Should assisted-suicide be legalized?
On Cross Country Checkup: assisted suicide
A Supreme Court judge in British Columbia has struck down the law forbidding physician-assisted suicide.
What do you think? Should Canadians who want help to die have that legal right?
Or will this set a dangerous precedent?
With guest host Suhana Meharchand Sunday on Cross Country Checkup.
Just over a week ago, a BC Supreme Court struck down the law banning physician assisted suicide.
The court ruled in the case of Gloria Taylor, a woman suffering from Lou Gehrig's disease.
Ms Taylor and the BC Civil Liberties Association were arguing for her right to a physician-assisted suicide. They wanted an exemption from the current law that makes physician-aided death a criminal offence.
In a landmark case, Justice Lynn Smith rendered a controversial decision and declared in their favour.
The judge ruled that the Criminal Code prohibiting physician-assisted death is unconstitutional because it violates the constitutional right to "life, liberty and security of person."
Gloria Taylor's lawyer Joseph Arvay called this "a case that ...touches everybody in Canada, if not directly then indirectly." He said, "all of us likely know a family member, or friend, who is suffering, and who has a fear of dying a horrible death."
Since that ruling, which gives Parliament a year to draft new legislation, physicians, lawyers, ethicists, patients and their caregivers have been debating its implications.
Many express concern that allowing physican-assisted suicide puts our most vulnerable citizens at risk of hurrying a death for pragmatic and economic reasons. They say the focus should be on palliative care and nursing at the end of life -- not on hastening it.
Others argue it's not the place of the courts to decide on these matters at all.
What do you think? Should physician assisted suicide be legalized in Canada?
The province of Quebec launched its own inquiry into the issue. We'll also be hearing about that later in the program.
Our question today: Should physician-assisted suicide be legalized in Canada?
Maybe you've had experience caring for a loved one in their final days and hours. Was the medical support what you expected? What other provisions need to be made to ensure as dignified and pain-free end of life care as possible?
If you're a doctor or nurse with experience in this field we'd also love to hear from you.
Should Canadians who want help to die have that legal right? Or will this set a dangerous precedent?
Does it change society to allow doctors to help patients die? People talk about this being an individual decision. Is it? Or do we as members of society have a right to be concerned with how a person dies?
I'm Suhana Meharchand on CBC Radio One and on Sirius satellite radio channel 159, this is Cross Country Checkup.
- André Picard
Public health reporter, The Globe and Mail
- Will Johnston
Family doctor, chair of the BC Chapter of the Euthanasia Prevention Coalition
- Jocelyn Downie
Professor, Faculties of Law and Medicine, Dalhousie University and Canada Research Chair in Health Law and Policy
- Margaret Somerville
Samuel Gale professor of law, McGill University and founding director of McGill Centre for Medicine, Ethics and Law
- Eugene Bereza
Director, Biomedical Ethics Unit Faculty of Medicine, McGill University
- Right to assisted suicide 'momentous' says B.C. woman
- Quebec panel backs MD-assisted suicide in 'exceptional' cases
The Globe and Mail
- BC Court strikes down ban on assisted suicide: the debates and live coverage
- Woman at centre of assisted suicide case 'still here for living'
- Landmark assisted suicide case raises 'arguable grounds for appeal'
- Legalized euthanasia only a breath away - by Margaret Somerville
- The importance of picking a vocabulary for dying - by André Picard
The National Post
- Ruling legalizing assisted suicide voluminous and sweeping
- The wrong decision on assisted suicide - by Will Johnston
- Letters: Only MDs who pledge never to kill can be trusted
- A loved one's journey into untreatable suffering
- Two sides in assisted-suicide debate remain worlds apart
I would like to ask about the difference between our response to suicide at 16 and 60. We spend a great deal of time protecting all kinds of people from killing themselves-we even have suicide watches in prisons. Yet, we are preparing to make it legal to kill oneself out of fear of what might be. Rather than lionize "assisted"-suicide and justify feelings of helplessness (loss of autonomy) as reasons for ending one's life why do we not put money into providing palliative care for all; care that makes it possible to enjoy what is left of one's time with family and friends? There is article in today's Post about a woman who planned her "death" party. She had cancer and having been told that she would die soon had chosen to take her own life. She might have had a few more months to live. She has a husband and a child. Why would she deny her family and herself the time to be together? Too many of us have come to expect that life should be fair. It isn't. It is our response to all of life's experiences that defines us.
