Humans are notably inconsistent beings, which may account for the contradictory attitudes we currently see to the phenomenon of suicide. On the one hand, every effort is made to prevent people taking their own lives; there are safety barriers on bridges, crisis hotlines, suicide prevention programmes in schools. At the same time there are organised campaigns for assisted suicide and other forms of euthanasia to be sanctioned by law.
According to euthanasia advocates, we have the right to end our lives, and as autonomous individuals, each one should choose whether to live or die. There are people, it's true, who think that autonomy and choice are too good to be wasted on just anyone. Someone commenting on a National Post blog recently insisted that "a 90 year old suffering dementia who is also blind, deaf and unable to walk is no longer a person." The implication is that the infirm can have the time of their death chosen for them- by someone else of course.
Yet autonomy and choice do lend respectability to the pro-suicide campaign because, when not used as mere buzz words, they are truly signs of the rational spark that differentiates us from our pet birds and rabbits. Autonomy, however, is only part of the human story. No man is an island, and, as part of the universal human family, both the way we choose to live and the way we die does have an impact on others.
This is never truer than in the case of suicide. Across the globe, daily, the suicidal jump off bridges. Overcome by depression or despair, they are as oblivious to the impact their actions will have on their families as on perfect strangers; anyone unfortunate enough to witness such a fall will likely never again look up at a bridge deck in the same indifferent way. Thus, although suicide has been practiced from time immemorial, we still do our best to prevent it; no one in their right mind would say that because "it happens anyway" we should encourage desperate people to end their lives in as humane a manner as possible.
Paradoxically, promoters of socially sanctioned assisted suicide or euthanasia use the "it happens anyway" argument to push a huge social experiment: bringing the moment of death under individual and/or medical control. At the same time they are sending mixed messages to would-be jumpers. One could argue that suicidal persons are usually healthy in every other way, and that they should not be compared to those who are on their last legs, or those suffering unbearable chronic pain. And yet, are they not all equally calling out for help?
Sadly, in their campaign to eliminate dying, instant-death peddlers like Australia's Dr Philip Nitschke pretend that the best help we can give the needy is a shot of Nembutal. Though he claims to fight for the right to "choose", nowhere in his handbook does he speak of the palliative care option for the dying.
In Quebec, where a government committee is currently hearing submissions on assisted suicide, the president of the Right to Die with Dignity Association even complains that "the debate is being sidetracked by calls for better palliative care, more hospital beds and better pain management." Helene Bolduc is "surprised by the opposition to euthanasia from doctors working in palliative care."
In fact, experts in that field are now saying that pain management has been inadequate worldwide and needs to be addressed.
The First International Pain Summit was held in Montreal this year. There, delegates drew up the "Declaration that Access to Pain Management is a Fundamental Human Right". The Montreal Declaration focuses on advocacy and assistance for the development of pain strategies worldwide, and Australian anesthesiologist Michael Cousins, who helped draft the declaration, said that inadequate pain relief is the third most costly health problem in all industrial countries.
Here is the professional and ethical answer to the cry for help from those with a terminal illness or chronic pain: to kill the pain, not the sufferer. Dr Pippa Hawley, pain management specialist at the British Columbia Cancer Agency and director of the University of British Columbia Division of Palliative Care strongly agrees. Not only is she convinced that in the vast majority of cases pain can be managed, she also knows from experience that we have all the technological armament at our disposal to provide relief without resorting to killing our patients. Her fear is that a move towards euthanasia and physician assisted suicide will detract from furthering the development of quality palliative care.
But, as we have seen from the comment quoted above about the 90-year-old suffering dementia, pain is not the only -- or perhaps even the main -- issue in this critical debate. The issue is really who "we" think is worthy to continue living: we, the healthy, who do not want to be burdened with a dependent relative, we who perhaps stand to gain an inheritance from their demise, we professionals who, trained in utilitarian ethics, see dying as a waste of public resources.
Blood-curdling comments have been posted on the Canadian Healthcare Network by healthcare professionals who believe the needy are a burden to society. As one bluntly put it … "most of the [dying] patients are just Debts to government and society and if they want assisted suicide I mean why not??" Or as another put it…. our health care system is VERY taxed right now. Why not just fast track death like we do everything else? PROVIDED all parties involved agree…It also gives everyone the opportunity to say good-bye -- just like our beloved pets."
Is this what we mean by "choice" -- making a national announcement to the chronically ill and dying that the decent and cost-effective thing to do is top yourself? And what about those who don't "agree"?
Dr. William Reichel is an affiliated scholar at the Center for Clinical Bioethics at Georgetown University School of Medicine, Washington, DC. He has studied assisted suicide and euthanasia since 1988, especially in the Netherlands, and disagrees that legalized euthanasia will allow Canadians (or anyone else) to remain "masters of their fate". While Dutch law calls for providing assisted-suicide and euthanasia with the patient's consent, "over time, assisted suicide on a strictly voluntary basis evolved into allowing euthanasia on an involuntary basis," he says. "Those who believe that legal assisted suicide and euthanasia will assure their 'choice' are naive."
Ah, but "we" can ensure there are strict conditions, can't we? Not according to Margaret Dore, an attorney in Washington State where assisted suicide has been legal since 2008. There, the supposed "strict conditions" of the law to protect patients appear to be a farce. In a recent letter to the Montreal Gazette, she called Washington a "Don't Ask, Don't Tell" state. Required official forms and reports do not ask about or report on whether the patient consented at the time of death. Consent at the time of death is also not required by the language of the act itself. Once again, and contrary to marketing rhetoric, she writes, patient "choice" is not assured.
When people are being killed without their own approval, choice turns out to be a lie. As with would-be suicides on the bridge deck, a gaping chasm awaits those who would be masters of their fate, only in the end, the choice may cease to be theirs.