Religion & Euthanasia - So how can we solve this dilemma?

Ok...we have spent a lot of time in this section of the blog talking about some of the dilemmas that can arise from mixing religion and euthanasia. We have gotten a lot of comments regarding the subject and we want to take this opportunity to thank those who have commented thus far. For the most part, we have focused on how religion can conflict with the medical field regarding the types of treatments that are performed on patients. However, one of the comments that we have received on this topic really caught us off guard and it touched on how religion can actually build upon medical intervention.

To make a long story short, the comment was basically saying that religion is often used by individuals as a pillar of strength while receiving medical treatment. The person was saying that religion can help someone to overcome their fear or doubts about receiving medical treatment and that religion can be used to help the patient to have faith in the doctors and their abilities. This provided a very different perspective on the topic and it sort of seemed like this person was thinking outside of the box. So on one hand, it can seem like religion is in total conflict with the medical field, but on the other hand religion can act as an ally to the medical field. It’s just very interesting to see how people can take the same topic (religion & euthanasia) and come to the table with very different perspectives. This is why we have encouraged everyone to bring their comments to the table which is this blog. We enjoy seeing all of the different perspectives on the topic.

Anyways, the initial purpose of this blog entry was not talk about all of the comments that we have received (which we would if we could), but we wanted to take a moment to perhaps discuss a solution to this dilemma regarding religion and medical treatment. How can we solve the problem (if you view it that way) of people refusing potentially life-saving medical procedures because of their religious beliefs? We spent a lot of time brainstorming ideas on how we could solve this dilemma and after hours of deliberation this is what we came up with...........nothing! We aren’t really sure that you can do anything that isn’t currently being done to deal with the situation. The way it currently works is that if a patient does not want to receive a medical procedure, then the doctors must respect their wishes and leave the patient without treatment...even if it results in death. Trying to force a patient to receive any medical treatment would involve changing the basic right that a person has to decide what happens to their body. If someone was bold enough to try and legally abolish this right (for the sake of solving the religion/medical treatment dilemma) that every person has, it would have to involve them making a change to a document that all Canadians cling to dearly...The Charter of Rights and Freedoms. Anytime you talk about changing The Charter it can be a very sensitive subject for some and most people would never agree to make any sort of change to the document.

So how can we solve this dilemma? Is there any sort of solution to the issue? Would it be unethical to force someone to undergo a procedure on their body, even if it could save their life? Maybe we missed something and we are calling out to everyone reading to lend us their ideas on how we can approach this situation?

Religion & Euthanasia - Cases (Continued)

Ok...so for those who didn’t read our last blog on Religion & Euthanasia here is a quick recap of the case before we move on:

A 14 year old boy from Seattle who was diagnosed with leukemia in early November 2007 died at the end of that month after refusing a blood transfusion (citing religious beliefs-Jehovah’s Witness). The state took legal action and attempted to force the boy to have a blood transfusion, but the Supreme Court denied the motion and the boy died shortly thereafter. The judge felt that the boy was mature enough to make decisions regarding the type of medical treatment that he received and also felt that he was not being coerced by anyone in any sort of fashion. The judge also said that the boy knew he was basically giving himself a death sentence by refusing the blood transfusion.

Alright, so now that everyone is caught up...here is the new twist:
At the time the boy was residing with his Aunt in Seattle. His aunt had custody of him and she was also a Jehovah’s Witness. His birth parents however, were not Jehovah’s Witnesses and they wanted him to have the blood transfusion. They felt that his decision to refuse the blood transfusion was a result of his aunt influencing him and they even went to the hearing in an attempt to change the judge’s decision. Did the parents have a valid point? Should they of had a say in the medical treatment for their son?

What this case shows is how difficult these cases can get when you are talking about ‘children’ making decision regarding their medical treatment. Not all kids follow the same religion of their parents and it makes these cases so tough when there are differences in religious views. Depending on the location, you are usually considered an adult between 16 & 18 and your parents are basically in control of you until then....from a legal standpoint. So how come at 14 you can make major decisions regarding medical treatment? You would think that this type of privilege (or right depending on your viewpoint) would come when you are granted the rest of your major privileges like drinking, licence, etc. Now we’re not saying that the judge was right or wrong in this case, we just feel that the ruling may be a little incongruent with the other laws or rights that are given to kids once they pass a certain age. The issue of his parents being against the ruling is another issue.

