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October 22, 2013

Legalizing physician assisted suicide?

Scott Stockdale

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As Quebec prepares to pass Bill 52, which will legalize physician assisted suicide, two of Canada's distinguished academics expressed diametrically opposing views on the issue.

Dr. Wayne Sumner, professor emeritus of law and philosophy at the University of Toronto, supports legally assisted suicide because, “Everyone knows there are some cases where even the best resources in palliative care cannot eliminate all suffering at the end of life,” and because, in jurisdictions where euthanasia is legal, only a small percentage of patients choose this option. He expressed his views on a recent edition of the TVO show The Agenda.

But Dr. Margaret Somerville, law professor and Founding Director of the Faculty of Law's Centre for Medicine, Ethics and Law at McGill University, said she believes it's inherently wrong to intentionally kill another person. Moreover, she noted that Bill 52 simply ignores the ethical aspects of this life and death issue.

“It will authorize doctors to give lethal injections to patients. It accepts that as a given and then establishes guidelines as to the management: how do you do it; under what circumstances and, who will be able to have access.”

She added that Bill 52 doesn't restrict access to assisted suicide to a small percentage of patients: quite the contrary. It offers access to many patients in their time of need.

“For start you don't have to be terminally ill to have it. You can have just mental illness, whether or not your pain and suffering are intolerable. Bill 52 makes that a decision just by the patient, if the patient finds it intolerable. Moreover you can refuse all suffering or pain relief measures and you can still have access because you have intolerable pain or suffering. So Bill 52 is extremely wide in what it would allow and who would be allowed.”

Dr. Sumner and Dr. Somerville proceeded to debate the numbers and/or percentages of people who actually opt for medically assisted suicide, in jurisdictions such as The Netherlands, where physician assisted suicide is legal. Dr. Sumner claimed only two per cent of all deaths are attributed to assisted suicide, while Dr. Somerville said she thinks it's gone up to four per cent. Meanwhile, Dr. Sumner saw the low percentage numbers as an argument in favour of assisted suicide.

“Whatever, two or four per cent. It's immaterial here. It's still a very small minority of all deaths. The number of patients who opt for assisted suicide or euthanasia is very small compared to the number of patients who opt for or decline life-sustaining treatment. The number of patients who accelerate their death by refusing treatment is actually enormous compared to the number who actually opt for an assisted death.”

Dr. Somerville explained that Bill 52 calls for “terminally palliative sedation”, whereby the patient is sedated and all food and fluids are withheld. Remarkably, this procedure is not classified as assisted suicide; and its use is increasing.

“The rate for that (terminally palliative sedation), in the Netherlands last year increased by 13 per cent. We just got the figures for that. There's concern in the Netherlands that terminally palliative sedation is being used instead of euthanasia and one of the reasons for that - and this would also be true under B 52 - is that the reporting requirements and the access to it requirements that exist under  euthanasia do not apply to terminally palliative sedation.”

Dr. Somerville noted that, under Bill 52, whether a patient is given terminally palliative sedation seems to be at the discretion of the doctor and, most importantly, a surrogate decision-maker can consent to it; whereas that's not true of euthanasia.

She also took issue with the fact that euthanasia is such a radical change to the ethos and ethics of medicine and our most important societal values: respect for life. She said that, in this context, arguing that only a small number of people opt for assisted suicide, doesn't justify it.

After moderator Steve Paikin brought up the Hippocratic Oath, which states that doctors should do no harm, Dr. Sumner said, not all doctors take this oath; and he feels assisting a person to commit suicide doesn't violate the Hippocratic Oath.

“In a case where the patient has requested either euthanasia or physician assisted suicide in order to escape what the patient himself or herself regards as intolerable suffering, you're not harming the patient, you're helping the patient.”

Dr. Somerville emphasized the importance of the Hippocratic Oath, which has guided what we regard as the ethical practice of medicine by physicians for two and a half thousand years. She said the Hippocratic Oath was a radical change from previous times when medicine men were both healers and killers; and Bill 52 will reverse this 2,500-year-old principle, making doctors both healers and killers.

But Dr. Sumner responded that not allowing people to opt for assisted suicide violates a basic tenet of our society.

“I think a law that stands in the way of someone opting for what they themselves think would be a way of alleviating or preventing further suffering is simply cruel; and it violates a basic tenet of our society, which is compassion for those who are suffering.”

In an attempt to illustrate one of the problems with assisted suicide, and the latitude it allows for potential abuse, Dr. Somerville talked about a film in Belgium, in which a 34-year-old depressed woman wanted euthanasia and the doctor goes ahead and gives it to her.

“And you see her lying there on the couch and she dies. It's absolutely horrific in my view,” Dr. Somerville said.

Dr. Sumner responded that where physician assisted dying is legal, one of the requirements is that a patient be inflicted with an incurable disease; and there can be no prospect of medical treatment that is actually going to make things better.

Dr. Somerville said you don't have to be dying or even physically ill to have access to physician assisted death.

“It's enough if you say you've got an incurable illness. Diabetes is an incurable illness; depression is an incurable illness. Probably most of us have got some incurable illness that we either know or don't know about.”

She emphasized that one of the things that is worrying about this kind of legislation is that it says death is a suitable treatment for suffering and that's exactly the opposite message from what the suicide prevention people want to give.

“If you believe that's true, then if you bring a person into the hospital who's attempted suicide; then you shouldn't treat them. They've got a right to do this.”

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