The idea that we are rational human beings who can guarantee that there will be no abuse of the assisted-suicide system has been proven incorrect. Abortion began as a procedure for a limited number of reasons. It is now an unfettered procedure that makes it possible for women carrying more than one fetus to say, "No thank you, I only want one." Or makes it possible for families to say, "No thank you, I don't want a girl," and access an abortion. I am pro-choice, but not to the point that having a child is like picking out a couch. Based on that experience, how can we guarantee that assisted-suicide won't expand to the point that elderly or unwell people won't feel obligated to end their lives or come to believe that an unhealthy life is not a life worth living?
How we treat people at the beginning and end of life speaks to who we are as a nation. We either value all life or we start to pick and choose. Under the guise of self-regarding ethics we are developing into a country of people with grandiose infantile delusions of entitlement, ethics that are selfish. We are losing the most important lesson that underpins the foundation of Western culture-that we care for the other, that we have responsibilities to others that must balance rights. That belief is the reason many of us are repulsed by sex-selection abortion and encouraging people to end their lives for fear of what might be. Our priority should be "LIFE WITH DIGNITY" rather than death with dignity.
My name is Debby Hanscom, until recently I was VP of the Board of Dying With Dignity. I live in Ottawa. I am a lawyer. I would like to tell listeners three things. The BC Court, Justice Lynn Smith, found that the prohibition on Assisted Suicide violated Gloria Taylor's fundamental right to life, liberty and security of the person. In other words, the court determined its not a matter of whether Canadians "should' have this right. We do have it and that right cannot be infringed by the present Code provision. Its a matter of Choice. The right to assisted death does not infringe the choice of people whose religious views require them to die 'naturally'. The evidence from Oregon, Washington, and other jurisdictions proves there is no 'slippery slope'.
I am 84 in reasonably good health and my greatest fear is having a stroke which will leave me helpless and bedridden. I have had a good life and inevitably life had to end, so why not in the kindest way possible.
I have watched my younger sister suffer through Alzheimers and I know that if she could have made her wishes known she would have begged us to let her go. Instead she had to live 12 years with this dreaded disease before death gave her relief.
Cowichan Bay, British Columbia
I may have missed the memo but I thought the role of our medical establishments is to preserve quality of life. My mother in law volunteered in a hospice where she spent the final moments with people who had no one else. She said many of these people would have preferred to die with dignity sooner than go through the process. Indeed after the death of many of her friends and during her lucid times of her terminal illness she expressed her desire to die on her terms. It seems we spend more time worrying about our own conscience than that of the quality of life of those who want help ending their life with dignity as they define it.
My mother died finally in the early morning of April 22, 2012. She was 94 and in late stage Alzheimer's. Four weeks earlier she had slowly reduced her food and liquid intake - she just wasn't taking in as much nourishment. I waited two weeks before contacting her case worker with CCAC, because I thought it might have been just another temporary phase of the illness. It was the following Friday when the nurse came out to do the assessment, and let me know a palliative care worker would be checking in each day. Sunday April 15 turned out to be the last time Mom had any food or drink. For the next six days, my siblings and I watched while my mother starved to death. I suppose technically it was the dehydration that killed her. We made mini-popsicles and let her chew on them whenever she could. Her flesh melted away until she was literally skin and bones. It was the most inhumane experience anyone can be forced to endure. During the final 48 hours Mom was unconscious and unaware of anything. Anyone who has been assessed as eligible for palliative care needs to have the right to a compassionate release from life. Her family should have had the right to decide at what point they wanted to say good-bye. No one benefited from her 'natural' death. I still feel really furious when I think about how we had to let her die. It was not right. And it must be changed.
Carleton Place, Ontario
People who oppose physician assisted suicide are people who oppose the rest of us having the right to decide for ourselves how to live and how to die. I trust myself, my family, and my physician.
Stoney Creek, Ontario
I have heard many doctors and people who are afraid of doctor assisted dying say we have ways to care for those who want assistance to die, to make the remaining life comfortable and free of pain.
But I have never heard any of them tell me what exactly it is they are going to do to make me feel comfortable when I am trapped in a body that cannot do anything and am unable to communicate, but still have to keep on living.
So, doctors, what have you got for my unending, unbearable frustration and boredom? Sedation? well, then, if you are going to sedate me to the point I am no longer aware, why do you want me to continue to live?
For myself, I'm not worried about the pain part. What scares me is that I may be forced to live when I want to die in order to protect someone else's moral scruples.
Keep your moral scruples off my body please.
