Many people are uncomfortable even talking about physician-assisted dying and euthanasia; the topic seems almost taboo. Yet surely we need to have open discussion on this critical issue.
Some people believe it would be dangerous or immoral to allow medical practitioners to help individuals suffering from painful terminal illness to end their lives. In Canada, for the past 20 years, upwards of 70% of the population have felt that people should have the right to choose how they end their lives – when there is no hope of recovery or guaranteed relief from pain.
I respect life and abhor murder. But if a mentally competent individual chooses to die rather than prolong a painful and undignified life, should the state have the right to deprive that individual of his or her freedom of choice? Why would we not respect that individual’s right to decide how and when to leave a life that, from the individual’s perspective, is no longer worth living? Why would the state force a person to suffer?
Opponents of physician-assisted suicide (PAS) and euthanasia have serious concerns: people who might find relief or even a cure could die unnecessarily; public confidence in the medical profession might falter if physicians were allowed to kill; the moral fabric of our society could be undermined if we no longer upheld the absolute sanctity of life; vulnerable people might be pressured into requesting PAS. Some argue that we should improve palliative care rather than legalizing PAS; with proper care, most people’s suffering can be alleviated.
In places where PAS is legal (Switzerland, the Netherlands, Luxembourg, Oregon and the state of Washington) confidence in the medical profession has not suffered: in a survey of eleven European countries, citizens of the Netherlands, where both PAS and euthanasia have been legal since 2002, have the greatest degree of trust in their doctors. There is no evidence that vulnerable elements of the population have become victims, nor that the moral fabric of society has been undermined. Palliative care is essential and should be expanded, but some people’s pain cannot be managed.
My mother died 13 years ago. An intelligent, active woman, she underwent a mastectomy at the age of 75. Three years later the cancer had metastasized to her bones and soon moved to her brain. She suffered unbearable pain which could not be alleviated; narcotics made her violently sick to her stomach. Bald from chemotherapy, blind in one eye from a brain tumor, with a disfiguring widow’s hump on her back, she suffered for months, crippled by pain, vomiting medications that should have soothed her, with no hope of reprieve except death.
Some say all human life has dignity. I believe all human life deserves respect, but dignity is subjective. During those long months, my mother felt deprived of dignity. The embarrassment of not being able to clean herself or use the toilet alone, of looking, in her words, like “a hideous old hag” was almost as debilitating as the pain she endured.
She and my father had living wills. They also read Final Exit and discussed how she might commit suicide, but given her inability to keep anything down – let alone an overdose of pills – there did not seem a reliable way. My father wanted her to stay at home and we had the good fortune to have a doctor who made house calls in rural Quebec. The family gathered, coming from as far as Kentucky, Japan and the United Arab Emirates to bid her farewell.
She hung on. That summer I made three trips from Stratford ON to the Eastern Townships to see her. Each time when I left, I thought I was bidding her farewell for the last time. She wanted to die. We all wanted to see her suffering end. We turned her over to prevent bedsores, swabbed her mouth with water to keep it moist, tried to persuade her to eat little bits of pudding. She’d get upset when she thought it was her duty to eat and she had no appetite; she wanted to do the right thing. She planned her own funeral, patted our hands, writhed in pain.
Finally, after almost nine months of pain and misery, she decided to stop eating and drinking. She weighed 90 pounds and looked like a skeletal child. The doctors said, given her emaciated state, she wouldn’t live longer than three days. After a few days, she slipped into a semi-coma. But a couple of days after that, she revived briefly and asked for some orange juice. My sister and I stared at each other in distress.
“Do you really want orange juice?” I asked.
She gazed at me and finally shook her head. “I forgot,” she said.
Ten days after beginning her fast, she finally died. She would certainly have preferred to die sooner, her dignity intact, with the assistance of a caring medical professional.
Partly because of her experience, I’ve recently joined the board of Dying With Dignity Canada (DWD). It is an organization of compassionate individuals who help people when they are dying – without breaking any laws – by providing them with information and advice. DWD also advocates for change to our current laws on PAS and euthanasia. Just this month they made a detailed submission to the all-party Parliamentary Committee on Palliative and Compassionate Care. If you want to read more about the arguments on both sides of this issue, I recommend this exceptionally well-researched and supported document. Another excellent exploration can be found in the Select Committee of the Assemblee Nationale’s consultation paper, which is being used as a springboard for public discussion of the topic in Quebec right now.
If PAS were to be decriminalized or legalized, firm parameters would need to be established. Countries and states where PAS is legal have strict conditions. Patients must be over the age of majority, lucid and suffering from terminal illness. The patient’s request must be repeated, with a certain amount of time between requests (in case the patient should change his/her mind.) Two doctors – one of whom is entirely independent (not connected with the presiding physician or the patient) – must examine the patient and confirm the diagnosis. The physicians must agree that the request is voluntary.
Interestingly, physicians in those parts of the world have not been overwhelmed with requests for assistance in dying. Many people who obtain the prescription do not ultimately use it, but they have the option. In Canada we do not.
My question remains: How can we ethically deny a lucid adult the freedom to choose a quick painless death if the alternative is pain and indignity?