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Physician, kill myself

Anyone who follows my Twitter feed will be familiar with my habit of occasionally spontaneously going on rants about how much I love my city. I really do – we have a mayor I can respect, we have a proud tradition of social activism, we live in greater harmony with our natural environment than most cities our size. Despite its faults, Vancouver is a great place to live. Similarly, despite the fact that I don’t hold our government in terribly high esteem, I do rather like the province of British Columbia. Lots of hydroelectric power, natural custodianship, and abundant natural beauty. We got it like that.

But I am pretty confident that I have never been more proud to live when and where I live that I do after hearing this news:

A B.C. judge ruled Friday to strike down the law that makes physician-assisted death illegal in Canada. B.C. Supreme Court Justice Lynn Smith ruled that the cur-rent law violates the constitutional rights of the three plain-tiffs who led the landmark legal challenge, launched by the B.C. Civil Liberties Association. “They succeed because the provisions unjustifiably infringe the equality rights of Gloria Taylor and the rights to life, liberty and security of the person of Lee Carter and Hollis Johnson,” the judge concluded in a 395-page written judgment released Friday.

I took a bioethics class as part of my undergraduate curriculum. Understandably (I think), it is a requisite course to get a degree in health sciences. The course touched on the philosophical underpinnings of the arguments on a number of issues – consent, autonomy, confidentiality – the usual suspects. Despite still occasionally flirting with my Catholicism (I lived in a state of ignorance about my own atheism for years), the issue of physician-assisted suicide never really seemed like much of a conundrum for me. Of course people should be allowed to decide when they die – it’s only moralistic fops who could possibly look at artificial heart and lung machines, defibrillators, incubators, and countless other life-prolonging technologies and say that the time of a person’s death is something that only their god can decide.

Of course we know much better than that. The vast majority of people do not want to die, but there are some whose circumstances make death preferable to life. Of that group, many are unable to self-terminate – either for reasons of fear or because they have a debilitating disease that prevents them from taking the physical steps necessary to do that. Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig’s disease) is one of those conditions that would make the act of throwing one’s self off a bridge or shooting one’s self or some other “classical” suicide method impossible. In cases like the plaintiffs’, physician assistance is required.

The central philosophical fight here is the extent to which patient autonomy trumps the rights of society to set its own moral standards. Strictly speaking, medical decisions are not made by popular vote, but because physician-assisted suicide will use publicly-funded resources (presumably drugs, hospital beds, etc.), the public technically has a say. As it happens, we appear to be facing one of those happy circumstances where public mores and patient autonomy are more or less in sync. Laws against attempting suicide were removed in the 1970s, meaning that while Canada may once have seen self-termination as a fundamentally immoral issue, it hasn’t been that way in nearly 40 years. When it comes to doctor-assisted suicide, public opinion has clearly shifted since then.

Much like the story of Ontario legalizing brothels, this is a provincial decision, meaning that the federal government (whose law is being deemed unconstitutional) has the option of appealing it to the Supreme Court of Canada. Because the government is made up of, and voted for by, the same moralistic fops I referred to in the previous paragraph, it is a virtual certainty that they will appeal. They have the option, of course, of revising the law to comply with the provincial court’s interpretation of the Charter, but this is fairly unlikely for a number of reasons. First, this isn’t simply a legal issue to the Republican North voter base – this is an incontrovertible moral issue. Second, that same base isn’t exactly wild about the Charter to begin with. Third, because this government is a bunch of dickish bullies who don’t seem to understand the concept of dissent as anything other than treason.

That being said, I’m not exactly wild about the legal justification for this ruling – a right to life and security of the person doesn’t necessarily confer a corresponding right to death, and I’m almost certain that will be part of the appeal fight. However, considering that the Chief Justice of the Supreme Court is on record supporting that interpretation, it’s a fairly safe bet that the appellate attorneys will have their work cut out for them*. If I was a betting man, I’d wager that the appeal will focus on whether or not adequate alternatives (like hospice care) already exist, eliminating any grounds to claim that the laws infringe on the plaintiff’s Charter rights.

However this shakes out next, Canada appears poised, despite the despots in Ottawa, to be moving along the path of a modern liberal country which prioritizes the well-being of people over the moralistic busybodyness of its more regressive instincts.

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*I searched for a bit, but I couldn’t find any legal precedent governing how a ‘right to life’ has been argued in court before. My legal team tells me that Section 7 challenges are predominantly about rights to ‘liberty’ and ‘security of the person’. If anyone has any references, I’d love to know about them.

Comments

  1. Dianne says

    I’ve always been of two minds about physician assisted suicide:

    On the one hand, it seems to me that the proper person to decide when a life is no longer worth living is the person living that life. It’s a bodily integrity issue on one level: I see no reason why someone should have the right to force a person to live any more than they should have the right to force that person to die.

    OTOH, the right to assisted suicide could all too easily slide into the duty to suicide and provides an excuse for not providing services from physical therapy to pain meds that might make a life seem more worth living. Barbituates are cheaper than gemcitabine: should pancreatic cancer patients be offered only the former?