First and foremost, they do not have custody of the boy so in the legal world their opinions would count for less when compared to the opinion of the aunt. However, they are still his birth parents and they probably cared for his well-being. Personally, I do not know how I would feel in this type of case. I’d probably be really upset that my child was allowed to make this type of life altering decision without my consent. For a parent that must be hard to have to sit by and watch as your child basically gives themself a death sentence. Thoughts??

Development of an Alternate Policy - Euthanasia in the Law

Based on concerns raised in our last blog entry regarding the alternate policies that have recently been developed surrounding euthanasia in Canada, we have developed our own set of recommendations. Using Bill C - 407 as a template we have created our own Bill regarding euthanasia in Canada.

Changes we did and did not make:

-Initially some of our group members wanted to ensure that all treatment options must have been tried in order to receive euthanasia. However, we did not include this option because it violated our freedom to consent to medical procedures and if it was enacted, the new policy would likely have been struck down as unconstitutional (Refer to previous post “Religion and Euthanasia - Intro” and "Religion and Euthanasia - Legislation")

-We have limited the practice of euthanasia solely to medical practitioners in order to prevent potential abuses of the system. The practice and execution (no pun intended) of euthanasia is highly complicated and many different issues are at stake. By making physicians the sole profession that can perform assisted suicide, we have helped to ensure that careful and educated consideration will be given to all issues at stake. This is an assumption on our part, but we believe it is a reasonable one.

- In our formulation of our new euthanasia policy we have also stipulated that the supervising medical practitioner must have been familiar with the case for at least 3 months. This helps to ensure that the medical practitioner is making informed and well balanced choices when he or she agrees to euthanize a patient. It also allows them a greater opportunity to perform their “due diligence” when assessing the patients request for assisted suicide. This familiarity with the patient hopefully means that they will be more aware of any external issues or pressures that may be influencing the patients decision.

It should also be noted that this particular guideline also limits “death tourism” to a large extent. It will make it very difficult for individuals outside the country to come to Canada to be euthanized. We would argue that Canadians are not interested in a “death tourism” industry and that this provision is in our best interests.

- The word lucid has also been more heavily defined in this amendment to the Canadian Criminal Code. Now someone's “lucidness” has to be determined by a registered psychologist or psychiatrist and their assessment must conform to the definition provided in the bill. The wording in the bill effectively allows the mental health professional involved the power to block approval for assisted suicide. This was determined to be a necessary concession to the possible psychological issues at stake in such an emotionally charged decision. (Refer to previous post on “Euthanasia and Depression”)

It is important to understand that this restricts eligibility for euthanasia to some extent for those who are suffering from mental anguish. However, due to the issues mentioned above this was a necessary sacrifice. This more conservative approach also makes it more likely that people will be more accepting of a bill surrounding euthanasia. (See previous post Assisted Suicide Eligibility Criteria - Some Thoughts)


- We have also stipulated that a hospital review board determine whether or not the assisted suicide conforms to the appropriate legal standards outlined by this amendment and we have given them the role of determining the most humane form of death for the patient. This allows the doctor who receives the euthanasia request some security and comfort, in that they know their actions have been verified by several other professionals who would support them should legal issues be raised during these proceedings.  

Although Canada is currently run out of a conservative government that does not mean we have to always think 'conservatively'. Canada is unique, and each individual in this country is unique as well; All with their own values, beliefs, and destinies.

Religion & Euthanasia - History of Important Cases (Part 2)

All of the cases that we have talked about to this point have involved adults making decision regarding the type of medical treatment that they receive but we would like to look at the topic from a different perspective.

What about children deciding the type of medical treatment that they receive? Part of the ‘Health Care Consent Act’ states that in order to decide on consent, a person must be ‘competent’ and know all of the risks going into the decision. This stipulation is not an issue when it comes to adults who are considered competent, but what about children. When are kids considered ‘able’ to decide on a major life decision such as the refusal of medical treatment? Generally, we are told that we reach adult between the ages of 16-21 and a lot of rights and privileges are given to us at this point. We can emancipate from our parents, drive a car, get into most clubs, drink legally, smoke, get married and even join the army. But when do we get to the point when we can refuse medical procedures without our parents consent.

Here is a case to consider (2007):
A 14 year old boy from Seattle was diagnosed with leukemia in early November of 2007. He began chemotherapy at a children’s hospital in the area but had to stop the treatments because his blood count was too low. The doctors wanted to give him a blood transfusion but the boy refused citing religious beliefs (Jehovah’s Witness). The case was taken to trial and the state tried to force the boy to take a blood transfusion. The case was heard at the Skagit County Superior Court and a judge ruled that the boy was within his rights to refuse the blood transfusion. The judge felt that the boy was mature, not being coerced and that he knew all of the risks involved with his decision. The judge also stated that the boy knew “he was basically giving himself a death sentence”. The boy died a few hours after the ruling from the court. Doctors stated that the boy would’ve had a 70% chance of surviving the next five years with the blood transfusion and other medical interventions and this also weighed into the court’s ruling.

