Assisted suicide: the issue we can’t afford to get wrong

Good facts are absolutely essential for good ethics.
Margaret Somerville | Apr 29 2014 | comment  



Globe and Mail columnist Jeffrey Simpson recently wrote a pro-euthanasia column entitled “Assisted suicide - the issue we can’t ignore”. If he’s correct, it’s also the issue where we can’t afford to get our facts wrong. So, looking at his column, where might some people be doing so? Responding to that question can provide important insights in relation to euthanasia, in particular how pro-euthanasia advocates present “facts” to support their case.

Mr Simpson writes: “Canada has been around the issue of physician-assisted suicide many times in the past two decades … but we have never arrived at a consensus to allow the practice, as some European countries have done.”

But no country has a real consensus either for or against euthanasia and in Canada our “consensus”, in this sense, as manifested by the Canadian Parliament, which voted down legalizing euthanasia in April 2010 by a vote of 228 to 59, has been to reject euthanasia as incompatible with foundational Canadian values; not ethically acceptable; seriously harmful to the institution of medicine; and too dangerous in terms of abuse, especially of vulnerable people.

There are several problems with Mr. Simpson’s statement that “A bill introduced by the Parti Québécois government would have allowed physician-assisted suicide with a range of appropriate safeguards and checks involving patients, physicians and families.

Bill 52 would have allowed euthanasia, but it’s quite unclear whether it would have allowed physician-assisted suicide. The reports that informed the bill had rejected the latter, for reasons that we can only speculate about.

Clarifying what the bill was allowing is the first safeguard needed. The term “medically assisted death” was used as a euphemism for euthanasia. In an Ipsos Marketing poll carried out September 2013, which covered 2,078 Canadian respondents, 1,010 of them from Quebec, two thirds of Quebecers didn’t understand this meant a physician could give a lethal injection to a patient, and 40 percent didn’t understand that was what euthanasia meant.

And the safeguards were based on the Belgian law allowing euthanasia which have been spectacularly ineffective in containing its expanded use or preventing its abusive use.

Mr. Simpson writes “that the new [Quebec] Liberal government might reintroduce the bill, or something close to it … [which might mean] the Quebec Liberals could take the Canadian legislative lead.”

But, if so, the resulting conflict with the Criminal Code prohibitions on murder and assisted suicide, and trespassing on federal jurisdiction make that an unlikely outcome.

Then we are told: “Doctors’ associations appear split on assisted suicide, judging from polling and resolutions debated and voted upon in general assemblies of physicians. There certainly is no consensus among the medical professions.

The words “split” and “no consensus” hardly capture the reality that doctors are among the major groups against euthanasia, not just in Canada, but worldwide. Around 70 to 80 percent of physicians, in general, and 90 percent of palliative care doctors oppose it. The World Medical Association, with its over 9 million members, has just condemned it.

Mr Simpson focuses on the Canadian Charter of Rights and Freedoms right to “security of the person” which, he proposes, “under a certain construction, could be used to make assisted suicide a legal right.”

But how would this fit with the Charter’s “right to life”, which he doesn’t mention?

He notes “the Supreme Court turned down assisted suicide” in the Rodriguez case, but could reconsider that decision in the upcoming Carter case, which will have “different judges in place and more time to have taken stock of public attitudes.

But, as the Supreme Court made clear in Rodriguez in rejecting the relevance to their decision of philosophical and religious perspectives on assisted suicide, the justices must decide solely on the basis of the law, which may well not include these “attitudes”.

Mr. Simpson finds persuasive that “assisted suicide is slowly gaining ground in the United States, where several states have policies.”

However, it’s been decriminalized in only four states and expressly rejected in some others, for example, Massachusetts.

He continues: “A few other countries, including the Netherlands, Belgium and Switzerland, have laws governing euthanasia or assisted suicide. …It should be noted that the number of people using these laws is a tiny fraction of the total deaths each year. Assisted suicides have been few in number. The notion that there are massive numbers of people choosing to use this avenue is misguided.

The Netherlands have stated that the number of reported euthanasia deaths increased from 2011 to 2012 by 13 percent, to 4188, which is more than 3 percent of all deaths. In Belgium, recent government statistics indicate the number of reported assisted deaths increased from 1133 in 2011 to 1432 in 2012, representing 2 percent of all deaths in that country. These latter statistics do not include the unreported assisted deaths, which are estimated at 47 percent of assisted deaths in the Flanders region, where this failure to report has been studied. These numbers are not a “tiny fraction” and are continuously increasing. They show that once legalized euthanasia becomes part of the norm and is certainly not a rarity.

It’s correct the number of assisted suicide deaths is low by comparison with euthanasia. Among the 4188 deaths in the Netherlands, 185 were assisted suicide deaths and 38 were a combination of euthanasia and assisted suicide. But this results from euthanasia being the preferred method of inflicting death, not from reticence to do so.

Finally, Mr Simpson reassures us that “[w]ith all appropriate safeguards in place, as they are in jurisdictions where the practice is legal, assisted suicide is a humane addition to individual rights and the dignity of the person.”

The evidence of both logical (expansion of access to euthanasia) and practical (abuse of euthanasia) slippery slopes in the Netherlands and Belgium testify to the falsity of this assertion with regard to intentionally inflicting death.

Let’s at least get our facts straight on such a critical ethical issue as legalizing euthanasia. Good facts are essential for good ethics.

Margaret Somerville is director of the McGill Centre for Medicine, Ethics and Law, in Montreal.



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