Assisted Suicide: Canadian Perspectives

SIMPLY CALLING A TELEPHONE AN ELEPHANT WON'T DO

Sandra J. Taylor SIMPLY CALLING A TELEPHONE AN ELEPHANT WON'T DO Assisted suicide and euthanasia are "bad" words in the practical world of health care. If a practitioner allows that active aid-in-dying of the sort connoted by these terms ought to be allowed in certain circumstances, he or she is very often looked at by colleagues as being morally questionable. This is in part because assisted suicide and euthanasia are legally prohibited and therefore assumed to be morally wrong. As well, many major religions prohibit suicide, assisted suicide and euthanasia. The result has been twofold. First, there is a real reluctance to look at both sides of the debate concerning both the conceptual differences (or non-differences) between what clinicians do every day and what we perceive to be assisted suicide and euthanasia, and the moral discussion concerning the Tightness or wrongness of active aid-in-dying. Generally health care practitioners are not interested in the conceptual analysis that helps clarify motives, intentions and the definition of actions. And that is understandable. That is the job of the philosopher or other theoretician, not the clinician...or at least traditionally that has been the case. But, second, euthanasia and assisted suicide have, for historical reasons, acquired the connotation of moral wrongness. Health care providers, like most in society, set out to do what they believe to be right. Webelieve that giving increasing doses of sedation 61 ASSISTED SUICIDE: CANADIAN PERSPECTIVES to a terminally ill, suffering individual is right, whether or not she might die sooner because of it than she might have otherwise . To sedate and remove a competent person from the ventilator at his request is viewed as right because of our emphasis on respect for an individual's self-determination. But the vocabulary of assisted suicide and euthanasia cannot be used to describe these actions, because these actions are right and assisted suicide and euthanasia are wrong. Therefore , it is argued and assumed, whatever is going on cannot be assisted suicide and euthanasia. Medicalpractitioners will say that they are just withdrawing treatment to allow the underlying disease to take its course. Orthey will saythat the sedation they are giving a dying patient is to alleviate suffering, not to kill the patient. And the fact is, both statements are correct. However, that may not change the fact that assistance of this sort in the dying process may linguistically and conceptually fit the definition of assisted suicide and euthanasia. The moral conundrum then becomes whether or not some instances of assisted suicide and euthanasia may be morally right and if they may, why will we not allow a competent , terminally ill person, but one who is not attached to a machine, to have active assistance in dying. And if they may not, how do we justify helping people die by sedating them and removing them from ventilators or not putting feeding tubes in their stomachs when that is all that is keeping them from living for many months or years. And how do we justify not resuscitating a patient in the final stages of ALSwho has attempted suicide. For nearly a decade I have practiced as a clinical ethicist in a large acute care teaching hospital where much of my work has centered on end-of-life decision making. In this paper I would like to look at the common end-of-life practices in health care today. Are they fundamentally distinguishable from definitions of assisted suicide and euthanasia? Whereas it is not my intent in this short paper to answer this question definitively, I will suggest by examples that it is not obvious that there is a clear distinction between these practices and what we define as assisted suicide and euthanasia. It may be 62 SIMPLY CALLING A TELEPHONE AN ELEPHANT WONTDO that our ever increasing emphasis on both respect for selfdetermination and the technological suspension of death results in health care providers unwittingly being put into situations where they are participating in actions in which the law simply does not jibe with practice. When law is in place that seems counter to actions that are generally perceived to be right and that are done routinely, a dichotomy exists that requires a serious look. The fundamental questions are two. First, is there a basic and articulable difference between those actions believed by physicians and others to be right (withdrawingtreatment and increasing amounts of sedation) and...