Do you think this child was within his rights to make such a decision? Do you think he was too young to understand the consequences? What if this was your child making this decision.

Other aspects of this case will be looked at in our next entry...
-Information regarding the case taken from cbsnews.com

The World is Changing....

All over the world, hundreds and thousands of people are in coma’s, on life support, or suffering in pain in hospital beds. Recently, as in the last 10 years or so, there have been many stories published in international newspapers, about terminal ill people and the choices they make along with their family and religious advisors, on how their life should end.

It is interesting that these stories are travelling so fast, and from around the world. Most North American papers are publishing stories that have taken place in Europe or Australia, about an individual’s fight to die. Most recently, on November 13, 2008 in The Toronto Star, we see such a story.

This story was titled ‘Woman in Vegetative State Allowed to Die’ and is the story of a comatose woman in Rome, and her family’s struggle to give her what she wanted, a peaceful death…16 years ago.

“Courts, politicians and the Vatican have weighed in on the fate of Eluana Englaro, who fell into a vegetative state following a car accident in 1992, when she was 20. The Court of Cassation said it had rejected an appeal by prosecutors against a lower court ruling in July in favour of Beppino Englaro. The father had said his daughter visited a friend in a coma shortly before her accident and expressed the will to refuse treatment in the same situation.”

Italy does not allow a living will, and although a patient can refuse treatment, it has to be voiced directly from the patient. In this case, Eluana’s father was pleading to be her voice, and he tried very hard. Beppino Englaro had fought a decade-long court battle to disconnect his daughter's feeding tube.

Catholic and anti-euthanasia groups had protested the ruling. Conservative politicians reacted angrily to the ruling as well, saying that the courts had overstepped their bounds. Some had even voiced their opinions in comparing it to a death sentence.

This article was also compared to a separate American case as well. Throughout our entire blog we have presented many cases that touch on people’s will to choose their own destiny. We also see how the legal systems in each country/state, do not grant this freedom and there have been countless trials and appeals. The amount of money, time, pain and stress that go into making personal choices has been outstanding.
There are so many levels, sides and perspectives in discussing euthanasia. There are several situations where one would see it as appropriate or inappropriate. It’s hard to generalize the issue of euthanasia, and so it is important to see it as a personal choice, in a personal circumstance.

Washington & Oregon Laws...

As proud Canadians, let us look over to the United States. In 1994, voters in Oregon legalized euthanasia under limited conditions. Under the Death With Dignity law, a person who sought physician-assisted suicide would have to meet certain criteria:
• The person must be terminally ill.
• The person must have six months or less to live.
• The person must make two oral requests for assistance in dying.
• The person must make one written request for assistance in dying.
• The person must convince two physicians that he or she is sincere and not acting on a whim, and that the decision is voluntary.
• The person must not have been influenced by depression.
• The person must be informed of "the feasible alternatives," including, but not limited to, comfort care, hospice care, and pain control.
• The person must wait for 15 days.

Under the proposed law, a person who met all requirements could receive a prescription of a barbiturate that would be sufficient to cause death. Physicians would be prohibited from inducing death by injection or carbon monoxide. (http://law.jrank.org/pages/6602/Euthanasia-Oregon-s-Euthanasia-Law.html)

Oregon was one of the first in the world to promote death with dignity, and one of the first jurisdictions in the world to permit some terminally ill patients to determine the time of their own death. In 1997, there was a ballot referred by the state legislator that sought to repeal the Death with Dignity act, but it was rejected by 60% of voters.

