Assisted Dying to be Legalised in Québec?

All I have to go on at the moment is the report in the National Post, but it seems that the government of Québec has found legal ways to work around the Canadian Criminal Code prohibitions of assisted suicide in order to provide for the legalisation of physician assisted dying, in the words of the National Post account, “in rare cases where a patient is close to death and unable to endure the physical or psychological pain.” Whether, in fact, the provisions will manage to skirt around the Criminal Code remains to be seen, but full marks to Québec for recognising, at least, that there is an issue of great importance here that demands attention. And far less than half marks to the spokesperson for the federal government who said:

This is a painful and divisive issue that has been thoroughly debated in Parliament. We respect Parliament’s decision.

To consider the “debate” in Parliament to have settled this issue once and for all is ridiculous myopic. the debate itself did not raise any points of importance. Most of those who commented in the debate did not seem to have considered the issue at any depth. And the refusal to pass the matter on to Parliamentary Committee was precisely a refusal to look at the matter in any depth, or to assess the general political will of Canadians on this issue. What is painful and divisive about the issue is that the church and the mosque is all wrapped up in making sure that the issue never gets an adequate airing in public debate. The position of the government on this issue is inadequate and evasive, and plays into the hands of religious opponents of assisted dying, who are the ones who make the most noise, and have the most money to spend in order to oppose it. It’s time for governments to recognise that the religious do not speak for the vast majority of people in this country, and that the refusal of government to conduct a widespread public discussion of the issues involved has left Canadian largely uninformed about current ethical thinking on the issue, as well as frustrated at the lack of action.

Unfortunately, it seems to be generally the case that a more consistent position on the issue of assisted dying is not being taken. Dr. Gaetan Barrette, president of the Federation des medecins specialistes du Quebec, expresses the fundamental basis of the decision procedures involved as follows:

It’s not the doctor’s decision, it’s not the system’s decision, but the patient’s decision.

There is, however, a tension between this, and the limitation of assisted dying to “rare cases where the patient is close to death.” How close?, one wants to ask. According to the National Post report, quoting from Barrette again:

Just because you are diagnosed with Lou Gehrig’s disease, you don’t have access to this. …

You have to be at a point in the evolution of the disease that it is intolerable.

Of course, for many people, the point in the evolution of a disease that is intolerable may come at some point at which death is still not close. Many cases of assisted suicide that have been considered by Canadian courts have involved persons who were not close to death, but found their conditions undignified and intolerable.

It is my hope, before this matter is made law, that those responsible for drafting the legislation, will take great care to reflect on the spectrum of cases of assisted dying that have already reached public attention in the last few years. In some cases, of course, death was imminent, but in other cases it was not. What was imminent was a state of life that the patient would have found intolerable. Tony Nicklinson, in England, for instance, who suffered from locked-in syndrome, might have lived for many years, yet found his present circumstances intolerable. If in the proposed law the patient’s autonomy is placed in the forefront, if that is, in Dr. Barrette’s words, “[i]t’s not the doctor’s decision, it’s not the system’s decision, but the patient’s decision,” then this will have to be recognised in any proposed legislation. To say this, and then say that it would involve only rare cases where the patient is close to death is already to have taken the decision out of the hands of the patient, and returned it decisively to the medical profession.

So, while I am heartened and encouraged by the news out of Québec, I am worried that, once again, the main point about assisted dying is simply being overlooked, that this is about patients’ rights, not about doctors’ or legislators’ (the doctor and the system) appraisal of what is or is not found intolerable by the individual, but the individual him or herself, and how the tolerability of a certain quality of life seems to them, that is of decisive importance in assessing a person’s right to be assisted to die. No doubt subjective evaluations of doctors and other professionals will be important too, but the final decision, after all avenues of examination and assessment have been exhausted, must be left up to the individual, and not to the official, whether of medicine or the law, to make.

The problem of doing otherwise, as I have said on numerous occasions, is that making the qualification for assisted dying rest with the doctors or the system would be to define a state of life which would be understood to be, in some objective way, intolerable — and of course, on the other hand, to define states of life which would be considered, in the same objective way, tolerable — and then individuals will be forced into the mould, without regard for what they themselves think about the intolerability or tolerability of their lives; and this would be an objective determination of something that should be left up to the patient to decide. It concerns me that this is something that those considering assisted dying do not seem to recognise.