The right to die

A report from the Royal Society of Canada recommends changing current laws to allow physician-assisted suicide.

“We are recommending that the Criminal Code be changed in such a way as to permit physician-assisted suicide and voluntary euthanasia,” said Udo Schuklenk, a bioethicist from Queen’s University in Kingston, Ont., who chaired the six-person panel that completed Tuesday’s report. Schuklenk said the basis for the recommendation was centred on the Canadian Charter of Rights and Freedoms.

The executive summary is here. The full report is here.

A private member’s bill—proposed by former Bloc MP Francine Lalonde—that would have amended the Criminal Code to allow for euthanasia was defeated in April 2010 by a count of 230-57.




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The right to die

  1. Of course it should be legal.

    What kind of person would refuse such a humane resolution?

    • Hey, and they have Royal in their title, so maybe it will be viewed with a little more thought.

      For myself, I’m all for it.  I’d tell you about my mother’s last days, but then I’d start to cry and I’m at work.

      • If the word ‘royal’ makes them take it more seriously, I’m all for it.

        It’s criminal what they make people ‘live’ through….we’re kinder to animals.

        • Get yourself a “living will” so your own children/grandchildren will feel no guilt when the time comes to pull the plug.

          • Living wills don’t have the power to override current consent though.
            I’d like some protection for my true wishes even when I’m suffering from a stomach cancer causing so much pain that I plead for death.

            After all, I think my mind and will are free when I am sound in mind and body, not when I am taught the true meaning of pain.

            I don’t see any such thing though, having any legal standing.

          • Yanni, what a living will provides is a determination from YOU of what YOU want.  That means that you can say that you do not want any heroic measures; you do not want to be given any medication EXCEPT pain medication which provides comfort; you do not want an IV, which will prolong your life…it is best to be without fluids and food as you will be delerious and you will not feel pain.  Your family will not want to do this to you because they will want to see you have food and fluids….not realizing that they will just be prolonging your time in pain.
            Yanni, all I can recommend is that when/if you get very ill, you talk things through with your physician and you discuss your concerns and fears about experiencing pain.  There are some cancers that are relatively pain-free and others that are notoriously painful.  At the same time, there are treatments available including nerve blocks that will cause the person to have absolutely no feeling whatsoever.  That is why it is very important to get into a hospice, they are the specialists in palliative pain management.

          • Well certainly that is all true.   But I also heard an old woman crying at night that she wished the Lord would take her and she clung on for months.

            The simple fact is that living wills can be shredded by the current wishes of the patient.  

            I think ultimately, it depends on what you think should happen to those who are suicidal.  Myself, I think largely they should be ignored and given the tools to deal with it the best they can because often they aren’t in their right mind.

            On the few cases where they are in their right mind, how to you tell whether your desire for suicide is justified?   Pain is such a subjective thing, and whether you are steered towards choosing life all depends on who is around you.  If you have a monitoring psychologist who believes that severe depression should be allowed as a criteria for assisted suicide, then the future me that has that severe depression will shred that living will and go through the deadly procedure.

          • @57fc79f8528c0aa6c4b4330d53700334:disqus 

            Actually Svend resigned, and turned himself in.

            In court it was decided he was having a major mental problem at the time, and he was discharged.

          • Yanni, that woman who was depressed should have had her depression treated.  Physician-assisted suicide will never apply to sucidal, depressed patients.
            Now as for living wills…they are just instructions for your family for when you get too ill to give your own instructions to the hospital and your physician.  Should you change your mind when the time comes that you are ill, you have that perogative to do so.   However, if you are too sick or not making sense, your family will have to make the decisions for you and they will appreciate knowing what you want them to do.

          • “Physician-assisted suicide will never apply to sucidal, depressed patients.”

            Switzerland shows that isn’t true doesn’t it?  Netherlands seems to be pushing in that direction as well.

          • The topic is assisted suicide, not ‘pulling the plug’. That is done routinely.

