On Monday, February 24th, a large crowd turned up to hear Dr Kerry Bowman and Dr Gary Rodin discuss the controversial issue of assisted suicide in Canada. They shared their background and experiences in dealing with palliative care patients, as well as general thoughts on the decriminalization of helping patients die. Should we have a right to die at the time of our own choosing? And if so, are we capable of enacting legislation with the necessary framework and regulatory oversight to protect the most vulnerable from abuse? Where do we draw the line in determine those we allow, and those we don’t?
Dr. Kerry Bowman began the evening’s discussion by giving a background of his time at Mount Sinai and his exposure to patient deaths. As a doctor, he was trained early on to distinguish between the act of killing versus letting a patient die. However, he is no longer convinced that boundaries are so clear cut. While cautious about jumping to conclusions on assisted suicide, Dr. Bowman believes the time has come to at least have a conversation on the subject and how legislation may be drafted, if we go down this road in the future. We can certainly look to Luxembourg, Switzerland and Belgium for guidance, but Canadians would need to find their own path on this topic, ensuring it respects our Canadian Charter of Human Rights. A necessary step will be soliciting health care workers’ views on the matter, as they are on the front line engaging with terminally ill and disabled patients every day. Specifically, he believes that the Supreme Court of Canada cannot rule on this issue without their guidance.
Dr. Gary Rodin spoke next, describing his experience in palliative care at the Princess Margaret Hospital. His view is that the topic of assisted suicide has become “popular” recently because it touches on an individual’s right to personal control over how someone lives their life, or chooses to end it. However, while a debate on whether we have a right to die is warranted, studies show that most people actually want to live as long as possible. Therefore what we should be focussing on is better palliative care for those with long term terminal illnesses instead of ending their lives. The medical community can treat pain, but it needs to improve in the way it engages with people who have a terminal illness and the resulting fear and despair they may be feeling. This is the starting point for where we should be focussing our attention and energy.
Ultimately, an individual’s wants and wishes fluctuate over time, and thoughts on assisted suicide may be transient and passing depending on an individual’s current state of mind. For most people, assisted suicide is a second or last resort. For the small subset of individuals who persistently and consistently want to end their lives, we should collectively as a society determine whether to allow that to happen. But this will be especially difficult for those working in the medical field, as they are the designated persons carrying out the task.
During the Q&A part of the evening, several audience members questioned our panellists for further thoughts on the subject. One audience member asked whether culturally we shared a fear of death and what role that played in our desire to decriminalize assisted suicide. Dr. Bowman acknowledged this thought and elaborated by saying that death used to be a social passage – until recently, when it has become more medical. There seems to be a fear of the medical system “taking over” once a terminal illness is diagnosed, and of people losing control and being at the mercy of an overbearing and intrusive healthcare system. Dr. Rodin agreed that death was terrifying, and that fear was prevalent when someone contemplated a slow death by illness. However, we can better deal with these fears by improving our palliative care towards patients and by being honest with them and providing them with the emotional support they need as they undergo this process. Aggressive medical treatment is not always the best approach.
Another audience member asked what we could do to improve palliative care in Canada and asked what kind of legislative oversight we would need if we decriminalized assisted suicide. Dr. Rodin reflected that palliative care used to have a lower ranking status within the healthcare system, lacking adequate funding. The United Nations has now declared palliative care to be a basic human right and the hope is that our senate in Canada will endorse that view through legislative action in the future. Dr. Bowman continued the conversation by saying that any legislation enacted on this subject would almost certainly have to include safeguards in place to ensure that anyone making a decision on assisted suicide was truly well and capable of doing so based on certainty of what they wanted. The problem, however, is whether we can really know ourselves at every stage of our life and therefore whether these types of conditions can ever be fulfilled.
Finally, an audience member asked about the role religion plays (if any) on an individual’s state of mind while in long term palliative care. Both Dr. Rodin and Dr. Bowman agreed that the answer varies depending on the person. Certain devoutly religious people are calm at the prospect of death because of their strong belief in the afterlife. Others start questioning their religion, becoming anxious at the prospect of death. Family member support also does not always guarantee a more tolerant state of mind when faced with death and dying. Many patients in palliative care react better with family support, though there are some who feel “detachment security” by going through the process of death alone.
It was clear by the atmosphere Monday evening that many people in the audience held a view on the subject of assisted suicide. For many, this topic generates strong reactions and beliefs in individuals’ right to self-autonomy and the ability to govern their lives and death in the way that they choose. Others do not feel that decriminalization is the right course of action to take. While there is no correct answer to the question of assisted suicide, it’s clear that further conversations on the subject need to take place and legislators must involve those in the medical profession. We look forward to future debates by informed and engaged Canadians.