Lillooet, British Columbia
Hi, I am in favour of this decision. I watched my father die slowly, over many months, from esophageal cancer. He had great difficulty swallowing food and water - and at the end he could not swallow anything. For the last several months of his life he was on a feeding tube. Through this tube my mother fed him his nutrients and drugs. It was extremely difficult, for my father and for my mother. One day my father had had enough, and he just ripped out the feeding tube. He died later the same day. While this sounds terrible, I think it was incredible - my father was able to say his final goodbyes, and then he chose when to die. He had his family around him, and he died at home, in his own bed. I hope that if I am in a similar situation that I have the courage and grace to do what he did - and I hope that I have the ability to choose to do the same.
There are those that say that suicide is a permanent solution to a temporary problem. Five years ago my 39 year old brother was diagnosed with PML. The lesions to his brain had spread to his brain stem. He weighed under 100 pounds, was unable to swallow (fed through a feed tube in his stomach), even sit up and was unable to speak. We were told that his life expectancy was 2-4 months and that he had a 0% chance of recovery. His form of communication was to nod, shake his head and to cry, He would have been an ideal "candidate for assisted suicide". He was originally in a hospital in Calgary and being in Edmonton, with a family to support, I could only visit him on weekends and watched him deteriorate. At that time he didn't have a feeding tube, and I believe that the medical staff in Calgary had decided to "assist his suicide" by letting him starve to death. I insisted on a feed tube and fought to get him transferred to Edmonton. Neither I nor the wonderful medical staff at the University Hospital in Edmonton would give up on him. He was given physiotherapy and speech therapy. He later was transferred to the Glenrose Hospital where he was given additional therapy. Today he lives on his own (with no assistance- shops, cooks, grooms and cleans his apartment); walks with a walker, travels around the country and is an outspoken advocate for the rights of the disabled. At the time he was in such poor physical health he was understandably depressed. When he recovered and was able to speak, he told me that he wanted to die when he was in poor shape and would have committed suicide, if he was able to. To have allowed his physician to assist with this would have been a travesty and the waste of a valuable life. We need to understand that people who are ill can easily become depressed and that can render them incapable of making rational decisions.
St. Albert, Alberta
As a disabled person (I am visually-impaired), I am compelled to agree completely with Amy Hasbrook's comments. It's been my unfortunate experience that doctors have refused to treat me because they believe that my disability will rob me of any quality of life I might have if they treated the specific problem in question.
Decisions to have an assisted suicide must rest only with the people directly affected. It is not up to the rest of us to decide who will die and how and when.
Thank you for a very thought-provoking show!
Those who attempt to foist their personal lifestyle choices upon others are unequivocally committing acts of violence. I appreciate the concerns surrounding slippery slope arguments, and thus we must take great care in drafting legislation. Should we deny the ultimate right of any living being to choose how they die from the whole population because a minuscule minority may be wronged, which may take place regardless? If so, similarly we must deny the right to engage in sexual activity from all citizens because a select few lack the cognitive ability to provide informed consent.
I do not force you to die at the end of your life, nor can you force me to stop myself from dying at the end of mine. Anyone who thinks it is reasonable to stop me from taking my own life, when I have made a well reasoned and informed decision is either not thinking clearly, deluded by antiquated social norms, or simply ignorant regarding this issue. Around this there are many concerns for potential abuse, which can be addressed, but fundamentally there is no right in life greater than that to choose my own death. This is a truth that only a fool can deny.
Victoria, British Columbia
My late husband was diagnosed with acute myloid leukemia. After going downhill rapidly, and being acute pain which was not alleviated with drugs (or perhaps the prescribed schedule of dilaudid was insufficient, given the terrible pace of the disease) he decided to end his life. He consumed the remaining dilaudid and sleeping pills and went to sleep.
His daughter, who had refused to believe her father was terminal, called 911. Then the horror started. Police and ambulance arrived. All parties were aware he was terminal. He was transported by ambulance to hospital. During the journey along country roads he vomited and aspirated. At the hospital the admitting physician, who had been advised by my husband's own physician that he was terminal, remarked that BC was far behind other provinces with this sort of legislation. My husband was put on an anti-narcotic iv. A respirologist was called in to help him breathe. He was wired, tubed and generally treated as if he would live. He managed to half open his eyes twice while in the hospital, but was not able to speak. After 24 hours he started to cry out in pain - the anti-narcotic drug had taken effect. This lasted for an hour, until narcotics were ordered to stop the pain - the very same ones that he took to end his life. After 48 hours in hospital he died. The coroner was involved because he had committed suicide.
