a long way and can deal with pain, pruritus (itching), nausea and other unpleasant symptoms. It cannot, however, palliate progressive weakness to the point where the patient requires help with all and even the most intimate self-care. I think it is no coincidence that the most ardent advocates for control over the end of life are patients with neurodegenerative disorders.
• This is a slippery slide. A slide from where to where? This is where the necessary legislation must be carefully crafted.
I urge that this legislation be passed expeditiously and very carefully. Why am I so passionate about this subject? It is a matter of control.
Patients with progressive illness, especially neurodegenerative, fear they will reach the point where they have no determination over their symptoms or their fate. Knowing that at any time they have the option to end their suffering will offer them invaluable peace of mind. Sometimes that is all that we can offer the dying.
In countries where assisted suicide is available, fewer than one per cent of eligible patients use this option to end their lives.
In this month when we remember the wars, it is a paradox that we send our youngest, fittest and finest men and women to kill and to be killed, while we deny a compassionate death to the terminally ill.
Canada is a compassionate nation again now. It is 22 years since that SCOC split decision. That is indisputably enough. Enough suffering. Enough uncertainty. Let us give the greatest gift that we can to the terminally ill: control and thus peace of mind.
Chris Pengilly of Victoria is a recently retired family physician.