Initiative 1000 (I-1000) was an adopted ballot measure dealing with aid in dying that was passed in the US state of Washington in the November 4, 2008 general election. The effort was started by former Governor Booth Gardner.
The measure was approved in the November 4, 2008 general election. 57.84% votes were cast in favor, 42.16% votes were against. (Washington Secretary of State – statistics website)

"This measure would permit terminally ill, competent, adult Washington residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician. The measure requires two oral and one written request, two physicians to diagnose the patient and determine the patient is competent, a waiting period, and physician verification of an informed patient decision. Physicians, patients and others acting in good faith compliance would have criminal and civil immunity."
Provisions in the law include:
• The patient must be an adult (18 or over) resident of the state of Washington
• The patient must be mentally competent, verified by two physicians (or referred to a mental health evaluation)
• The patient must be terminally ill with less than 6 months to live, verified by two physicians.
• The patient must make voluntary requests, without coercion, verified by two physicians
• The patient must be informed of all other options including palliative and hospice care
• There is a 15 day waiting period between the first oral request and a written request
• There is a 48 hour waiting period between the written request and the writing of the prescription
• The written request must be signed by two independent witnesses, at least one of whom is not related to the patient or employed by the health care facility
• The patient is encouraged to discuss with family (not required because of confidentiality laws)
• The patient may change their mind at any time and rescind the request
("Initiative Measure 1000 "The Washington Death with Dignity Act"". Secretary of State of Washington (2008-01-24).)

This past November, this law went into affect. The people that were against it included the Coalition Against Assisted Suicide and other ‘Pro-Life’ groups. However, there were many groups that encouraged the law, most of which stemmed from different long-term illness support groups, as well as the Washington Chapter of the National Association of Social Workers. We’re so curious to see, which country or state will be next…

Euthanasia & Depression

We’ve noticed lately that the blog has taken on somewhat of a pro-euthanasia vibe and in an attempt to give equal play to both sides of the debate. We feel it is important to discuss one of the major arguments against its legalization. As the title foreshadows, this argument centers around the mental health of those who seek assisted suicide and euthanasia.

If someone who is terminally ill, or is paralyzed from the neck down in an accident requests for someone to help them die, it is automatically attributed to their illness or disability. When a healthy, non-disabled person attempts suicide, it is seen as a cry for help, a sign that they require psychological assistance. Is it possible that the ill and disabled who wish to die are also crying out for help in the same manner and that society is too preoccupied with what they already “know” to get them the help they need?

We don’t need to tell you that once a person is euthanized there is no going back, the process cannot be undone and life cannot be restored. This is relevant because recent research argues that many who seek euthanasia suffer from mental illness and might chose to reverse their decisions if they were to receive proper psychological treatment.

Under the Death with Dignity Act in Oregon, only those with terminal illnesses can apply for aid. The policy also specifically states that candidates can’t be suffering from any impairment. Although it is not specifically expressed in the policy, I would tend to believe that suffering from a mental illness such as depression would cloud one’s judgment and leave them impaired. This stance would explain why In Oregon, doctors are required to refer patients applying for “death with dignity” to a psychiatrist if they appear to have a mental illness.

The above argument may seem to counteract the argument that euthanasia is killing those with depression considering the listed safeguards. However, a study conducted by researchers at Oregon University found that as many as 25% of those successfully taking advantage of Oregon’s Death with Dignity Act meet the standards for clinical depression and are never referred to a psychiatrist. Although doctors are intelligent people they lack the specific training to recognize the signs of depression or other mental illness in just a single appointment.

A similar study conducted in Oregon found that 28 out of the 58 person sample who ended their lives under the Death with Dignity Act met the criteria for a mental illness (15 depression, 13 anxiety). Of these 28, none were referred to a psychiatrist by their doctor before they were supplied with the necessary materials to kill themselves.

A Canadian study found results supporting the argument that many euthanasia seekers are suffering from depression. Two hundred terminally ill patients were interviewed and 59% of those wishing to die were depressed, compared to only 8% of those not interested in hastening their death.

All of this is interest but it raises a very important question, if treated for mental illness, would their spirits and hopefulness improve to the point where they would no longer desire death? Well the same Canadian study reported that that when re-interviewed two weeks later after receiving psychology treatment, 4 out of every 6 patients who had previously wanted to die, had changed their minds.

A second major point of contention in this topic, is whether or not depression truly impairs mental competence. Some people may argue that it does not cause psychosis or severe disruption of brain functioning. However, it has been shown to clearly impact mood in a negative manner and has been linked to low self-esteem, feelings of self-blame and worthlessness, and feelings of hopelessness which is the primary trigger for suicides.

Lastly, I will point out one common sense argument that make every argument I’ve just made seem kind of silly. Then there are the realists who point out that depression is to be expected from this population, these people are dying after all. When viewed from a common sense perspective, it only seems rational that most terminally ill people who apply for euthanasia services would meet the criteria for a diagnosis of depression. As one author puts it, “you’re dying and you’re in pain, but you’re too depressed for assistance”. Seems kind of silly doesn’t it?

