Assisted Suicide: Canadian Perspectives

PREFACE

PREFACE In August of 1992,1drove out to an unassuming suburban house on the Saanich Peninsula north of Victoria. A tall, attractive woman, age 42, met me at the door. Except for a slightly unsteady gait and hint of a quaver in her voice, she seemed outwardly healthy; but she was dying. Her name was Sue Rodriguez and she had decided that summer to challenge the lawthat prohibited assisted suicide. I was the first journalist to interview her. We sat in the dappled shade of her backyard and talked about life and her approaching death from amyotrophic lateral sclerosis. As a mother with young children myself, it was impossible not to identify with her struggle . It was impossible not to ask: What would I want if I were in her situation? Sue's determined battle to have an assisted suicide eventually captivated a nation and put a personal face on what had been largely a conceptual issue. It forced our society to begin looking at whether we can safely give an individual the right to ask for help in death without endangering the lives of others . Her situation wasbyno means an isolated one, but her decision to challenge the most powerful institutions in our land—the medical establishment, the government and the law—was almost mythic in proportions. Here was an ill and dying David taking on society'sGoliaths. XV ASSISTED SUICIDE: CANADIAN PERSPECTIVES Her fight, coinciding as it did with Dr. Jack Kevorkian's increasing activities in the United States, with referendums for assisted suicide in Oregon and Washington, with the first scientific studies on assisted deaths out of the Netherlands, built a momentum that will keep this issue on the forefront of medical , legal and societal concerns for decades to come. And make no mistake—the questions of when we die and how our death occurs will inevitably become larger as years go by. There are five distinct trends pushing the growing debate over managed death: a rapidly aging population, an increase in patient autonomy and corresponding decline in medical paternalism, a growing disillusionment with medical management at the end of life, a century-long rise in individualism and a decline in religious belief. All these forces are coming together and will determine whether we, as a society, are able to allow choices in death to become an even more dominant conundrum in the future. First, however, to deal with these issues, weneed to be able to talk about them. The essays collected in this book will help in defining the territory for discussion. It is a vast landscape that is impossible to cover in a single volume. Law, medicine, ethics, religion, philosophy, sociology, psychology, history, public opinion and public policy all play a role in whether individuals should be allowed to ask someone else to help them die. In this collection we are fortunate to be able to look at the issues through the experience and reasoning of clinicians, legal experts, philosophers and ethicists. One of the more unique contributions in this book is the annotated bibliography of all the major articles on assisted suicide and euthanasia that appeared in three prominent newspapers over the last decade .l To read it is to witness firsthand a time-lapse picture of an issue in evolution. In the years ahead, some of the debate over managed death will be illuminated by the experiences in a few pioneering jurisdictions. For 20years, the Netherlands has been leading the experiment. Now Oregon and Australia's Northern Territories will offer other examplesabout whether choices in XVI PREFACE death can be safely managed and controlled without putting the lives of vulnerable people at risk and without changing society in ways the majority regrets. The challenge for social scientists will be to assess these unique situations fairly, and honestly, without the blinkers of ideology. As the Netherlands has shown, those looking for evidence of abuse will find it and those looking for confirmation that the policy is workingbeautifully will find it, too. Asajournalist who studied the Netherlands in depth, I found the truth lies somewhere in-between. The elderly are not afraid. Pain control and care ofthe dying can rival any Western nation and a wide range of choices, including British-style palliative care, are increasingly available. Yet two national studies have shown the guidelines for assisted death sometimes are not strictly followed and some doctors, out of the paternalistic belief they know...