Dr. Jeff Blackmer knows the thin line that exists between helping someone die in comfort and purposely ending their life through medical euthanasia.
The Ottawa physician, who also runs the Canadian Medical Association’s office of ethics, deals mainly with spinal cord injuries, and a number of his patients are quadriplegics who depend on a respirator to stay alive. Some of those have asked to have their ventilators removed and be allowed to die. Dr. Blackmer, though an opponent of euthanasia, will prescribe drugs that allow the patient to pass without suffering.
“So what’s the difference between letting someone die and giving them drugs to make it easier and giving them drugs that will kill them?” he asked. “Some may argue it’s splitting hairs, but for a physician it’s a critical difference in that in the former case it’s the underlying disease that is causing death — we’re letting nature run its course.”
“The second situation [of giving lethal drugs] is more active, and it’s opposed to what doctors are supposed to stand for.”
Such arguments will be aired again this fall when Bill C-384, which would make euthanasia and physician-assisted suicide legal, will come up for second reading, the furthest such a bill has ever gone in Canada. It is the third time in four years that Bloc MP Francine Lalonde has sponsored such a bill.
Ms. Lalonde, who has battled cancer for the past two years, said she was only diagnosed after she introduced the bill in 2005. She said before her diagnosis, pain was a theoretical issue. But after what she experienced while she was ill, “pain was no longer theoretical” and so seeing a bill like this passed meant even more.
She is not overly optimistic that will happen. It is a question, she said, of whether parliamentarians have “the guts or courage” to reflect what appears to be the popular will.
Ms. Lalonde believes that such a law would be “reasonable,” not a slippery slope to irresponsible killing of the weak and defenceless, and would be a mark of a compassionate society that is willing to help end irreversible pain and suffering.
“Someone’s religious or moral beliefs should not become my law,” Ms. Lalonde said.
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Under C-384, two categories of people would be allowed medical assistance in hastening their own deaths: those with a terminal illness and those who, “after trying or expressly refusing the appropriate treatments available, [continue] to experience severe physical or mental pain without any prospect of relief ...”
The bill adds “safeguards,” such as forcing the patient to request death on two occasions. It also requires the doctor to get a second opinion from another physician with no ties to the patient. The patient must also be deemed to be lucid, the bill states.
Opponents of such legislation are watching the bill with concern. With each attempt to legalize assisted suicide, they say, Canadians are getting more desensitized to the idea. Margaret Somerville, founding director of the McGill Centre for Medicine, Ethics and Law, said that if C-384 should pass, it would push society over a dangerous line and lead to killing of the aged, weak and vulnerable.
“It is so important not to have the precedent of killing each other in society,” Prof. Somerville said.
An Angus Reid poll this summer found 77% of Quebec respondents believed euthanasia should be allowed. The only instance in which Quebecers showed no support is in the case of a person wishing to end their own life because of the death of a spouse.
The poll was inspired by a decision of the Quebec College of Physicians and Surgeons that has asked Ottawa to amend the Criminal Code to allow for euthanasia in specific cases. The formal proposal will be out in the fall.
In 2004, Environics Research Group found 68% of all Canadians approved of euthanasia. In a poll last year it found, given the choice, 44% of Canadian would choose euthanasia and 44% would opt for palliative care.
Bill C-384 is far broader than the laws in Oregon and Washington, the only two jurisdictions in North America where physician-assisted suicide is legal and two of only a handful of jurisdictions in the world that allow it.
Oregon has had physician-assisted suicide for the past 11 years. (Washington made it legal in November.) It allows only those who have been told they have less than six months to live to apply for the lethal medication. In 1998, 25 people were given the drug and in 2008, 88 prescriptions were given. Last year, 54 patients took the lethal medications, 22 died of their underlying disease and 12 were alive at the end of the year.
It is believed that some patients take the drug home as insurance against a painful death but never use it.
Euthanasia, the act of the doctor administering the drug, is forbidden in both states.
Ruth von Fuchs, president of Right To Die Canada, said euthanasia is actually preferable because it allows patients to live longer. Patients might be concerned that they will reach a point when they do not have the strength or manual dexterity to take the drug themselves, she said.
But Prof. Somerville said euthanasia or physician-assisted suicide can never be “simply an individual act.”
“The argument that supports legalizing this comes from intense individualism: ‘If that’s what somebody wants, who am I to stop them?’” she said. “It necessarily involves other people. And you need a complicit society to make it possible through legalizing it. So it dramatically impacts on society.
“They don’t see what it means to society ... and let’s be blunt in the language we use: you will have doctors killing people and the law authorizing them to do it. Two of secular society’s two most important institutions, which are meant to uphold the respect for life, will be changed.”
The Canadian Medical Association, for example, is against euthanasia and physician-assisted suicide because it believes a doctor should never take a life.
“It’s a central tenet of medical ethics that thou shall not kill, that you first do no harm,” said Dr. Blackmer. “This debate is a clash of moralities, but against the most deeply held morality that physicians have.”
Pain management has advanced greatly in the past 10 years, he said, meaning it is a rare case in which pain cannot be managed.
“The counter-argument is that euthanasia ends suffering, even if it’s for just a few cases. The question is, ‘Is that enough of a reason to end a life?’ ”
Dr. Nuala Kenny, director of bioethics education and research at Dalhousie University in Halifax, said it is easy to be misled by the language of Ms. Lalonde’s bill.
Someone with a terminal illness can often live for years, so there is a danger someone could take their life simply over the fear of the unknown. The use of the term “mental pain” is also worrying, she said.
“In the Netherlands we know people who have been depressed have been allowed to take their own lives. Grief is suffering and under this legislation it would be perfectly allowed. I don’t think people are paying attention to what is being proposed here: death as the answer to any human distress,” said Dr. Kenny, who is also a pediatrician and a Catholic nun, but who has never worked in a Catholic institution.
“You don’t change the whole way in which medicine in particular interacts with those who are dying or suffering because a small number of people have this extreme understanding of their rights and freedoms.”
