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This article was published 18/7/2012 (2995 days ago), so information in it may no longer be current.
Gloria Taylor, a British Columbia ALS patient, insists it should be up to her to decide when the prospect of continued life is worse than the prospect of hastened death. Once she reaches that point, however, she may no longer be physically able to end her own life. So, she claims, it is her right to seek assistance in dying from a willing physician.
"What I want is to be able to die in a manner that is consistent with the way that I lived my life. I want to be able to exercise control and die with dignity and with my sense of self and personal integrity intact," she has explained. "I want to be able to experience my death as part of my life and part of my expression of that life. I do not want the manner of my death to undermine the values that I lived my life in accordance with..."
A great majority of Canadians supports Taylor's position. Similar support existed 19 years ago for Sue Rodriguez, another ALS patient who took her case all the way to the Supreme Court. Rodriguez lost, but only very narrowly, by a five-to-four vote.
Despite strong public support for decriminalization of physician-assisted suicide, it remains illegal in Canada. Attempting suicide ceased to be a crime in 1974; but aiding someone to commit suicide remains an offence punishable by up to 14 years in prison. The voluntary request of the patient -- even when she is a competent adult, rational and fully informed -- is no defence.
In a dramatic decision, however, the British Columbia Supreme Court has ruled it is Taylor's constitutional right to decide for herself whether she wants a physician to assist her to die. The federal government is appealing this decision. Ultimately, the Supreme Court of Canada will have to rule.
The essence of the government's case for upholding the current prohibition is that only a complete ban can offer adequate protection to vulnerable people. The government claims no set of safeguards, however stringent, can prevent serious harm. Advocates of patient autonomy argue, on the contrary, it is possible to implement careful safeguards, which would securely protect those who are vulnerable against the possibility of mistake or abuse.
Linda Ganzini, an Oregon psychiatrist who has done many studies of PAS in Oregon and in the Netherlands, argues the empirical evidence refutes claims that legalization will lead to a slippery slope. The data do not show any trend toward abuse of vulnerable groups of people -- such as the poor, the elderly and the disabled. Indeed, what the data show is patients receiving PAS in Oregon and the Netherlands are disproportionately those who "enjoy comparative social, economic, education, professional and other privileges."
The fear rates of PAS would escalate after decriminalization -- because financially strapped governments will want to save money -- has simply not been borne out by experience. PAS has been legal for 11 years in Oregon and at present accounts for only about one out of every 1,000 deaths per year. That number has remained consistently tiny. In the Netherlands, where euthanasia has been legalized as well as PAS, the annual rate has gone down rather than up (from about three per cent in 2001 when it was first legalized to less than two per cent in 2007).
Critics are not assuaged and point to the grim statistic that 0.4 per cent of patient deaths in the Netherlands (2005) were the result of LAWER -- life-terminating acts without explicit request of patient.
The existence of such cases, in violation of Dutch law, proves, they argue, the safeguards do not work. The slope is indeed slippery. But, these LAWER cases -- almost all of which involve dying cancer patients who discussed the possibility of PAS with their physicians but who became incompetent before making an explicit request -- have actually decreased since the introduction of legalized euthanasia.
It must be admitted statistics from jurisdictions that have legalized PAS -- U.S. states such as Oregon, Washington and Montana and countries such as the Netherlands, Belgium and Switzerland -- are like a Rorschach blot test. Opponents of PAS look at the data and find their worst fears confirmed. Advocates of decriminalization look at the data and find it disproves the slippery-slope argument.
The B.C. Supreme Court judge heard testimony from expert witnesses on both sides and concluded there was no good evidence decriminalization caused harm to vulnerable patients. Soon it will be up to Canada's highest court to decide whether, in light of all the evidence, the autonomy right of Taylor and others like her can be upheld without imperiling others.
Arthur Schafer is professor of philosophy at the University of Manitoba and director of the university's centre for professional and applied ethics.
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