Assisted-Suicide Ban Struck Down in Canada

February 06, 2015

In another sign of the burgeoning death-with-dignity movement, the Supreme Court of Canada today struck down that nation's ban on assisted suicide, calling it a violation of the constitutional "right to life, liberty, and security of the person."

Canada's high court said it was swayed by evidence showing that physician-assisted suicide laws in Oregon, Washington, and several European countries protect vulnerable individuals who are not competent, or who could be pressured into taking their lives by greedy relatives. The court suspended its lifting of the assisted-suicide ban for one year to give the Canadian parliament time to draft a law like Oregon's, which has been a template for other states and nations.

The Oregon law permits a physician to prescribe a lethal drug to a terminally ill adult who requests it, provided certain prerequisites are met, such as counselling on palliative and hospice care, and a determination of competence and independent decision-making. Canadian lawmakers may not necessarily limit physician-assisted suicide to terminally ill patients, however, given the ruling by the Supreme Court of Canada. The justices extended the right to die this way to competent adults with a "grievous and irremediable medical condition that causes suffering that is intolerable to the individual." Terminal illness, defined in the Oregon law as one that likely gives the person only six months to live, does not enter into the court's formula.

The case before the Supreme Court of Canada involved two women who together with their families challenged the ban on assisted suicide in a British Columbia trial court. One of the women, Gloria Taylor, was dying of amyotrophic lateral sclerosis.

"What I fear is a death that negates, as opposed to concludes, my life," the supreme court ruling quotes Taylor as saying. "I do not want to die slowly, piece by piece. I do not want to waste away unconscious in a hospital bed. I do not want to die wracked with pain."

The other plaintiffs were the daughter and son-in-law of Kay Carter, who had spinal stenosis. The couple took Carter to a Swiss assisted-suicide clinic, where she died, and then joined Taylor in the lawsuit. The trial court ruled in their favor and exempted Taylor from the assisted-suicide ban. She never took advantage of it, dying of an infection instead. The attorneys general of Canada and British Columbia contested the decision in an appeals court and won. That set the stage for the supreme court decision.

Canadian Medical Association Will Support Physician Conscience

The eventual lifting of the assisted-suicide ban will be a moment of truth for Canadian physicians. The Canadian Medical Association (CMA) states as a matter of policy that physicians should not participate in assisted suicide, but only because it is illegal. In a brief filed in the supreme court case, the CMA said that if the law were to change, it "would support its members who elect to follow their conscience."

The medical society noted in its brief that some of its members oppose physician-assisted suicide, or aid-in-dying, as it is called in the death-with-dignity movement, as a violation of the traditional medical injunction to do no harm. Other physicians, it said, support assisted suicide because of the "equally established principle" of considering patient well-being and autonomy.

"The CMA accepts that…it would not be appropriate for it to seek to impose or advocate for a single standard for the medical profession," the association said.

Its stance, by and large, contrasts with that of organized medicine in the United States. The American Medical Association opposes physician-assisted suicide, as do some of its affiliates in states that have legalized the practice, or voted it down. However, rank-and-file physicians here, like their Canadian peers, are divided on the issue. In a Medscape ethics survey last year, 54% of physicians said they support assisted suicide, up from 46% in 2010. Thirty-one percent said they opposed it, while another 15% said "it depends."

The Risks Can Be Limited, Says Canada's High Court

Today's decision by the Supreme Court of Canada reverses a 1993 ruling in which it upheld the ban on assisted suicide. In its latest ruling, the court noted the spread of assisted-suicide laws since 1993, beginning with Oregon's in 1994. Washington and Vermont have followed Oregon's legislative lead. Physician-assisted suicide also is legal in Montana because its supreme court ruled that nothing in state law prohibits the practice.

Meanwhile, bills legalizing physician-assisted suicide have been introduced, or promised, in some two dozen states, including California, according to the aid-in-dying group Compassion and Choices. A group of physicians and patients in New York this week asked a state court to declare that physician-assisted suicide is not against the law.

Countries where physician-assisted suicide is legal include Switzerland, Belgium, Luxembourg, and the Netherlands. The last three countries have gone one step further to permit euthanasia, in which someone actively administers a death-dealing agent, as opposed to just prescribing it. Parliament's House of Lords in the United Kingdom is considering an Oregon-style bill legalizing physician-assisted suicide, which the British Medical Association opposes.

Opponents of physician-assisted suicide contend that legalizing it endangers vulnerable citizens such as the elderly or those with disabilities who may be pressured or manipulated into ending their lives. In addition, some people may irrationally seek a physician's help in dying, given a cognitive impairment, depression, or some other mental illness. However, the Canadian supreme court agreed with the trial court that physician-assisted suicide laws like that in Oregon has curtailed such abuses and missteps.

"The risks associated with physician-assisted suicide," the high court stated, "can be limited through a carefully designed and monitored system of safeguards."

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