The Controversy over the ‘Medical Assistance in Dying’ Legislation

The true societal cost of medical assistance in dying (MAD) may be the degradation of the value of the lives of our most vulnerable. Medically assisted dying is very controversial and has been debated over all around the world for years. In an environment of ever-rising medical costs, the question that comes to mind is whether legislation permitting medical assisted death was put in place to offset the high cost of treatment in keeping someone alive. MAD is morally and ethically wrong while pain can successfully be treated, and a cure could potentially be found. Secondly, it’s wrong because assisted suicide engages society in killing one of its own members, rather than being a private matter. Finally, MAD is wrong because vulnerable people who are living with chronic pain or terminal illness may feel societal pressure to accept that their lives are not valuable.  Fundamentally, I believe that assisted death is ethically and morally wrong on many levels and should not be allowed in our society.

 The topic of medically assisted dying is very relevant because on February 6, 2015, the Supreme Court of Canada put an end to the prohibition of MAD in a unanimous decision. On June 17, 2016, Bill C-14 formally legalized assisted dying by amending the Criminal Code of Canada. The physician or nurse practitioner can either directly administer the injection to cause death or the eligible person can be prescribed the deadly medication that they can take themselves (Government of Canada). Some people believe it is a virtuous way to put terminally ill patients out of their pain and misery in a humane and dignified way. Others believe it’s ethically and morally wrong. There is a great deal of rhetoric around the right of the individual to choose a dignified death, which appears on its face to be a noble thing for an advanced society to permit. However, I believe medically assisted death is wrong because there is too much at stake in letting that choice be prescribed as a universal right, especially where not so altruistic factors can influence the reason underlying such decisions.

MAD is wrong because pain can almost always be alleviated and in the meantime, a cure may be found. Many patients requesting MAD cite uncontrollable pain as a reason. However, incorporating optimal palliative services to the care of a person who is experiencing intolerable pain, facing an incurable illness would help to make a person’s suffering more tolerable. Pain relief is almost always possible with the advancement of analgesic options. With more palliative care available, perhaps fewer patients would be driven to seek assistance to end their life. A publication of the Linacare Quarterly states, “since pain can be alleviated, there is no basis to assert a need for physician assisted suicide (PAS) because of intractable pain. This may explain in part why many requests for PAS are no longer related to or initiated because of intolerable pain, but because of fear of such intolerable pain (Ely, Mitchell, Sulmasy, Travaline).” Surely a request for assisted death should not and must not be granted on the basis of the ‘fear’ of pain. We attribute permitting assisted death in cases where there is no cure, and therefore no hope for the chronically or terminally ill person to have a meaningful life. The law in Canada under Bill C-14, requires the person to make the decision while he or she has capacity to do so (Parliament of Canada), which in the case of certain types of illnesses such as Alzheimer’s, may mean making a decision too early and potentially prior to a medical intervention becoming available. Technological advances over the last 100 years, continues at a near vertical trajectory as compared to the prior history of mankind (Fogel). MAD should not be permitted because of anticipated pain or because there is no cure at the present time because pain can be managed, and while a person is made comfortable a cure could potentially be found.

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 Secondly, MAD is immoral because it is no longer a private matter and engages society in killing one of its own members. It is made to appear that assisted suicide is a personal decision of the individual requesting the right to die with dignity, however that is a simplistic notion and involves various members of society. We place our trust in physicians to heal us and make us more comfortable, and then our laws (through Bill C-14) ask any two doctors or a nurse practitioner to make a legal determination that there is nothing more that can be done for a person who is seeking assistance with death (Parliament of Canada). The prescribing doctor or nurse practitioner has to then interact with the pharmacist, who is required to dispense the drug, irrespective of his or her own moral or ethical views. Family and friends may also be involved in witnessing or actually participating in the act. This has the potential to psychologically traumatize anyone involved. Although there may be rare cases that may justify assisted suicide, these should be decided on a case by case basis, rather than legislating medical professionals to make this decision. This highlights a conflict in the medical profession between their duty to save lives versus being given the responsibility to end lives. According to a structured in-depth telephone survey of U.S. oncologists who reported participating in physician-assisted suicide, “nearly a quarter of the physicians regretted their actions. Another 16 percent reported that the emotional burden of participating in assisted suicide adversely affected their medical practice (Pies).” Apart from the potential psychological impact on such health care professionals as well as on family and friends, the danger is that the doctors, who are usually perceived as the purveyors of hope, instead become agents of death, which can undermine their integrity. By legislating the right to medically assisted death, we are making the decision a public event, involving and negatively affecting many members of society, which is ethically wrong to ask of its members.

