“We’ve got a growing group of people in this situation,” said Michael Bach, Executive Vice-President of the Canadian Association for Community Living (CACL), on the topic of the Supreme Court of Canada’s recent decision regarding physician-assisted suicide, “and the biggest national conversation—the option we’re making available—is about physician assistance to kill yourself?”
On February 6th, 2015, the country’s top court decided that sections 241(b) and 14 of the Criminal Code, which make it illegal for anyone—doctors included—to assist in the death of another person, violated the constitutional rights of ‘grievously and irremediably ill’ adults.
Last week, the Harper government announced the creation of a three person panel to collect feedback on the ruling from Canadians, consisting of individuals who are professors at distinguished Canadian universities and who have experience in the areas of palliative care, disability studies, and constitutional law. The panel, which consists of Chair Harvey Max Chochinov, Catherine Frazee and Benoît Pelletier, has one year to compile a report for the Ministers of Justice and Health containing recommendations to shape the government’s response to the Supreme Court’s ruling.
In the case, Bach’s association and Community Living Ontario took the position that a total ban on assisted suicide should be upheld, and the two groups were disappointed when it was ruled otherwise. “The ban is in place,” he told Update Friday, “to protect vulnerable persons from being induced to commit suicide in times of weakness. Our argument is that anyone who is at the point where they’d want to take their own life [is] by definition, a vulnerable person.”
In clarification, he made it clear that they have great concern for people who are suffering. He pointed out, though, that in a lot of cases many of the pains and stresses for people who want to die in this way could be alleviated if our system accommodated them better. Bach said “…with medical advances, in 99.99% of cases, the physical pain can be dealt with through intervention.” It’s not just the pain—often people want to die because they are in a situation where they feel they have no dignity. This can be rectified, Bach says, with proper palliative care. “Only 30 to 40% of the need for palliative care is being met. It’s an underfunded and underdeveloped system.”
People also choose assisted suicide because they feel they’re a burden on families. If families could be better supported in helping an ailing family member then people wouldn’t feel that way as much, according to Bach. “I think people are turning to assisted suicide as a way of solving what is essentially a policy issue, because there are no other options.”
He believes that the push for physician-assisted death will reinforce stereotypes that receiving support from others is something to be ashamed of, which may influence more people’s decisions in this matter.
While CACL is vehemently opposed to the ruling, it will work with the situation as it is, rather than as the organization would like it to be. “We continue to be of the view that assisted suicide would not have been legalized. We continue to be against it. Some have proposed using the Notwithstanding Clause to uphold the ban in the Criminal Code and basically go against the Supreme Court’s decision, but that’s not the approach we’re taking. Because one way or another, I don’t think that’s politically viable.” Instead, he plans to focus on ensuring that enough checks and balances are in place to keep the actual number of assisted suicides to a minimum. “The law has changed, and so we want to get the most robust safeguard system possible in place to minimize, as much as possible, the authorization.”
The association will be submitting proposals for these safeguards to the panel, but Bach described what CACL hopes to emphasize, “…and that’s that disabilities should not be a reason for getting physician-assisted death. The disability itself cannot be a reason.” He also stressed that assisted suicide should always be just one aspect of the conversation when it comes to options for people who are suffering, and it should always be a last resort. “Before this intervention can be approved, the full range of alternatives needs to be considered, and an assessment of whether a person is in a vulnerable situation [must be performed]. Those dimensions of vulnerability need to be identified, and if they exist, alternatives to address them need to be considered, and I think this is a pretty reasonable approach.”
Another tricky subject is how the process would work for somebody interested in assisted suicide. Bach said that the family physician should not be the one to administer the treatment, as it would be a conflict of interest. “The role of physicians by virtue of the Hippocratic Oath is to do no harm, to heal, to provide interventions that address someone’s physical and psychological well-being.” Bach believes that putting them into a position of being able to proactively lead to somebody’s death is at odds with that oath, and that everything should be done to “…protect the integrity of the relationship between patients and doctors.”
“[It’s] not the same as the right to refuse treatment,” Bach explained. “When you’re asking a physician or a professional to step in to take proactive steps to kill you that crosses a line.”
So, CACL envisions the family doctor as only the first step in the process. A patient would express their desires to the physician, who would determine if they were in extreme enough pain and if they had the capacity to make the decision. If so, the doctor would then refer them to a counsellor who would assess their level of vulnerability, and whether all alternative courses of action had been considered. Then, all of this information would go to a review board that would make a final decision.
“We want to make sure that [these steps] are only taken in the most extreme circumstances, after we’ve done absolutely everything possible, as a community, to support this person, and that the pain and suffering is so absolutely excruciating and nothing can relieve it, and the person fully understands the nature and consequences of what this intervention is going to mean,” Bach stated, in no uncertain terms. Only once these conditions have been met does he believe that an assisted suicide should be authorized, and, in the interest of full transparency, the board should release annual reports on how many people were approved and the exact nature of their situations. In addition, he emphasized that, to avoid coercion or other undesirable possibilities, the individual person who is suffering must be the one pushing for this, during their time of need. It cannot be an advance decision, he told Update Friday, nor can someone with power-of-attorney be allowed to make this determination. “So if a person needs support to make this kind of decision, we would say that they’re not eligible to make it,” he said. “A person has to, on their own, fully understand the nature and consequences of this decision.”
Bach is worried that Canada won’t be able to institute all of these safety measures in time for the panel report’s February 6th, 2016 deadline, though he does believe that they can ensure that all of these factors are included in the conversation. “I don’t expect we’re going to have a national palliative care framework and a new framework for access to comprehensive disability supports by that time, but we’ll certainly be pushing that this conversation include consideration of those factors, even while we move into designing the elements of the safeguard system.”
– Daniel Share-Strom