Executive Summary

    1. The Latimer Case

Which way are we moving as a country? Toward making every disabled Canadian safe and welcome? Or toward making it easier to dispose of them?

"Life, even a life full of suffering, is precious. Taking it, even for the best of motives, is reprehensible. If we do not believe that, then we believe nothing." - Editorial, Globe and Mail

 

2.  Palliative Care: The Caring Response

Canadians have always accepted that a person who suffers due to unremedial disability or illness has a moral claim on our care and compassion. As a society we have made great strides in providing medical treatment and human support for those who suffer.

When people are dying from terminal illness, or suffer from chronic or degenerative illness, competent palliative care can bring immeasurable relief. Palliative care may be defined as "care aimed at alleviating suffering - physical, emotional, psychosocial, or spiritual - rather than curing." The biggest fears that dying people have are pain, loneliness, and loss of dignity. Palliative care responds to all three. As a result, any desire for suicide or euthanasia is normally prevented or removed.

Unfortunately, as many experts attested before the Special Senate Committee on Euthanasia, most Canadians do not have good access to palliative care. The Committee learned that such care is (a) unevenly distributed across Canada; (b) insufficiently funded; (c) often poorly coordinated; (d) lacking in sufficient numbers of trained professionals; (e) seriously underprovided in medical training programs; (f) in need of further research in pain management.

The Committee called for "universal access to competent and effective palliative care." It urged governments to "make palliative care programs a top priority in the restructuring of the health care system." But is anyone listening? The glacial pace of delivering palliative care to those who are suffering is perplexing and frustrating, and only fuels demand for euthanasia.

Parliament must not accept the status quo. When people are suffering and need help, it is no answer merely to reject euthanasia. It is time for our political leadership to work energetically to ensure that every Canadian who needs it has access to palliative care.

The Canada Health Act should be amended accordingly. Indeed, should not failure to provide palliative care be a more serious matter than extra-billing or a waiting list for cataract removal?

As governments discuss the future of health care funding, major support for palliative care should be a top priority. Funding should include the Canadian Palliative Care Initiative (see Tab 2).

Competent care is the right answer to the problem of suffering. But delivering the goods takes hard work.

3.  The Doctor-Patient Relationship: Killing as a Cure?

"The very soul of medicine is on trial." - Willard Gaylin, M.D. et al.

Most euthanasia proposals involve a physician ending a patient's life. Do Canadians want doctors to be killers for hire (no doubt a suitable euphemism could always be found)? Or is our idea of a good doctor still one who often cures, always cares and never kills? Hippocrates set Western medicine on a historic course, one that distinguished healing from killing. In our view, this is no time for physicians to again dabble in the poison arts.

The medical professions in Canada, the United States and Great Britain have not been eager to conflate caring with killing. The Canadian Medical Association opposes physician involvement in euthanasia and assisted suicide.

"The medical profession will not tolerate being put in a position to judge the value of the lives of the patients we are trained to heal, comfort and care for..." - Dr. Nancy Dickey, American Medical Association

Of all doctors, moreover, those closest to the dying - palliative care physicians - are the most resistant to euthanasia.

It is also curious that those closest to death are less interested in euthanasia than others. It is as if the perception of another's suffering is more of a problem than the reality of one's own suffering. We should surely be guided more by the experience of those who suffer than by uninformed value judgments about other people's quality of life.

Once doctors are granted the power to kill patients, the impossibility of restricting that power has been amply demonstrated in Holland where voluntary euthanasia was allowed and then only in cases of terminal illness. Information contained in a 1991 Dutch government study showed that most physician-involved deaths were not voluntary. Moreover, a 1997 study concluded that "virtually every guideline set up by the Dutch ... has failed to protect patients or has been modified or violated." The slippery slope theory has been confirmed.

"The Netherlands has moved from assisted suicide to euthanasia, from euthanasia for people who are terminally ill to euthanasia for those who are chronically ill, from euthanasia for physical illness to euthanasia for psychological distress, and from voluntary euthanasia to involuntary euthanasia (called 'termination of the patient without explicit request')." - H. Hendin, M.D.

"A matter between a patient and their doctor"?

The argument is sometimes made that euthanasia should be treated as an essentially private matter between a patient and their doctor. This argument is problematic from several standpoints.

1. It asserts to become public policy. If society had never enacted laws against patient killing, it would be possible to conceive of euthanasia as a purely private matter. In the present context, if legalized it would always remain a foundationally public matter.

2. The argument implicitly asks society to approve killing as a solution to suffering, and sanctions the role of doctor as killer. The "privacy" of the doctor-patient relationship would thus, from the beginning and under public auspices, be morally skewed in favour of euthanasia.

3. One of the parties in the relationship is by definition weak and vulnerable because of illness and suffering, thus deserving of safeguard measures. Yet enactment of safeguards would involve the public in the relationship.

