Right to die

This article does not reflect the opinions of Disability Alert. It is a discussion of the topic.

By DONNA CASEY

Where there’s life, there’s hope

Life or death situation

The day will come. It may be 50 years from today or it could be next month but the day will arrive when you are sitting in a doctor’s office or lying in a hospital bed, when you’ll hear the words, “There’s little we can do for you. We will try to control your pain as much as possible.

“You are dying.”

You may already be picturing your last days and hours — at home, in your own bed, surrounded by your loved ones, free of pain, ready to go.

But that vision is wishful thinking. Most of us will draw our last breath in a hospital bed. Some of us will die alone, while many will be lost in a medicated fog. Genetic counselling and in vitro fertilization has revolutionized how life begins. Now many think Canada is overdue for an honest public debate about how life ends.

Today, assisted suicide and euthanasia barely registers on the political radar screen. Like abortion, same-sex marriage and other hot-button social issues, lawmakers are loathe to venture into the ethical minefield.

Across the country, Canadians are running for the cure, not marching in the streets for the right to die.

But with baby boomers shifting into their senior years, some believe the fight for what some call “the last right” will heat up as a generation raised on freedoms and liberties grow old, sick and helpless.

During the past decade, the Netherlands, Belgium and Switzerland have legalized euthanasia or doctor-assisted suicide. For the last nine years in Oregon, a competent person with a prognosis of less than six months to live can obtain a prescription from a doctor for a lethal dose of barbiturates.

Today in Canada, a person who carries out euthanasia faces a first-degree murder charge, with a mandatory minimum life sentence and 25-year prison term. Anyone who helps a person commit suicide could face up to 14 years in jail.

Could assisted suicide become law in Canada? A decade ago, few would have predicted same-sex marriage would be as Canadian as Mounties and maple syrup.

There are a growing number of people who believe we have the right to make that decision — to end our own lives with the help of a doctor.

In 1994, a doctor helped Sue Rodriguez end her life, a few months after the Supreme Court of Canada rejected the B.C. woman’s Charter challenge.

Elizabeth MacDonald didn’t wait for Canadian lawmakers. Earlier this year, the 38-year-old Nova Scotia woman with advanced-stage multiple sclerosis travelled to Switzerland to have an assisted suicide.

In 2005, Marcel Tremblay, a 78-year-old Ottawa man with a chronic lung condition, publicized his planned suicide by helium gas to help the right-to-die cause.

A 2002 Gallup poll showed support for euthanasia has risen steadily over the past 30 years, with a majority of Canadians now favouring it for people with terminal illness who are in pain.

One ethicist says most Canadians tolerate the idea of assisted suicide without necessarily supporting it.

“I think the middle ground of tolerating without approving is expanding,” says Bernard Dickens, professor emeritus of health law and policy at the University of Toronto Joint Centre for Bioethics.

Dickens calls it a replay of the abortion debate in the 1980s — two entrenched, committed camps at opposite ends of the issue.

Supporters of the right-to-die movement are “independent, strong-willed people” — determined to choose how they will die, says Ruth von Fuchs, president of the Right to Die Society of Canada.

In Canada, the movement fits into two camps, with the 300-member Dying With Dignity Canada doing low-key lobbying on the assisted-dying issue.

Its more radical cousin, the Right to Die Society of Canada, counts only a few dozen members and offers legal advice and self-help assistance, including a mail-order guide on “a humane self-chosen death.” But both organizations see assisted suicide as a human rights issue.

Depicting assisted suicide as an issue of personal choice and dignity makes the cause more agreeable, says a historian of the euthanasia movement.

“If the issue is framed as an issue purely in terms of personal autonomy, of choice and human rights, the vast majority of baby boomers are going to be sympathetic to the legalization of assisted suicide,” says Ian Dowbiggin, professor of history at the University of Prince Edward Island and the author of A Concise History of Euthanasia.

But one physician says assisted-suicide supporters have “perverted” the notion of dignity.

“The moment the right-to-die movement sees discomfort, disability or social embarassment — like having to have someone wipe your bottom for you — they immediately declare a loss of dignity, as if dignity was no more than social status or personal ability,” says Dr. Will Johnston, chairman of Canadian Physicians for Life.

“There must be big problem with the reality when the image has to be so carefully manipulated to make it palatable to the public,” says Johnston of the shift among right-to-die groups to use “aid-in-dying” instead of the assisted-suicide term.

But Donald Babey, executive director of Dying with Dignity Canada, sees the assisted-dying cause as a grassroots movement standing up to “power structures” like mainline churches which “grasp at straws to legitimize its existence.”

“I’m convinced they’ve taken a manipulative and emotional approach and not a logical one,” says Babey of the argument that likens assisted suicide to “some kind of social cleansing.”

