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Podcast and Event Summary: New St Cross Special Ethics Seminar: Medically Assisted Dying in Canada: from where we’ve come; to where we’re heading, presented by Professor Arthur Schafer (Centre for Professional and Applied Ethics, University of Manitoba)

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Written by: Dr Amna Whiston

In this seminar (available on podcast), Professor Arthur Schafer discussed the ethical challenges involved in the Canadian euthanasia debate at the New St Cross Special Ethics Seminar (online). Professor Schafer, who has written extensively over the last thirty years about a range of topics that includes professional and bio-medical ethics, having been a long-standing proponent of the view that allowing people to die with dignity enriches our rights as humans, critically addressed the question of whether Canada is currently heading in the right direction regarding the legalization of medical assistance in dying.

Autonomy, as Professor Schafer reminds us, is one of the core Canadian values, and this is reflected through the public battle against the prohibition of assisted suicide.  Back in 1993, (Rodriguez v. British Columbia [Attorney General]), the majority of the Supreme Court of Canada urged that at that time there was no public consensus among Canadians that the autonomy interest of people wishing to end their lives is paramount to the state interest in protecting the lives of its citizens. In recent years, Canadian public opinion has undergone a significant shift in favour of the autonomy interest of irredeemably suffering patients who, with no hope of recovery, wish to end their lives with dignity. In June 2016 the Canadian Parliament passed a legislation bill legalizing medical assistance in dying, which has now become legally permissible in several American states (Oregon, Washington State and Montana) and in a number of European nations (the Netherlands, Belgium, Switzerland, and Luxemburg). Today more than two-thirds of Canadians support the new legislation which makes it legally permissible for doctors to help the terminally ill to end their lives. This fact, nonetheless, leaves open a more general question (beyond the Canada context) of whether constitutional rights should be settled by opinion poll.

One consideration is the question about the extent to which the public are adequately informed about issues such as health care. Evidently, people living in countries like Canada that have high-responsive health care systems are less opposed to assisted suicide and euthanasia. And yet we may wonder what a high-responsive health care system ought to entail. This brings us to a bold statement that Professor Schaffer makes about the position of medical staff including physicians. It is expected that countries with responsive health care systems will ease the potential fear that physicians will misuse euthanasia. But should physicians, as Professor Schafer seems to think, who for religious or any other ethical reasons wish to opt out from helping people die, be told that they should perhaps reconsider their career options? There is no easy answer to this question, although one ought to recognise that Canada’s experience illustrates how conscience protections could become very weak in the light of such circumstances. Indeed, the new circumstances, emerging from the Carter ruling, now place high burdens on physicians who refuse to participate so that those who refuse to offer help people to die face expulsion from the medical profession. It could be argued that physicians’ conscience protections are outweighed by the aim to provide equitable access to assisted suicide. But perhaps, and especially given the relatively small number of terminally ill patients who wish to be assisted in dying, the two aims need not conflict in a high-responsive health system. Also, given the view that euthanasia and assistant suicide are issues about which the society as a whole ought to decide, and given that physicians facilitate these practices, it does not seem fair that their voices should be discouraged. Also, there may be a range of options and opportunities for them to exercise their conscience when providing palliative care.

While both mercy killing and medically assisted suicide are now legal in Canada, Professor Schafer asks whether the safeguarding measures are too strict, and especially when compared to safeguarding for permanent tranquilizers. This seems like a legitimate question. Should people have to endure intolerable suffering for 90 days before their request is approved?

This question draws attention to a more basic, definitional, issues: how do we define intolerable suffering? How should we treat people’s choice to refuse the offered pain-relieving medication? In the Rodriguez v A-G of British Columbia (1993) case, as Professor Schafer illustrates, a patient with motor neuron disease wished to have in place a mechanism to self-termination of her life when she became paralysed. The court decided that State prohibitions that would force a painful death on a rational but incapacitated terminally ill person would be an afront to human dignity. Ms. Rodriguez did have access to excellent palliative care, but she wanted to live until she decided it was time to die, and she wanted to do it quickly and while she was still lucid. Palliative care can dull the pain and sedate one into unconsciousness, but it cannot give one control or choice – and that is what Ms. Rodriguez wanted. Being able to make an (informed) choice is, undeniably, an important ethical consideration.

Finally, another interesting and thought-provoking aspect of Professor Schafer’s analysis is the slippery slope argument. Some euthanasia opponents fear that the use of assisted suicide and voluntary euthanasia could eventually lead to involuntary euthanasia for persons deemed no longer valuable to society. Professor Schafer points out that not all slopes are slippery. And this is true, although as noted by one of the seminar participants, the trouble with slippery slopes is that once we are on it, it is too late. Such fears and concerns, it seems, are best countered by an appeal to rigorous set of safeguards that ought to be satisfied and maintained.


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