The majority of Canadians, in recent polls, favour physician-assisted dying. In response, the Canadian Medical Association passed a motion in August, with 91 per cent in favour, that physicians may “follow their conscience when deciding whether to provide medical aid in dying as defined in CMA’s policy on euthanasia and assisted suicide.”
In June, Quebec’s Bill 52 was passed in a free vote 94-22 in favour of allowing physician-assisted death in certain circumstances. Predictably, the Conservative government has said it might appeal the legislation.
And now a non-partisan select standing committee in the B.C. legislature will examine health-care sustainability, focusing on four separate medical issues, one of which is end-of-life care.
Sadly, it has taken a quarter of a century since Vancouver Island’s Sue Rodriguez cogently stated her case for physician-assisted death, urging our politicians to seriously consider the issue.
Let’s try to clarify the muddled thinking on this topic. For the vast majority of patients who are dying of untreatable conditions, conventional palliative care is an acceptable choice for dying.
Most patients with terminal cancer can tolerate the wasting away, weakness, pain and emotional stress with adequate palliation. Most patients with progressive crippling neurological paralysis are able to cope in spite of horrific disability.
This has led to the erroneous view that palliative care is sufficient and obviates the need for physician-assisted death. Interestingly, palliative care is available to only about 20 per cent of Canadian patients who need it.
Regardless, palliative care does not address the needs of a small number of patients. Therapy-resistant symptoms might be unbearable. Loss of control and dignity might be intolerable. They choose an alternative treatment to obliterate their symptoms, namely physician-assisted death. They have a right to make that decision.
It is noteworthy that those countries or states that allow physician-assisted death have far greater availability of palliative care facilities than in Canada. This is not surprising. Both therapies are available because of the need for a full spectrum of treatments for dying patients.
An Ipsos Reid poll, conducted in August, discovered a major shift in Canadians’ thinking on this topic. Sponsored by Dying with Dignity Canada, the poll found:
• Eighty-four per cent of Canadians say doctors should be able to help someone end their life, if asked.
• Eight-five per cent of regulated health-care professionals support a physician’s ability to assist in dying, should someone be terminally ill and be suffering unbearably.
• Eighty-five per cent of people with disabilities support a physician’s ability to assist in dying, should someone be terminally ill and suffering unbearably.
In Canada, attempted suicide is legally acceptable. Most of the people who do this don’t have a terminal disease. And yet when someone is terminally ill and can no longer cope with the overwhelming burden of their disease, and is too frail and dependent to take their own life, no one can assist that patient obtain the relief from suffering that they request.
There are three major reasons why it has taken us so long to start serious discussions of physician-assisted suicide:
• Unlike other suicides, it directly involves a third party — the physician.
• There’s the fear that physician-assisted death, once accepted, will lead to widespread abuse, the “slippery slope.”
• There’s a belief, often influenced by theological concepts, that the taking of life is never acceptable.
The recent change in physicians’ attitude demonstrates that acting in the patient’s best interest supersedes all other medical ethical guidelines that have influenced physicians since the times of Hippocrates, especially the “do no harm” dictate, which, at its worst, might cause death.
But for the dying patient with unbearable suffering, the choice of death might be preferable to living. Assisting that patient cannot possibly be construed as doing harm.
The theoretical notion that the slippery slope will lead to widespread abuses has been repeatedly refuted by scholarly research. In places where it is allowed, physician-assisted death accounts for less than 0.5 per cent of all deaths.
Interestingly, a sizeable proportion of those whose have been approved for physician-assisted death do not exercise the option. They die from their disease, but they undoubtedly take comfort in the knowledge that they have a choice if the situation becomes unbearable.
Religion has scorned homosexuality, birth control, gay marriage and many other social behaviours. It cannot accept physician-assisted death. But a religious credo cannot be forced on Canadian society. Those who share that religious belief are free to choose to reject the concept for themselves. Others should be allowed to make whatever decision they feel is best for them.
Opinions on physician-assisted dying and other issues can be submitted through the standing committee website (https://www.leg.bc.ca/cmt/health/submission.asp), by fax (250-356-8172) or by mail (Select Standing Committee on Health, Room 224, Parliament Buildings, Victoria, B.C., V8V 1X4). The deadline is Dec. 31.
Dr. Adrian Fine and Bernice Halvorson are members of Choices in Dying Victoria.
