Monday, November 10, 2008

Assisted Suicide Eligibility Criteria - Some Thoughts

As mentioned in some of the previous posts, assisted suicide has no legal status in Canada. Of the many bills which have proposed the decriminalization of assisted suicide, none have been voted into legislation by the House of Commons. For the sake of debate, if Canada were to change their stance on assisted suicide, who would you feel ought to be eligible for the service and what established foreign policy would you hope to emulate? The answer may seem straightforward to many, but examination of the different criteria for assisted suicide in Oregon, the Netherlands, Belgium, and Switzerland reveal the issue to be fairly complex.

If I asked you to imagine the typical person who requests assistance in committing suicide, the majority you would most likely picture someone with a terminal illness. Perhaps, you’d envision someone with AIDS, cancer or Lou Gehrig’s Disease. This view is consistent with the assisted suicide legislation in Oregon, where only terminally ill patients (less than 6 months to live as diagnosed by two physicians) are eligible.

Although most readers think of the terminally ill first when considering those eligible for assisted suicide, perhaps a few pictured non-terminal cases of severe suffering such as Lupus, chronic pain disease, or a variety of neurological conditions (i.e. reflex sympathy dystrophy). Unlike in Oregon, where such people wouldn’t meet the criteria, in the Netherlands and Belgium, a person requesting assisted suicide does not have to have a terminal illness, they only have to be experiencing “lasting and unbearable” suffering which is “constant” and “cannot be alleviated”.

Essentially for a patient to receive suicide aid, they must undergo an exam from a physician who determines whether they meet the aforementioned criteria. Prior to receiving their fatal request, a second physician must agree with the original physician’s opinion. However, the issue of what constitutes unbearable suffering is still very much a grey area in the legislation and appears to be up to each individual physician’s discretion.

People meeting the criteria for unbearable suffering can include the terminally ill, but can also include those who could potentially live for many years with their non-fatal illnesses. However, these people seek the comfort and release of death as opposed to living for a prolonged amount of time with the suffering they see as unbearable.

I think it is safe to assume that when asked to consider who is an acceptable candidate for assisted suicide that no one considered the mentally ill, such as someone with depression. Well, under the extremely liberal policy of the Swiss Government, those with mental illnesses may soon be eligible for suicide aid. This is an idea I’ll get back to a little later, but first I’d like to take a more in-depth look at their current legislation.

Unlike the policies mentioned previously, Swiss law does not require a physician to be involved in the process at any time. Since assisted suicide is expressly forbidding in all Swiss hospitals, many facilities exist within the country for the sole purpose of providing assisted suicide. These facilities do no employ physicians because those seeking help in taking their own life do not require a physician’s approval prior to receiving their wish. Therefore, the person merely has to arrive at said facility and demonstrate that there is a legitimate reason in which they wish to die.

Once again, what constitutes a legitimate reason to end one’s own life is a grey area. However, under Swiss law, as long as the person assisting with the suicide can prove that their actions were not motivated by selfishness but were instead altruistic, than they are free of punishment under the penal code.

As a result of this policy, people are eligible to receive suicide aid as long as the person (can be anyone really) who assists them does so in what they believe to be their best interests. Therefore, nearly anyone who feels as if they would like to die is eligible for this service under Swiss law, this includes the terminally ill, those with painful non-terminal illnesses, and those with physical disabilities. As you can see, this policy appears to allows for the mentally ill to seek aid from such facilities if they wish to escape from the psychological turmoil they associate with their illness.

The first such instance occurred in 2005, when a manic depressive Dutch man who was unable to meet the criteria for assisted suicide in his homeland, travelled to Switzerland to end his life at one of these facilities. The man had a long history of depression which culminated in several suicide attempts. This man was simply tired of the strain and unhappiness in which he lived his life.

Fear of legal repercussions (psychological suffering being reason for this service was unheard of) prevented said facilities from helping the man. Eventually the highest court in Switzerland would rule that no distinction should exist between psychological and physical suffering and thus the man possessed equal rights under the law to receive assistance in ending his life. This case set a controversial precedent regarding mental illness and assisted suicide.

Although all the policies share the same goals (autonomy & alleviation of suffering), I suspect differences would exist in the level of support each would receive if enacted in Canada. Feel free to leave some feedback and voice which policy you would be most accommodating to and why. Love to hear from you!

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