            In fact, if you go into a nursing home you have to answer if you wish ‘extraordinary measures’ or letting nature takes it’s course when something happens.

            Having been through it twice myself, I have long since spoken to my family about it.

          • I am talking about other decisions as well, Emily such as if you are dying whether you will be given medications that will prolong your life or only “comfort measures”.  Also, whether when you are terminal, you will have no nutrition or fluid given via IV to speed up your demise.  Extradinary measures means if you die, they will perform CPR…and possibly bring you back to life……I am talking about you putting down you instructions that if you are terminally ill, you want NO INTERVENTIONS that will slow down your death.  That way you will likely experience the least amount of pain.

          • @57fc79f8528c0aa6c4b4330d53700334:disqus 

            I believe I said I’ve been through it twice already, so I am aware of the options.

            I am also in agreement with assisted suicide.

            Btw  Sue Rodriguez had ALS, and Svend sat with her while she died after she’d had ‘assistance’. It did not end his political career.

          • Thank you Emily for correcting me about Sue Rodriguez and Sven Robinson.  Ya, I forgot he stole a ring…that is what ended his career.

      • As I mentioned to Patchouli (above), when we talk about physician-assisted suicide, we aren’t really talking about “immediately-terminal patients”.  It is not really uncommon for patients to be given more opiates (morphine) than are probably needed and those suppress their respirations and hurry them into passing but physician-assisted suicide means a disabled person (Sue Rodrigez with Guillian-Barre Syndrome who is not dying) would ask a physician to help her end her life.  Sven Robinson (NDP MP) did that for her and it ended his career.  I am not saying I am against the concept, I just don’t think that will happen here in Canada.  It is available in other countries but so are legalized drugs and legalized prostitution.  This is not Amsterdam or Switzerland.

        • Actually, what ended Sven’s career was stealing a ring to give to his boyfriend.

          • Yes you are right about that.  I forgot all about that.  Thank you for correcting me.

  2. My rights to safety and security when I am sick and vulnerable trump the rights of those who wish to end their lives.  Aside from external threats from hospital or care home officials who wish to free up a bed or dispose of a problematic patient, or from unsympathetic relatives who wish to take hold of my property, I am also threatened by myself.

    Even when my judgement is impaired through pain, desperation or mental illness, I deserve protection.  That is why suicide is illegal in the first place.

    • The se concerns are oft cited yet easily remedied and safeguarded against. 

      • The research of jurisdictions where assisted suicide has been legalized beg to differ.   There have been cases of accidental assisted suicide, snap decisions on assisted suicide, assisted suicide on the basis of depression, assisted suicide without consultation with families, pressure to commit suicide by well-meaning hospital staff, and a notable drop in the quality of institutional palliative care.

        Now can these accidents and incidents be mostly minimized?  Sure, just as a long and rigorous legal battle and investigation can help weed out false convictions.  However, it cannot guarantee that wrongful deaths do not occur.   It is a guiding principle of liberty that it is better for the guilty to go free than an innocent man be imprisoned or killed by the state.   I would prefer that the sick, the elderly, and the mentally ill are granted the same consideration as convicts.

        • In the executive summary of the report quoted we have this paragraph:

          “We discussed in considerable detail the arguments against assisted suicide. The evidence does not support claims that decriminalizing voluntary euthanasia and assisted suicide poses a threat to vulnerable people, or that decriminalization will lead us down a slippery slope from assisted suicide and voluntary euthanasia to non-voluntary or involuntary euthanasia. The evidence does not support claims that decriminalization will have a corrosive effect on access to or the development of palliative care.”

          So you’re saying that the Royal Society of Canada, lead by distinguished bioethicists and experts in the field are all morons and you, distinguished by choosing a bad musician for a moniker, are correct?

          I’m calling BS. Provide sources for your claims.

          • Okay, but before we get into a link war about it, and then the inevitable questions of whose research is biased among the organizations and bodies cited, can you accept:

            1) That there will be cases in which there will be accidental cases of assisted suicide

            2) That there will be cases in which assisted suicide goes against the true wishes of the patient?

