Jessica Orazietti
Death itself is an event that we as humans cannot know. It is something that is a huge part of our living existence, though it is an unworldly, mysterious thing that we cannot even begin to construct in our imagination. In their book, Physician Assisted Suicide: Expanding the Debate, Battin et al. (1998) explained that religion and other spiritual narratives are able to explain death in a more literal sense, as a continuation of life, providing comfort to those confronting the reality of its inevitability. Though regardless of what a person believes, death is still something that plagues us with questions (p. 13). A terminally ill diagnosis is something that can bring on these questions, as well as conflicting emotions felt by the individual diagnosed and their friends and family. When left with the prospect of the serious physical and emotional pain that comes with a situation such as this, in addition to the psychological turmoil of watching loved ones deal with their grief, some people choose to end their lives in a way that they believe will provide them with dignity and control. Assisted suicide is one option that some people now have available to them in Canada, as a way to go about achieving this, though with it’s legalization, comes many ethical and moral implications that must be evaluated.
At Sault Area Hospital, medically assisted death is a legally practiced procedure. An interview with an anonymous nurse, who is employed there, brought the reality of the situation to light. When questioned about her thought’s on the topic she stated that she isn’t sure how she feels about it, but “it’s a much more difficult process than just making the decision; there’s a psychological evaluation involved, a concrete terminal diagnosis must be made and the individual has to be of sound mind up until the very moment that they receive the end of life drugs” (personal communication, October 28, 2017). The College of Physicians and Surgeons of Ontario’s (2017) Policy Statement on Medical Assistance in Dying, concurs with this account, outlining a precise process for this procedure. The first step involves the initial inquiry the patient makes to the physician, followed by a criteria evaluation and a secondary request, in front of two independent witnesses. The patient is then reminded that they can rescind the request at any time and a second physician ensures that the “eligibility criteria” have been met. A “ten-day period of reflection” then takes place, before the medication can be administered. Finally, the pharmacist is notified and the physician ensures the individual still has the “capacity” to consent. After which, they provide one more opportunity to withdrawal the request, prior to administration. (p. 7) The Centre for Effective Practice (2016), outlines capacity as the patient being “able to understand the information relevant to deciding to consent, or to refusing to consent, to MAID” and “to consider and appreciate the reasonably foreseeable consequences of consenting or not consenting to MAID?” (p. 4). Now, although the person is faced with making the decision time and time again, is re-addressing it and a measly ten-day reflection, sufficient enough? This is the biggest decision a person can make; they are quite literally confronting the absolute unknown and consenting to the end. Further, when will someone ever have the “capacity” to truly understand the consequence of such a decision?
When discussing Bioethics, Boyle, J. et al. (2008), wrote that putting physicians in the position to legally provide medically assisted death, might raise concerns regarding coercion, abuse, or the risk of error. The authors believe that self-determination is something that should always be recognized; however, it shouldn’t be something that is necessarily prioritized, when there are so many other ramifications at play. With assisted suicide, death, rather than treatment, is the primary objective, but should death really be something that is considered a medical procedure? (p. 73). At the end of the day, the legalization of killing someone in a medical setting is really what we’re talking about. When explicitly stating what it is, is something that would make the majority uncomfortable, should it really be something that is practiced? It probably shouldn’t be an option, especially when considering the old and the poor may become susceptible to pressures from either the people caring for them, or from healthcare organizations, that feel it would be too difficult and too expensive to continue with care.
In the physician’s case, though the prospect of completely removing one’s self from the equation, in order to respect the autonomy of a patient is honourable, it doesn’t seem like a possibility, when they are in fact killing someone. The moral implications placed upon a physician must be evaluated as well. Bill C 14 of the Canadian Royal Assent (2016) amends the Criminal Code to protect physicians from offences of “culpable homicide and aiding suicide” (para. 1), but there isn’t a safeguard in place to protect them against judgements of conscience that come with the knowledge that they assisted someone in, or facilitated, their death. Sometimes actions should be judged based on intention, but when the action is so absolute, it cannot be overlooked; there should be no justification for purposefully ending a life. In The Cambridge Textbook of Bioethics, Boyle, J. et al. (2008), stated that, with the argument that assisted suicide can be a way to relieve the terminally ill from their suffering, comes the counterargument that, though compassion is important, there is no way to ensure that this will be limited to “truly voluntary patients” and it may bring about an “increasingly casual attitude toward private killing.” (p. 17). As true as the intentions may be, killing and suicide should never be something that becomes so common, and accepted, that it is no longer serious.
Mentioned many times, is an argument based on the belief that this procedure is the ultimate way to give individuals autonomy, in a situation that is, for the most part, out of their control. Respect for the freedom and individuality of a person, outweighing everything in the ethical decision making process, is a belief that needs to be looked at a little more closely. In discussing end of life perspectives, Battin et al. (1998), made a good point when they wrote “a person dying loses their autonomy and their existence becomes their relationships with others” (p. 18). If one is to think about this, and try and put themselves in the position of knowing death is imminent, then yes, life probably would, more so than ever before, become about interpersonal connections – has everything been said; does everyone know their importance? Things are no longer about self – autonomy isn’t necessarily something with which people are primarily concerned. The decision is ultimately more outwardly influenced, and granting such a request isn’t really then achieving the goal it has set out to. Much of the time the motivation for an early end, has much to do with protecting loved one’s from having harmful memories, which of course, is something that is wonderful to do; however, probably shouldn’t be a primary force in a decision to die.
As grand as a notion is – to be so compassionate as to allow for someone to die in a peaceful way, where they are in control, sacrificing personal discomfort to help them do so – in a society such as ours, disingenuous motives are assumed. As much as many of us would like to it to be, people are not always virtuous and concerns about malevolent, or misguided intentions are valid in this regard. The killing of another human being, regardless of the reasoning, should not be something that becomes regularized. The lack of knowledge and comprehension about death and what truly happens confounds our ability to make true decisions about how we should pass. Leaving our conscious world should be something that is natural, especially being that we have the means to provide comfort and alleviate suffering in an individual approaching death.
References
Battin, M. Rodes, R. Silvers, A. (1998) Physician Assisted Suicide: Expanding the Debate. New York, NY. Routledge.
Boyle, J., Dickens, B., and Ganzini, L. (2008). Cambridge Textbook of Bioethics. Euthanasia and Assisted Suicide. Cambridge University Press. Retrieved from: http://www.dphu.org/uploads/attachements/books/books_5318_0.pdf#page=89
Centre for Effective Practice (2016) Medical Assistance in Dying (MAID): Ontario. Retrieved from: https://thewellhealth.ca/wp-content/uploads/2016/11/20161118_MAID_Final_Fillable.pdf
Parliament of Canada, Royal Assent (2016). Bill C 14. Statutes of Canada 2016. Retrieved from: http://www.parl.ca/DocumentViewer/en/42-1/bill/C-14/royal-assent
The College Physicians and Surgeons and Ontario (2017) Policy System # 4 – 16 Medical Assistance in Dying. Retrieved from: http://www.cpso.on.ca/CPSO/media/documents/Policies/Policy-Items/medical-assistance-in-dying.pdf?ext=.pdf