To kill or not to kill?


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The other evening, I watched the television program Frontline on PBS. The segment was entitled The Suicide Tourist. It offered viewers an inside look at Dignitas, the Swiss organization that helps people to end their lives.

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Hey there, time traveller!
This article was published 22/03/2010 (4748 days ago), so information in it may no longer be current.

The other evening, I watched the television program Frontline on PBS. The segment was entitled The Suicide Tourist. It offered viewers an inside look at Dignitas, the Swiss organization that helps people to end their lives.

The PBS program followed the last part of the life and death of Mr. Craig Ewert, a 59-year-old man diagnosed with ALS, a degenerative neuro-muscular disease. Ewert ended his life by consuming two different drinks. The first was intended to prevent vomiting and the second was a sodium pentobarbital mixture that caused his death. The death was videotaped and broadcast as part of the program.

In Canada, assisted suicide is currently against the law. Last week, however, federal MP Francine Lalonde’s private member’s Bill C-384 is being debated in Parliament. The purpose of Bill C-384 is to decriminalize assisted suicide. The summary of the bill reads:

“This enactment amends the Criminal Code to allow a medical practitioner, subject to certain conditions, to aid a person who is experiencing severe physical or mental pain without any prospect of relief or is suffering from a terminal illness to die with dignity once the person has expressed his or her free and informed consent to die.”

In the past, there have been other private member’s bills in Parliament calling for a change in Canada’s law. To date, however, none has succeeded.

If the law in Canada were to change, how should physicians, other health-care professionals and health-care organizations respond to requests from patients for an “assisted” death?

To some, the direct taking of another’s life is justified to relieve unbearable pain. Even though we have made great strides in pain management, there are still some situations where pain, let alone suffering, cannot be fully alleviated. Proponents of assisted death maintain the most compassionate thing is to directly intervene and end a life of pain; address the suffering by eliminating the sufferer. Others who support assisted death regard this choice as the ultimate expression of autonomy and self-determination. People have the legal right to refuse or discontinue life-sustaining treatment. To some, a request for assisted death would simply be an extension of the existing right to decline life-saving treatment. Others see this decision as, quite simply, a “personal and private” matter. Those adopting this view hold that if an action does not harm or compromise another, then a person should be free to choose the time of death and to have a care provider assist.

What of arguments against assisted death?

Many oppose euthanasia and assisted suicide because of a belief it is wrong to kill another or to assist another in choosing death. Such opposition may be grounded in legal concerns, religious commitments concerning the sanctity of life, philosophical principles or professional codes of ethics.

Others argue physician or care-provider endorsement of euthanasia or assisted death would fundamentally compromise and change the underlying ethos of healing health-care professions. Those who hold this view cannot reconcile ethical commitments to care and heal with actions directed at intentionally ending a person’s life.

Finally, others oppose euthanasia and assisted death because of concerns about the long-term social consequences of legitimizing the practice of assisted suicide.

Even if society were to permit euthanasia and assisted suicide in certain restricted cases, so the argument goes, it would not be long before other “exceptions” are tolerated. We would witness a move from voluntary, patient-requested assisted death to the involuntary euthanasia of vulnerable and dependent persons living in our community. To date, the experience in the Netherlands would seem to confirm such fears.

What to do? I believe we can “care well” for the dying and terminally ill in our society without intentionally bringing about their deaths or assisting in their suicides. Often, those who gravitate toward euthanasia or assisted suicide do so because they fear they will lose control of decisions at the end of their lives. They may have witnessed family members dying with little control over decisions or they may have witnessed loved ones die in great pain.

Via their words and actions, health-care professionals and health-care organizations must assure patients and families they will be involved in a meaningful way with decisions about their care. Patients must be assured they will not be abandoned, left to die in isolation and/or excluded from important choices at the end of life.

In our time, no one need die in this way. Fear of loss of control and fear of a painful, protracted dying process are basic issues for all in this debate. However, all too often in the discussion of assisted suicide the public is presented with two scenarios — a death characterized by loss of control and unrelieved pain and suffering or a peaceful, calm death. This is, quite simply, a crude and simplistic caricature.

Assisting the suicide of those in our community who are dying and/or others who may be struggling with mental anguish eliminates tragedy and suffering by eliminating the sufferer. Rather than being an expression of mercy or respect, communal endorsement of euthanasia and assisted suicide is the ultimate abandonment of the person.

Palliative care is a viable alternative to euthanasia and assisted suicide. The philosophy of palliative care encourages each patient to live to the fullest as they confront their own unique dying. Palliative care demonstrates death is a communal event and not simply a private matter. Those working in palliative care bring specialized skills to respond to pain, psychological distress and the spiritual needs of patients and their families.

If we are to truly honour and respect those among us who are dying, or those whose hold on life is weakened by disease or suffering, then we must keep company with these people and respond in concrete ways that communicate faithfulness and attentiveness.

George C. Webster is clinical ethicist, Health Care Ethics Service, at St. Boniface General Hospital

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