            If you accept either of those premises, you can understand why I am against assisted suicide.   It is the same reason I’m ultimately against capital punishment.

          • First, 1 and 2 are the same. Second, no, I cannot accept those premises, given a half-way reasonable system. This isn’t like a court system where we’re dealing with adversarial evidence. This is simply a choice issue.

          • No, it isn’t the same issue.  I do not trust the medical professionals administering my care not to promote assisted suicide as you do, because I think you vastly underestimate how much power of self-determination is already lost once you enter palliative care, particularly if you are mentally incompetent.

            Also, you think that pain and despair makes one just as capable as making decisions as when they are mentally and emotionally well and healthy.  I do not, and there is simply no way to ensure, legally, that my mentally, physically, and emotionally well self can make that will stand when my free will is ripped away by pain, despair, confusion, institutionalized care and relations.

            Even the best possible system will never, ever assure a 100% accuracy rate of following patient wishes.

  3. I cannot see it ever being made legal.  Families are not comfortable with standing by and doing nothing for their immediately terminal family member…..you think they will be okay with a doctor helping end the life of a family member who is not immediately terminal…..no way.

    • I realize from your moniker that you work in the healthcare system and I am not, but read 2Jenn’s comment above, and here’s mine: I think we should legalize choice — and that very choice would empower the terminally ill at the time when they are losing all.  If rather than fighting for breath and drowning in morphine my mother could have, at some point prior to reaching that awful point, chosen to gather us around her and brush her hair and teeth, and drink a little shot of something — well she would have died a few days earlier, or maybe she would have never taken it — but if she had chosen to die that way, she would have avoided those last horrible days of gasping and agonizing pain, and watching her husband and kids crying at her pain and begging nurses to help her.  She would have been afforded dignity and choice.  I actually think most people would not take the drink, but would appreciate knowing they could.  Because as her cancer progressed, it was not death that Mum feared — it was the dread of wondering just how horribly ill she would become before death took her.  Here in SK, they won’t even drain the fluid off the lungs once patients are in palliative care.  So much for comfort.  No thoughts for dignity at all.

      For my 21-year old cat, I was able to hire a very compassionate in-home vet who came over and let us hold our dear pet and pat her while she put her under.  The vet showed much more compassion for us and our pet than my mother’s doctor showed — oh and he just won national accolades.  So he’s one of the better ones.

      • That is where the perspective differs I guess, because I see it as fundamentally disempowering someone, and putting them at risk.

        I understand the desire to reduce pain, but I simply don’t trust that you can institutionalize death without it being a tragedy that ends people’s lives without their consent.   I will grant that you can certainly devise controls to try and prevent that tragedy, but the price is simply too high when those controls fail.

        • Wait.. where are you getting any inclination that this does not involve the consent of the person dying?

          • I think it would all depend on your milestones of who “is vulnerable” and who is capable of giving informed consent.

            I’m rather leery of the idea that those who are suffering from the desperation of being chronically ill, mentally ill, or an extreme amount of pain are even capable of giving informed consent.  Hence why wills are often prefaced with the assurance that they are “sound in mind and body”.

            In the wikipedia link about Dignitas that Emily gave, a man committed suicide who wasn’t chronically ill, but wished to join his wife in death who was chronically ill.  Now, you may feel that he wasn’t vulnerable or unjustly slain That he is the best person to judge whether he could deal with his emotional pain. 

            Now I can understand that.  I’ve struggled with depression, and there is a good chance that I’m going to have a severe form of Alzheimer’s when I am old.  There is a good chance that I’m going to die in pain and despair, like most of us do.   To guarantee that my wishes are carried out, now that I’m in sound mind and body, I need help to keep the option of death away when I am weak, vulnerable and desperate.   It is for that reason that I’ll never support institutionalized assisted suicide.

