The Crowning Dilemma

"There's no moaning or groaning. The person might say a few goodbyes, or thank-you's, and then just falls asleep."
"[Under U.S. law overdose drugs must be oral, not by injection; a feeding tube could work] but the patient would need to do that. No other person could push it through. But that's much less likely, or common."
"People generally fall asleep within three to five minutes. It's a very quiet and gentle death. It's just a falling into a very gentle sleep and then, when the breathing stops, the heart stops a minute or two later because there's no oxygen in the blood. It's just very simple."
"I have seen technology keep people alive and suffering. I think  you have to think about it a long time for  yourself -- you have to realize we're no longer able to cure now; these are people who can't be healed. And we can't abandon them."
Dr. David Grube, Philomath, Oregon

"When I've done it, I've never felt like I was killing someone, that's why I don't like the word 'killed'. I always saw it, and most of my colleagues will see it, as terminating the suffering of a patient."
"We know from the scientific research that it can take up to 24 to 48 hours [process of dying with drugs administered]. That is considered to be inhumane for next of kin. That was not the (intention) for assisted suicide."
"Many times we ask ourselves why we have 100 percent positive treatment success with our euthanasia, and they have those failures in the United States."
Dr. Rob Jonquiere (former) chief executive officer, Dutch Right to Die Society, Amsterdam

"Doctors who are going to participate in this are going to want to know, 'What drugs do I use, at what doses? How do I administer'."
"We've seen recent examples in the U.S. of botched executions (of death row prisoners) and medications at the wrong dose, or in the wrong combination."
"What is the standard of care in the Netherlands? What is the standard of care in Belgium? Have you had any difficulty getting access to these substances? Have you had studies on efficacy and what works and what doesn't?"
"What we have now are many years of these procedures being done in other countries that we can learn from. That provides me with some comfort."
Dr. Jeff Blackmer, director of ethics and professional affairs, Canadian Medical Association

"The prohibition on assisted dying is overboard. It imposes unnecessary suffering on affected individuals, deprives them of the ability to determine what to do with their bodies and how those bodies will be treated and may cause those affected to take their own lives sooner than they would were they able to obtain a physician's assistance in dying."
Supreme Court of Canada, February 2015

Doctors in Oregon are permitted by law to prescribe a lethal dose of medication to terminally ill, mentally competent adults whose life expectancy has been diagnosed as less than six months. The state's Death with Dignity Act came into effect in 1997. From that date forward, 1,327 people had prescriptions written under that legislation. Of that number, 859 patients died from the effects of swallowing the drugs, and the numbers of those events have been steadily increasing.

The patient, according to rural practitioner Dr. Grube, is instructed to take a stomach-lining drug an hour before, to avoid vomiting the lethal drugs after administration. An overdose of a barbiturate is mixed as a powder with two or three ounces of water and people are required to swallow quickly, within minutes to avoid falling asleep before they've imbibed the full dose effectively. Most patients take less than an hour to die but there have been incidents (19%) where people took longer to die.

A Belgian “euthanasia kit.” What can Canada learn from other jurisdictions when it comes to what method is best for medically ending a life? ETIENNE ANSOTTE/AFP/Getty Images

A handful have, in fact, survived the event. One man asked his wife when he awoke, "Why am I not dead?" The prescribing doctor was present for only 14 percent of patients, at the time of death, in 2014. Dr. Grube explained that in each failed case full directions were not heeded; the drug wasn't taken, for example, on an empty stomach or the person fell asleep before taking the full dose. "The consequences were only that the patient awakened, which of course was not the patient's desire", pointed out Dr. Grube.

On the other hand, pointed out Dr. Jonquiere, with lethal injection, death is almost instantaneous. "That's something you have to prepare the family for, because it happens really fast." In the Netherlands, euthanasia accounts for 2.8 percent of all deaths, and 0.2 percent by assisted suicide. Dutch doctors first inject pentobarbital to induce coma. Then a powerful muscle relaxant is injected, paralyzing breathing muscles.

In studies of 515 cases of euthanasia performed by Dutch doctors from 1990 to 1996, physicians reported technical problems along with additional complications such as difficulty accessing a vein, spasms and nausea and vomiting. Assisted suicide was more frequently associated with complications than was death by lethal injection. Canadian doctors are now facing the necessity to confront these background concerns to better inform themselves of what they might expect of their enabling role.

A new law in Belgium would grant children, with the consent of their parents, to end their own lives, as well as dementia patients in the early stages of the disease. Fotolia

Canadian leaders in the field of public medicine, since the Supreme Court struck down legal proscription against assisted dying, are looking now at the experience of doctors abroad in coping with the need to assist some of their patients to end their lives rather than endure additional suffering in a life whose time has come to an end. Ironically, it seems that the safest, fastest and most efficiently successful method may be death by lethal injection, a prospect that most doctors find appalling to their medical ethics and personal philosophy.

Which has led leaders of the Canadian Medical Association to turn to American and European jurisdictions that have legalized doctor-assisted death to help them better understand the successes and failures of the paths they have chosen to take, in a field that still represents as experimental and one completely contrary to the medical oath of professional conduct; to 'do no harm'. It takes a philosophical leap to convince oneself that there are times when the greater harm may be to let a death proceed whose journey is cruelly painful.

While many doctors grapple with their consciences and their squeamish attitudes toward hastening death when all their training and the weight of long tradition in the healing arts inform them that they must never be involved in inviting death to enter when medical science and technology make it increasingly more possible to extend life, even a life of excruciating pain, others wonder why the careful administering of pain-relievers and the compassionate attendance of end-of-life care workers does not represent a more humane option.

Euthanasia and assisted suicide are highly controversial, but so too is the debate about which method is best. FRED DUFOUR/AFP/Getty Image