By Paul Schachter On February 6, 2015 the nine justices of the Supreme Court of Canada unanimously struck down the laws prohibiting physician-assisted dying (PAD).
The ruling only applies to competent adults who clearly consent to the termination of life and who have grievous and irremediable medical conditions that cause enduring, intolerable suffering. The laws forbidding non-medical personnel from providing assistance in dying were left in place.
The decision means that individuals will now have a choice for addressing end-of-life anguish. Even though this is a strictly personal right belonging solely to the patient, PAD remains a polarizing issue. The justices acknowledged that many of us “instinctively recoil” from the decision to seek death because of our belief in the sanctity of human life, but they also accepted the truth that those who seek PAD do so “out of a deeply personal and fundamental belief about how they wish to live, or cease to live” when confronted by intolerable suffering.
The justices set an example for us, basing their decision on strong legal principles and not on any religious canon.
The medical system urgently needs to provide improved palliative care, but our current science does have limits. There are mistaken notions that doctors can always alleviate pain for grievously ill patients. In reality, effective pain relief is often not achievable. And, unhappily, there are still incurable conditions where patients lose all control of their bodily functions.
Some observers have expressed concern about undermining protections for vulnerable persons induced to commit suicide at a time of weakness. While this is a worthy concern, it cannot justify laws that go too far. The justices found that an absolute prohibition on PAD has a heavy impact on rights guaranteed by the Charter of Rights and Freedom of competent individuals who do not need protection, and is not the least drastic means to achieve protection of vulnerable populations.
As for stories of patients supposedly being denied needed medical treatment or being pressured by doctors to end their lives, the justices confirmed that, to the contrary, there was no evidence of inordinate impact on socially vulnerable populations in those countries and jurisdictions that permit physician-assisted dying. The court found that, in some cases, care of the terminally ill improved after legalization of PAD and physicians were better able to provide overall end-of-life treatment.
I appreciate those who are apprehensive of atrocities or a new holocaust, but this decision does not pave the way for immoral practices such as coerced euthanasia or eugenics. The top court rejected that allowing PAD was a “practical slippery slope” and agreed that “the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards.”
There is no reason to fear that patients’ relations with their doctors will change for the worse after this decision. It will still be unethical for doctors to suggest that patients terminate their lives. On the positive side, doctors will no longer have to stand by and ignore their patients’ requests for relief from a long agonizing and degrading subsistence when the end is looming and inevitable. Some doctors may find it against their personal ethics to end life, and the Supreme Court affirmed that its decision will not mean that physicians are compelled to provide assistance in dying.
Carter versus Canada is a constructive step forward. We are taking the lead for ourselves and other civilized nations to positively address the hard issues involved in improving end-of-life alternatives.
Paul Schachter is a retired lawyer and director of BC Civil Liberties Association.
