Beyond the Debate: The Future of Physician Assisted Suicide

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By: Katherine Schwenger and Jonathon Chio

On February 6th, 2015, the Supreme Court of Canada struck down the law prohibiting physicians from helping a patient end his/her life. In response to this, the Institute of Medical Science hosted an event on June 19th, 2015, entitled, Beyond the Debate: The Future of Physician-Assisted Suicide. The objective of this discussion was to explore the impact of this ruling on Canadian health care system and society as a whole. Prior to the discussion, event attendees were asked to vote whether or not they believed the Canadian health care system (and society) were ready for physician-assisted suicide; 51% voted “yes” in support of this belief, while 49% believe that Canada was not yet ready. The moderator, Richard Minster, MD, JD, then opened the event by briefly discussing the medical, judicial, and social/ethical components behind the Supreme Court’s ruling. Dr. Minster then proceeded to introduce the four panellists: Jeff Blackmer, MD, Jean Echlin, RN, MScN, Kerry Bowman, PhD and James Downar, MDCM, MHSc. Audience members listened intently as the four panellists contemplated the future of physician-assisted suicide.

The Supreme Court of Canada was very enigmatic in their description of parameters governing physician-assisted suicide (PAS). Instead, the Court delegated this responsibility for doctors and legislatures. Dr. Downar indicated that while physicians support PAS, they view themselves as inadequate in determining patient qualification criteria for PAS and hence, detest to play such role. Jean Echlin strongly advocated for hospice and palliative care as attractive alternatives to PAS. While acknowledging that PAS allows the patient to maintain autonomy over his/her pain, it depletes them of hope. A common concern—and one that Ms. Echlin cited—was the slippery slope argument. Jean used this philosophical platform to highlight evidence of eventual legislative abuse in Belgium and Netherlands where PAS has already been legalized. Ms. Echlin expressed great concern that accepting PAS will coerce healthcare providers to devalue lives of terminal patients, ending them for socioeconomic purposes. Despite building a strong case for hospice and palliative care, her comments were met with considerable resistance from the other panellists. Statistics have demonstrated that while numerous patients often request both hospice care and PAS, many never receive PAS due to palliative interventions. As for the slippery slope concern, Dr. Downar and Dr. Blackmer cautiously suggested that data from other countries might not accurately reflect the conditions and values of Canadian healthcare and citizens respectively.

Divided in their opinion to accept PAS, they unanimously agreed that Canada was not ready to introduce assisted death options. The panelists focused on the issue of patient vulnerability; for which a strict definition and evaluation currently don’t exist. Socioeconomic factors complicate matters further, as those with greater income and higher education are less likely to request for PAS compared to someone with lower education, income, and living alone. When a governing board is asked to thoroughly and transparently review PAS cases on per patient basis, is safeguard of the patient worth the emotional burdens experienced by the board members? Once the rules have been determined, top-down alterations must follow to ensure that current and future generations of physicians are prepared.

At the end of the discussion, event attendees were asked to vote on the same question: do you believe that the Canadian health care system and society are ready for physician-assisted suicide. The results were shocking: only 28% voted “yes” to being ready, while 72% believed that we are not. What do you think? Are we ready?