The subject of assisted death became part of Canadian public consciousness when Susan Rodriguez, a BC woman with amyotrophic lateral sclerosis (ALS), went to the Supreme Court of Canada to ask for the right to die. Her request was denied in 1993; but another BC woman with amyotrophic lateral sclerosis, Gloria Taylor, later made a similar application before the BC Supreme Court. The BC judge’s ruling in her favour was struck down by the federal appeal court in 1912.
Since the Canadian Supreme Court’s ruling to strike down the ban on physician assisted death in February 2014 , I have been following the developments and discussions about this matter with interest and concern. Viewing it as more than a legal matter, I began work on the following article three months ago. I trust readers will find it informative and helpful when considering the moral implications of assisted death. Parliament will be preparing legislation to legalize physician assisted death in the coming weeks. Meanwhile, provincial governments and health professional regulatory bodies are developing necessary guidelines and protocols for the various stages of the process.
The following opinion editorial was published on the Opinion page of the Edmonton Journal on April 11, 2016.
Assisted dying is the moral quagmire of our time
Hazel J. Magnussen
The Supreme Court of Canada ruling that struck down the ban on physician assisted suicide has sparked a nation-wide conversation about a moral issue that affects us all.
The Court found that sections of the Criminal Code violate the Charter of Rights and Freedoms by prohibiting “physician-assisted death for a competent adult person who clearly consents to the termination of life.”
It directed the Canadian government to prepare legislation granting “adults with grievous and irremediable medical conditions that cause enduring and intolerable suffering” the right to medical help to end their lives. The ruling was a response to presentations by the British Columbia Civil Liberties Association and the family of Kay Carter, who went to Switzerland to end her life in 2010. .
More than a legal matter, physician assisted death presents a moral predicament for health professionals who have a duty to both preserve life and support a peaceful, dignified death.
In August 2015, members of the Canadian Medical Association voted not to support physician assisted death, but agreed that physicians “have a duty to provide information on options and access.”
The Canadian Nurses Association (CNA) brief to the parliamentary committee reviewing the matter, emphasizes that assisted death is more than an act. It is a relational care process.
Already caring for dying patients, nurses will likely care for patients choosing physician assisted death. Education, clear guidelines, along with ethics, psychological [and spiritual] support are essential for health professionals involved in this process.
The parliamentary committee released its report on Medical Assistance in Dying on February 25, 2016. Arguing that assisted death is a Charter right, the committee recommends making it more accessible than stipulated by the Court.
For example, it acknowledges that making assisted death available to persons with mental illness will be challenging for health care professionals; but then reassures them that it has faith in their expertise “to develop and apply appropriate guidelines for such cases.”
This moral quagmire has set off alarm bells and fears about the ethical implications of assisted death for society, especially if the legislation is applied too broadly. It also places enormous expectations and moral burdens on health care professionals and institutions.
Responding to the report, Justice Minister Wilson-Raybould reassured the public that the government would take an empathic, balanced approach that recognizes autonomy, protects the vulnerable, and respects the conscience rights of medical practitioners.
Indeed, legislators must prudently weigh the legal and moral concerns regarding physician assisted death. Meanwhile, health care decision makers need to rebalance the system’s priorities that seemingly condone aggressive treatments, which may exacerbate suffering or prolong the dying process; while rationing palliative, mental health and other support services.
Better access to palliative care that relieves pain, suffering and embraces death, not as the enemy, but as a natural passage from this life, may well decrease the demand for physician assisted death.