Dr. Avnish Jolly, Toronto, Canada February 9, 2015 ; Recent decision of the Supreme Court of Canada (SCC) declaring Terminally ill patients have a constitutional right to assisted suicide (with the recommendations of doctor) is going to be big issue in coming Parliament election of Canada. Luxembourg, Belgium, the Netherlands, Switzerland, Germany, Japan and some American states have some forms of legally assisted suicide. In Carter V/s Canada; on February 6, 2015 the court suspended the effect of the ruling for next 12 months. Justice Minister Peter Mackay hinted it could take a year granted by the court to develop a legislative response. Both NDP as well as Liberals do not stated a clear party position, but both hinted at the need for federal guidelines to protect the vulnerable. The judges declared the right to life does not mean individuals “cannot ‘waive’ their right to life.” Both the federal and provincial governments have the power to legislate assisted suicide. Quebec is the first in Canada to allow medically assisted death under a law that has already been challenged. A federal government could invoke the Constitution’s little-used escape or override clause that allows governments to legislate “notwithstanding” basic rights in the Charter. In an election year, that’s seen as political issue. The judges made clear their ruling does not compel physicians to provide assistance in dying. There is also a question about where it leaves Catholic hospitals such as St. Joseph’s Healthcare.
About 75 per cent of Canadians over 65 are reliable voters, they voted in the last federal, provincial and municipal elections, according to the Statistics Canada General Social Survey (and nearly 90 per cent vote in federal elections). Among 25- to 44-year-olds, the proportion of reliable voters is closer to 45 per cent. These older voters going to dominate coming elections because they dedicatedly spend their life for Canada and still volunteering for the Country. Government of Canada running many projects for the welfare of Senior Citizens and this recent Judgment and Political will plays important role in coming elections.
Terminally ill people have rights to live their life peacefully till the last breath. Hospice and palliative care is dedicated to provide medical treatment that concentrates on reducing the severity of disease among people suffering with life threatening illness. The principle of palliative care is to alleviate pain, reduce suffering and provide psychological / emotional help and to provide a network of support for their parents’ family and friends to improve the quality of life of the patient and his/her family.
Assisted suicide is suicide committed with the aid of another person, sometimes a physician. The term is often used interchangeably with physician-assisted suicide (PAS), which involves a doctor “knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide, including counselling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs. Physician-assisted suicide is contrary to the original Hippocratic Oath that has been in use since the 5th Century BC, stating “I will give no deadly medicine to anyone if asked, nor suggest any such counsel”. The Declaration of Geneva is a revision of the Hippocratic Oath, first drafted in 1948 by the World Medical Association in response to euthanasia, eugenics and other medical crimes performed in Nazi Germany. It contains, “I will maintain the utmost respect for human life.” The International Code of Medical Ethics, last revised in 2006, includes “A physician shall always bear in mind the obligation to respect human life” in the section “Duties of physicians to patients”.
It set out circumstances where the SCC said assisted suicide is constitutional — under a doctor’s care, for consenting adults who determine they cannot tolerate the pain brought on by a severe, incurable illness, disease or disability. The court overturned its own 5-4 ruling from 22 years ago Sue Rodriguez case. The judgment was signed by SCC, as a signal of a powerful consensus among all nine judges including the retiring Louis LeBel, and six of Prime Minister Stephen Harper’s appointees. Judgment is not limited to disabled individuals who are unable to kill themselves unaided, nor to cases of terminal illness or people near death. Instead, the ruling applies broadly in cases of a major illness, disease or disability that inflicts intolerable physical or psychological suffering on a patient. The court said nothing in its ruling would compel a physician to act against his or her conscience or religious beliefs, and it is up to lawmakers to balance conflicting rights.
Legislation on euthanasia in Canada distinguishes between passive euthanasia (withholding or withdrawing of life-preserving procedures including water and food) and active euthanasia (intentionally killing a person to relieve pain). Whereas passive euthanasia is legal in Canada, active euthanasia is illegal and is considered to be murder. This decision by SCC has reversed this, though it does not take effect until 2016.
Lorne Sossin, Dean and Professor, Osdoode Hall Law School, Toronto wrote an article in Canadian Lawyer and advocated Carter & Dying with dignity: now comes the hard part.
Prof. Carissima Mathen, University of Ottawa said unlike when the abortion law was struck down in 1989, the overall law against assisted suicide still stands, so a national regime that codifies the Supreme Court ruling would be an appropriate legislative response rather than no law at all, said Mathen, “and you need co-operation with relevant health authorities to ensure the system is managed competently.”
“I’m most interested in what is going to happen next,” said Lisa Schwartz, the Arnold L. Johnson Chair in Health Care Ethics at McMaster University.
Health Care Providers in Canada are calling for a new law that will respect the wishes of patients while protecting health-care providers. “We all have a right to our own views, but it’s dangerous to disregard those who don’t share the same perspectives,” said Doris Grinspun, CEO, Registered Nurses’ Association of Ontario. “We need to work together to ensure this process is respectful, and keeps the patient’s best interest and wishes at the forefront.”
The Canadian Medical Association has said doctors are divided on the issue.
“I have huge reservations if Canada goes down this path,” said Dr. John You, a researcher in end-of-life care at McMaster University and Hamilton General Hospital. “You have to make sure they’ve had access to optimal palliative care … that is not the case across the country.”
In disparity, Turnbull who treats and researches amyotrophic lateral sclerosis (ALS) — the disease that one of the appellants in the case had — feels the ruling will give patients psychological comfort.
“Knowing they have a right to control their destiny is very powerful to people,” he said. “In a disease like ALS, it’s nice to be able to control what is going to happen.”
Medical ethicists are also split on what the decision means for the country.
Margaret Somerville, director of the Centre for Medicine, Ethics and Law at McGill University said that “It’s a disaster for Canada, Canada has fallen over the edge of the abyss in legalizing the intentional infliction of death on our most vulnerable citizens — those who are old, frail, disabled, depressed, mentally, physically, or terminally ill.”
She called it a slippery slope that will result in the death of those whose lives are determined to be “not worth living.”
“This is not an incremental change, but a seismic shift in one of our most important foundational values — respect for human life at both the individual and societal levels,” she said. “I believe that future generations will look back on this decision, in the light of its future consequences, as the most important, harmful and regrettable ethical, legal and public policy decisions of the 21st century.”
Parliament now has following options:
A federal government could invoke the Constitution’s little-used escape or override clause that allows governments to legislate “notwithstanding” basic rights in the Charter.
It could enact a new law laying out a scheme for physician-assisted suicides — setting out guidelines for determining consent, as Quebec has done.
It could decide not to draft a new law, allowing the ruling to stand as an expression of principles and leave details up to provinces or medical regulatory bodies and authorities to oversee.