Quebec moving forward on “dying with dignity” measures

Euthanasia has always been a controversial topic.

Proponents see it as a simple, logical route to a “good death”, as found in the word’s Greek roots. After all, we all die. Offering a less painful exit (in appropriate circumstances) is simply humane.

Meanwhile, the concept runs contrary to deep religious prohibitions against murder and suicide. (Playing God, if you will.) It runs afoul of the classical Hippocratic Oath – and possibly the modern version too. (For medical professionals who no longer want to “swear by Apollo.”)

Setting religious objections aside, many fear euthanasia risks legitimizing the elimination of unwanted, troubled or ‘surplus’ human life.

Pull quote from an article published during the Massachusetts Death with Dignity ballot initiative, which was narrowly defeated in November. Photo: Steve Garfield, CC some rights reserved

After considering a 400-page report on the legalities of the issue, officials in Quebec recently announced that province plans to move ahead with “dying with dignity” legislation. (I can’t find that report in English, but the Montreal Gazette has a summary of its recommendations here.)

Writing on the Globe and Mail, André Picard called the effort “an important step in the evolution of patient rights.”

In contrast, writing in the National Post, Margaret Somerville asks “If it’s not killing, what is it?”

One of the challenges for any right-to-die measure in Canada is the position of the federal government. Quebec officials think they have the authority to address this on a provincial level. Quebec has studied the matter for some time and officials there are ready to try.

Most observers say the move will likely succeed. As Chantal Hébert put it:

It is not so much that on such matters Quebec is systematically ahead of the curve as that Parliament has a well-documented tendency to lag behind public opinion.

Some forms of euthanasia are already legal in Oregon, the Netherlands and Belgium. Earnest, heartfelt individuals and organizations work to allow the practice. Equally well-intentioned individuals, organizations and religious groups work to curtail it.

Here is a top-10 pro/con list on the topic from which aspires to neutrality in presenting controversial issues. And a detailed timeline of developments on this topic.

Belgium’s practices made headlines recently with the news that 45-year-old twins who dreaded impending blindness were granted death by euthanasia. (Identified in some media reports as Marc and Eddy Verbessem.) Already deaf, the prospect of never able to see each other again – or continue to lead independent lives – reportedly made death seem preferable.

Our usual understanding of euthanasia is that of a controlled end when death is (or will be) imminent and suffering is already present. In such circumstances, the thinking goes, why can’t humans expect the same mercy readily extended to a dying animal, or pet? Quebec’s proposal doesn’t stray very far from that framework, focusing on establishing a right for terminally ill adults (emphasis added) to choose death or refuse treatment.

But the heart-rending Belgium case did not involve terminal illness. It was more about quality of life, and raised troubling questions. If fear, unhappiness or misery are all that’s needed to justify euthanasia, (not just impending death) millions would qualify.

This is often dismissed as a “slippery slope” argument. Yet, isn’t that what’s happening? Consider this rather forceful article from 2011 in Current Oncology, which argues safeguards and controls are an illusion:

In 30 years, the Netherlands has moved from euthanasia of people who are terminally ill, to euthanasia of those who are chronically ill; from euthanasia for physical illness, to euthanasia for mental illness; from euthanasia for mental illness, to euthanasia for psychological distress or mental suffering—and now to euthanasia simply if a person is over the age of 70 and “tired of living.” Dutch euthanasia protocols have also moved from conscious patients providing explicit consent, to unconscious patients unable to provide consent. Denying euthanasia or pas [physician-assisted suicide] in the Netherlands is now considered a form of discrimination against people with chronic illness, whether the illness be physical or psychological, because those people will be forced to “suffer” longer than those who are terminally ill. Non-voluntary euthanasia is now being justified by appealing to the social duty of citizens and the ethical pillar of beneficence. In the Netherlands, euthanasia has moved from being a measure of last resort to being one of early intervention. Belgium has followed suit and troubling evidence is emerging from Oregon specifically with respect to the protection of people with depression and the objectivity of the process.

Some will say “Good. It’s about time we reduce suffering.” I have relatives who strongly favor a right to assisted suicide. Their thinking goes: “As long as there is no coercion or fraud, that should be the patient’s decision”.

I get that. Choice is crucial. Explicit consent, as they say. I have a legal/notarized end of life directive with the basic “do not resuscitate” clause for the dreaded vegetative states, etc. I can easily imagine circumstances where I would ask for (demand?) a mercifully hastened death, or hope trusted relatives would seek that on my behalf. But this issue does end up spilling beyond personal choice.

Consider the millions without good access to health care, who have fallen through the safety net – or never had one to begin with. People for whom a better income, a little access to health care, some practical assistance with personal care could make life very much worth living.

How should society address issues of suffering – and personal choice – without devaluing human life, or making it all about money? If it’s not possible to take money out of that picture, are we ready for a society where assisted suicide becomes a logical choice for the very poor?

Countries with very good socialized medicine and support services wrestle with where to draw these lines. Imagine how bitter the choices might be where such resources are sorely lacking, as is often true in the U.S.

