Recently, the Globe and Mail, Canada’s national newspaper, published an editorial, “Quebec gets it right on the right to die”, which articulated the strongest case that can be made for supporting legalizing euthanasia and Quebec’s Bill 52 which seeks to do just that.
At the time of publication of the editorial, the Bill was expected to pass within days. As events have unfolded that has not occurred due to an unexpected move by the opposition Liberal party members of the Quebec Legislative Assembly, which delayed the Bill being put to a vote. In the interim, a budget bill was introduced and seems almost certain to be voted down, which will lead to a provincial election. Bill 52 will fall with the calling of an election, but if the Parti Quebecois is re-elected it is certain to again be brought forward, so this might be a temporary reprieve.
But here I want to address the Globe’s editorial. Like Bill 52, it focuses only on the individual person who wants euthanasia, and, moreover, is in “unbearable pain”. The editors see the goal of Bill 52 as seeking “to sensibly regulate how a physician can deliberately end a patient’s life”. And they accept that doing so is “a medical and not a criminal matter”.
They take comfort in recognizing that “Quebec’s criteria [governing euthanasia] closely resemble the rigorous six-part test offered in the Netherlands” and reassure us that “Quebec has given no indication that it seeks to emulate Belgium’s approach” of recently extending euthanasia to children.
I will critique these points in order. Good ethics depend on good facts and we need to get our facts straight.
First, the terminology of a “right to die” is problematic. If you have a “right to die”, someone else has an obligation to kill you. Rather, as is fully recognized in Canadian criminal and civil law, and medical ethics, you have a right to be allowed to die by refusing medical treatment. This is a natural death, not euthanasia.
The discussion of the consequences of euthanasia must go beyond its impact on the individual person, important as that person is. Legalizing euthanasia is also a major issue for society, as a whole, and the institutions of medicine and law, which in a secular society, such as Canada, carry the societal value of respect for life.
With respect to “unbearable pain”, we must kill the pain, not the person with the pain. As the internationally recognized Declaration of Montreal recognizes, for healthcare professionals to unreasonably fail to offer fully adequate pain management to a person who needs it is a breach of that person’s human rights.
Regarding “sensible regulation”, we should keep in mind that we don’t regulate that which we believe to be inherently wrong, we prohibit it. For thousands of years we’ve prohibited intentional killing of another human being, except where it is the only feasible way to protect innocent human life, as in self-defence. Euthanasia crosses that clear line that we must not intentionally kill and, once crossed, there is no obvious stopping point, as both the Netherlands and Belgium so manifestly show us,
As the article of Globe columnist, Margaret Wente, published opposite the editorial, documents (“Assisted suicide – what could possibly go wrong?”), contrary to the Globe’s editors’ assurance that all is well in those jurisdictions, neither the logical slippery slope – the extension of euthanasia to a much wider range of people than were initially included – nor the practical slippery slope – the abuse of euthanasia and its use outside the legal requirements – have been avoided.
In short, once introduced, euthanasia cannot be controlled, despite the best of intentions to do so. And those most at risk are vulnerable people – people with disabilities, those who are old and fragile, including those with dementia.
Moreover, even before Bill 52 becomes law its extension is being raised. For instance, just this week, Dr Yves Robert of the Quebec College of Physicians and Surgeons, which has strongly supported the Bill, is reported, as saying its extension to children will need to be considered. In the future, might its application to people with dementia also be contemplated? The reasoning in relation to children and people with dementia for doing so is the same. If competent people can have their suffering relieved through euthanasia, it’s wrong not to offer the same benefit to incompetent people.
It’s legally wrong to say euthanasia is “a medical and not a criminal matter”. It’s a criminal matter because, under the Canadian Criminal Code, it’s first degree murder – the physician has an intention to cause death and does so through a “planned and deliberate” act. The penalty for that is life imprisonment, not “14 years in prison” as the editorial states. The latter is the penalty for assisting in a suicide, but it’s unclear whether Bill 52 contemplates allowing that. Bill 52’s emphasis on euthanasia being a medical act is the Quebec government’s attempt to claim jurisdiction to legislate on euthanasia.
I believe that history will view the current euthanasia debate as having been the most important values debate of the 21st Century. Whatever its outcome, it will be seen in retrospect, as a critical point in determining the shared values handed on to future generations to become the values on which they will base their Canadian society.
The euthanasia debate focuses attention on the importance to humanity of putting into practice the belief that all human life has dignity and deserves respect and protection. What that requires we must either not do or do is where the pro-euthanasia and anti- euthanasia adherents disagree.
Margaret Somerville is the founding director of the Centre for Medicine, Ethics and Law at McGill University.