          • Well, that and I worked as an orderly/security guard, so I saw patients with severe mental problems drugged without their knowledge and families lied to about whether their elders were confined or tied down.    It makes me leery about trusting an institution with the power to end my life.

            I also saw men who old and suffering various forms of mental degredation who were still physically powerful who were physically and even sexually dangerous to the largely female staff that were caring for them.   These men were shuttled from institution to institution and it isn’t hard to imagine these men being steered towards death to solve the problem they pose.

          • So what is it that you want to live for when your mind has gone, you are in pain, and you won’t be getting better?  I’m not trying to be insensitive, I honestly don’t understand that viewpoint and I’m trying to come to grips with it.

          • Because the alternative is to be dead.  I may have become a limited creature who is perpetually befuddled, in pain, or both, but I am still alive and I exist.  I don’t romanticise death as being sleep or peace, but merely the end of life.   I’m the type to rage against the dying of the light.

            Some of it is also religious, in which it is a sin to commit violence against myself.  I’d go into such themes as why suffering is a necessary and essential part of life and how I reconcile a loving God with debilitating pain of chronic illness but doubtless you wouldn’t accept those theological explanations/arguments.

            But my reasons aren’t important.  I have the right not to be killed by the state by any system devised and that right trumps any desire of others for death. 

          • Yanni, sorry I couldn’t find a place to reply to you….
            You asked if physician-assisted suicide isn’t just suicide…
            There are some definite differences….
            The candidate for physician-assisted suicide is usually terminally ill (although not immediately) or he/she is very disabled with no chance of recovery; living uncomfortably and has little quality of life with no expectation of improvment (in the candidate’s opinion).
            Suicidal people on the other hand usually have mental health problems in the absense of life-threatening physical illnesses.  They are despondent and hopeless, sometimes for reasons that cannot explain.  Because they have a have a “realistic” chance to see a total reversal in their condition with treatment, they would not be candidates for physician-assisted suicide.

          • @8070786956a13baf8e6aaa2a9db834d4:disqus 

            This whole thread is ABOUT legalizing suicide, NOT euthanasia.

          • Where are you getting any inclination that the person has to be dying to avail themselves of this?

          • If the avail themselves of this, they’re dying/dead, yes?

          • Although Dignitas and Exit provide little or no data into its
            activities, it is known that 21% of people receiving assistance by
            Dignitas and 65% of women attending Exit do not have a terminal or
            progressive illness.[15]
            15 Fischer S. Huber CA. Imhof L. Mahrer Imhof R. Furter M. Ziegler SJ.
            Bosshard G. Suicide assisted by two Swiss right-to-die organisations. Journal of Medical Ethics. 2008; 34(11):810-4.

          • Although Dignitas and Exit provide little or no data into its activities, it is known that 21% of people receiving assistance by
            Dignitas and 65% of women attending Exit do not have a terminal or
            progressive illness.[15]15^
            Fischer S. Huber CA. Imhof L. Mahrer Imhof R. Furter M. Ziegler SJ.
            Bosshard G. Suicide assisted by two Swiss right-to-die organisations. Journal of Medical Ethics. 2008; 34(11):810-4.

          • Bingo!  This is the key to physician-assisted suicide….the person does have to be dying…in the immediate future anyway.  They just have to be living an unsatisfactory life due to a disability/illness.

          • But HealthCareInsider, aren’t we then merely speaking about legalizing suicide, not just so called euthanasia?

          • You asked if the person “dying” has to consent…Great Walls of Fire said the person doesn’t have to be dying…..

            but of course they will be dead after the service is provided and yes they did consent to the service being provided BUT is “being terminal” a necessity of the service being offered?  No.
            Physician-assisted suicide is offered to people who have a poor quality of life due to disability/illness and no immediate threat of death.  If the threat of death were immediate, they likely wouldn’t bother with the physician-assisted suicide.

          • Yup. I was responding to his semantic nit with one of my own.

