The evening was warm on Sept. 10. At Riverview Community Centre, around 50 people gathered to hear a lecture about death. The talk, entitled “The Great Canadian Euthanasia Debate: Where are we now?” was given by University of Manitoba philosopher Arthur Schafer and supported by Dying with Dignity Canada.
Schafer is the director of the centre for professional and applied ethics at the U of M. He has published prolifically since the 1980s on topics such as conflicts of interest, the use of scientific data from Nazi experiments, and the rights of panhandlers. Schafer’s research often focuses on medical patients’ rights with respect to end-of-life issues.
The lecture dealt largely with material drawn from Schafer’s forthcoming article in the International Journal of Law and Psychiatry. Schafer began by discussing how doctors used to “[decide] what’s good for you rather than providing you with the information to make decisions for yourself.”
“I think medicine has come a long way since then,” he said. “It’s less paternalistic now.”
Schafer asserted the importance of patients informing doctors and family members of their personal attitudes concerning the end of life. He noted that 30 per cent of people given the power of attorney for a patient make a decision against the patient’s wishes. “Part of the reason people get it wrong is [that] there hasn’t been enough discussion,” he stated.
He noted that very few people have advanced directives, or “living wills,” indicating their desires should they become terminally ill and legally incompetent to make their own decisions.
“Everyone is in favour of advanced directives, but nobody has one,” said Schafer.
Schafer asked those in attendance—a group self-selected for their interest in end-of-life issues—to raise their hand if they had a living will. About a third of the audience—around 15 people—raised their hands, including Schafer and Dying with Dignity executive director Wanda Morris.
“Not only are we bad at guessing other people’s preferences, but we’re bad at guessing our own preferences,” said Schafer, emphasizing that people’s preferences change over time.
“Personally, if there were no more tennis and no more sex, I’d be ready to check out. But in 20 years, maybe tennis won’t be as important to me.”
Schafer examined the historical and current state of attitudes toward physician-assisted suicide in Canada. Since 1972, suicide has not been a criminal offence. With this law came the legally established right to refuse medical treatment.
“If you’re a competent adult, you’re not depressed, and you don’t have a psychiatric disorder, you have a right to give informed consent or to say no to treatment,” Schafer said.
However, Section 241 of the Criminal Code prohibits Canadians from counselling or aiding another person to commit suicide. Patients dependent on a respirator or feeding tube can refuse treatment, effectively hastening their death. Patients who are terminally ill, but not dependent on a life support machine and are otherwise unable to commit suicide (e.g., due to severe arthritis) have no recourse. Moreover, patients who are dying, on drugs, and possibly depressed may not be judged competent to make end-of-life-decisions.
In 1993, the Supreme Court examined these issues in the case of Sue Rodriguez v. British Columbia. Rodriguez, who had been diagnosed with ALS (Lou Gehrig’s disease), argued that the laws prohibiting physician-assisted suicide discriminated against her as a disabled person. Moreover, as Schafer pointed out, the legislation would actually force her to shorten her life by committing suicide while she was still physically capable of doing so.
The Supreme Court ruled against Rodriguez. However, Carter et al. v. Attorney General of Canada, a more recent case dealing with many of the same issues, reached the opposite result. The B.C. Supreme Court ruled: “the legislation’s absolute prohibition [on assisted suicide] falls outside the bounds of constitutionality.” The Carter case is currently under appeal, and a decision is expected imminently.
Schafer is optimistic about the future of assisted suicide rights in Canada. “In theory, it’s a serious crime. In practice almost no one goes to jail [ . . . ] Often they’re not even charged.”
Everyone involved in the debate concedes that patients have a right to hasten their death, should they choose to do so, Schafer said. The debate concerns whether this right should be overridden to protect the vulnerable. At the time of the Rodriguez case, he noted, there were no countries that permitted assisted suicide. Now there are four, as well as three U.S. states.
“Today the evidence [ . . . ] shows that the vulnerable and disabled are better protected where physician-assisted suicide is legal.”