One of Canada’s top biomedical ethicists calls assisted suicide “a pretty straightforward issue.”

“The issue is how we die and whether there is something wrong with actively killing people,” says Margaret Somerville, the founding director of McGill’s Centre for Medicine, Ethics and Law.

Support for euthanasia reflects a shift in societal values that looks at death as “sanitized, medicalized and intensely individualized,” says Somerville, the author of Death Talk: The Case Against Euthanasia and Physician-Assisted Suicide.

Sanctioning assisted suicide would have a “huge symbolic effect” on how society treats its most vulnerable, says one religious leader.

“The response that should be given is one of care and compassion and support to those people at this point in their lives, not to kill them,” says Bishop Ronald Fabbro, a board member of the Catholic Organization for Life and Family.

‘CRY FOR HELP’

When a seriously ill person becomes depressed and dependent on others, their death wish is really a “cry for help,” says Fabbro.

“You’re talking about people at their most vulnerable time. People often need to be protected at that time from others and … even from themselves,” says Alex Schadenberg, executive director of the Euthanasia Prevention Coalition.

Supporters and opponents of assisted suicide use the experiences of the Netherlands and the state of Oregon to make their case.

After existing underground in Dutch hospitals for decades, euthanasia was legalized in 2002. In the Netherlands, a person can request an assisted suicide if their suffering is “unbearable with no prospect of improvement.”

The request must be voluntary and the death by lethal injection must be performed by
a physician.

Dowbiggin believes the Dutch experience offers a “cautionary lesson” for Canada, showing that countries that begin to take a permissive attitude to assisted suicide keep pushing the boundaries.

But others say the Dutch law brings the practice out in the open.

“The dangers of abuse and exploitation and mistakes in Holland are significantly less than they are in Canada,” says Dr. Arthur Schafer, director of the University of Manitoba’s Centre for Professional and Applied Ethics.

“We know it happens in Canada but it happens in the dark,” he adds.

In Oregon, aid-in-dying has been legal since 1997. Defenders of the Oregon law say the statistics have proved its critics wrong, showing the law’s safeguards both protects against abuses and respects the wishes of competent individuals.

“You have evidence and data about why people are seeking it, who’s seeking it and the fact that it’s not the vulnerable who are accessing assisted suicide in Oregon but it’s the privileged,” says Jocelyn Downie, professor of law and medicine at Dalhousie University and the author of Dying Justice: A Case for Decriminalizing Euthanasia and Assisted Suicide in Canada.

The overwhelming majority of the 292 people who died using the law were white, college-educated, middle-class seniors.

Any change in Canada’s laws won’t likely be coming from Parliament. The best odds for a change in law would come from the courts. Any legal challenge would need to wind its way through several lower courts before getting before the Supreme Court of Canada.

ASSISTED SUICIDES IN CANADA

1994: Sue Rodriguez, 44, of Victoria, B.C., dies after an anonymous physician helps end her life. The death of the assisted suicide advocate, who lived with ALS, comes months after the Supreme Court of Canada ruled against her constitutional challenge of the assisted suicide law.

1998: Dr. Maurice Genereux, a Toronto doctor, is sentenced to two years in jail after pleading guilty to prescribing lethal doses of barbituates to two men with HIV.

1998: A Nova Scotia judge dismisses a murder charge against Dr. Nancy Morrison, right, a Halifax physician accused of hastening the death of a terminally ill cancer patient by lethal injection.

2002: Evelyn Martens, 73, of Duncan, B.C., is found not guilty of assisting in the suicides of two women.

2006: Marielle Houle, 59, of Sherbrooke, Que., is sentenced to three years probation for helping her son Charles Fariala, below, commit suicide. Houle pleaded guilty for her role in helping her 36-year-old son, who was in the early stages of MS, complete his suicide plan in September 2004.

June 2007: Dr. Ramesh Sharma, a general practitioner in Vernon, B.C., is handed a two-year sentence to be served in the community for helping a 92-year-old patient with a suicide attempt. He’s also stripped of his licence to practice medicine.

June 2007: Elizabeth MacDonald, 38, right, of Windsor, N.S., travels to Switzerland to end her life after years of chronic pain from multiple sclerosis. MacDonald’s husband, Eric, is questioned by the RCMP after returning, but it is determined he hadn’t broken any Canadian law on assisting a suicide

THE LAW

In Canada, it’s illegal to assist someone end their own life, covered by section 241(b) of the Criminal Code, with a maximum penalty of 14 years in prison. Euthanasia, which is Greek for “good death”, is the deliberate action by a physician or other person to end another’s life for benevolent reasons and with the consent of the person.