It’s been a highly controversial issue for decades. In a significant ruling this week, B.C. Supreme Court Madam Justice Lynn Smith ruled that the ban on physician-assisted suicide was unconstitutional. In doing so, she agreed with plaintiff Gloria Taylor, age 64, who suffers from Lou Gehrig’s Disease, or amyotrophic lateral sclerosis. In making her ruling, Justice Smith suggested that a year was necessary to let the “laws catch up” with the ruling, but granted Ms. Smith a special exemption, so that if she so desires, she can, with the help of a physician, end her own life.
The decision reverses previous rulings, like the famous case involving Sue Rodrigues, also from B.C., who took her quest for the right to die to the Supreme Court of Canada in 1992 and, in a split 5-4 decision, lost. Ultimately, Rodrigues took her own life with the aid of an anonymous doctor, but had to do so illegally.
If upheld, Canada will become one of few jurisdictions that legally recognize the right to assisted suicide. Currently, it is allowed in the Netherlands, Belgium, Luxembourg, Switzerland and in three U.S. states, Washington, Oregon and Montana.1
No sooner had Justice Smith ruled, than did the polarities of opinion re-emerge. Petti Fong from The Toronto Star reports: “Dr. Will Johnston, a family doctor in Vancouver with the Euthanasia Prevention Coalition, said an appeal will most certainly be launched.”2 The Vancouver Catholic Archdiocese has spoken out publically against the decision.3 Lawyers representing the government in the Taylor case “argued that overturning the ban [on physician-assisted suicide] would put the elderly, depressed and disabled at risk.”4
In a DeanOnCampus blog one year ago, when physician-assisted suicide advocate Jack Kevorkian died, I posed the question, “was he (Kevorkian) a villain, a misdirected zealot, or a hero ahead of his time?”5
Gloria Taylor 6
It is certainly my personal opinion that we should embrace Justice Smith’s ruling and understand that the fundamental right to end one’s life should rest with the individual, not with the society. To be sure, safeguards need to be put in place, and abuses of such a law could pose a threat. But when facing the undeniable savagery of a disease like ALS, Canadians should be proud that it will be up to Gloria Taylor to decide what is the right course of action for Gloria Taylor.
If you have any thoughts on physician-assisted suicide, please respond to the blog, or better yet…please stop by the Macklem House, my door is always open.
Richard
1. http://en.wikipedia.org/wiki/Legality_of_euthanasia
4. http://www.ctv.ca/CTVNews/Canada/20120615/bc-supreme-court-on-assisted-suicide-expected-120615/
I am dismayed by the immediate opposition that surfaces whenever courts begin to zero in on the fundamental question, which is the right of an individual to control their destiny. The opposition is usually religious, which should have no bearing on a judicial ruling, or from those who fear abuse.
I applaud the decision by the BC courts.
One of the issues that seems to get lost in the discussion is the loss of dignity that may occur with devastating disease. Too often the discussion is framed around pain control (which in this age should never be a concern). Loss of dignity however, is not countered necessarily by even the very best hospice care, and can involve the inability to keep oneself clean, independent and self fed. Loss of dignity does not get the recognition it deserves as a powerful inducement to make alternate decisions about end of life care.
I know from discussions with my father, who was a physician for a very wealthy community in the US, that physician assisted suicide has been practiced under the radar for decades, by an astonishing number of individuals. These patients were often self-made, extraordinarily wealthy and in complete control of their destinies, and were not about to surrender the control of their lives and death to others. He estimated that up to 30% of his wealthy patients made alternative decisions when facing a terminal prognosis.
I see in my own work that too many patients and their families faced with a terminal prognosis have not had the subject of death broached by their physicians, which I think is close to malpractice. It is certainly one of the drivers of inappropriate and unnecessary end of life heroic care.
I will stay tuned to see how this judicial precedent continues to unfold.
Dear Colin,
Thanks for your comments which are so articulately presented. I agree with you that the issue of “loss of dignity” is something we need to pay more attention to. I remember discussing this issue with my cousin, when he was dying from ALS 10 years ago.
I also agree with your view of the need for advanced directives. Readers may want to check out DeanOnCampus about that subject a few months back. http://meds.queensu.ca/blog/?p=1463. Thanks for your views,
Richard
I’m not a lawyer, we are doctors after all. But I believe Judge Smith ruled that because suicide is not illegal, banning assisted suicide discriminates against the disabled and is therefore unconstitutional. It is not news for physicians to hear that suicide is not illegal. There is after all, absolutely no sense even thinking of prosecuting the perpetrator of a successful suicide. This “problem” we address for the still living, with our Mental Health Act (under the supervision of our College and legal system).
