Assisted Suicide: Canadian Perspectives

INTRODUCTION. Nunc lento sonitu dicunt, morieris: (Now this bell tolling softly for another, says to me,Thou must die)

C. G. Prado INTRODUCTION Nunc lento sonitu dicunt, morieris (Now this bell tolling softly for another, says to me, Thou must die) A sea change is taking place in our attitude toward death. Death has come out of the closet. Moreaccurately, dying is being increasingly acknowledged as an integral part of human life, as was the norm prior to our century's hygienic isolation of death. Dyinghas ceased to be something fearfully unspoken and, in reversion to earlier times, involves the community both as an event and an issue. In particular, our attitude toward death has changed with the need for reflection and planning about how we die beyond the financial and funerary arrangements necessitated by death itself. A major cause of the change in attitude toward dying is the increasing capacity to sustain life by the application of technology . Medicine's new power to stretch out the time it takes to die forces historically novel decisions on people whose lives are ending. When it became possible to extend the process of dying, it became necessary to make decisions about when to stop doing so. Protraction of death prompted a good deal of thought about the wisdom of delaying the inevitable at great personal, familial and social cost and generated much talk about "dying with dignity" and "the right to die." As a consequence , many reject the protraction of dying beyond a point at which livingbecomes meresurvival. However, the protraction of dying is a highly technical process, and decisions to stop that process can't be enacted by 1 ASSISTED SUICIDE: CANADIAN PERSPECTIVES the patient alone. Enacting a decision to stop life's technological maintenance almost invariably involves the participation of those whose expert efforts pose the need for the decision in the first place. The result is that patients who choose not to have their lives technologically maintained, or to accelerate the deaths entailed by terminal illness, embroil their doctors in their decision. This practically inescapable embroilment produced the historically new idea of physician-assisted suicide , that is, the decision made by incapacitated individuals who are under medical care not to live under certain conditions , a decision that requires the help of their attending physicians to carry out the chosen course of action. However, for physicians to actively involve themselves in the deaths of patients in their care is to violate, or at least to challenge, professional principles and traditions, social trust and legal interdictions. Taking one's own life is still criminal in only a few places,1 but helping someone else to die is proscribed in most jurisdictions . Despite the decriminalization of suicide, assisting suicide is classed with performing euthanasia as forms of culpable homicide. Though judges and juries may ultimately temper the consequences of violating the proscription, in the first instance someone who assists in suicide is chargeable with murder or manslaughter. While this is the status quo with very few exceptions,2 special situations produced by the medical protraction of dyinghave made many accept the view that "managing"3 the deaths of terminal patients must be allowed . The result is that we've been debating for some time about decriminalizingthe helping to die of some who want to die and who have good reason to want to die. Unfortunately, the debate has grown in scope and intensity without making proportionate progress. Proponents of managed death think of the application of medical technologyas only postponing imminent death. Thus stopping the application of that technology is not seen as advancing death but as ceasing to prevent its "natural" occurrence . Delaying death is seen as gaining borrowed time, so ceasing to delay death isn't seen as killing, but as not continu2 INTRODUCTION ing to artificially maintain life when doing so becomes harmful . Hastening death in terminal illness is more contentious, but in both cases the position is essentially utilitarian. That is, life is considered renounceable if the interests of the individual are best served by avoiding pointless suffering. Against this, opponents see medical technology as having established a new temporal horizon for human life. They see patients as not only having a right to technologically gained time, but an obligation to avail themselves of that time. That right and that obligation are seen as following on life's unique and ultimate value. The possibility of preserving life is taken to entail its preservation, so for their part, physicians are perceived as obliged to employ the...