    Even if the above isn’t an issue, if the medical system is always able and willing to treat marginal cases when the patient wants to press on, there are still too many reasons that a person might think suicide the best option when it may not be. Perhaps they feel that they’re a burden to their family–when at the same time the family is desparately hoping that they’ll be willing to hang on just a little while longer and feeling guilty about “forcing” the patient to keep living. Maybe their pain is inadequately treated. Maybe they are afraid of the costs they will leave their families. If those issues were addressed, they might get a few more weeks or months.

    So, in the end, I think I’m pro-assisted suicide-but only with safeguards and clear guidelines to make sure that all reasonable avenues have been explored and it is the true will of the patient to die.

    Wimpy enough position for you?

  2. Ian Bushfield says

    In a 400 page decision, I’m sure there’s other arguments that may stand up better under appeal. For example, I know they cited the evidence of Oregon, the Netherlands, and Belgium as jurisdictions where it has been shown to be safe (I.e. there is no slippery slope to elder abuse and involuntary euthanasia).

    What will be interesting (in both cases) is if they stand and the government does not pass a law. In that case, these issues will be in the same realm as abortions where the rules are set by health care professionals, not politicians.

  3. justsomeguy says

    What always bothers me about this debate is when people go on and on about how assisted suicide is terrible because the patient has a right to life… but making this type of procedure illegal obliterates a person’s right to be alive, and replaces it with an obligation to be alive.

  4. says

    The medical system currently takes patient autonomy extremely seriously. Patients are not forced to have any treatment they do not want, except in very specific circumstances. I can’t imagine that docs would just chuck that ethos out the window because physician-assisted suicide is on the table. I’d imagine that there would be something akin to an ‘informed consent’ process whereby patients would have to demonstrate some understanding of the consequences of their actions, and reasonable alternatives are discussed. Beyond that, I don’t think it’s reasonable to grill patients on why ze wants a certain course of medical management – we certainly don’t do that for people who refuse life-saving treatment.

  5. says

    Yeah, this is one of the reasons I love being an Oregonian. Also one of the reasons I have pipe dreams of the West Coast of North America seceding from their respective federal governments and forming Cascadia.

  6. says

    cf. the Oregon Death With Dignity Act. It’s a little too restrictive (the patient must take the medication themselves), but it has good safeguards. One thing that I think is appropriate that goes beyond usual informed consent is a psychiatric evaluation. If the desire to kill themselves is a result of treatable clinical depression, I think that should generally be preferred. This is similar to what responsible cosmetic surgeons do for patients who want multiple sequential surgeries, since the reason they want them might be a treatable organic illness which the surgeries will not help (or may exacerbate).

  7. Dianne says

    Doctors, probably not. Insurance companies…that I can see. Although really not having assisted suicide doesn’t protect against that sort of abuse: it’s easy enough for an insurance company to refuse to cover palliative chemotherapy when hospice is available, for example. Perhaps this is a US specific concern.

  8. Timid Atheist says

    …making this type of procedure illegal obliterates a person’s right to be alive, and replaces it with an obligation to be alive.

    This. Both my parents have said they do not ever want to be “revived” if something happens to them as they age. And my father especially is adamant he doesn’t want to live without his mind. I’m sure he’ll choose suicide or assisted suicide if it ever happens to him. And I respect his right to request that. It’s his life, his body and he’s had a long life. He has no obligations anymore. I’d miss him and my mother so very much, but I wouldn’t be so selfish as to demand he life just for my sake.

  9. says

    The US doesn’t exactly have the best track record for “informed consent.”

    I support assisted suicides but fear the obligation to suicide that may arise if the laws aren’t handled properly.

  10. says

    I spent from 2001 through 2003 watching my mother slip into Parkinson-related dementia (I don’t know how much of it was actual neurological degeneration, how much was the ever-higher doses of L-dopa needed to cope with the Parkinson, and how much was the anti-psychotics needed to counteract the side-effects of the L-dopa) in which state she remained for three more years until she died, probably of some cardio-vascular catastrophe. My family knows that, should I ever be stricken with that sort of degenerative condition, I want whatever cardio-vascular therapy I may be on (which most people are, eventually) discontinued, and a DNR put in place. And when I go, I go clean and quick.

  11. John Horstman says

    there are still too many reasons that a person might think suicide the best option when it may not be

    This is paternalism; if we’re going to have an individualistic, agent-based code of ethics, we have to allow people to determine their own desired ends (I think it’s still appropriate to debate the means to those ends; we have to allow people to define what their own best interests are, but it’s legitimate to debate the best way to achieve the desired outcomes). Any ban on suicide, no matter what the reason is for the suicide, is an imposition on another’s bodily integrity for the sake of making oneself (the people who love the person attempting suicide and other parties who have decided that person’s living or not is their personal concern) feel better; I find the idea of forcing someone to live in misery, be it physical or psychic, so that one is not saddened by the death of that person to be utterly abhorrent. It’s not okay for exactly the same reasons that rape, forced pregnancy, slavery, physical assault, and murder are unacceptable – they’re all impositions on the bodily integrity/autonomy/agency of another for one’s personal benefit. The reason the person in question wants to be dead and the self-perceived motivation for wanting to force someone to be alive are entirely immaterial.

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