My understanding of this matter of “Physician Assisted Suicide” (PAS) has absolutely nothing to do with any religious belief. My understanding of PAS comes simply from an informed, objective and open minded and I am proud to say I completely agree with our College on this subject.
http://www.cpso.on.ca/policies/policies/default.aspx?ID=1582
I am unaware of any study that concludes “the opposition (to PAS) is usually religious”. In fact I’d bet that both parties holding divergent views on this topic of PAS are equally mixed with religious and non-religious views. 85% of the people on Earth believe in a God.
But perhaps most importantly, as Physicians we must at all times strive to mindfully listen to our patients. And Gloria Taylor obviously needs our ear. Please simply listen to her fear:
http://www.cbc.ca/news/canada/british-columbia/story/2012/06/18/bc-gloria-taylor-assisted-suicide.html
Or on your phone:
http://www.cbc.ca/m/touch/video/clips/ys_2247460918.html?st=news&ln=topstories&pid=2247460918
And I quote: “There is a better way to die. To die screaming at the top of my lungs because the pain is so great. I can’t stand it. It is something I’ve tried not to think about”.
I suggest to you when Canada can provide the same level of excellent palliative care as we do neonatal care, and we as a profession address and improve, substantially solve the widespread and perenial problem Dr. McIver describes where “too many patients and their families faced with a terminal prognosis have not had the subject of death broached by their physicians”, then even a larger majority of Canadians (helas never all of us of course) will not feel a need for any form of assisted suicide.
And finally, I ask you re-consider this now old but very pertinent lesson:
http://www.cmaj.ca/content/early/2010/05/17/cmaj.091881.full.pdf+html
There always is security in numbers. But just because a lot of people do something, it doesn’t make it right. For instance, I’ve way more problem with what we’ve done and what we have unleashed in Iraq compared to our painfully terrified patients facing their terminal illness thinking they want to die.
Dear Dr. Kennedy,
Thank you for your insightful comments and links to additional perspectives on this issue.
Richard
“Vice is a monster of so frightful mien, As to be hated needs but to be seen; Yet seen too oft, familiar with her face, we first endure, then pity, then embrace”
Alexander Pope, circa 1700
Dear Dr. Kennedy,
thank you for providing this quote shedding light from your perspective.
Richard
This has been a challenge for physicians for centuries at the beginning of life as they have faced the resolution of obstructed labour with the options of a craniotomy of a living fetus or section with major maternal mortality
Dear Dr.Thank you for reminding us of our history. Richard
If I take my life it is suicide. If another party becomes involved it is something else:
euthanasia?, murder? act of war? execution? –call it what you will but it isn’t suicide .
Dear D H Braden
thanks for your perspective.
Richard
No, it’s not suicide, I would say “assisted death”. Having seen family and friends go through the “normal” process, I would welcome assistance, if needed when the time comes. I think this ruling is fantastic and I hope it won’t be appealed. Should we be sending messages of support to our MP?
Suzanne
Suzanne
Thanks for your comments. To be honest, I am uncertain as to the exact nature of any future legal/political process.
Richard
Suzanne, it maybe is a very good idea to voice our opinions immediately to our federal members of parliament. NOW is the time, the appeal process must (I think) proceed within the next few weeks. So much, so fast… what is happening to Canada?
Again such an important social issue is very much influenced by politics and emotion. So many people have an opinion and a strong opinion at that, on this “issue”, yet have relatively very little knowledge of the current realities and the movement of palliative care in Canada. So many opinions are made on imaginings and/or very emotional personal experiences the likes of loosing a family member. Quite obviously, more information on palliative care, advanced directives and the natural course of terminal disease is sadly necessary.
Chantal Hébert tells us that “according to the polls a strong majority of Canadians support the concept of legal assisted suicide. In regions such as Quebec, that support is overwhelming.”
http://www.thestar.com/news/canada/politics/article/1213305–hebert-tories-not-eager-for-divisive-debate-on-assisted-suicide
And Chantal thinks the next “political move” on this issue (to appeal or not to appeal) will be akin to the political ruminations of same sex marriage and abortion (i.e. avoidance).
Add to that Chantal’s declaration that “Its Canadian proponents are back in court armed with data to back their contention that the predicted slippery-slope effect has not materialized.” Where in fact we have known for years that in Belgium, nurses involved with end of life care, when polled (n=1,678) anonymously: over 50% (mostly male) of these nurses admit to terminating life WITHOUT consent and AGAINST the law and scope of their practice (see, if you haven’t already, the CMAJ link in my first posting above)…
Endure, pity and finally embrace. Is assisted death a fait accompli perhaps for Canada now?