This nightmare, this horror, this ridiculous use of resources, could have been alleviated had he been legally allowed to chose to end his own life with grace, dignity and love.
I am not in favour of any type of suicide, nor am I in favour of abortion, but these are my views. Who am I to impose my views on anyone else? These decisions should be left up to the individual. If the state is to play any part in these decisions, its role should be to make sure this is the decision of the person without coercion.
Port Coquitlam, British Columbia
Pleased to see that the subject of appropriate time for end of life is getting more attention and being openly discussed. There is no doubt that at some point it is 'time', so the ways and means must be clear. My mother is in the early stages of Alzheimer's; by the time she has no sense of her inner and outer world hopefully the regulations will be in place on how to have her peacefully put down.
I believe strongly that the court decision supporting physician assisted suicide is the correct decision. Despite issues regarding abuse that may be raised by those opposed to the decision, it is my view that a carefully crafted law and procedures along with vigorous enforcement can prevent these abuses. Generally speaking the wish for assisted suicide relate to continued pain or the entering into a persistent vegetative state. Thus, for example, if someone defines the conditions under which they wish to die (assisted suicide for constant pain or euthanasia for a persistent vegetative state) through a living will there should be no question but that the participation of a physician should be legal.
While I have no doubt that members of the palliative care profession do the best they can to alleviate patients' pain, the fact in that historically, research in pain management has not been a high priority of those funding research and there are still many cases where little can be done to alleviate pain
While the Hippocratic Oath requires doctors to do no harm to their patients, this may not be possible in all instances today. In my view, it would be doing greater harm to a patient to extend a life of constant agonizing pain for days, months or even years where a patient has requested assisted death to end that pain.
I'm listening to your broadcast this Sunday afternoon and can hardly contain myself! Listening to the doctor who said "patients can be kept comfortable until the end of their natural life" or some such comment enrages me. My wonderful, loving, caring mother, who died at 96 in 1996 was in a care home for 11 years. From about 89 years on she was quite frail but physically healthy. During the last 3 years of her life she did not know who I. She was completely bedridden and spent that time crying and miserable in every way. Many, many times she asked me and others why she couldn't die, and why she had to lie in bed in misery. I visited her every day and during those last 3 years I could not hug or touch her in any way as that caused her pain. She cried and begged me continually to let her die. She was on pain medication, but it did not really help her. The day before she died I called her doctor once more and begged him to give her something stronger to ease her pain. He told me if he gave her any more morphine she would die and he could not do that. What an incredulous statement!
He had been her doctor for 25 years, and yet was hesitant about giving her relief. That night I called the doctor on call in the care home and asked if he could help. In the end he gave her morphine, and that morning she died in her sleep. If you wish to know how the public really feels about this question, I suggest you talk to those of us who had to witness the torture, unhappiness and helplessness during those long, last years. What a terrible memory I have of my mother having to endure what you could almost call torture of dying a long and painful death.
Chilliwack, British Columbia
Are we not kinder to our pets than our families? My eldest brother suffered from cancer, in great pain, in the hospital. He hung on to life for several days, heavily drugged to mask the pain. My mother had Alzheimers and suffered for over 8 years in dwindling health. If my brother or mother had an arrangement to have their lives peacefully, and painlessly ended, then why not allow that to happen? If I, perfectly healthy, decided that I've just had enough of living and wanted out, why not allow me to go to a clinic, sign the papers and end it? When my father died, his cat needed a home. It was an older cat which no one wanted. I took the cat to the vet, paid a fee and watched as it was injected with life ending drugs. The cat died quickly and painlessly. Are we not more compassionate to our pets than our loved ones?
I found it very useful to research online the related sites outlining the policies/laws regarding this that presently exist in Washington State, Oregon, and Montana. Not only do they fully outline the criteria in place for qualifying for this but also provide statistics around how many individuals actually follow through once they have been able to obtain a prescription for life-ending barbiturates. Listeners should be informed that all of the laws insist that first of all the patient must have a fatal disease or condition that will end their life - even naturally - within 6 months. Secondly the onus is on the patient to find a doctor willing to participate i.e. write the necessary prescription. They must then meet with the doctor and be deemed capable of making the decisions for themselves. Then there is a waiting period of 15 days before they can meet with the doctor again and ask a second time for the prescription. And then a further waiting period of 48 hours after which the prescription can be written if they still desire it. Interestingly there are far more prescriptions written than deaths that would have resulted from taking the barbiturates. I imagine that many who go to these lengths want to have something on hand "just in case". The mean age of those wanting this "end" is 70, so we are looking at a segment of the population where disease and illness are more likely to be present and where, perhaps, people have seen friends and relatives suffer through terminal conditions that they themselves are not sure they want to. You cannot clarify enough to the general population the difference between "physician-assisted suicide" and euthanasia.
