Ewan C Goligher MD is an Intensivist at Toronto Western Hospital and a doctoral student in the Department of Physiology at the University of Toronto, Toronto, Ontario
Stephen W Hwang MD MPH is a General Internist at St. Michael’s Hospital and Professor of Medicine in the Department of Medicine at the University of Toronto, Toronto, Ontario.
The writing is on the wall. Physician-assisted death is very likely to soon be legal in Canada. Although legal decisions cannot put to rest ethical controversy, the winds of public opinion have shifted considerably, and policy changes will probably gain rapid and widespread acceptance in Canadian society. Requests for assisted death will become more frequent. Canadian physicians, of whom only a minority have indicated a willingness to provide or administer lethal doses of the drugs at their disposal, will therefore be faced with the serious personal ethical challenge of deciding whether to honour such requests and whether to refer patients to physicians willing to accommodate such requests. ...continue reading →
Every year at Dying With Dignity Canada our Personal Support and Advocacy Program receives calls from hundreds of individuals who are grappling with a horrific diagnosis and want to explore an early exit strategy. Only a tiny fraction of these individuals will ultimately hasten their dying.
Yet even though most deaths physically unfold as they would have done if there had been no contact with us, our clients often have a very different experience of dying from other Canadians. Simply by learning about their options, as limited as they are under our current legal constraints, those who reach out to us have much greater peace of mind, whether or not they ultimately take action to control the timing of their deaths.
James Downar is a Critical Care and Palliative Care physician with a Master’s degree in Bioethics. He is an Assistant Professor in the Department of Medicine at the University of Toronto, and co-chair of the Physicians’ Advisory Council for Dying with Dignity Canada, a group that advocates for the legalization of Physician-Assisted Death.
Physician-Assisted Death (PAD) is a controversial subject in Canada, but it shouldn’t be. The latest polls show that Canadians support PAD almost as much as they support sunlight and clean drinking water. PAD is now legal in many jurisdictions, and we have a large body of evidence to address fears about slippery slopes. When PAD was legalized in Europe, it did not become the default option for dying patients; it generally remained stable while Palliative Care grew dramatically. According to the Economist, the 5 countries that have legalized PAD are world leaders in the “Basic end-of-life healthcare environment”, while Canada sits in the middle of the pack. According to the Center to Advance Palliative Care, all three US states that have legalized PAD by statute rank in the top 8 for availability of palliative care services in hospitals. The vulnerable do not appear to be pressured into accepting PAD - on the contrary, the patients who receive PAD appear to be disproportionately wealthy, educated, and well-supported by family members and health insurance. I would almost call them “privileged”, but then I remember that they were suffering enough that they chose to end their lives.
I don’t support death. I enjoy my life, and I work very hard as a Critical Care physician to keep patients alive when I can. But I accept that there are times when I can’t. And there are times when I can keep people alive, but not in a state that they would value. ...continue reading →
Prof Harvey MaxChochinov, OC OM MD PhD FRCP(C), is Canada Research Chair in Palliative Care; Director, Manitoba Palliative Care Research Unit; Chair, Canadian Virtual Hospice; and Distinguished Professor in the Department of Psychiatry, University of Manitoba
Prof Balfour M. Mount, OC QC MD FRCP(C), is Eric M. Flanders Professor Emeritus of Palliative Medicine, McGill University
On October 15th, the Supreme Court of Canada will hear an appeal by the BC Civil Liberties Association that could grant terminally ill Canadians the right to assisted suicide. Given that impending ruling, the recent passing of Bill 52 in Quebec (legalizing euthanasia or what is euphemistically being called Medical Aid in Dying [MAD]) and rumblings from parliament of yet another private members bill on assisted suicide, Canada is clearly at a crossroads on this issue. The Court faces a daunting task. Where rhetoric ends, the war of what the data say begins; with each side invoking elements of empirical evidence that happen to support their particular argument. Add fear of death, dread of the process of dying—and our societal aversion to discuss these issues—and one begins to appreciate what the court is up against.
First and foremost, the Court must consider how people in this country die and whether their decision will move us toward improving care for the terminally ill. Dying in Canada can be a scary prospect. According to a parliamentary report from 2000, the vast majority of Canadians of all ages do not have access to comprehensive, quality palliative care. ...continue reading →
For most Canadians, the October 14 arguments at the Supreme Court in Ottawa will be about medical “aid in dying,” what the Dutch bluntly but accurately call physician assisted or directed termination. But what is really at stake in Carter et al. versus Attorney General et al is Canadian law itself, the meaning of its guarantees, promises, and injunctions. In effect, lawyers for and against “aid in dying” are asking the Supreme Court’s justices to interpret two sections of the Canadian Charter of Rights and Freedoms.
The result will define not simply issues of “assisted dying” but the future of Canadian law and society for years to come. ...continue reading →