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Tuesday, December 15, 2015

Is 'Assisted Death' Legalized Murder?

"A five-year-old? A seven-year-old? They would never be seen as having the capacity or competence of making these decisions."
"I could definitely see 12-year-olds having that capacity [to exhibit maturity and mental competence], and I could see 16-year-olds not have that capacity."
"We [nine-member advisory committee] just didn't feel that to make an arbitrary decision that, at 17 years and 364 days you wouldn't meet the criteria [as an adult], but the next day you would. We felt that wasn't the way to go." 
"We heard from stakeholders on both sides who agreed with each other that there shouldn't be a list of conditions set out -- don't list cancer and don't list Lou Gehrig's disease' -- because that list will always change. What is incurable today might become curable tomorrow. Everybody said don't come up with a list, it wouldn't be workable."
Maureen Taylor, physician assistant, assisted-death advocate

"That's already well established in our system [the 'mature minor' making their own medical decisions including discontinuing life support]."
"The idea of an arbitrary age limit, and people suffering intolerably and waiting days, weeks or months to die because they haven't reached that limit, seems morally unacceptable."
"End-of-life decisions are being made every day in Canada by mature minors. Doctors make decisions about competence and capacity all the time."
"I'm asking readers to imagine a patient with metastatic cancer that has spread throughout her body, who has received the best possible care but who is suffering intolerably and is almost certain to be dead in two weeks, and who requests assistance to hasten her dying." 
Arthur Schafer, ethicist, panel member, director of Centre for Professional and Applied Ethics, University of Manitoba
02_13_FE0107_Euthanasia_07 The Levenseindekliniek, an 'end-of-life clinic' opened in 2012 in Amsterdam, offering services to patients whose doctors refuse to cooperate with requests for euthanasia or assisted suicide. The suitcase with necessities the GP of the End-of-life clinic' uses when the life of a patient is terminated. Jean Pierre JANS/REA/Redux

The nine-member expert panel assigned to produce a report on euthanasia in Canada came up with a number of recommendations, the most controversial of which is that there should be no "arbitrary age limits" for assisted death. Eligibility, in their considered opinion, should logically be based on maturity and mental competence, and not age. The criteria by which maturity and mental competence would be based in any such instance presumably would be a matter for the consulting physician to judge augmented by the parents' assurances should they agree.

Last February the Supreme Court of Canada granted the right of mentally competent adults suffering from "grievous and irremediable" conditions the constitutional right to request a doctor-assisted death. The federal government was given a year in which to see an appropriate law drafted. The advisory panel's purpose was to give guidance to the provinces and territories to come to terms with the prospect of legalizing assisted death. On the issue of who might be age-eligible, the Supreme Court did not specify any age limit, speaking only of "adult" competence; the age of maturity in most provinces being 18.

The panel's argument hinges on the issue of the "mature minor" concept, where minors are held capable, if they comprehend the full nature of their illness and the repercussions of their decisions, to make a life-ending decision to discontinue life support. No age restriction currently mandates when someone can decide to discontinue the often-terminal use of a respirator or ventilator, or to refuse an antibiotic or to halt kidney dialysis, goes the panel's argument. Why should it be any different for requesting an end to suffering by doctor-assisted suicide, since decisions as noted above also lead to death.

In a 2009 case, the Supreme Court had ruled that children under 16 who were capable of demonstrating sufficient intellectual maturity should have their wishes respected with relation to their medical treatment. Experts and organizations across Canada were consulted by the advisory panel. The end result was a final report listing 43 recommendations ranging from qualification criteria for lethal injection or doctor-prescribed drug-overdose, to the ethical obligation of doctors objecting on religious or moral grounds to become involved other than referring a patient to another doctor.

Belgium became the first country in the world, in 2014, to legalize euthanasia by lethal injection for children. Belgium's Parliament approved the law passed previously by its Senate. Under this law young children are permitted to end their lives with the assistance of a doctor. In 2015 the Netherlands sought to follow Belgium's example:
"We feel that an arbitrary age limit such as 12 should be changed and that each child’s ability to ask to die should be evaluated in a case-by-case basis", said Eduard Verhagen, paediatrics professor at Groningen University.

Assisted suicide deaths and euthanasia has doubled in the Netherlands in five years. In Belgium the increase has been over 150-percent in the same time-frame. Most Belgian patients suffered from cancer, but people were also euthanized who were suffering from autism, anorexia, borderline personality disorder, chronic-fatigue syndrome, partial paralysis, blindness and deafness, and manic depression. One 44-year-old man was euthanized as a result of being devastated by the failure of his sex-change surgeries.

In 2014, 13 percent of Belgians euthanized had no terminal health condition; about three percent suffered from psychiatric disorders. Euthanasia accounts for close to five percent of all deaths in Flanders.  Last year, De Standaard, a Flemish newspaper, saw fit to publish a human-interest story as a tribute to a depressed mother who was euthanized after having been abandoned by her boyfriend and becoming disillusioned by the psychiatric care she was given.

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