There is no right and wrong when it comes to this topic, but both sides can present formidable arguments as seen above. Feel free to comment and let me know how you view the issue and as always no judgments, just good discussion :)

http://www.portlandtribune.com/news/story.php?story_id=122342291083984500

http://www.nrlc.org/euthanasia/asisuid1.html

http://www.hospicecare.com/Ethics/RWethics1.htm

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?

Religion & Euthanasia - Judaism

In our past entries we have look at religions such as Jehovah’s Witnesses and Christian Science and there stances on certain medical procedures, but we would like to switch gears for a bit. More specifically we’d like to take a look at the Jewish perspective on the subject.

Before we do though, something just occurred to us. Now when we talked about Jehovah’s Witnesses and Christian Science we focused on the refusal of medical procedures due to religious beliefs. According to the official euthanasia website, the differentiation between this type of behaviour and passive euthanasia is the ‘intent to kill’. But what if the patient does not know that they are basically killing themself. For example (I will use the refusal of blood transfusions as my example), what if a patient refuses a blood transfusion for a major surgery and the doctor knows that the person will die if they do so? What if the doctor tells the patient that they are basically committing suicide by refusing the blood transfusion for the major surgery? When does it start to count as euthanasia? Actually, can you imagine what type of dilemma this would cause for a doctor, in a patient role, who was also a Jehovah’s Witness? They would have to choose between their religious background and their medical background. On the one hand, they would have their faith that they believe in and moral rules that they have been living by for an extended period of time. On the other hand, they would have all of their medical knowledge that would be based on statistical fact. That is a moral dilemma that I would not want and one that I am glad I don’t have to deal with. But I digress.

Anyways, to get back on track, let’s talk a little bit about euthanasia and the Jewish perspective. Jewish Law has very strict rules regarding euthanasia. In Judaism, murder is one of the 3 cardinal sins and it can take 2 forms. The first type is to the detriment of the victim and the second type is to the benefit of the victim (the exact purpose of euthanasia). So even if euthanasia is done to help the patient, it is still considered murder according to Jewish Law.

The Jewish believe that all life was given by God and only he has the right to remove it. To draw on a quote from Jewish teachings, “He who closes the eyes of a dying person while the soul is departing is a murderer”. That’s a pretty clear cut statement. If I assist in someone’s death, regardless of reason, I am considered a murderer. Pretty straight forward...well almost.

Certain activities are still allowed under Jewish law, but it depends on how it is done. For example, if an individual wants to refrain from putting in a feeding tube, that is allowed to a certain degree. However, once that tube is already in the patient, it cannot be removed for the purpose of killing the client. Guess it all comes down to semantics and interpretation.

All religions have their views in terms of what is right and what is wrong. It is just up to each individual to determine what practices they will follow and what practices they will not. It is definitely clear though that the institution of religion can complicate medical practice. More cases regarding refusal of medical procedures to come in the next blog on religion.

Re-cap on our blog...

Here’s a re-cap for those of you just tuning in…

This is a blog we have created to discuss the different legal, health, religious, and ethical issues related to euthanasia. Although euthanasia continues to be illegal in most countries, it is constantly up for debate.

We began by explaining how the legal standing came to be. We discussed the different cases that were used as examples for future judgements. Along with those cases we explored more personal impacts that those individuals had on society and the euthanasia campaign. We mention the different choices that were made and how they were received by the public, if they were socially accepted or not.

Our discussion on abortion was very interesting. We received many comments expressing concerns on the comparison of abortion and euthanasia. Although we have cleared up the fact that we were comparing them based on the idea of ‘choice’, we were pleased that you showed interest and shared your thoughts. When is comes down to it, how do you determine what should be a law? And why is there no consistency with the idea of ‘choice’?

We have offered you facts and the history of euthanasia throughout the world, and hope that helped to give you an idea of the different progressions that took place. We also examined the different religious perspectives, and how each religion may differ or resemble another’s belief when it comes to euthanasia and assisted suicide.

We have brought you political statistics, and many case studies and personal stories that will help you understand different perspectives and in some cases, different motives. Recently we discussed Bill C – 407, which is the most recent Bill in Canada. We hope that you have read those entries and become familiar with the present Canadian policies.

Also, we will be posting more on the health care side of euthanasia and delve deeper into the moral and ethical predicaments. Please continue to comment on any and all entries that have sparked an interest, and we are always open to your feedback :)

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!

http://www.hospicecare.com/Ethics/RWethics1.htm
http://www.portlandtribune.com/news/story.php?story_id=122342291083984500
http://www.medscape.com/viewarticle/557817