What moral code, or protective guidelines, would you want established in this highly-charged issue?


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14 Comments on “Quebec moving forward on “dying with dignity” measures”

  1. The Original Larry says:

    “What moral code, or protective guidelines, would you want established in this highly-charged issue?”

    There is no “moral code” that can justify this abomination nor “protective guidelines” that will mitigate it. People often laugh at the “slippery slope” argument but, as the Current Oncology quote shows, it’s quite true. The prospect of government bureaucratic involvement alone should be enough to stop anyone from considering this.

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  2. Marvel says:

    What is it though? To me definitions are very important in this area. For example, is deciding to not treat a disease euthanasia? For me the proactive outside intervention to kill someone would always be wrong and particularly dangerous as the state becomes the major player in health care. So in Quebec it would be mainly the State carrying out these killings.

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  3. JDM says:

    What moral code, or protective guidelines, would you want established in this highly-charged issue?

    That one choice always be to “stay alive with dignity” no matter what the cost, no matter what the issue.

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  4. tootightmike says:

    Governments should stay as far out of this discussion as possible. Some day when I make my choice it will be mine, and yours will be yours, and no bureaucrat should have any say, yes or no.

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  5. Mervel says:

    But the issue is in a place like Quebec with a national health system the government would be very involved of nothing else in carrying out the suicide .

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  6. Walker says:

    “That one choice always be to “stay alive with dignity” no matter what the cost, no matter what the issue.”

    I’m not sure what you’re saying, JDM. What if there is no dignity?

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  7. Walker says:

    My thoughts accord entirely with Too Tight’s. It’s amazing how conservatives seem to line up on the opposite side of the individual’s freedom on these issues.

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  8. mervel says:

    I see too many people who suffer from depression and mental illness to play around with encouraging and legitimizing suicide.

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  9. mervel says:

    If you read what Lucy is talking about, we are talking about cases of perfectly healthy people, people who are not at the end of their life who are not terminal, but for a variety of reasons may wish to commit suicide. The state can’t become a willing cheerleader and helper in those cases.

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  10. mervel says:

    I have immense compassion for people who are suffering from an immediate terminal disease who do not wish to go through endless and painful treatments that have small probabilities of succeeding or who do not want their bodies artificially kept alive through extreme medical interventions. I think in those cases people certainly should be able to choose to not partake in the medical process and to be kept pain free. This is certainly something I would consider.

    In today’s world of very very good pain medications and management I am not sure that physical suffering cannot be handled pretty well.

    The issue in many of these cases is not physical pain or suffering it is depression or despair.

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  11. Peter Hahn says:

    Depressed people commit suicide all the time. Depressed teenagers are a big source of childhood mortality – and maybe partially responsible for the current epidemic of mass murder/suicides (schizophrenia is in there too). Personally, I dont think we should be encouraging or facilitating children to commit suicide – just the opposite. They have their whole lives ahead of them.

    But if a depressed elderly person wants to commit suicide I’m not sure we should deny them access to painless suicide technology. Especially if they have a terminal disease they may be making a very rational and reasonable decision.

    Its entirely possible that treating an elderly persons depression may make them less suicidal. Hopefully they have health care that offers them the possibility of treatment. But they may still prefer suicide.

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  12. mervel says:

    I think the issue is though Peter that if an elderly person is depressed and we offer them help in committing suicide why would we not offer a teen help in committing suicide? Logically there is no real difference. In the grand scheme of things we are ALL terminal. In fact everyone over 55 has a terminal disease that will kill 80% of them within 25-30 years, called aging.

    Yes we need to really look at people with physical illnesses that will kill them within 6 months, hospice does a very good job of treating those people and helping them die without pain and with dignity.

    I don’t think it will be possible to say a 65 year old with depression can be encouraged to commit suicide without encouraging a 16 year old with depression to commit suicide. Suicide is suicide regardless of the age.

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  13. Walker says:

    “…why would we not offer a teen help in committing suicide? Logically there is no real difference.”

    Ah, the old slippery slope. Ridiculous! There is a huge difference between someone near the end of life and someone just starting out. We base all sorts of things on age, including Social Security and Medicare. The first step, of course, would be to try to treat the depression. But suppose you’re depressed because everyone you ever knew is dead, and you have no family to look after you, and you recognize that you’re starting to slide into dementia. I can imagine lots of perfectly reasonable circumstances where suicide makes sense.

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  14. Rancid Crabtree says:

    So it’s not okay for a young person to decide to commit suicide but it’s okay for them to do all sorts of other dangerous and potentially fatal things? I’m certainly no fan of suicide, but the logic of the argument is lacking. If it’s okay for a young person to make major life altering decisions in every other area, why is it not okay regarding their death? Because they’re depressed? Then why are they in the correct state of mind to make any other decision?!!

    Personally, as long as the gov’t isn’t making a decision for the person, I don’t have a problem with them ending it. But if we’re going to take that route, then we need to stop including suicide in “gun violence” statistics. It’s just another tool in that case, same as a drug, rope, auto exhaust, plastic bag, razor…….

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