Q & A


Nine Questions and Answers about Euthanasia and Physician Assisted Suicide

Q1: What is euthanasia?

First we should clarify what euthanasia is not – euthanasia is not withdrawing or refusing treatment or life support. A patient may refuse treatment, at any time if competent or through advance directives or the patient’s substitute decision maker if incompetent. The care can also be withdrawn if medically futile. Competent adults have a right to self determination which means they have a right to refuse treatment for themselves and there is no obligation to provide medically futile treatment.

It is also not euthanasia when a treatment, administered with the primary intention of relieving pain and suffering, could shorten life – which is a very rare risk with competently administered pain and suffering relief treatment.

Euthanasia involves a physician committing an act with the primary intention of ending a patient’s life, which results in the death of the patient. An example of this would be a lethal injection – the patient does not die of their underlying medical condition but as a result of the injection. This is murder under the Canadian Criminal Code, as it presently stands.

Q2: What is physician assisted suicide?

Physician-assisted suicide involves a physician instructing a person in how to commit suicide or providing them with the means to kill themselves. The person uses that information or those means to commit suicide. This is also a crime with a penalty of up to 14 years imprisonment under section 241 of the Criminal Code.

Q3: What is palliative care?

Palliative care can be described as an approach that aims to improve the care delivered to the patient and his or her family, taking into account specific problems related to terminal illness: prevention and reduction of suffering and , in particular, early detection, evaluation and treatment of pain, in addition to responding to the patient’s other psychological and psycho-social needs.

Q4: Aren’t euthanasia and physician-assisted suicide a matter of autonomy? Why should the state interfere with a patient’s choice to die?

There is a major difference between a person committing suicide and society authorizing a physician to help them to do that; in the latter case, not only the physician, but also society is complicit in the suicide. Likewise legalized euthanasia involves complicity by society. Respecting patients’ refusals of life-saving treatments does not involve such complicity, because death does not result from physicians’ interventions authorized by society, as in euthanasia and physician-assisted suicide, but from the patient’s underlying disease.

Respect for individual autonomy is an important value, but it is not absolute and sometimes has to be limited in the interests of maintaining a more important value. Legalizing euthanasia and physician assisted suicide involves society and its values because they require the participation of the law and medicine – two of the nation’s most important value carrying institutions, and society’s agreement to and tolerance of acts that are currently the criminal offences of murder and counselling or aiding suicide, respectively 1.

Q5: Euthanasia and physician assisted suicide are happening anyway – shouldn’t we just make it legal and safer?

Even if people have been breaking the law, and it’s not clear that this is in fact as common an occurrence as some pro-euthanasia advocates claim, this is not a reason to change the law. The law exists to uphold a given social value, in this case respect for human life. If physicians are breaking the law, especially a law as serious as the law against murder then they should be prosecuted, not facilitated.

Q6: If this law is passed will medical students have to learn how to kill patients in medical school?

Yes, like any other procedure that physicians will be expected to perform, medical students will have to learn how to competently perform euthanasia – that is, kill a patient.

Q7: Is euthanasia a form of care and what about rare cases when all other pain relief measures are ineffective?

Euthanasia is not medical care; it is intentionally killing the patient rather than caring for them. We have always had the means to end the lives of suffering people but for thousands of years this has been a rejected practice. Medicine is now better equipped than ever before in history to offer high quality care to suffering people, ranging from pain management to counselling for depression. In rare cases, if no other treatment is effective, palliative sedation is also available. The difference between this and euthanasia is that the patient is not killed, but dies of natural causes. As a group of Quebec palliative care physicians 2 have asserted, there is no justification for a doctor to intentionally end the life of a patient.

Q8: If people are suffering we need to be able to offer them relief – what is the alternative to physician assisted suicide and euthanasia?

The first alternative is better training for health care providers as well as medical and nursing students in the most advanced techniques in palliative care and pain management. Few practitioners receive sufficient training in these areas and their ability to provide treatment or refer patients to the care they need relates directly to the patient and their family’s ability to cope and the patient’s quality of life in the context of terminal illness.

In addition, there are many reasons why patients may express the wish to die and these include loneliness, depression and despair. 3 Our response to such patients must be one of compassion and care; there are treatments for depression, and ways to work with patients and their families in dealing with issues of hopelessness and loneliness. It is both a serious wrong to patients and their loved ones, and a betrayal of the medical profession, for society to decide that a patient’s quality of life is not worth these therapies and that euthanasia is the best we can do.

Q9: Euthanasia won’t affect people who don’t want it; so why not support it?

Euthanasia and assisted suicide change physicians’ approach to respecting a patient’s life and create conditions under which a physician can kill a patient. A first consequence of this will be a radical alteration of the relationship of trust between the doctor and patient. The latter will have to wonder at the former’s assessment of their life and at the possibility of third parties attempting to influence the actions of the physician. In countries where euthanasia is legal, many senior citizens in particular, are terrified of going to hospitals and frequently sign orders not to be killed. The presumption is no longer in favour of protecting patients’ lives.

Most countries that have legalised euthanasia and physician assisted suicide started off only making it available to terminally ill, consenting adult patients. In the Netherlands, the evolution of the practice has been from terminally ill consenting patients, to disabled adults, disabled children whose parents consent to their death, to healthy individuals who want to die with their terminally ill partners. It has come to include death on demand, death at the consent of parents and death without consent. Ultimately, physicians are put in a position to decide the value of each life, rather than doing their best for each life.

Many people alive today will one day face illness or a disability that makes them very vulnerable. To protect everyone in society, including the lives of the vulnerable, all lives must be of equal fundamental value in which there is no speculation as to criteria for respect for and the protection of life


References

[1] Criminal Code of Canada, http://laws.justice.gc.ca/en/ShowFullDoc/cs/C-46//20090909/en (accessed September 12, 2009)

[2] Ayoub, J., Bourque, A., Ferrier, C., Lehmann, F., Morais, J., « Non à l’euthanasie et au suicide assisté: Aucune condition particulière ne les justifie » Mémoire présenté au Collège des médecins du Québec , le 27 aout 2009.

[3] Hamilton, N.G., Hamilton C.A., “Competing Paradigms of Response to Assisted Suicide Requests in Oregon,” American Journal of Psychiatry, Vol. 162, pp 1060-1065, June 2005