Physician-assisted suicide

Exploring a sensitive issue

Physician-assisted suicide is a sensitive and polarizing topic among Canadians. For some, the choice to die with the assistance of a physician in the face of terminal illness, severe disability, or lowered quality of life is a right that they want to be given. For others, the sanctity of life, the protection of the vulnerable, and the trust between doctors and their patients take precedence.

Soon, voters will be electing the next Federal government. This government will be responsible for overseeing the outcome of a Supreme Court ruling earlier in 2015 that declared laws preventing physicians from assisting patients with suicide invalid.

The ruling deemed that the current laws were not justified under the Canadian Charter of Rights and Freedoms, violating the right to life, liberty, and security of the person. Being denied the autonomous choice of death takes away the choice of bodily integrity, and therefore the right to liberty. Additionally, being forced to endure intolerable suffering was found to infringe on the right to security of the person.

The ruling states that a competent adult can consent to physician-assisted suicide if they are “suffering intolerably” due to their “grievous and irremediable” condition.

Prior to this ruling, it was possible that physicians could be charged with murder or manslaughter for helping a patient die. The Criminal Code of Canada makes aiding or abetting a suicide illegal.

The federal and provincial governments were given a year from the date of the February 2015 ruling to develop laws overseeing physician-assisted suicide.

In July, five months after the court’s ruling, the Conservative government assigned a panel to discuss the issue and to report the results after the October federal election. It appears likely that an extension on the ruling will have to be requested by the new government, according to Justice Minister Peter MacKay.

For Steven Fletcher, the Member of Parliament for Charleswood-St. James-Assiniboia, the matter of physician-assisted suicide is very personal.

Fletcher became quadriplegic when he was 23 after a vehicle collision with a moose in 1996. He relies on 24-hour care for all his basic needs. After the accident, he continued to suffer from complications, and during a 2012 surgery, he asked that the surgeons walk away from the operating table if brain damage would leave him “cognitively impaired.”

In 2014 Fletcher presented two bills in the House of Commons regarding physician-assisted death. The first bill would allow physicians to assist patients in dying, and the other would create a commission to keep track of physician-assisted deaths, collect data, report to Parliament, and to help improve oversight.

The Conservative party, of which Fletcher is a member, does not support physician-assisted death, and so Fletcher introduced the bills as a private member.

It is clear why Fletcher feels strongly about this topic; in an unexpected accident his life completely changed, and in the years following he endured suffering, loss of independence, lowered quality of life, and physical pain from complications. At the very least, he wished to have had the choice to die if his situation were to deteriorate further, and would hope that his loved ones have the choice if they ever find themselves in similar circumstances.

The argument against physician-assisted suicide can be just as persuasive. While those who support physician-assisted suicide strongly believe it is a choice to be made willingly, those opposed suggest that there will be instances where a patient might be pressured into the choice by their families, by their physician, by economic circumstances, or the belief that it is their only option.

It is also possible that an assisted death could fail and leave the individual in worse condition than before the attempt.

Importantly, it potentially gives physicians too much power over who lives and dies.

Currently, physician-assisted suicide is legal in Switzerland, Albania, the Netherlands, Colombia, Belgium, Luxembourg, and the U.S. states of Oregon and Washington. Switzerland is the only country which permits foreigners to seek physician-assisted suicide.

When considering a Canada where physician-assisted suicide is legal, it may be important to consider how the laws and culture surrounding assisted suicide have evolved in other countries.

In Belgium, physician-assisted suicide became legal in 2002. In 2014, the laws were extended so that anyone of any age may request an assisted death if they are terminally ill. For a child to request an assisted suicide, it has to be proven that they understand what they are requesting, and they must undergo evaluation by physicians and psychologists, and have approval from their parents.

In the summer of 2015, a 24-year-old Belgian woman was granted an assisted suicide due to emotional suffering from a lifelong affliction of depression and suicidal thoughts. She was considered to have been suffering excessively and endlessly.

Some other issues Canadians and lawmakers must consider: How would a physician-assisted suicide be carried out once requested? Is there a timeline between when the request is made and when it is completed? What if a patient diagnosed with dementia didn’t want the suicide to occur until a future date? What safeguards will be in place to protect the vulnerable? How many times should a patient have to request an assisted suicide before it is granted?

Regardless of where Canadians stand on the topic, it is clearly time for it to be discussed, especially in light of an impending election.