            My use of the word “dying” came from trying to think of a single word to encompass all the people who might seek out the service, without being redundant; ie, “does not involve the consent of the person requesting the treatment.” Technically, that would have been the more correct construct, but it sounds bloody stupid because it makes it obvious how consent is implied simply by the request existing.

            Wait. You may have just highlighted some of the differences Yanni and I are having:

            Yanni: Do you think physicians would do this at the bequest of family members in the case of a person being incapable of making their wishes known? Because from where I’m sitting, that’s an entirely different kettle of fish — not voluntary euthanasia/physician-assisted suicide at all.

          • Semantic nit it may have been, but it was intended to convey what I submit to be the highly critical distinction between euthanasia and assisted suicide.  Notwithstanding there are entirely different ethical considerations informing both issues, these differences seem to be glossed over or ignored by many.  Removing all sanctions impeding assisted suicide, without any thought or consideration of how close to death the person actually is, IS a slippery slope, as it would result, in very short order, in a (likely court-ordered) removal of sanctions against ALL suicide and that is an entirely different debate than the one the likes of the Royal Society seems to want.

      • Patchouli, I never said I am against it.  Quite the opposite in fact.  I just don’t think it will ever be made legal here.  Families have a hard time letting go.  They want to do something and doctors are trained to keep working until the end. 
        What is being discussed with physician-assisted euthanasia is a bit different than what happened with your mom.  Your mom was dying of a terminal illness and perhaps physicians could have given her more morphine which would have caused respiratory suppression and “hurried” up her passing by a number of hours but physician-assisted suicide relates to people like Sue Rodrigez who have illnesses like Guillan-Burre Syndrome which can cause paralysis and is not curable.  An NDP MP, Sven Robinson, helped Ms. Rodrigez commit suicide.

        • I appreciate your response: I know you didn’t say you were against it; I just felt that as a healthcare worker, you would have more knowledge than I have, and so was deferring to your experiences over my one.   All in all, it’s pretty hard to watch someone you love die and not have some issues about the system that keeps them alive so they can die just a few days later.  I remember the Sue Rodriguez case well, but forgot that Sven Robinson helped her. 

          • As I said to another blogger, there are things that can speed the process of death along…stopping the IVs that provide fluid and/or nutrition; not providing any medication except those that manage pain. 

        • Are you kidding?  Families are begging to end the suffering–and if the person is suffering, with no hope of improvement, but not near terminal, so much worse.  Of course not all families, but that’s why it needs to be a choice.

          • People may not want their family member in pain but they are often not ready to let them go either.  They refuse to permit the staff to stop IVs and medicines that prolong life needlessly.  There seems to be alot of guilt with hurrying a loved one out of the world.  At any rate, physician-assisted suicide is not really about speeding up the “end of life”.  It is not uncommon for doctors to give patients increasing amounts of morphine until they have full pain management knowing they will also have significant respiratory depression and as a result, die sooner.  No one has an eithical issue with that or questions the physician’s right to make that judgment when the patient is clearly terminal, in pain and likely to die within days.  Physician-assisted suicide would not be applicable to your mother.  It is when a physician assists a person with a disability or who has a diagnosis of MS or Guillian-Barre Syndrome with a severe disability but no immediate concern of dying, with commiting suicide.

    • I only have anecdotal evidence, but the people I know all tend to have the same opinion on it — “of course it should be legal, why isn’t it already?”

      Now, that always comes with various caveats of course.. enforced waiting periods with psychologist evaluation, no decision made by a lone physician, etc.  But aside from that, I’m not sure the opposition to the idea is as great as some people think.

      Then again, you’d probably have more personal experience in this area — so you’re saying this from what you’ve seen of these types of situations?

