Sunday, November 16, 2008

Suggestions For Alternate Policies - Euthanasia in the Law

The need for an alternate policy regarding euthanasia in Canada is clear. Euthanasia whether we care to acknowledge it or not, still occurs. For many physicians this represents a fundamental dilemma they face in practice and due to the nature of the law they are essentially cut off from any sort of outside debate or expertise. They can even be isolated from the family of their patient in this decision, due to the legal liabilities that accompany euthanasia. This debate needs to be brought out into the open. We need to know about and acknowledge cases of euthanasia, not just the active instances, but also cases of passive euthanasia. Only by decriminalizing it and establishing clear limits for what constitutes abuse of euthanasia can we bring this issue out in the open and have an honest debate around its merits and deficiencies. The current legal system does not allow for this and thus we as Canadians must propose alternate policies to ameliorate this situation.

In a previous blog, we began to discuss Bill C - 407, which was introduced by the Bloc, a potential ally for policy change. Bill C - 407 was the most recent of a string of attempts to amend the Canadian Criminal Code to decriminalize assisted suicide, as long as it was documented and the correct procedures were followed. However, as noted in the entry, there were several problems with the bill. The chief one was that the language of the bill was vague, and the procedures were ill considered. This being said, if these problems were addressed in the bill, the revamped version may serve as a good alternate policy.

These are the issues that need to be addressed in the bill (some of which were covered in the last entry on Bill C - 407):

Who qualifies for euthanasia? This issue has been raised in several posts so far, and is addressed in Bill C - 407 to some extent, however, the eligibility was rather broad. Anyone who had refused appropriate medical treatment to alleviate their suffering was eligible for assisted suicide. This particular position is rather controversial for many Canadians. Many Canadians find this to be rather repugnant and do not condone the killing of individuals who have refused such treatment. This particular point builds on a previous post regarding different countries policies for eligibility for euthanasia and the varying levels of support for those policies. To realistically pass a euthanasia bill in Canada we must consider the varying opinions on eligibility and try to come to some sort of consensus. I believe that the more restrictive policy would be more acceptable to the majority of Canadians.

The issue of consent has not been extensively covered in the bill either. How do we define who is eligible to give consent? The bill stipulates that anyone “lucid” should be able to give consent. However, there were no significant procedures in place to define how we might determine who is “lucid” and who is not. In the legislation enacted in the Netherlands this issue was covered more extensively. As part of the request process an individual is required to undergo extensive psychiatric assessment to determine their level of suffering along with their psychological state. Obviously should any issues arise that may compromise the ability to give consent, the process is put on hold and the relevant issues are examined.

Additionally, according to Bill C - 407, someone could request and obtain euthanasia within approximately two weeks (theoretically, how this would have played out in practice is up for debate). This issue raised much concern from many interests groups in Canada, because the timeline seemed rather rushed. In the Netherlands, the relationship between the consulting physician and the patient requesting suicide has to be rather substantial and reasonably long term. The supervising physician must be extremely familiar with the case, and have had extensive contact with the patient, so that they are completely aware of the situation the patient faces and can make an informed judgement.

Bill C - 407 also stipulates that anyone so long as they are supervised by a “medical professional” can help an individual euthanize themselves. Additionally, they leave the definition of medical professional to the provinces to decide. For many advocates of the anti-euthanasia movement this leaves the impression that euthanasia is an unregulated medical practice because literally anyone can do it. While this may not be an accurate impression, it should be addressed in order for the policy to appear workable to the public.

Ironically, the bill also did not mention anything about the methods with which euthanasia should take place. What is the acceptable method with which we can kill someone (a rather controversial question)? Is suffocating someone to death an acceptable way to commit euthanasia? As far fetched as this sounds, many people believe that we should define every aspect of euthanasia, to protect others from its misuse and abuse. After all the word euthanasia (as I am sure we have mentioned) means “good death” and for many people an essential part of a good death is the method by which you were killed.

This is an extremely complex issue and these are just a few of the issues that we need to address in an alternate policy for euthanasia. There are several more issues that will be considered in future posts and we encourage readers should they think of any more to comment and tell us. If you were voting for a bill allowing assisted suicide, how would you want it to be conducted? Who would you allow to be euthanized? What possible issues could arise that might be reasonably prevented or at least addressed in this bill?

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