Let the soul searching begin.
True, the Supreme Court of Canada delivered a unanimous and historic decision last Friday, striking down the country’s ban on doctor-assisted suicide for consenting and severely ill adult patients. It gave Ottawa a year to enact new legislation.
And true, an opinion poll last fall indicated 84 per cent of Canadians believe “a doctor should be able to help someone end his or her life if the person is a competent adult who is terminally ill, suffering unbearably and repeatedly asks for assistance to die.”
But the issue is striking closer to home for health care providers, who, some day in the very near future, could be asked to help patients end their lives, according to Dr. Cindy So and Jonathan Breslin.
So is the medical director of palliative and supportive care at Southlake Regional Health Centre’s Stronach Regional Cancer Centre and also the regional palliative care lead for the Central Local Health Integration Network, which oversees health care planning for a wide area, including York Region.
Breslin is an ethicist with Southlake and Mackenzie Health.
He will help the Newmarket and Richmond Hill hospitals address ethical issues surrounding doctor-assisted suicide on an organizational level and as they deal with concerns of individual health care providers.
There will be a lot of soul searching among health care providers as they decide if they are willing to actively and deliberately help severely ill patients end their lives, Breslin said.
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“It’s always been a theoretical discussion. They’ve never really had to think, ‘If I’m asked, what will I do?’ Now they have to ask themselves that question,” he said, adding only a very small percentage of patients in other jurisdictions with assisted suicide actually take advantage of the practice.
“For some, it’s the discomfort with being involved in that step. For some, it feels like they’re killing their patient. Others see it as providing end-of-life care, as supporting their patient to the end… I think that’s the personal and moral struggle that a lot of health care providers will have to wrestle with.”
So has been approached by patients and their families seeking her help to end a life and she has always been able to tell them that is not legal in Canada.
She is unsure if she will be able to participate in doctor-assisted suicide, saying much will depend on how new legislation addresses wide-ranging issues such as consent, eligibility protection of vulnerable people and definitions of what constitutes intolerable suffering.
“I don’t think that’s something I could answer right now. My role and the reason I’ve chosen to dedicate my career to palliative care is about alleviating suffering and improving quality of life and comfort and dignity at the end of life,” she said.
“It’s just, you take this Hippocratic Oath and you say ‘Do no harm’ so there’s just that internal struggle about where this lies. Is it within the spectrum of palliative care or is it a different entity altogether? And for the medical community, and I don’t want to speak for the whole medical community, but, generally, as a medical community, I think we’re still struggling with deciding that piece of things.”
Proper palliative care is available to fewer than 30 per cent of Canadians, So said. Providing reasonable end-of-life care that addresses patient concerns such as pain management would prevent many people from seeking doctor-assisted suicide, she said.
Meanwhile, So is pleased the court decision opens up a broader conversation about issues surrounding death and dying in Canada.
The historic ruling is also resonating with others.
Lorne Sossin, dean of York University’s Osgoode Hall law school, called it a remarkable constitutional judgment that appears to reflect a shift in societal sensitivities to doctor-assisted suicide during the last couple of decades.
While the court ruled 20 years ago that all life is important, now the court has decided that dying with dignity is part of life, he said.
Physician-assisted suicide will remain part of the Criminal Code as the court gave the government a year to adopt new legislation.
But given the unequivocal decision of the Supreme Court justices, it’s unlikely a doctor who helps a severely ill patient kill him or herself will face prosecution in the absence of a new law, Sossin said.
Calling the court ruling a landmark decision, Markham-Unionville MP John McCallum said he’s pleased the ban was struck down.
“My personal decision is, subject to safeguards (to protect vulnerable Canadians), it should be allowed. I have felt like that for a long time,” he said.
“I think people in the last stage of life, who may be in great pain, who wish to die with dignity, the state should not stop them.”
While not all Liberals agree with doctor-assisted suicide, it is not a divisive issue within the party, McCallum said.
He hopes the Conservatives, who would have more members opposed to the concept, will bring in legislation that follows the spirit of last Friday’s court ruling.
“This is a sensitive issue for many Canadians, with deeply held beliefs on both sides. We will study the decision,” York-Simcoe Conservative MP Peter Van Loan said.
Bryan Keshen, president of Thornhill-based Reena, an agency supporting people with developmental disabilities, did not want to comment on the court decision or how new legislation should address issues such as protecting vulnerable Canadians.
However, as a religious-based Jewish organization, Reena is opposed to assisted suicide because the agency values the sanctity of all life, he said.
The Canadian Civil Liberties Association applauded the court decision.
Control of bodily integrity is crucial to Canadians’ right to life, liberty and security of person, the association said.
Meanwhile, the Institute for Canadian Values said it was saddened by the ruling.
“Life is too precious to allow a doctor to kill,” president Dr. Charles McVety said in a statement.
Nurses, who play a critical role in end of life care, should be consulted as Canada adopts new legislation, Doris Grinspun, CEO of the Registered Nurses Association of Ontario, said.
Although Sue Rodriguez unsuccessfully challenged the ban on doctor-assisted suicide in 1993 while suffering from Lou Gehrig’s disease, the Markham-based ALS Society of Canada did not want to comment on the court ruling.
“As a society, we neither oppose nor support any attempt to change the law regarding euthanasia or physician-assisted suicide,” marketing and communications director Rebecca Grima said in an email.
“We provide support to all Canadians affected and living with ALS.”
Marie Morton, executive director of Hospice Georgina, a visit hospice, which means they provide non-medical support in the community, said Hospice Palliative Care Ontario is not taking a position on either side of the doctor-assisted suicide issue.
If patients and their families have their needs addressed when it comes to pain management, caregiver support and respite and grief and bereavement support, often people will not make the decision to ask for doctor-assisted suicide, she said.
“It’s not a question of living with that disease or choosing to die,” she said, adding there are a lot of care and support options that can be provided between those two opposites.
“From a hospice perspective, we try to respect people’s individual decisions, but I think some people who work with hospices might want to opt out of (being involved with assisted suicide).”
Officials contacted at other hospices in York Region either could not be reached for comment or did not want to comment on the issue.
