Winnipeg Free Press - PRINT EDITION

How you define dignity shapes your view

Expert on medical, legal issues to speak in Winnipeg

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Margaret Somerville is one of Canada's foremost authorities on medical ethics.

Her work, including books and countless articles, has shaped this country's debates on how we handle the big picture around medical-legal issues, including euthanasia.

Along with Winnipeg's palliative advocate, Dr. Harvey Chochinov, another of the country's leaders in medical ethics, Somerville will deliver keynote speeches at the national conference on euthanasia in Winnipeg.

The Canadian Association for Spiritual Care hosts the event April 9 to 12 at the downtown Delta Hotel.

Somerville spoke to the Free Press from her office at McGill University in Montreal where she is the founding director of the Centre for Medicine, Ethics and Law. She's also the Samuel Gale Professor of Law in the faculty of medicine at McGill.


Q: Your speech is titled Disputes with Dignity, the role of dignity in the euthanasia debate -- timely, given the debate in Canada. What's your take on how Canadians are handling the debate?

A: One side in the euthanasia debate says we have to have euthanasia to respect the dignity of the people who want it. That's the pro-euthanasia side, of course. And the anti-euthanasia people say dignity prohibits euthanasia. It's a failure to respect human dignity if you're giving someone a lethal injection or, putting it much more bluntly, if you have doctors killing their patients.

So, how can that be that both sides say the same thing justifies what they want to do, but one is pro-euthanasia and one is anti-euthanasia?

The answer is they've got completely different definitions of what dignity is and what it does.

The anti-euthanasia people say we have dignity simply because we're human.

To respect dignity means we have certain protections and rights, among the most important of which is the right to life. You can't breach that by killing a person. Therefore, they say you've got to prohibit intentional killing and the only exception to that is when it's the only thing you can do to preserve human life. The best example of that is justified self-defence.

Pro-euthanasia people say dignity is having autonomy, being in control, having the right to choose what you want to do and don't want to do. You own your own life and dignity requires that your choices should be honoured. They also say you can be in such a terrible state when you're dying or you've got such disabilities that living your life in that state is a failure to respect your dignity. Therefore, to respect your dignity, we will put you out of your undignified state. We'll give you a lethal injection.

 

Q: Both sides claim the high road.

A: Well put, Well put. They have to, of course.

This is the single most important values-ethics debate of the 21st century. Depending on which way we go on this, we will have an enormous impact on future society. Down the generations... . We have to come to a resolution because it is a black-and-white issue. Either you've going to allow doctors or somebody else to kill people or we don't. You can't do a bit of both. You have to decide what you're doing.


Q: Where does that take us then?

A: The people who are promoting this say 'Well, we're only going to allow it in rare cases.' We've already seen that is not possible. It just doesn't work. When you look at what has happened in the Netherlands and in Belgium, what's called the logical slippery slope, that is the situations you can use it. It has rapidly expanded... that is even though you have rules, they're not obeyed. This is abused. Particularly vulnerable people get abused. They get given lethal injections. We've seen that, dramatically in those countries. The reason you can't stop the slippery slope, once you step over that line -- the line is we must not intentionally kill each other. And once you step over that and say it's OK... in this rare case. What happens is you get used to that. You look at other situations and say, oh, that's no so different. Then you start expanding the justification.


Q: What's the worst thing we can do?

A: We've got to look at the impact of legalizing euthanasia on institutions such as law and medicine and in a secular society, which is what we are. Law and medicine are the two institutions that carry the values for the respect for life.

In past societies, it was religion that mainly carried that. And 100 years ago, most people at least pretended to belong to a religion. What happened in religious attendance, we engaged in what I call 'death talk' and for that one hour a week in your church, your synagogue, your mosque, whatever it was, you engaged in talking about death in a defined place for a limited time and then you came back out into the world and lived your life.

I believe we have to talk about death in order to be comfortable about living it in our ordinary lives.

I believe the euthanasia debate is a form of 'death talk.' We're terrified of death, we can't deal with it. We can't avoid it and it makes us fearful. The remedy to fear is to try and take control. Euthanasia is a way to take control of it.

One of the problems in the debate is we talk about these heart-wrenching cases, whether it's Dr. Donald Low or Susan Griffiths in Winnipeg or even Steven Fletcher (the Conservative MP from Winnipeg with a private member's bill to legalize physician-assisted suicide). Your heart goes out to them and you think, 'Gosh, maybe if I was in that situation, I'd think of that.'

But this is really one situation where we have to say we understand how you feel. We listen to what you're saying. We will do everything we can to try to support you. But we will not legalize killing in our society and in particular, we won't have our physicians doing it in our hospitals.

Republished from the Winnipeg Free Press print edition April 5, 2014 A13

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