Assisted Dying

"The tough cases fall in the grey zones. People's lives don't fit neatly into boxes and checklists."
"It's only reasonable to expect things don't work perfectly smoothly on day one. There's no way of knowing at this point how many patients requested [assisted death] and were blocked."
"End of life is available. If you're suffering and you're dying; just ask for it, you'll get it [the feared and incorrect message coming through to the public]."
Dr. Eugene Bereza, director, centre for applied ethics, McGill University Health Centre, Montreal

"Yes, the death of a family member is traumatic. A death of a patient under your care is also traumatic. But what about if you actually went to the extent to [not only] alleviate pain, but terminate the life?"
"A police officer involved in a shooting, they get support. What about doctors that are getting involved in these types of discussions, that actually perform the act. It's going smoothly for the moment [assisted death practised in Montreal under the law permitting such medical intervention] but the aftermath is what we need to start to care for."
"We're hearing it changes the relationship; it changes how you interact with the care team after making such a decision. There's that effect that I think we need to start to manage."
"The hard part is what comes after."
Normand Laberge, executive director, Quebec Medical Association

MPs will have a free vote on new legislation doctor-assisted suicide that was tabled today. (Shaun Best/Reuters)

Conventionally and historically the role of the medical profession has always been to assist people to live. When health crises arise, this is the profession to which we turn for diagnosis, advice, prescription, support and encouragement. "Do no harm" is what the profession has embraced, and certainly not "when all else fails, offer death". In the best of all possible worlds there would be no acute medical crises to be handled; alternately, once such crises arise the warmth and security of palliative care would ease the suffering toward eventual death.

Canada, however, following directly in the lead of the Province of Quebec, has decided, because the Supreme Court of Canada saw fit to strike down prohibitions against assisted suicide citing the law prohibiting assisted death as violating Canadians' Charter rights, has now passed the requisite legal hurdles to make it possible for some adults under some circumstances to request and to receive assistance in seeking death. Such physician-assisted death is to be restricted to mentally competent adults suffering from serious and incurable illness, disease or disability.

The bill, tabled on April 14 in Parliament, sets out protective safeguards to ensure that vulnerable Canadians are not absorbed into a process they have no wish to be part of. A parliamentary committee that had been struck to consider and issue recommended guidelines included extension of the right to die to "mature minors" as well as the mentally ill, and extending the potential for inclusion for patients with degenerative disorders to issue advance consent. Not all of the recommendations were accepted.


The bill also:

• Protects people from being encouraged to die in "moments of weakness."
• Includes a mandatory 15-day "reflection period" so people don't make rash decision after a diagnosis.
• Re-affirms goals on suicide prevention and encourage a "consistent approach" across Canada.
• Allows doctors and nurse practitioners to provide assistance without risk of criminal charges.

But what Dr. Laberge is concerned with, now that Quebec is four months into its euthanasia assistance to eligible patients program, is the fallout effect of potential trauma on assisting medical practitioners. A process that was once far from anyone's imagination has now become legal in Canada. Since assisted death became legal in Quebec in December a few unexpected situations in dealing with the issue have already arisen. One doctor tried to block a terminally ill cancer patient's access in reflection of his personal moral opposition to assisted death.

Raising the larger issue of patients erroneously believing that "Euthanasia on demand", has become a legal end-of-life process in Canada is yet another complication that must be clarified. Another emerging challenge is how to treat people whose situation "almost fits" the criteria for acceptance, but who are denied on the basis that they are missing one of the key criteria. A man from Sherbrooke met all requirements other than that his death was not imminent. He  had lost use of his legs and stopped eating in order to qualify for an assisted death.

"That must have been three or four weeks of hell, for everybody involved", noted Dr. Laberge. Who feels it is critical that doctors need more guidance so that those who are willing to take part in assisted death protocols that act with a level of confidence, and those who are not prepared to take part in assisted death as well, are helped "through the ethical discussions you're going to have with yourself".