Assisted Dying in Canada

Christopher A. Riddle, Assistant Professor of Philosophy & Director of the Institute of Applied Ethics, Utica College, NY, USA, email: cariddle@utica.edu

Nearing the end of 2011, The Royal Society of Canada’s Expert Panel on EndofLife Decision Making released a detailed report exploring both the feasibility as well as desirability of making assisted suicide and voluntary euthanasia legally permissible.  A report with similar recommendations was also released not long after by a Select Committee of the Quebec National Assembly on Dying with Dignity.  Both reports, while strongly recommending palliative care, ultimately suggested that assisted suicide and voluntary euthanasia should be legally permissible.  This has understandably sparked a heated debate across the country.  My intention here is to support, albeit briefly, the findings of these reports.  While there are many objections to these reports, including, but not limited to the legal, religious, and medical, I will focus on what I view to be the most common concern expressed by disability theorists and advocates.

Margaret Somerville, a Catholic, legal scholar at McGillUniversity, expressed a concern in Canada’s National Post that seems to be echoed throughout disability literature on the topic.

Somerville has suggested that “[m]any seriously harmful consequences from legalizing euthanasia could far outweigh any benefits it might have” (2012).  The emphasis in this passage needs to be placed on ‘could’.  Surely it might be the case that the burdens may very well outweigh the benefits, but the point is that this is most certainly not a necessary implication of permitting assisted dying or voluntary euthanasia.  I will return to this point in a moment, after demonstrating how this concern is expressed directly in relation to people with disabilities and other vulnerable groups.

In responding to claims made by pro-euthanasia advocates against disability rights arguments, Carol Gill has suggested that many people with disabilities are harmed by physicians “who [know] little about [disabled people’s] lives” (2010).  Gill rightly claims that those who dismiss these concerns because doctors are not intentionally out to get people with disabilities, are wrong.  Her attention is focused on the harm that could be done to people with disabilities by able-bodied physicians, unfamiliar with the experiences faced by the disabled, who in fact, think they are helping through acts of euthanasia to end otherwise burdensome lives (Gill, 2010).

Gregor Wolbring (1998) astutely makes a related point when he highlights that society is both responsible for the misplaced pity that physicians feel toward people with disabilities, as well as the lack of support and understanding that many people with disabilities experience.

To be clear, while I think Gill and Wolbring are correct in the concerns they express, I think the implications are perhaps overstated.  Wolbring has stated that “every safeguard put forward at the beginning of the debate [i) that euthanasia is for a terminal condition; ii) that the purpose of euthanasia is to abolish physical pain; iii) that euthanasia is only for people who can provide informed consent; iv) and that euthanasia is about self-detremination] has already been broken beyond repair” (1998), and my position (or indeed, the endorsements made in the abovementioned reports) need not deny this.

Returning to an earlier claim, certainly the harm done to people with disabilities by physicians in the name of ‘helping’ otherwise burdened people, could have be reduced, if not altogether, than substantially.  That said, this harm is certainly not an inherent feature of medicine.  In other words, there is nothing associated with making assisted suicide or voluntary euthanasia permissible that makes harm to people with disabilities necessary.

We can reaffirm Wolbring’s concern about a broken system, while endorsing a reform of the conditions required to permit assisted suicide or euthanasia.

To deny there is a potential for abuse/harm would be foolish.  That said, we do routinely engage in activities with a potential for harm.  I am not talking about skydiving, swimming with sharks, or anything of the like.  Take for example, the relatively benign action of visiting an emergency department.  A recent study of Canadian emergency departments has found that of a particular segment of the population, those who visited the hospital for emergency medical treatment were more than twice as likely to obtain a new infection than those who opted not to visit the hospital.  In this study, the incidence of new infection dropped from 8.3% to 3.4% (Quach et al. 2012).

There is also further potential for harm when being admitted into a hospital.  Another Canadian study has found that 7.5% of patients admitted into acute care hospitals in the year 2000 experienced more than 1 adverse effect (unintended injury or complication resulting in death, disability, or a prolonged hospital stay) (Baker et al. 2004).  36.9% of the individuals experiencing adverse effects were judged to have experienced a “highly preventable” adverse effect.  This means that of the 2.5 million annual hospital admissions inCanada, approximately 185 000 are due to adverse effects of treatment while already at the hospital, and that almost 70 000 of these instances are preventable (Baker et al. 2004).

Another example can highlight the intended point further.  Driving a car leads to a greater potential for harm than many other modes of transportation.  Nonetheless, many of us opt to drive, despite the potential for harm, because there is a perceived benefit that outweighs this potential for harm.  Similarly, in the above examples, we opt to go to the emergency department, or to get admitted into the hospital, because the perceived benefits of doing so outweigh the perceived harms.