      • Perhaps you remember the case of Robert Latimer, a farmer who ended the life of his disabled daughter.  Disabled groups are very much against physician-assisted suicide.  They see is as a kind of “genocide” for people with disabilities.
        Proponents of palliative care say it is unnecessary as they can deal with pain issues in end of life so there is no reason to hurry people out before their time.
        I have met people in various cultures (Asian) who are devastated and disgusted that our medical system could not save their 90+ year-old family member…even though the family member was ready to die.
        We are a medical system and a culture that thinks a “good death” is important but is still a failure and we do everything in our capability to extend life as long as we can.
        Doctors in our culture save people – they don’t help people kill themselves – because they no longer want to live with a disability or because they are old or because they are facing a death in the not too immediate future….for those reasosns I do not believe we will ever see assisted suicide legal here. 

        • Even if you indicate officially (ie fill out the little donor card)  that you want to donate your organs after death, family can over-rule that.  I guess the indication is not actually legal — the family still has to consent after you’re gone.  So you may be very right that assisted suicide may never become legal here. 

          • That is why it is important to fill out your living will…not that it is legally binding but that it will give your family the permission to do exactly what you want….no heroic measures, no medications, no fluids to prolong life….only pain medications.

        • Isn’t the oath to end suffering, or is it to prolong life?

          But hrmmm. Latimer’s one of those harder cases I don’t like to think on too much, because informed consent of the child is impossible to ascertain. Thanks for reminding me of it. Perhaps this is the stuff Yanni was talking about.

          In those cases is where you need the protection: physician panel assessed both for likelihood of recovery and the probability that the person is suffering.

          Beyond that, I think we also need to have almost a tribunal type evaluation of the effects of the suffering on those closest to the person and on the general community of the area.

          Proponents of palliative care don’t seem to understand that suffering goes beyond physical pain, and it goes beyond the simple person who is ill.

  4. Hurrah! We can already murder our babies, we can murder our parents soon as well! 

    • Given the sincere and pained comments that 2Jenn and myself have made to further this discussion, I find your comment despicable, cruel and hate-filled.  I guess that’s what you were going for.  Now I wish I could pull my comment off; I should have known someone would post something horrible and insensitive.  Someone like you.  Sometimes flippancy is really misplaced.

  5. From C.Ball:
    The right to die or to live should be an individual’s decision, with the right of that individual to change their mind.  This can be embedded in a living will and appointment of an “attorney” to supervise but not change the application of the documented decision.  The document and subsequent amendments should be witnessed by two independent adult persons, one a notary.

    The state has no place in the nation’s bedrooms per Pierre Trudeau.  Likewise the state has no place overriding these properly documented individuals’ decisions on critical life matters for any individual.  This extends to governments and the courts, medical boards and any other “persons”.  Even the family next of kin or legal guardian should not be able to materially schange an individual’s so documented decisions.

    The proposed debate suggested by the distinguished experts for the Royal Society of Canada, while interesting, is ultra vires – as the position above transcends government and the rest of society.  Its results or conclusions would not change the fundamental rights of individuals to control their own lives.  Even laws purporting to make “suicide” illegal are based on a false premise of legal jurisdiction.  The matter of “assistance in the suicide of another person” raises a different other freedom of expression issue.

    Medical and other professionals, religious leaders or counsellors and family members share the opportunity to discuss the options with a patient may have, and assist in drawing up appropriate documents to reflect their wishes, but not to dictate or determine their final choices, including the choice to leave previous stated decisions alone.

    Where an individual is a person younger than the age of majority, or is vulnerable and without previous documented power of attorney ( e.g. suffering from depression or mental illness, or unable to reach an independent decision) then some form of independent tribunal should reach a timely decision considering the person’s earlier witnessed expressions on the subject and those of available close relatives and friends.  In our society the pervasive notion of minimization of pain and suffering for all life forms should be strongly considered.

    An earlier commentator’s comparison to the treatment of the convict in prison is a red herring.  In the corrctional process no human right should be surrendered unless explicitly required by the prisoner’s sentence.  Any person’s right should be protected to the maximum extent possible while preserving the rights equally of all others in our society.  Yes, that should apply even to wayward politicians!

    • If this guy’s vision is implemented, I’m getting the hell out of the country.

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