4. The argument falsely assumes that euthanasia could remain totally voluntary. Once society has approved killing as a solution to suffering, there would be a tendency to apply that principle to patients in general, in their best interests. Euthanasia would especially be applied to noncompetent patients. The net result: public intervention would be required.

The idea of making euthanasia a purely private matter between a patient and doctor is a myth, but could hardly become a coherent and workable social reality. Only a society indifferent to the welfare of patients and the responsibilities of doctors should want to entertain it as a public policy. Killing is an inherently public matter, and should be recognized as such.

4. Other Jurisdictions

The international consensus is strongly opposed to the active termination of sick, disabled and dying persons. Many eminent bodies have examined the issue.

"Society's prohibition against intentional killing is the cornerstone of law and social relationships. It protects each one of us equally." - Select Committee on Medical Ethics, United Kingdom House of Lords

"We are confronted with a consistent and almost universal tradition that has long rejected the asserted right, and continues explicitly to reject it today, even for terminally ill, mentally competent adults." - U.S. Supreme Court

"Legalizing assisted suicide and euthanasia would be profoundly dangerous for many individuals who are ill and vulnerable." - New York State Task Force on Life and the Law

In 1997 the Australian National Senate repealed a Northern Territory law allowing euthanasia. In the same year, the State of Oregon became the first jurisdiction to statutorily legalize assisted suicide. The Dutch experience suggests that it will not be long before the Oregon experiment unravels. Euthanasia advocates immediately began calling for more permissive measures.

5.  Should Changes Be Made to the Criminal Code?

"The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government."- Thomas Jefferson

In recent years Canada's courts and Parliament have seriously examined the question of changing existing prohibitions against euthanasia and assisted suicide. Both decided in the negative and gave numerous reasons which we find compelling.

In 1993 the Supreme Court of Canada rejected Sue Rodriguez' bid to legalize assisted suicide. It said that "the policy of the state that human life should not be depreciated by allowing life to be taken" reflected a legal and societal consensus. It said also that "Given the concerns about abuse and the great difficulty in creating appropriate safeguards, the blanket prohibition on assisted suicide is not arbitrary or unfair."

In 1995 the Special Senate Committee on Euthanasia and Assisted Suicide recommended that Criminal Code prohibitions on active euthanasia and assisted suicide be maintained. Among the reasons which the majority gave:

• "In a pluralistic society, respect for life is a societal value that transcends individual, religious or diverse cultural values."

• "Legalization could result in abuses, especially with respect to the most vulnerable members of society."

• "Changes in the law with respect to competent persons could lead the way to possible changes in the law for incompetent persons."

• "The Netherlands experience illustrates that guidelines are not always followed."

• "Individual rights must be limited to the extent that they cause harm to other persons."

• "Since we are aware of an unacceptably high rate of suicide among young people, especially in the aboriginal community, how can we justify any action that suggests assisted suicide is a legitimate response to suffering? "

• Dignity exists when one faces the final stages of life with a feeling of self-worth and with the care, solicitude and compassion to which all human beings are entitled."

• " The common good could be endangered if the law is changed to accommodate the few cases where pain control is ineffective."

Compassionate homicide?

Proposals to reduce the criminal offence of euthanasia have been advanced, especially in light of the Latimer case. Some wish to create a new category of "compassionate homicide."  For three reasons, it would be unwise public policy to enact this type of provision.

8.  Euthanasia Prevention Coalition BC

Formed in 1995, the Euthanasia Prevention Coalition of BC is a coalition of organizations and individuals opposed to the legalization of euthanasia (see Tab 8). Members of the coalition believe that euthanasia should continue to be treated as murder, irrespective of whether the person killed has consented.

The Coalition wants to promote serious public debate about euthanasia, and strongly advocates universal access to quality palliative care.

At present 49 diverse medical and community groups belong to EPC. EPC is a member of Care in Dying / The Canadian Coalition Against Euthanasia, based in Ottawa.

The Need for Prudence as Well as Compassion

EPC is deeply concerned about the manipulative haste with which some euthanasia advocates are pressing for legal change. These partisans seem all to ready too traffic in tragic anecdotes about individual cases. Yet they are all too reluctant to demonstrate how the benefits of legalization would outweigh the harm to the common good and the rights of the most vulnerable.

Adeptness at appealing to the fear of suffering is not being matched by zeal for responsible public discussion. Euthanasia proponents would erect medicalized death as one of the columns in our Canadian health care edifice. But what assurances do they offer that patient killing would not result in the roof falling in, ethically speaking, on the entire system?

Right Question. Two Very Different Answers.

The euthanasia issue raises a question Canadians must face: How do we deal with human suffering? But proposals to legalize the killing of those who suffer do not offer the right answer.