The state of living

The debate on end-of-life care in Québec

My partner told me he wanted to kill his father. The only thing in his way was the law. Terminally ill, his father had been occupying one of the 637 beds at the Jewish General Hospital in Montreal for several weeks and had asked to be relieved of his pain during many long nights. Euthanasia was and still is in the process of being decriminalized in Quebec. Doctor-assisted suicide is not even currently discussed as an option in the court of law. Naturally, there was no dignity in dying.

Quebec and the “good death”
Euthanasia – derived from the Greek meaning “good death” – is defined as the practice of a doctor intentionally ending a life to relieve the patient of pain and suffering. The most common method of euthanasia is when a doctor increases the dosage of medication to a lethal level, such as raising the number of morphine injections to a patient. Doctor-assisted suicide, on the other hand, is when the doctor gives the patient the tools to end their life. For example, a patient could be given a button that, when pressed, would administer an overdose of a painkiller.

Presented to the National Assembly of Quebec last March, a detailed report entitled “Dying With Dignity” hopes to address concerns surrounding euthanasia and propose a system that would protect the rights of all terminally-ill patients to end their lives. Legal experts say this does not include doctor-assisted suicide.

The report discusses at length the state of palliative care in Quebec and how end-of-life care can be improved. Following these recommendations, the all-party select committee for “Dying With Dignity” proposes to expand the provincial healthcare system to include medical aid in dying on the grounds that “some suffering cannot be effectively relieved, and individuals who want to put an end to what they consider senseless, intolerable suffering face a roadblock that goes against Québec society’s values of compassion and solidarity.”

Euthanasia, if legalized, would not be accesible for everyone who requests it. The patient must fulfill the proposed six criteria outlined by the report to be able to make a request. The criteria propose that the patient must be suffering from a serious, incurable disease, is in an advanced state of weakening capacities with no chance of improvement, and is undergoing constant and unbearable physical or psychological suffering that they feel cannot be eased. Legally, they must also be a Québec resident under the Health Insurance Act, an adult able to consent to treatment under the law, and be able to make a free and informed decision to request medical aid in dying.

Ultimately, the report strives to create a system that gives agency back to the patient. Dr. Gaétan Barrette, president of the Fédération des médecins spécialistes du Québec (FMSQ), said in an interview with the National Post: “It’s not the doctor’s decision, it’s not the system’s decision, but the patient’s decision.”

Currently, euthanasia and doctor-assisted suicide are deemed crimes in the Criminal Code of Canada. But this means little when the enforcement of criminal law is up to each province. In addition, the committee is proposing provincial legislation to prevent the criminal prosecution of doctors if this act is carried out.

Though not officially ratified, many, including Dr. Catherine Ferrier of the Geriatrics department at the McGill University Health Centre (MUHC), believe that Dying With Dignity will soon become a part of Quebec law.

Values and the meaning of life
A philosophical debate over the meaning of a well-lived life and how individuals and society value life has arisen from the debate on euthanasia. Although Dignity for Dying makes a compelling case, there exists a strong opposition to the way enabling doctors to carry out euthanasia, will change the way we view medicine and value life, particularly for those Ferrier cites as traditionally marginalized in our healthcare system, such as the elderly.

In the Roman Catholic Church’s Declaration on Euthanasia, which was approved by Pope John Paul II, euthanasia is a “violation of the divine law, an offence against the dignity of the human person, a crime against life, and an attack on humanity.”

Conversely, Dignity in Dying describes euthanasia as, “compatible with changes in social values, medicine and the law.” The report adds, “our social values have shifted from religious or ideological beliefs to notions of personal liberty, respect for autonomy, inviolability and integrity of the individual, all consistent with the concept of medical aid in dying.”

In a survey, conducted by the committee who wrote the report, of 6,558 people – nearly 50 per cent of which were from the administrative regions of Montreal, Montérégie, and Capitale-Nationale – 80 per cent feel that euthanasia should be decriminalized for people who suffer from an incurable illness or have unbearable psychological and physical pain.

The argument for euthanasia stems from the idea that if patients are legally allowed to refuse treatment, they should also have the right to doctor-assisted death for the goal of reducing pain. Inaction on the part of the doctor has as much of a direct effect on the patient as assisting a patient in performing euthanasia.

Professor of Law and founding director of the McGill Centre for Medicine, Ethics and Law Margaret Somerville and Ferrier disagree with the leanings of the majority of the Quebec population, insisting that euthanasia is not a viable option in end-of-life care.

Somerville believes that “it is inherently wrong to intentionally kill another person and this is what euthanasia involves,” adding that “you can’t do [euthanasia] without harming the general value of respect for life in society.”

Ferrier said in a phone interview with The Daily that the likelihood of euthanasia being legalized could be attributed to negative changes in our society, which is “a lot more individualistic than it use to be” and being much less family-oriented. “There’s nobody in society that is allowed to kill other people. If we make doctors an exception, we would be giving an awful lot of power to doctors and in my mind, [doctors are] not better than anybody else.”
This ignores much of the detailing of the report that constricts who can request and receive euthanasia.

Sommerville adds that the “appropriate charge would be first degree murder” for doctors who perform euthanasia or doctor-assisted suicide.

Ashes to ashes
When both were asked about how they value a well-lived life, they described a bleak existence devoid of pain. Both doctors had spoken to me at length about their experience helping patients alleviate their pain and increasing the quality of palliative care for patients. A strong voice for preserving the current methodology of end-of-life care in Quebec, Somerville even described herself humourously as “15 per cent of a journalist.”

I cannot position a doctor as a murderer for assisting a patient in euthanasia, though my own values are not intrinsically different from those of Somerville and Ferrier; we all value the quality of a person’s life. What differs is where we want to see those values upheld. A patient cannot determine if they will be terminally ill, but they should be able to determine when that pain should end. I watched a person lose his mind and body before his suffering ended in what anti-euthanasia advocates describe as a natural death. Only as the moon changed phases did we see his physical body go. All had turned to dust again.