Thursday, September 26, 2013

My thoughts on "death with dignity"

The recent passing of Dr. Donald Low, who guided Toronto through the SARS crisis in 2003, unexpectedly sparked a revival of the difficult issue of assisted suicide when his widow, CBC alumna and medical expert Maureen Taylor, released Low's final home video where he asked Canadians to consider what it would be like to live in his body -- rapidly degenerating -- for twenty-four hours.

At the outset, I want to express my condolences to Maureen and her family.    His was certainly no way to die.

That said, this is truly a conflicting issue for me.   As most of you know, I'm pro-life.   Unlike a lot of social conservatives, that to me means from birth to natural death.   I certainly don't support capital punishment, and the concept of assisted suicide goes against my conscience at every possible level.

It has been, however, twenty years since Rodriguez v. Attorney General of British Columbia.   In the very close 5-4 decision the point was made by all sides that the plaintiff, Sue Rodriguez, was in an impossible situation with Lou Gehrig's Disease.    Writing for the majority, though, the late John Sopinka began his opinion by making reference to Jack Kevorkian.   It was an understandable viewpoint.   The assisted suicide law doesn't only ban active and passive euthanasia -- this ban was what Rodriguez was challenging -- it also bans counselling someone to commit suicide; and all lines on which Kevorkian was often very close to crossing and which he finally did cross when he openly put down a patient on 60 Minutes -- the first ever televised snuff film.

No question that no one should be bullied into doing anything against one's self-interest, certainly something like that.   Ever.

But when the most strident opponents claim to offer alternatives, the first thing they point to is palliative care; trying to make the patient as comfortable as possible in an attempt to make death more manageable.    Reasonable but the problem there is, as far as I can see, palliative care hasn't really improved that much over the last two decades since the Rodriguez case.   And as the population gets older, the more the clamor for end of life rights is getting.

Every time the issue is brought up in Parliament, the powers that be impose party discipline (at least within the ruling party) and vote down the measure even though this is as much a matter of conscience as abortion is.   So to say Parliament has "voted" and there is no call to revisit the issue is disingenuous at the least.

On the one hand, there is for me a big difference between actually committing suicide as quite a few terminally ill people do before they aren't able to, and getting the help of someone -- presumably a medical professional -- in assisting the patient in ending his or her life.   It certainly goes against both the ancient and modern renditions of the Hippocratic Oath, the latter which includes the promise by the doctor that he or she will not play God.

And let's not forget Robert Latimer, someone with no discernible medical training, who took the law into his own hands when he killed his daughter Tracy.   I have previously argued that this was a situation that called for the creation of a tier of third degree murder -- something between a crime of passion (murder two) and recklessness causing death (voluntary manslaughter) -- but that Mr. Latimer shouldn't have gone unpunished.

On the other hand, there are some patients, perhaps a small fraction of those who say they want to die, for whom there is reached the point that is no hope that medical assistance can ever turn things around.   I say a small fraction because such a drastic measure should not be made available to anyone, presuming such a law is enacted.    The Belgian law that is so broad that recently one patient  ended his life because he was told he was going blind but was otherwise healthy, proves the point.

The number of doctors who would be willing to step up for such a "service" must be very small, for the reason I noted above.   This isn't exactly something one would want to advertise his or her services for.    We certainly don't know -- still -- who helped Rodriguez in her last moments and, really, the vast majority of all of us don't even want to know.

But I suspect that to the argument that a doctor musn't play God, he or she might counter that God has already made the decision for the patient making the point moot; and postponing the inevitable and making things worse is only a disservice to the patient and his or her family.

Martin Luther King, quoting Saint Augustine, pointed out an unjust law is no law at all.   He was referring to the unfairness of segregation and eventually Congress backed him up albeit years after the courts did.  

Morally, and in this instance I still think the law has a place.

But from the legal standpoint that most people have the right to end their own lives and others do not, I have to say that is a denial of the equal protection of the laws and is therefore unconstitutional.    This is based on the same principle why I now support same sex marriage -- whatever moral qualms I have, it's a matter of legal equality.  Given the current composition of the Supreme Court of Canada, there's a better than even chance that Rodriguez will be overturned when a contemporary case working its way up from the BC courts hits its docket, and then Parliament will have a huge hornet's nest to deal with.

It shouldn't get to that.    There has to be a proactive approach to this.  For once, and before the case reaches 301 Wellington Street, we need to have something we've never really had in Parliament -- a serious and broad debate about the issue down the street from the court at 111.   All 302 MPs who are not party leaders (the Speaker, who is neutral, is not included in that number) should be able to give his or her 20 minute talking point.   The five leaders, of course, get unlimited time but they should also make a cogent and concise argument.   Maybe then there can be compromise legislation that draws a line but leaves the door very slightly open and sets very clear rules when a physician -- and not a family member -- can intervene.

That it would take just one man, a true Canadian hero, to reopen the debate, is extraordinary.   But it is refreshing and if anyone should have done it, is was him.   Rest in peace, Dr. Low.

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