The strongest case for legalization of euthanasia and assisted suicide is individual experiences of suffering, although this case is counteracted by the fact that suffering can be relieved by modern medical and palliative care techniques. The strongest case against is the effect on society of allowing doctors to kill. These were basic arguments put forward in the recent TVO The Agenda debate on euthanasia and assisted suicide prompted by the current bill, Bill C-384, before Parliament (for an in-depth analysis, visit the Euthanasia Prevention Coalition website.)

The individual cases recounted by the two proponents on legalizing euthanasia and assisted suicide, who spoke in the TVO debate, were heart-wrenching. Eric MacDonald, a director of Dying with Dignity Canada, spoke of his wife who had suffered from an aggressive form of multiple sclerosis causing her entire lower body to be paralyzed. Philosopher Sholom Glouberman, a founder of the Patients Association of Canada and an Adjunct Professor at McGill University, referred to the case of Jennifer Flowers, an Australian who had posted a plea on YouTube to be allowed legal access to the barbiturate Nembutal - she had had Crohn’s disease for years and was suffering from multiple cancers.

Why should such people not be allowed assistance in dying, even after having given much thought and consideration to their situations, both Mr. MacDonald and Prof. Glouberman asked. What is the difference between such people committing suicide and being helped to die?

Mr. MacDonald made an unsubstantiated claim that where euthanasia is permitted, palliative care improves, contrary to the experience of another panel member, Dr. Jose Pereira, a physician and professor of Palliative Care at the University of Ottawa. He had found exactly the opposite when working in Lausanne, Switzerland, where Mr. MacDonald’s wife had finally gone for euthanasia.

Prof. Glouberman stated that people should be allowed to make a rational decision to ask for help in dying after long and careful consideration. Dr. Margaret Somerville, Founding Director of the McGill Centre for Medicine, Ethics and Law, the Samuel Gale Professor of Law, and a Professor in the Faculty of Medicine at McGill University, countered this by saying that it is not a rational decision because it ignores the effect on wider society.

Relief from pain and suffering

Dr. Pereira’s arguments in opposition to legalization included the following points:

• Research among more than 200 patients receiving excellent palliative care showed that a majority would favour legalization but only five per cent would ask for it for themselves.
• In 85 per cent of cases, doctors can treat the pain and the medical conditions that people suffer from, including the pain and bowel obstruction that were leading Jennifer Flowers to seek assistance in suicide. The suffering of the other 15 per cent of cases can be reduced by use of palliative sedation therapy.
• Not enough is being done to train doctors in pain relief and palliative care.
• Morphine and other pain medications do not shorten life if properly administered.
• Patients in Lausanne changed their minds about requesting euthanasia or assisted suicide after they were given treatment for the conditions from which they were suffering.
• In a matter of weeks after assisted suicide services were launched at the Lausanne hospital, the palliative care unit was shut down and the palliative care doctors were reduced from two to one.
• When patients ask for death as relief from suffering or out of fear of lack of dignity or fear of being a burden to family, doctors need to talk with them to see how their fears and pain can better be relieved without resorting to death.

Fundamental change to society’s values

Dr. Somerville’s main argument was the effect on the medical and legal professions of legalising euthanasia. In answer to Prof. Glouberman’s question about suicide, she said that individual suicide is a private act, while assisted suicide makes society complicit in an act most people intuitively reject.

• The responsibility of the medical and legal professions is to protect life, but legalization of euthanasia and assisted suicide would change fundamental societal values to allow killing.
• With palliative sedation, the primary intention is to relieve suffering. In euthanasia the primary intention is to kill.
• Some ways of dying are ethical, some are not. Intention and cause make the difference.

In her experience and research, she has come to realize that people have a terror of dying. Those who seek euthanasia do so as a means of coping with this terror by taking control of death. There are better ways of addressing this terror, she said, such as palliative care.

She defined euthanasia starkly as injecting another person with a lethal poison. Both Mr. MacDonald and Prof. Glouberman rejected this definition, talking instead of “assistance in dying.” Prof. Somerville said that their avoidance of the definition displayed an intuitive rejection of the idea of euthanasia. Dr. Pereira protested that their definition of “assistance in dying” is confusing, because what he and his palliative care colleagues do is also to assist people in dying, not by causing the death but by reducing the suffering.

Prof. Glouberman called for better palliative care.

With reference to the current bill being debated in Parliament, Bill C-384 which would legalize euthanasia and assisted suicide, even Mr. MacDonald expressed concern over the safeguard in the bill regarding the competency of a person to make a decision on euthanasia or assisted-suicide based on “appearing to be lucid”, which does not assure that the person actually is lucid.

Far-reaching dangers 

Although the individual cases of suffering discussed by Mr. MacDonald and Prof. Glouberman were severe, such suffering can be relieved, Dr. Pereira said. He added warnings that:

• It has been seriously suggested in the UK and Australia that euthanasia will reduce health care costs.
• In Netherlands, euthanasia went from being allowed for only terminally ill severe cases to now being suggested for anyone over 70 who is tired of life.

 To legalize euthanasia and assisted suicide as a means of ending suffering would extending euthanasia far beyond the painfully terminally ill who are the focus of concern by Mr. MacDonald and Prof. Glouberman. It would have far-reaching and negative consequences for society as a whole, replacing care for some people with killing.

Jennifer Flowers obtained her Nembutal illegally, but never used it. She died, instead, of her disease.