For thousands of years the medical profession has worked to save and improve lives. As medical advancements were made, we found ourselves faced with the need to decide whether to extend life mechanically or "pull the plug" and allow death to take its natural course.
Most recently, the Supreme Court of Canada answered another question: should we be able to medically assist someone to die? Yes, the court found that Canadians should be permitted to request medical assistance in dying in certain circumstances. And it is defining those circumstances, while balancing the need to protect the vulnerable and the sanctity of life, that has become so hotly debated.
Last week the national disability rights community and their allies issued an open letter to members of Parliament and senators, urging both Houses to adopt Bill C-14. Some senators have said that thousands of Canadians have written them letters and sent messages on social media about the bill. Some are concerned that Bill C-14 is fundamentally flawed because it restricts access to people whose "natural death is reasonably foreseeable."
"Isn't that discriminatory?" they ask. "What about people who are suffering and who are not dying? How can we deny them access to medical assistance to die upon their request, if they find their suffering from a psychiatric disability or chronic condition intolerable?"
Some provincial courts have issued their own decisions and some colleges of physicians have issued guidelines, with mixed results. Some indicate that people with irremediable conditions which cause them intolerable suffering should have access to medical aid in dying, whether or not they are actually dying. This is the principle at the heart the passionate debate within Senate this week.
For people who are suffering intolerably but not at the end of their lives, medical aid in dying is not the right response.
Should the medical profession help people who are not actually dying, to die? Should a profession that has studied medicine for millennia in order to reduce human suffering, now determine what level of suffering makes life no longer worth living? These are perhaps the heaviest of issues these two Houses have ever had to debate.
To help inform this debate, our organizations, along with several others, convened a large coalition: The Vulnerable Persons Standard. We are working together to ensure that legislation protects vulnerable persons. The boundary established in Bill C-14 for reasonable foreseeability of natural death will serve as an essential safeguard to protect vulnerable persons from being induced to commit suicide through the system.
Yet some senators are suggesting that equality demands that people who are suffering should have access whether or not they are dying. And we have been told that the health care regulators have come up with the protocols needed to ensure that people who are not dying are not at risk of abuse or pressure to end their lives.
This is an unacceptable starting point. From our perspective, anyone who is not dying, but who is nonetheless seeking death, is by definition vulnerable. They should get the response, care and support they deserve. A number of legal experts agree that this limitation is constitutionally justified under Bill C-14's objectives to ensure "inherent and equal value of every person's life," to protect the vulnerable, and to "avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled."
Bill C-14 provides for medical aid in dying to assist people who are suffering intolerably at the end of their lives, to exercise autonomy in how they die. This is exactly as it should be written in order to uphold the government's obligations to balance both the respect for autonomy and the sanctity of life.
For people who are suffering intolerably but not at the end of their lives, medical aid in dying is not the right response. It would undermine the value of the lives of people with disabilities or chronic conditions. Rather, governments and communities must respond by ensuring access to the supports that people need to ameliorate their suffering and improve the quality of their lives, respecting individuals' right to decide whether and how they take advantage of the options provided. Death should not be one of those options when one is not actually dying.
We need to do much more in Canada to ensure that people who are dying have the options they need, through palliative care and other supports, to exercise autonomy in how they die. We must also do much more to ensure that people with disabilities and chronic conditions who are not dying have the supports, autonomy and equal respect they require in order to maximize their quality of life, participation and inclusion in our society. We can do both of those things. But first, we must pass Bill C-14.
Michael Bach is the Executive Vice-President of the Canadian Association for Community Living and James Hicks is the National Coordinator of the Council of Canadians with Disabilities.
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Here's a look at the state of Euthanasia laws in Canada and their history.
Suicide hasn't been a crime in Canada since 1972. (Shutterstock)
Doctor-assisted suicide is illegal, although the ruling of the B.C. Supreme Court will force Parliament to alter the law within one year. The Criminal Code of Canada states in section 241 that: "Every one who (a) counsels a person to commit suicide, or (b) aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years." (Alamy)
Passive euthanasia involves letting a patient die instead of prolonging life with medical measures. Passive euthanasia is legal in Canada. The decision is left in the hands of family or a designated proxy. Written wishes, including those found in living wills, do not have to be followed by family or a proxy. (Alamy)
Sue Rodriguez, who suffered from amyotrophic lateral sclerosis (also known as Lou Gehrig's disease), launched a case asking the Supreme Court of Canada to allow her to end her own life on the grounds that the current law discriminated against her disability. Because suicide is legal in Canada and Rodriguez was unable to end her life because of a lack of mobility, she argued it was discriminatory to prevent her from ending her own life with the aid of another. The court refused her request in 1993, but one year later she ended her life anyway with the help of an unnamed doctor. (CP)
Robert Latimer was convicted of second-degree murder in the 1993 death of his severely disabled daughter Tracy. A lack of oxygen during Tracy's birth led to cerebral palsy and serious mental and physical disabilities, including seizures and the inability to walk or talk. Her father ended Tracy's life by placing her in his truck and connecting a hose to the vehicle's exhaust.The case led to a heated debate over euthanasia in Canada and two Supreme Court challenges. Latimer was granted day parole in 2008 and full parole in 2010. (CP)
Former Bloc Québécois MP Francine Lalonde tried repeatedly to get legislation legalizing euthanasia in Canada passed. Bill C-407 and Bill C-384 were both aimed at making assisted suicide legal. C-384 was defeated in the House 228 to 59, with many Bloc MPs and a handful of members from all other parties voting for the legislation. Tetraplegic Tory MP Steven Fletcher, pictured, made the following statement after C-384 was defeated: "I would like to be recorded as abstaining on this bill. The reason is I believe end of life issues need to be debated more in our country. I believe that life should be the first choice but not the only choice and that we have to ensure that resources and supports are provided to Canadians so that choice is free. I believe, when all is said and done, the individual is ultimately responsible. I want to make this decision for myself, and if I cannot, I want my family to make the decision. I believe most Canadians, or many Canadians, feel the same. As William Henley said in his poem Invictus, "I am the master of my fate: I am the captain of my soul."(CP)