Assisted Suicide: Canadian Perspectives

FOREWORD

FOREWORD Out here, in the rest of the world, we must greet the appearance of an "all-Canadian" volume on physician-assisted suicide with exceptional enthusiasm. It may be difficult to realize how important an all-Canadian contribution to the global discussion of assisted dyingis, if one just thinks of Canada as a chilly, spread-out land that disappears on the north into arctic tundra, on the west to the remote Pacific rim, on the east into internecine tensions over language-groups and on the remaining, southern edge to a long, tough border with a 900-pound gorilla of a neighboring country. But Canada is an exceptional country—on many indices, one of the best in the world—and it is this fact that makes this collection about physician -assisted suicide so important. To be sure, the fact that this collection is "all-Canadian" gives it particular relevance for a Canadian audience. Thevolume presents Canadian philosophers, Canadian physicians and Canadian legal theorists all talking with each other, among them some of the most distinguished voices in applied ethics that Canada—or the world—has to offer. There is a commonality of understanding in this volume; these authors understand Canada's urban and rural social patterns, its ethnic groupings, its economic conditions, its common-lawlegal structure and both the past and recent history and institutions IX ASSISTED SUICIDE: CANADIAN PERSPECTIVES of Canada's medical world: its regional health system, its history of nationalization, its arrangements for reimbursement and salaries for physicians, nurses and other health-care providers, and the structure of health insurance and coverage for all individual Canadians. One might think that these common understandings would limit the interest ofthis volume to Canadians only. But, on the contrary, it is precisely these common understandings among a group of Canadian thinkers discussing sensitive issues about physician-assisted suicide that make this volume so important for the rest ofthe world. For it is these matters— social histories, ethnic relationships, economic conditions, legal structures and the practices and institutions ofthe medical world—upon which manyof the contentions in such disputes, the practical premises, are based. The argument over assisted suicide is not a merely theoretical argument; it is a real-world argument, involving many factual, empirical claims. Everywhere in the world they are occurring, the disputes overphy-. sician-assisted suicide flare up as an argument between those who favor patient autonomy and personal choice, on the one hand, and those on the other hand who are concerned about the erosion of protections against killing and the so-called slippery slope. Ofcourse, there are other concerns as well, including the avoidance of pain, the mandates of religious principle and the integrity of the medical profession. But I think the root tension in these disputes is between support for selfdetermination on the one hand and fear of abuse on the other. These applied-ethics issues are not merely philosophical;they are conditioned by the practical environment in which they take place. It is precisely this that makes a Canadian discussion of these issues so important for an international audience. Canada is a country in which the practical conditions relevant to this dispute are, so to speak, at their best. Canada's English and French heritage gives it a legacy ofEnlightenment respect for self-determination.Canada's more recent tradition ofwelcomed immigration and renewed respect for indigenous X FOREWORD peoples has meant a tradition of respect for "minority" persons that is, while not perfect, as genuine as that anywhere in the world. Canada has a much greater degree of social and economic equality than many other countries, and hence is less subject to class-related tensions. Of course, Canada has problems over self-determination, particularly in friction over francophone secession in Quebec. But Canadian respect for self-determination, both for individuals and for an immense range of ethnic and racial groups, is still an admirable achievement, particularly when compared with the much greater degrees of racism and ethnic tension evident in many places in the world, including myown country, the 900-pound gorilla to Canada's south. Canada's health-care situation is also distinctive, and, again, among the best. Canada offers all its citizens acrossthe -board, government-provided access to health care. It is particularly noteworthy that Canada offers access to health care at the same level for all. Its system is a one-tiered system, offering the same coverage to all residents...