Wednesday, April 20, 2016

No Simple Solutions

Over the years, I have learned to be wary of those who promise simple solutions or argue issues within a black and white framework. People who embrace, for example, Donald Trump's promises to 'bring jobs back to America' without asking the key question, 'How?' are acting like those religious fundamentalists who accept The Bible as literal truth. Similarly, when a particularly contentious issue arises in public policy, to reflexively embrace or reject it based on personal values, beliefs or ideologies is to negate the crucial role that critical thinking must play in informed and effective policy formulation.

Such, I believe, is happening in the assisted-suicide legislation introduced by the Liberal government. It is, admittedly, very cautious and conservative legislation:

The government’s proposal is more restrictive than some proponents of legal assisted suicide had sought. It does not include provisions for minors who may be capable of making decisions about their own medical care to choose to end their lives, nor does it allow for people in the early stages of illnesses like dementia to request an assisted death while they are still competent.

As The Star's Tim Harper points out, this compromise legislation satisfies few:
It created a void that is rapidly being filled by progressives who are understandably upset that the rights of those suffering grievously from mental illness, mature minors, or those who wish to provide advance directives have not been respected in this legislation, providing two tiers of those who are eligible to die with dignity.

It also left enough holes in the legislation for conservative opponents, in this case, many of Canada’s churches, to exploit concerns from their perspective.
In other words, almost no one seems satisfied with the proposal as it stands, including many Liberal senators, who want a bill that grants far greater accessibility.

But I am satisfied with the bill as it now stands.

I have given the issue a lot of thought, and although my position is perhaps no more valid than that of others who have devoted similar time to considering the notion of assisted death, allow me to state my view, for whatever it is worth.

First, I am totally in favour of the right to choose death for those who have terminal conditions and are facing a great deal of suffering as their disease progresses. ALS is one of the cruel diseases that comes to mind. Without any effective treatment or symptomatic relief, its terminal stages are terrible to even contemplate.

That said, I am also in favour of the very cautious approach evident in the proposed legislation. I have surprised myself by also being in agreement at this point not to allow those in the early stages of dementia to request assisted suicide after their disease has progressed.

This position, which I have come to after much thought, is not the one I thought I would hold.

I suspect that the majority of us fear dementia more than almost anything else. I certainly do, and for a long time I agreed with the notion that it would be good to be able to prearrange one's exit from a hopeless situation. However, two experiences, upon reflection, have altered my view and caused me to ask a fundamental question: Whose interests are really being served by allowing a dignified demise to the demented?

My mother suffered from dementia for the last five years of her life. Additionally, due to protracted stays in the hospital, she developed gangrene, first in one leg and then the other, both requiring amputation. During her full-blown dementia, which seemed to manifest itself with her first hospital stay for a broken hip, she was quite delusional, never really aware, it seemed to me, of her actual situation. Objectively speaking, by most people's standards, she had little quality of life - bedridden, confused, a mere shell of who she had been.

Yet she was sufficiently aware, until the last few months of her life, to know us whenever we visited her, and I like to think that those visits brought her some pleasure. Although she had been having earlier memory problems, my mother's abrupt transition into dementia seems to have also protected her from any awareness that would have produced profound suffering. If anything, she seemed always to be in good cheer.

Unlike my mother, my mother-in-law was aware that she was developing dementia, something she had always feared. Her descent was gradual, as is usually the case. It caused her some distress for a time as she realized what she was losing. Yet again, after being in assisted living and eventually a nursing home, as her disease progressed, she no longer seemed in distress, as her awareness of what was happening decreased to the point where it was ultimately non-existent. Again, I can't say that she was suffering, except perhaps due to what she once told me was her discomfort over 'communal living.'

Eventually, at some level, my mother-in-law decided it was time to die; she no longer ate, and drank very little. Quite rightfully, the family respected her wishes and allowed her a dignified exit without imposing a feeding tube, etc. to keep her alive. It was the right choice.

So I now return to my earlier question about whose interests are being served by allowing a dignified demise to those suffering from dementia. As my two examples suggest, it is not necessarily for the one suffering such a terrible fate. Could it not, at least in some cases, be for those loved ones who are distressed to see a parent, husband, wife, brother or sister in such a broken state, assuming theirs are lives no longer worth living?

My point in writing this is a simple one: while currently in our right minds, we may indeed feel that it would be best to prearrange our assisted death to avoid a protracted and undesirable demise. However, can we really know what we will feel like once the acute awareness stage of early dementia passes? If we cannot answer that question with any degree of certainty, it is best, I believe, to err on the side of caution, as the Trudeau government is currently doing.


  1. I disagree, Lorne. I think it's possible and reasonable to stipulate the deterioration at which point you want to be relieved for further existence. Your "how can we really know" test sets the bar at an impossible height. Your approach would condemn many to die a protracted and agonizing death. Do you really believe your government should have that right?

    1. Your objection is duly noted, Mound. My wife, in fact, feels much the way you do about my position. After posting this piece, I said to her that I would be more in favour of a preexisting plan only if its execution were contingent upon tangible evidence of ongoing, unrelenting distress, distress that not only a loved one saw but also a medical person, be it a nurse or a doctor.

      I don't claim that mine is the correct position; I only offer it as a perspective in what needs to be an ongoing discussion. As Trudeau himself said in the above video, this is a law that will likely evolve. As indicated, I have no quarrel with its initial incarnation.

  2. By the way, I think it's inappropriate to label this "assisted suicide." It's a pejorative when it is used to encompass the terminally ill with those who simply choose to end an otherwise viable life. The terminally ill aren't choosing to die. They are dying. They would happily choose not to die if that was possible. They are not suicidal. They are dying not of their choice. They merely want the right and the power to determine how and when they exit life as they must.

    1. That is a fair distinction, Mound, as long as we are confining right-to-die legislation to the terminally ill. As you know, there are many who want it to encompass what they term 'irremediable suffering,' including the mentally ill who can't seem to find relief. If the progressives get what they want and legislation does ultimately include them in the future, it will, without doubt, be assisted suicide.