THE BLOG

Completing Life With Dignity in Canada

09/27/2013 05:28 EDT | Updated 11/27/2013 05:12 EST

On September 17, I had the honour of accompanying my friend, Henry Rempel, as he completed his life with dignity. This was the culmination of a long journey, medically, mentally, and physically for Henry.

Henry was diagnosed with Rheumatoid Arthritis more than thirty years ago. Even as his body betrayed him in painful ways that interfered with his ability to continue enjoying outdoor life and travelling, Henry dedicated himself to continuing his job as an employment counsellor with the Canadian Employment service. He continued to enjoy his daughter, and later his grandson, and to revel in their lives.

As time went on, his susceptible body took on the burdens of osteoporosis, prostate cancer, hernias, and COPD. His Rheumatoid Arthritis continued its onslaught. In the final few months of his life, Henry lost the feeling in his lower arms and hands because of the effects of the Arthritis on his upper spine. Those hands had already been rendered virtually useless by the crippling effects of his Arthritis-fingers locked together and folded back on themselves by his frozen knuckles. His knees were weak and immobile: one had deteriorated to the point that he could only support his own weight for brief moments at a time.

Because of his inability to walk, Henry was confined to a hospital bed or to his wheelchair. He depended on overworked personal service workers in a nursing home to change his diaper and get him to the toilet if they could. More often than not, they couldn't in time, and Henry had to lie in his own urine and feces until suffering the indignity of having them change his soiled diaper, pajamas, and bedclothes.

However, Henry had planned for this and had been a member of Dignitas, a Swiss assisted suicide organization, for about fifteen years. About eighteen months ago he received final approval for an assisted suicide from that organization. Still, he persevered, determined to enjoy as long a time as bearable so that he could see his daughter and grandson when they journeyed from Switzerland to see him.

Finally, realizing that he was deteriorating further, and requiring more morphine to reduce his pain, Henry decided to complete his life with dignity at a time when his six-year-old grandson could remember his granddad as a smiling, caring person rather than an expressionless shell in a wheelchair.

The journey to Switzerland, the final approval by two doctors, final warm and pleasant visits with his family, took over 72 hours including over 9 excruciating hours on the plane.

It also included a trail of smiling airport and airline employees who benefitted from Henry's ability to make everyone he encountered feel like a valued human being without realizing that they had just encountered a man in serious pain.

The point of my telling Henry's story is to strongly advocate for legal assisted suicide in Canada.

Why should someone like Henry be forced to travel to a foreign country, albeit one that has sympathetic and empathetic people, to complete life with dignity?

Oh, I know, dignity is a subjective concept, but I think Henry and thousands like him meet whatever objective standards can be applied to it. Everyone deserves to complete life with dignity.

Switzerland, contrary to common understanding, does not have a law allowing or defining assisted suicide. Recently, two referendums -- one to prohibit foreigners from coming to Switzerland for assisted suicides, and one to limit assisted suicides to the terminally ill -- were defeated by 80 per cent and 78 per cent against votes respectively.

The process that prevents improper assisted suicides in Switzerland is left to organizations like Dignitas and others. Their model should serve Canadians well if we decide to put an assisted suicide law in place or if current legislation is overturned and we, like the Swiss, have no law in place.

In Canada, attending a suicide is legal; assisting a suicide is not. Suicide itself is legal in Canada, thus preventing the further injustice of charges against the many unassisted suicides that result in survival in some kind of reduced quality of life.

Let's be clear. Euthanasia is distinctly different from assisted suicide.

The former is an action taken to end the life of someone without informed consent of that individual. Such an action could conceivably be justified with a living will, but that is fodder for another ethical debate.

The latter, assisted suicide, is an act to help a sane person who makes a rational decision to complete life with dignity because of physical conditions that make life intolerable. Again, a living will could provide a mechanism to make the decision.

Assisted suicide should not be available to people who are in a dark place in their life and who, without significantly intolerable physical conditions, could continue life productively and comfortably with robust counselling. Dignitas spends about 33 per cent of its effort to counsel such people to prevent their suicide. Canada needs more robust counselling services to this end.

We must legalize assisted suicide in Canada. There are two ways this can happen.

First, the courts could decide that the current law against assisted suicide is unconstitutional, and I think it is since it interferes with the right to self-determination. That would put assisted suicide in the same position as other legal practices and would put the onus on provinces to define it within their health care mandate or to turn it over to volunteer (definitely not-for-profit) organizations just as they have in Switzerland.

Second, the federal government could replace the current legislation with a federal law that would define the parameters of legal assisted suicide. This approach is too paternalistic for my taste since I think it better to have assisted suicide provided, as Québec proposes, under health care provision.

Yes, some controls are necessary. Aside from the passport, and certificate of domicile requirements that are in place for foreign applicants, elements of the Dignitas model serve to give us a starting point.

Their process includes:

1. preliminary approval given by independent doctors based on medical records that objectively, without comments regarding suitability for assisted suicide, describe the medical condition of the applicant,

and

2. final approval by two other doctors based on determination that the person is of sound mind immediately prior to the assisted suicide.

Additionally, objective reports by care workers or objective assessment people, again without comment on the eligibility for assisted suicide, about the conditions of the person's life, would be helpful.

Terminal illness should not be a determining factor. The requirement for terminal illness as a qualifier is purely arbitrary. Prognoses are often inaccurate and don't take into account the personal dignity of the person involved.

In addition, thousands of people, like Henry Rempel, would not qualify, but would continue to suffer the intolerable life that Henry suffered in his last few months because doctors of such patients are often convinced, with all the best motives, that they can improve the life of their patient.

I am pretty sure Henry would have asked them one simple question, "Will these treatments allow me to go the toilet by myself?" The answer, in thousand of cases like his, would likely be, "No."

Life would be prolonged; dignity would not.

The Harper government, has decided to avoid discussion of this topic. Write your MP and insist the topic be brought up whenever the PM decides to face parliament. Support organizations like Farewell Foundation, and Dying With Dignity.

Everyone has the basic human right to dignity. Everyone should have the right to complete life with dignity.