Assisted Dying: A medical student’s perspective
I would like to introduce you to June Duong, Meds ’19. It was a pleasure to invite her to write a guest blog to share her thoughts on assisted dying.
I first became aware of the debate surrounding assisted dying six years ago for a high school law course. The task was to choose a court case that went all the way up to the Supreme Court of Canada and provide arguments both for and against the decision made, while taking a personal stance on one side of the issue. Six years ago, there was no Kay Carter or Gloria Taylor. The case that I studied, analyzed, and wrote about was that of Sue Rodriguez in 1993.
Rodriguez was a 42-year-old woman suffering from amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. She challenged Criminal Code Section 241(b) which criminalized assisted dying. Rodriguez argued that it infringed on three sections of the Canadian Charter of Rights and Freedoms, making it unconstitutional. Section 7 of the Charter includes the rights to life, liberty, and security of person. Does Section 7 also include the right to choose how one ends their life? Who does this life belong to: myself or the state? Section 12 of the Charter ensures the freedom from cruel and unusual punishments. Is being forced to live out a menacing and degenerative illness a form of cruel and unusual punishment? Is our healthcare system inflicting this fate on our patients? And lastly, Section 15 of the Charter guarantees equality. With suicide having been decriminalized in Canada since 1972, does leaving Section 241(b) in place discriminate against those who are physically incapable of taking their own lives? Is having no assisted dying options for the physically disabled an acceptable safeguard? These were the questions that the Supreme Court faced and there was no easy answer, with the final decision coming down to a 5-4 split1.
The arguments against legalizing assisted dying gave me pause, as they should have and still do, but many countries have managed to legalize assisted dying successfully without any evidence of compromising the safety of vulnerable groups2,3. So it wasn’t like Canada was venturing into completely unchartered territories (no pun intended) because there was plenty of legislation that we could have turned to for help in writing our own. Ultimately, at 16-years-old, I sided with Rodriguez. I truly believed then, and I still do, in the importance of autonomy. Now that I am a physician-in-training, my understanding and appreciation for autonomy has only grown. As medical professionals, we are here to help the patient make their own decision, not make it for them. A lot of these decisions aren’t easy to swallow, such as a patient who refuses treatment. Aren’t we supposed to do everything we can to save a patient? Isn’t that what our profession is sworn to do? Maybe back when the medical field was still paternalistic was it acceptable for a doctor, the one who knows all and knows best, to impose their will on their patient. But now it would be wholly unacceptable. You are not saving the patient, you are condemning them to a life they did not want to live. We are not in this profession to make the easy choices, we are here to make the right choices.
On April 14, the government introduced Bill C-14 to address the Supreme Court ruling that Section 241(b) did indeed infringe on the rights and freedoms guaranteed by the Charter. This new ruling was quite simply a reflection of changing public opinion. In 2015, 77% of Canadians support assisted dying for those who are terminally ill, up 10% from just four years ago4. The Supreme Court had seen this case before: the Taylor case was a revival of Rodriguez’s. Canadian society wasn’t ready in 1993, but we are now. Lawmakers didn’t have a choice, the law must keep up with public opinion. And so must the healthcare profession else we let our patients down.
Dean Reznick already covered what the new legislation entails in his blog: https://meds.queensu.ca/blog/?p=3335. My personal opinion is that it is a good starting point for assisted dying legislation. If this bill were to pass, I am not confident that it will last long before another court challenge, maybe by a 17-year-old or maybe by someone with dementia who wants to leave an advanced directive. However, the reason why I think this is a reasonable bill is because of the circumstances surrounding it. The Supreme Court decision that knocked down Section 241(b) of the Criminal Code was made on February 6, 2015. The ruling would not come into effect for another year, giving Parliament some time to come up with legislation to regulate assisted dying. But during this time, there was a handover of power from the Conservatives to the Liberals, who were left with a very limited time window to come up with this bill. An extension was granted, giving the Liberals until June 6, 2016 for the new bill to pass. Conjuring up new legislation to regulate a very sensitive topic is not easy, and I think the Liberals did what they could. It was either play it safe in hopes of getting legislation in place by the deadline, or risk having the Criminal Code section knocked down with nothing in its place.
Physicians, right-to-die advocates, patients, and just about everybody else interested in this debate have been holding their breath since the Supreme Court decision. And I feel like some of us still are even after the bill was revealed. The narrow scope of the bill almost guarantees a challenge in the future, but as with every task that seems insurmountable, all we can do is take it one step at a time.
I hope that you enjoyed reading June’s perspective as much as I did. As always, I invite you to share your thoughts by commenting on the blog, or better yet, drop by the Macklem House…my door is always open.