Finally, we come to the most important reason why the practice of medically assisted death should be stopped. MAD is ethically wrong because vulnerable people who are living with extreme, chronic pain or terminally ill patients may feel increasing societal pressure to accept that their lives are not valuable and puts them at risk of being coerced into the decision to end their life. Human dignity is intrinsically tied to the value of a person, which is infinite, no matter how ill that person might be. Typically those impacted by painfully chronic and terminal illnesses are usually the elderly, disabled or mentally ill. The person who is already marginalized is under psychological pressure including depression, hopelessness and despair to make a decision that is not in their own self-interest (Anderson). The patient has to bear the burden of deciding whether their life is worth living, whereas society should be saying ‘all lives matter’. The terminally ill person may feel that they have become a burden to society and are therefore, of less value than a healthy, productive person. The Oregon Health Authority, in a State where assisted suicide has been legalized for some time, notes that 40 percent of those who were assisted with suicide cited being a burden on family or friends and caregivers as their motivation to end their lives (Oregon Public Health Division). Additionally, physicians who are asked to decide whether a person is a candidate for assisted death would likely be inclined to approve the suicide instead of expending medical resources (Finnis, 265). Eventually, as our society ages, the increasing cost of medical care for chronic illnesses will mean the more cost-effective option will be pushed on the person rather than going through a cycle of hospitalization.  The resulting impact to society will be that our most susceptible population may be pressured into making a decision to end their life because they feel they have no value, during a period of despair.

The ability for the dying person to have autonomy and be able to decide when and how they die in order to stop their suffering is one of the most important arguments put forward in support of assisted death. People in support of this argument maintain that when death is inevitable, the chronically or terminally ill person should be able to choose how and when they would end their life with dignity. They believe assisted suicide would give a person some sense of control in an otherwise out of control situation (Wiebe). This position argues that it is better to articulate your health care wishes, including when to die, rather than leave it to the whim of your caregivers. While this is a sympathetic argument, as who would not want to control their destiny if they had the opportunity, it is a far too simplistic approach. A blog written by Dying with Dignity Canada in favour of MAD stated “many of us think about dying in a vague way, hoping it will happen at home after a brief illness, without pain, surrounded by loving friends and family. In fact, most Canadians don’t die that way. Too many of us die in hospital, tethered to machines, tagged to receive CPR even if we don’t want it” (Dying with Dignity Canada).  This statement is emotional and untrue. A person has the right to provide their health care wishes to a family or friend under a Power of Attorney over Personal Care that may provide instructions to their doctor and health care providers to ‘Do Not Resuscitate’ so that no mechanical interventions are provided to prolong life. What is being advocated here is a step beyond because it changes the health care dynamic from ‘don’t touch me to save me’ to ‘end my life, because I want you to’. Although I can empathize with one’s wishes for autonomy and control, this should not justify purposely ending someone’s life.

 The right to decide when and how to die is a complex issue, and one where the courts may be better equipped to deal with on a one off basis, rather than through legislation. Many believe that the dying person should have autonomy and be able to decide when and how they will die with dignity. I disagree because as a society, we need to evolve to a point where we protect all of our most vulnerable. Society owes both a duty to protect life as well as a duty not to destroy or injure a person. The legislation of MAD is fundamentally wrong. It is unacceptable because pain can be alleviated and a cure could potentially be on the horizon. Secondly, MAD is immoral because it engages society in killing one of its own members, rather than being a solely private act. Most importantly, it should not be allowed because the most vulnerable may feel societal pressure to accept that their lives are not valuable and puts them at risk of being pressured to end their lives. We can’t let the high medical costs dictate whether we let someone take their own life to spare the financial burden on their families or society as a whole. In order to be a culture where true dignity and equality prevail, we need to concentrate on caring for those vulnerable persons who suffer, rather than legislating the right to die, where too many non-altruistic factors can influence such a critical decision.

Works Cited:

• Anderson, Ryan. “Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality.” The Heritage Foundation. March 24, 2015. Retrieved from: https://www.heritage.org/health-care-reform/report/always-care-never-kill-how-physician-assisted-suicide-endangers-the-weak
• Dying With Dignity Canada. “End of Life Planning Canada’s Patient Rights Booklet breaks down the end-of-life rights and options that exist for Canadians.” Patient Rights Booklet. Accessed on December 2, 2018, Retrieved from: www.dyingwithdignity.ca/patient_rights_booklet

         Ely, Wesley., Mitchell, Louise., Sulmasy, Daniel., Travaline, John. “Non- faith-based arguments against physician-assisted suicide and euthanasia.” The Linacare Quarterly. August 2016. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102187/

• Finnis, John. Human Rights and Common Good: Collected Essays Vol 3, Oxford University Press, May 7, 2011.
• Fogel, Robert. “Catching up with the Economy.” The American Economic Review. March 1999. Retrieved from: https://www.die-gdi.de/fileadmin/user_upload/pdfs/Messner_WS_2016/Fogel_Catching_up_with_the_economy.pdf
• Government of Canada. “Medical Assistance in Dying.” Innovation, Science and Economic Development Canada. October 26, 2018. Retrieved from: https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html
• Oregon Public Health Division. “Oregon’s Death with Dignity Act – 2014.” Retrieved from: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year17.pdf

         Parliament of Canada. “Bill C-14.” Statutes of Canada 2016. June 17, 2016. Retrieved from: http://www.parl.ca/DocumentViewer/en/42-1/bill/C-14/royal-assent

         Pies, Ronald. “How does assisting with suicide affect physicians?” The Conversation. January 7, 2018. Retrieved from: http://theconversation.com/how-does-assisting-with-suicide-affect-physicians-87570

         Wiebe, Ellen. “Canada’s example of assisted dying refutes those who argue against it.” The Economist. August 27, 2018. Retrieved from: https://www.economist.com/open-future/2018/08/27/canadas-example-of-assisted-dying-refutes-those-who-argue-against-it