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.
Nor is our experience unique. In Oregon and the Netherlands, the two jurisdictions that first legalized assisted dying, many individuals seek out the means and support to end their lives, yet never take the final fatal steps and subsequently die of natural causes. It is knowledge and control that seem to be the most potent cocktail for reducing end-of-life suffering, even more so than the actual availability of life-ending medication and support.
Very few peoples’ deaths are hastened by physician assisted dying. In Oregon there are less than 100 deaths a year under assisted dying legislation, in the Netherlands assisted dying is a part of just 2% of all deaths. Nevertheless, legislation in these two jurisdictions has provided countless dying individuals with tremendous peace of mind.
Many conversations we have with those who call us for help start with a request for drugs or other means to hasten the person’s death (“Could you come over next Sunday at 2:00 p.m. with a sympathetic doctor?”). But they don’t end there. Once people have a conversation about their wishes – one where they really feel heard – then they typically become open to other ideas.
It is in this ensuing conversation that the sick and dying get the information and support that most often addresses their real concerns: misunderstandings about palliative care can be corrected, accurate information can be given about the right to refuse treatment and the importance of advance care planning, or problems with pain control can be highlighted and steps taken to address them.
And in those few cases where, despite the very best that medical care has to offer, people still feel it is more harmful to be kept alive than to be allowed to die, shouldn’t they have more humane options than furtive internet drug purchases, helium tanks or plastic bags?
Dying with Dignity is not pro-death. We just want to reduce unwanted suffering, and we accept that some people will hasten their dying as a result. We do not believe those who speak against legalizing assisted dying are pro-suffering. In supporting a total ban on assisted dying they see life as sacrosanct and are willing to accept that some suffering must inevitably occur as a result. Our priorities differ: at Dying With Dignity Canada, we believe compassion should trump the preservation of life at all cost.
Let me be clear, we want thoughtfully legislated access to assisted dying – not a free for all. We have established a Physicians Advisory Council to ensure we have input from physicians across the country. We want to work with doctors and medical associations to support legislation that provides choices and safeguards for both patients and doctors.
With 84% of Canadians in favour of the legalization of assisted dying, Quebec’s new law, the Supreme Court hearing and two private members’ bills, we believe change is coming. It is time to stop debating yes or no and start the critical work of figuring out how to make assisted dying work well for all concerned.