Medically Assisted Dying

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On October 15, the Supreme Court of Canada heard a case for physician-assisted suicide. Two and a half weeks later, terminally ill 29-year old Brittany Maynard ended her life in Oregon under the jurisdiction of the Death with Dignity Act in that state (Cavaliere, 2014). The legality of end-of-life decisions is high in public awareness right now.

There is also a sense that in Canada social mores have shifted since the last time this issue was brought before the Supreme Court, in 1993. Public opinion polls show that the majority of Canadians (68-84%) favour the right to a medically assisted death, provided there are proper safeguards in place for vulnerable people (Dying with Dignity Canada, 2014).

Canada is not alone in struggling with this issue, as many jurisdictions internationally are seeking to enact legislation to manage the demand for this ethically problematic service. The accompanying table presents a summary of which types of medically-assisted dying are available in which parts of the world.

Type of medically-assisted dying

Description

Where it is legal

Physician-assisted suicide Patient self-administration of life-ending medication, prescribed by a doctor Washington, Vermont, Montana, New Mexico and Oregon State; Luxembourg, Netherlands, Switzerland, Belgium
Voluntary euthanasia Patient requests a doctor to administer life-ending medication Netherlands, Belgium, Luxembourg, Quebec
Non-voluntary (or pre-planned) euthanasia Patient requests euthanasia when competent, but it is carried out after he or she has lost competence Netherlands (restricted)
Involuntary euthanasia Someone’s life is taken against their will by the administration of life-ending medication Nowhere

Table 1 – Types of medically assisted dying (Dying with Dignity Canada, 2014)

Advocates of right-to-die legislation say that individuals who are unbearably suffering should have the right to end their life when and how they see fit. They argue that the principles of justice and compassion should allow it. Circumstances in which this would be allowed are most commonly terminal illness, irredeemable traumatic injury, and unbearable suffering; patients requesting to die must also be mentally and emotionally competent. Proponents also argue that although such practices are currently illegal in Canada, palliative sedation is common, and the increasing use of living wills requires more clarity in the law (Dying with Dignity Canada, 2014). Pro-euthanasia advocates see the need for strict guidelines regarding consent, and want stringent safeguards to be put in place to protect vulnerable people.

In places where medically assisted dying is legal, evidence shows that although people value their right to have this option, it is not widely used. For example, in Belgium and the Netherlands, assisted dying accounted for 1.1%-2.9% of all deaths. In the states of Oregon and Washington, the corresponding number is approximately 0.21% (Steck, Egger, Maessen, Reisch, & Zwahlen, 2013). The ‘typical’ assisted dying patient is a 60-84 year man with a terminal cancer diagnosis, while ALS and other degenerative diseases make up a smaller proportion of euthanasia patients (Steck et al, 2013).

Opponents to medically assisted dying are often religious groups, medical practitioners, and disability rights organizations. Some religious groups believe that human life belongs to God, and as individuals, we have no right to end it (Death with Dignity National Centre, 2014). Medical practitioners against medically assisted dying often quote part of the Hippocratic Oath to ‘above all, do no harm.’ Many physicians believe that assisting a patient to die is against the code of ethics of the medical profession (Physicians’ Alliance Against Euthanasia, 2014). Disability rights groups are concerned that if medically assisted dying becomes legal, vulnerable people could be coerced into accepting euthanasia when they don’t want to (Council of Canadians with Disabilities, 2010). Also, some people believe that suffering is virtuous and valuable.

The case before the Supreme Court of Canada will be a landmark decision. Due to the support in public opinion polls for medically assisted dying, as well as evidence from jurisdictions where this practice is legal, many observers are predicting that the current case will be decided in favour of the plaintiffs (Fine, 2014). This means that the federal government could be tasked with rewriting legislation to reflect the change, as well as provide safeguards for vulnerable populations.

It behooves all Canadians to be aware of this development, as it purports to constitute a legal reflection of our assumed shared values. Issues like this one, regardless of on which side each of us falls, represent opportunities for a deeper personal exploration of both individual and societal values.

 

References

Cavaliere, V. (2014, November 3). ‘Terminally ill woman ends her life using Oregon’s assisted-suicide law.’ The Globe and Mail. Retrieved from    http://www.theglobeandmail.com

Council of Canadians with Disabilities. (2010). Canadians with disabilities – we are not dead yet. Retrieved from http://www.ccdonline.ca/en/humanrights/endoflife/ euthanasia/Canadians-with-disabilities-we-are-not-dead-yet

Death with Dignity National Centre. (2014). Religion and spirituality. Retrieved from http://www.deathwithdignity.org/ historyfacts/religion

Dying with Dignity Canada. (2014). The case for medically assisted dying. Retrieved   from http://www.dyingwithdignity.ca/ database/files/library/The_case_for_medically_assisted_ dying_print_version.pdf

Dying with Dignity Canada. (2014). First release poll results: key findings. Retrieved from http://www.dyingwithdignity.ca/ resources/first-release-poll-results/inner_articles/726.php

Dying with Dignity Canada. (2014). Right to die FAQs. Retrieved from  http://www.dyingwithdignity.ca/learn/your_right_to_die.php

Fine, S. (2014, October 15). ‘Physician-assisted death case could usher in epoch making change.’ The Globe and Mail. Retrieved from    http://www.theglobeandmail.com

Physicians’ Alliance Against Euthanasia. (2014). Open letter to the Canadian people on euthanasia and assisted suicide. Retrieved from            http://collectifmedecins.org/en/open-letter/

Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and assisted suicide in selected European countries and U.S. states: Systematic literature review. Medical Care, 51(10), 938-944. doi: 10.1097/MLR.0b013e3182a0f427

 

 

 

 

 

 

 

 

 

 

 

 

 

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Nicole Haywood

Associate editor for the IJHS. Bachelor of Health Sciences, class of 2014, University of Ottawa.

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