Last week, “Dying With Dignity,” a series of public hearings debating the issues of euthanasia and physician-assisted suicide, kicked off its province-wide tour in Montreal. Led by a National Assembly committee exploring citizens’ opinions on the subject, the hearings consisted of discussions with individuals, medical experts, and pro-euthanasia groups. Euthanasia and assisted suicide are both illegal in Canada. Margaret Somerville, a McGill professsor and Director of the McGill Centre for Medicine, Ethics, and Law, submitted a briefing to the National Assembly committee titled “Living with Dignity When Dying.” She spoke to The Daily on the issue from a palliative care conference in Australia.
McGill Daily: What are the differences between euthanasia and assisted suicide?
Margaret Somerville: There are very much the same moral and ethical issues because they both involve somebody intervening in some way to help someone end their life. The technical legal difference is that in euthanasia, somebody – let’s make it a physician – gives a lethal injection. In other words, the act of the physician causes the death of the patient…putting it bluntly, the physician kills the patient. In assisted suicide, the physician gives the patient the means of killing themselves. That’s what suicide means: you kill yourself. And euthanasia is actually homicide; it means somebody else kills you.
MD: Is withdrawal of life support a completely separate issue?
MS: It’s a totally separate issue, yes, because in withdrawal of life support you’ve got to look to what it is the patient told you they want or don’t want. In Canada everybody has got a legal right to refuse all medical treatment, and life support is medical treatment. If somebody says they don’t want life support, to impose it on them is assault, and you can’t do that. Withdrawal of treatment is not euthanasia, providing it’s a justified withdrawal. Some of the cases end up in court, when the family or the patient want the treatment continued, and the doctors and the hospital want it withdrawn. That’s a very common situation that ends up in court, and it becomes an issue of who’s got the right to decide.
MD: What are the arguments surrounding the legalization of euthanasia?
MS: The strongest argument for euthanasia is that you’ve got an individual, and that person wants it. They say, “it’s my life and I want to do this.” So that’s a strong argument for euthanasia; its autonomy, self-determination. The strong arguments against it are at the societal level. Once you institute this you can’t control it, and we’ve seen that…we’ve seen it in the Netherlands, who have the longest standing experiment in euthanasia, who have legalized euthanasia for 30 years. When it started off you had to be a competent adult who was in terrible pain that couldn’t be relieved, you had to be terminally ill, repeatedly ask for euthanasia, and then you had to give someone consent for it. Now, none of those conditions apply. Recently in the Netherlands they’ve broadened the law that parents who have a disabled baby can request euthanasia for the baby in the first month after it’s born, children aged 12-16 can with parents’ consent, those over 16 can consent for themselves, and those who are not terminally ill [can request euthanasia]. The [Dutch] courts just held that a seriously depressed woman whose psychiatrist gave her euthanasia was justified. As well as that, [the Dutch] government reports that at least 500 people a year are euthanized who haven’t given consent to it and don’t know what’s happening, they’re either incompetent or the doctors say, “well they asked for pain relief treatment and we take that as consent for euthanasia.” So all of those reasons. The most recent thing in the Netherlands is a petition signed by over 100,000 people that’s gone into the Dutch Parliament to legalize euthanasia for anybody over the age of 70: you don’t have to be ill, you don’t have to be in pain, you just have to be over 70 and…say that you’re tired of life. Now you imagine what’s going to happen when we’ve got an aging population and scarce healthcare resources. People will be pressured. If we have euthanasia there’s no question that they’ll be pressured into asking for it or accepting it in order to save resources. We used to not talk about saving resources as a reason for euthanasia. Even people who are in favour of it say “no that would never happen,” but now people are talking about that. You’ve [also] got to think about what’s the effect on health care professionals, and especially physicians. If we’re going to have euthanasia, we’re going to have to teach medical students how to teach their patients. It’s just a horrible thought; I can’t imagine doing it.
MD: In the parts of the United States where assisted suicide is legal [Oregon, Washington, and Montana], do you see the issue developing the way it is in the Netherlands?
MS: I just heard a report from Oregon where physician assisted suicide was initially legalized. There’s extensive care, which can on average extend life between three and six months at the end of life, and people in Oregon [can apply] for the state to cover the cost of these drugs. The Oregon Health Authority, if they refuse to send the drugs, which they mainly do, send the patient a message that says, “we’re not going to send you the drugs but we’d like to remind you that physician-assisted suicide is covered by the health insurance and is not expensive.” And so, there is extension of what’s happening. The people who are most at risk are the elderly. And it’s even more dangerous when you implement things under a cloak of ethics and compassion. When doctors do things we often assume that it’s got to be ethical or else doctors wouldn’t be doing it, so [by making] euthanasia a medical act [you make it] a compassionate act, and both of those things stop our normal intuition. One of the things I talk about in some of the lectures I give – and this is not my original suggestion – is that if we’re going to have euthanasia, we shouldn’t have doctors doing it because, first of all, it mixes you up as to whether it’s ethical – I call it putting a medical cloak on the act – and the other thing is that people actually become frightened of going to doctors, because people become frightened of accepting pain relief treatment. In one case, in [one territory of] Australia, they did legalize euthanasia for a period of about 11 months in 1997… and the Australian aboriginal population simply refused to go anywhere near a doctor or a hospital, so they had outbreaks of contagious diseases [among] the kids; they had a public health crisis.
One alternative that was suggested was that if we’re going to have euthanasia we should have lawyers doing it, because they know how to strictly interpret the law and how to apply it. And most people have a complete freakout when you suggest that you have a lawyer. As one of the doctors who was for euthanasia said to me, “You’re crazy, Margo, you’d have lawyers killing people,” but it’s exactly the same thing when doctors are doing it, except we don’t see it the same way.
MD: Will these hearings in Quebec move the debates in the province and country forward?
MS: Well it depends what you mean by forward, doesn’t it? If by forward you mean that we’re going to legalize euthansia, then I’d see that as a backwards step, so it’s very much a value question. Certainly I think it’s good that we’re having the debate and I would hope that the outcome would be that we’d reject euthanasia but we’d understand how very important good palliative care is, and in particular how fully adequate pain relief treatment [is] for everyone who needs it…all of those things are essential and absolutely required, but none of them are euthanasia. I think the big divide is, should we allow doctors to kill people? And my answer to that is no, absolutely, totally not. And you know the question you have to ask is why are we debating this now? It’s not like new reproductive technologies where we’ve never faced the questions in the past. There’s nothing new about euthanasia. So what is it that we think after thousands of years of saying this is wrong, suddenly think it’s a great idea? And I think what it is, is some values in society that have gone astray that we need to come back to and rethink.
—compiled by Queen Arsem-O’Malley