Nanaimo, British Columbia
I appreciate the concern for those with terminal illnesses to be guaranteed the right to end their own lives, when they see fit. However, I believe that the new legislation must also be applied to those who suffer from a different form of incapacity, such as dementia. I have made it clear to my doctor, and my family, that I do not wish to be kept alive if I am suffering from a disease such as Alzheimer's. I expect that, while I am of clear mind, to make that decision and know that those who assist to end my life will not be held legally culpable. Through decades of discussion on the rights of those experiencing physical pain and the role of palliative care, I have heard no reference to suicide for those suffering from dementia. It is time to look at the rights of those citizens, too.
Telkwa, British Columbia
My grandmother was a nurse, and my grandfather a funeral director. Having worked in professions so close to death, they both wanted to ensure that when it was time for them to go, their wishes would be upheld.
My grandfather lived to a ripe old age and died in his sleep. My otherwise healthy grandmother developed Alzheimer's in her late 80,s . She thought her wishes were clear. Yet, towards the end, our family found it very difficult to make her wishes followed. We found obstacles every step of the way. Were her last months alive painful? We will never know. They were however not dignified, and certainly not what she wanted. How can that have been the right thing. Terminally ill people should have the right to die on their own terms.
Sometimes suicide is not a true choice if someone is profoundly depressed and incapable of seeing any way out without help.
However, I believe, many very rational people would like to have and should have the choice to obtain help to end their lives when they choose.
The truly inept care my mother received toward the end of her life was beyond belief. She was in a government-funded care facility run by a Baptist Church in the lower mainland and I, a retired nurse, felt helpless and many times hopeless in trying to see that my Mom got adequate care in her final months. About 3 days before her death I came to spend the night by her bed. The nurse was giving her some pain medication subcutaneously and informed me that they wouldn't be able to give her as many doses through the night as was ordered, because they hadn't had enough brought in before the weekend (this was a Saturday night)!
When I registered my total distress, she called the "in house" pharmacist at home and he drove to the pharmacy where he works and got enough medication to get through the weekend. The nurse then announced to me that the pharmacist who did this was the "hero" of the night. I pointed out to her that everyone on staff knew that my Mom was near the end, the weekend was coming and obviously no planning had been done for her care. This was the final blow to my trust - there had been many points of erosion of that trust all through the time my Mom was there.
I have no intention of ever finding myself in any kind of care facility as my life moves to a close. If it is in my power in any way, I will be seeking the help I need to end my life and if there is no legitimate way to do that, I will be well prepared to do the deed myself hoping that I can carry this out causing the least amount of pain and distress for the loved ones I leave behind.
Langley, British Columbia
A few years ago a relative ( in his mid 80's) underwent surgery and experienced a massive heart attack while in recovery. He was moved to the ICU and a day later the doctors called to request permission to remove him from life supports. We agreed and with his 89 yr old sister present, we said goodbye to a sweet gentle man. The first death I have witnessed. We should have the right to make these decisions about our end of life care, which should include quote pulling the plug. If the cost of keeping someone in ICU without hope of recovery lead to a hastened death, why shouldn't I be able to decide when my life's journey is to be ended? Is the ultimate visit to the ICU the only time when someone can be allowed to die? I would rather not have to go to the hospital and the doctor who made the recommendation to end our relative's life was never at risk of a criminal charge, then my physician should not be at risk of assisting me or my loved ones to choose a humane way die ,without suffering.
We make these decisions for our pets all the time, am I not more important than my beloved pet? I certainly think so.
In 1952 my sister, then aged 32, was assisted by her physician to die by lethal injection. She was suffering from terminal cancer and she, like us her family, had witnessed our mother die one year previous. Since I was only 15 at the time I had no idea that this procedure was illegal. We had placed my sister in a private nursing home so perhaps that had something to do with having access to the assistance my family and my sister wished to have.
Our mother suffered horrifying pain during her ordeal even after receiving treatment, which at that time was primitive, and her physician despite administering huge doses of morphine "Enough to kill a horse" - his words - was not able to assist her to die. She lingered on and on until she looked like a living skeleton, weighing probably 80 lbs.
I am 100% in favour of assisted suicide under controlled conditions. In some case where there is no hope but awful pain then why would we keep someone alive?