Suzanne, when you have a quiet hour, watch this video please:
http://vimeo.com/25239708
This is the video of Terry Pratchett’s witness to assisted death. Terry is a man with Alzheimer’s, who is obviously (to me) terrified of his lot and wants to decide when he will die.
I think you should know a few things about me: the past now more than 25 years of my career has been with pretty much nothing but Alzheimer’s patients and their families, end of life care. You will not be surprised to hear that the vast majority of my families fight terribly to shun and finally embrace palliation. And if you just think about it for a minute this gut wrenching difficulty is a very beautiful thing. I sure hope my family will have trouble accepting my demise. I can also easily imagine that countless families we’ve cared for according to the “state of the art of palliative care” (hardly rocket science) were so grieved coming into the nightmare of Alzheimer’s disease, their minds were made up and could not be helped by the facts… and today they share with conviction a belief in “assisted execution”…
“Assisted death” if you prefer. In my mind, this “issue” crosses a line we must not cross, so I use the semantic “execution”. Who cares what we call it. I’m only hoping you can appreciate what I’m trying to share with you today. We are powerfully influential people and I believe (and I’m sure you agree) as we lead we must strive for clarity of mind with devoted compassion.
Next, I’m quite sure that you will be astounded to hear that I’ve cared for my patients in a way very much different than I will be cared for: You see, if ever I dement, no one will ever give me an enema or any form of laxative! When I become too confused to know the simple reason my “stomach cramps” is that I’m constipated, I do want more than to go upstairs in the farm house to die with my bowel obstruction. I want my doctor to bring out the narcotics, sedatives, cool face cloths, fans and “oxygen” and I want to be keept comfortable. If ever I must die with Alzheimer’s, I want to pass on peacefully, hopefully surrounded by those who love me, leaving them my last intention: I cherished and faced my life to the end, as I cherish this most precious gift of life for all of my medical practice, holding true to the essence of the art I was taught at Queen’s and lived here at Providence Care: to comfort and care never abandoning the prime directive, our Hippocratic Oath. So, I’ll move along naturally, basically the same way my countless patients over the years have, in comfort and peace, but constipated with a bowel obstruction (or acute obstructive urinary retention), rather than a few years later with aspiration pneumonia.
One last point: if anyone thinks that understanding “advanced directives” is an easy task, you have only to listen to the fear of Terry Pratchett and Gloria Taylor. Advanced directives have a whole lot to do with informed consent. I’m betting what you just read about death with Alzheimer’s is news to you, when you thought you knew already. And my bet is hedged on 28 years of talking to families dealing already for years with this terrifying disease. I could help Terry and Gloria, if only I could get to them, listen to them and then help them understand and help them to not fear what lays ahead. And this understanding would free them to enjoy the precious day we’ve had together today and hopefully tomorrow… But it is likely too late. Like many of my families, Terry’s and Gloria’s mind is made up, especially now they have gone public.
Dear Lois,
Thanks for your eloquent commentary and for providing additional materials to our readers. You also bring the perspective of the someone who has thought deeply about this issue, and whose opinions are informed by a lifetime of experience.
Richard
Several years ago, Dr. Philip Hébert spoke at a conference held here at Queen’s on biomedical ethics. I posed to him the question of assisted suicide, to which he shared very similar concerns and consensus. His work highlights some key issues already discussed here.
Yet upon personal reflection, it seems strange, the concept of death. It makes people uncomfortable. Even for those who see it so often, for one reason or another, there is something innately unsettling about death. Perhaps it taps into the deepest of our instincts, an ingrained understanding that death is bad because if we see death, we are almost certainly too close to it ourselves. This may have been true for our ancestors, but it’s obviously less likely to be so now. The trouble is, the deeper the instinct, the more of an affective component is attached. We also quantify variables in making logically sound decisions. Yet since death is so emotionally complex, what and how can we quantify as variables which determine whether a case of dying is “good” or “bad”?
Can society judge the morality of being able to choose how to die based on intuitive emotion? Conversely, can morality regarding death be judged by logical reasoning alone? Can it be done in conjunction with consideration for emotional association? If so, can they be weighed equally in our judgement and if not, which one takes precedence, why? Lastly, the point you’ve already raised: with all of these questions, who gets to decide?
Dear Ralph,
Thanks for your reflective comments and provocative thoughts.
Richard