In the unfortunate event that we do find harm befalling us in any of the three abovementioned examples, we do not conclude we should abandon those activities altogether.  If one acquires a new infection after a visit to the emergency department, one does not view emergency departments as lacking worth.  If one suffers from an adverse effect associated with medical treatment, one does not conclude that modern medicine should be abolished.  Finally, if one is in a car accident and suffers harm, one does not think we should abandon cars or similar transportation devices altogether.

Similarly, simply because assisted suicide or voluntary euthanasia have a potential for harm, does not mean they are practices that should be abandoned altogether.  Pointing to particular cases where perceived harm was done (a strategy often employed by disability theorists and advocates) does little more to suggest that assisted suicide and voluntary euthanasia should be avoided, than pointing to a particular scenario that resulted in an adverse effect of medicine to conclude that all modern medical treatment should be prohibited.

In the unfortunate event of a new infection occurring, an adverse effects being suffered, or an accident happening on the road, we do one, or both, of the following things.  First, we critically engage with the system surrounding that phenomenon.  We ask probing questions into the design of the system to see if w can reduce instances of harm.  We question the triage system in emergency departments, and ask if those with communicable infections ought to be prioritized, or treated differently than those who do not have such illnesses.  We question surgical practices to ensure the physicians are following only the safest methods available.  Finally, we examine traffic regulations and ensure they are working for, rather than against, us.

Secondly, we explore the actions of the individual(s) that have been harmed.  We ask if it was imprudent for the individual with the autoimmune disorder to visit the emergency department during cold and flu season.  We ask if the failure to disclose an aspect of one’s medical history contributed to the adverse medical effect.  We ask if the driver in an accident was distracted or disobeying laws designed to promote safety.

Similarly, we can take action to drastically minimize the potential for harm to people with disabilities and other at-risk groups.  If the system is as broken as Wolbring concludes (and I tend to agree), then we should adjust the regulations surrounding access to these medical interventions.  Furthermore, we as individuals, should take action to explicitly express our desires to ensure there is as small of a grey area as possible.

To point to examples in the history of euthanasia where people with disabilities have been perceived to be harmed and to suggest this is reason to stop assisted suicide or voluntary euthanasia, is to throw the baby out with the bathwater.  This potential for harm is great, but the potential for harm reduction is greater.  There is nothing in expressing the concerns that have been made by disability advocates that suggests an all-out ban of these practices.  Instead, the experiences relayed by people with disabilities and the words of caution expressed are valuable in assessing the system to reduce or eliminate the possibilities of harm, but not to eliminate or prevent the system itself.

References:

Baker, G. Ross,  Peter G. Norton, Virginia Flintoft, Régis Blais, Adalsteinn Brown, Jafna Cox, Ed Etchells, William A. Ghali, Philip Hébert, Sumit R. Majumdar, Maeve O’Beirne,

Luz Palacios-Derflingher, Robert J. Reid, Sam Sheps, Robyn Tamblyn. 2004. “The Canadian Adverse Events Study: The Incidence of Adverse Events Among Hospital Patients in Canada.” Canadian Medical Association Journal 170, no. 11: 1678-86.

Commission Spéciale – Assemblée Nationale Québec. 2012. Mourir Dans La Dignité.Quebec: Assemblée Nationale Québec.

Gill, Carol J. 2010. “No, We Don’t Think Our Doctors Are Out To Get Us: Responding To The Straw Man Distortions of Disability Rights Arguments Against Assisted Suicide.” Disability and Health Journal 3: 31-38.

Quach, Caroline, Margaret McArthur, Allison McGeer, Lynne Li, Andrew Simor,

Marc Dionne, Edith Lévesque, Lucie Tremblay. 2012. “Risk of Infection Following a Visit to the Emergency Department: A Cohort Study.” Canadian Medical Association Journal 184, no. 4: E232-9.

Udo Schü¨klenk, Johannes J.M. Van Delden, Jocelyn Downie, Sheila A.M. Mclean, Ross Upshur and Daniel Weinstock. 2011. End-of-Life Decision-Making in Canada: The Report by the Royal Society of Canada Expert Panel on End-of-Life Decision-Making. Ottawa: Royal Society of Canada.

Somerville, Margaret. 2012. “National Assembly Report Reads Like a Pro-Euthanasia Assembly Report.” The National Post, March 26, 2012.

Wolbring, Gregor. 1998. Why Disability Rights Movements Do Not Support Euthanasia: Safeguards Broken Beyond Repair.

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