When assisted suicide become banal

This article was published in the CMAJ blogs on November 24, 2015

Dr Rene Leiva

Dr Rene Leiva

By Dr Rene Leiva

I read with interest the CMAJ Editor in Chief’s latest editorial about protecting the right of physicians to conscientiously object to being party to physician hastened death. Principled medicine has dealt with suffering since Hippocratic tenets were first formulated about 2400 years ago. It is only in the last fifty years that causing death has been construed as ‘medical treatment’ for suffering, which I firmly believe to be erroneous. I’m disturbed to see that while Quebec is leading the country on euthanasia only a fraction of its population has access to palliative care. Palliative Care has been around for close to forty years, but Quebec's new law on ‘medical aid in dying’ expects to make that option available to 100 per cent of Quebecers in a matter of months.

In Belgium, hastened death has become part of the culture: despite having initially focused on the competent adult who is terminally ill, it has quickly moved into euthanasia for mental suffering and dementia, and for those tired of living, as well as children; it is commonly practiced by other health professionals such as nurses despite this being illegal. Medically assisted deaths have risen by 640% in Belgium since the law was adopted in 2002 and there are a significant number of deaths without consent as well as under reporting.

When I first met Tom Mortier through mutual acquaintances, he impressed upon me his concerns about the dangers of living in a society that embraces hastened death and shared the sad and tragic account of his mother’s euthanasia under the Belgian law. Her story was the focus of a recent article in the New Yorker and part of an Australian TV documentary. He often forwards me information on euthanasia cases and events that in a different culture or time would have been unthinkable: from the doctor who euthanized his mother leading an ‘educational trip’ to the Nazi camp Auschwitz to leaders in the field celebrating euthanasia as having ‘a life-intensifying and sacred dimension’.

Not all the founders of the hastened death movement have remained convinced they were doing the right thing. Ann Humphry, the late co-founder of the Hemlock Society, now Compassion and Choices, deeply regretted her actions. She was concerned that sick and vulnerable people might feel subtle pressures to relieve their families and friends of the emotional burdens of their lingering death. Is this unrealistic? Last year, a Canadian woman committed suicide while promoting the legalization of hastened death. Part of her manifesto stated that ‘I can live or vegetate for perhaps ten years in hospital at Canada’s expense, costing anywhere from $50,000 to $75,000 per year,” she said. “Nurses, who thought they were embarked on a career that had great meaning, find themselves perpetually changing my diapers and reporting on the physical changes of an empty husk. It is ludicrous, wasteful and unfair”. Is this the message we want to communicate about the value of our parents’ and grandparents’ lives as the end approaches?

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