Tuesday, March 8, 2016

The Archbishop And Assisted Dying

One of the things that I think distinguishes progressives from rabid reactionaries is that the latter tend to have reflexive positions on key issues, while the former can appreciate nuance. I hope the following helps to reflect that difference.

The other day, the Archbishop of Toronto, Cardinal Thomas Collins, issued a statement and a video about assisted dying, read and shown in over 200 churches in the Archdiocese of Toronto:

If you watch the above video, you will note that Collins is citing from a 70-page report tabled Thursday, called "Medical Assistance in Dying: A Patient-Centred Approach," a report that sets out the recommendations of a special committee of MPs and senators on who should be eligible to request assisted suicide. When I first heard what he had to say, I thought that Collins was engaging in some dishonest fear-mongering, but closer examination shows that, for the most part, he was not.

The report includes the following recommendations:

- the right to assisted death should not be limited to physical conditions, and that Canadians with psychiatric conditions should not be excluded from doctor assistance to end suffering.

- a two-stage legislative process. The first would apply to competent adults 18 years or older to be followed by a second stage with competent mature "minors" to come in to force no later than three years later.

- establish a process to respect health care practitioners' freedom of conscience.

- doctors opposed to assisted suicide would have to recommend someone willing to perform it.

While there is much more to the report, including safeguards against abuse, I must confess that I feel deeply ambivalent about the anticipated legislation for a number of reasons. I am cautiously supportive of its overall goal, to offer a way to end intractable suffering, but it is the parameters of how that suffering will be defined that bothers me.

For example, when one ventures into mental suffering, one cannot help but wonder if such a request for termination would spring from a failure of all treatment modalities, or an inability of the sufferer to access those modalities. Waiting lists for treatment can be very long indeed. Can a person truly be deemed competent to choose death over life in the midst of crippling mental illness?

The proposal to lower the age of consent to include minors also troubles me deeply, especially if we are talking about suffering that is not strictly physical. As well, can a minor, no matter how mature, truly make such a momentous decision. I can't help but think, for example of the 11-year-old girl, Makayla Sault, who, with her parents' support, opted to end treatment for her leukemia, treatment that would have likely resulted in a cure. She died as a consequence of that decision.

The matter of a doctor's conscience also causes me some concern, While some go so far as to argue that a publicly-financed hospital should provide a completer suite of services, including assisted suicide, most seem satisfied that they provide a referral to someone who will. However, I can see that in such a contentious issue, even that might be too much for some medical practitioners. What will be the consequences of a refusal to refer?

As you can see, I have but scratched the surface of this issue. While I have no window into the suffering that others experience, I do believe that much more vigorous debate is needed on this question. It demands that we examine our own values, and the values we think are important in our country, so that we don't plunge headlong into a practice that, once begun, could lead to consequences that none of us desire.


  1. I think that's a masterful bit of diatribe, Lorne. Collins is using a couple of fairly narrow complaints to undermine the greater issue. In this way he conveniently dodges the fundamental question that he prefers to attack obliquely rather than address.

    This 'refusal to refer' controversy is probably meaningless. All will know in very short order those physicians prepared to assist and we'll know those who will not.

    Why should a chronic mental illness be considered more endurable than a chronic physical illness? Surely the issue is whether the ordeal is chronic, incurable, unresponsive to treatment. Would you prefer we simply put them in a vegetative state and clean their arses twice a day?

    This is not a novel idea. The subject has been debated, at length, in a number of jurisdictions. A lot of that is accessible to those who wish to explore the arguments on both sides. How few are willing to make even that effort?

    Collins presents a sham argument. There is no 'death with dignity' option he would tolerate - ever. He's just too corrupt to admit it.

    1. While I understand that Collins is opposed to euthanasia under any circumstances, Mound, not a stance I favour, I do have to be very wary of conditions that are perhaps intolerable to the sufferer, but may in fact be treatable. Will there be an exhaustive effort made to determine whether the illness of the candidate is chronic, incurable, unresponsive to treatment? Here I am not thinking of a disease like ALS which almost always has a cruel course. Intractable pain? I am reading a book right now on neuroplasticity that suggests chronic pain can in fact be controlled, even eliminated, with the right methodology. Until such options are explored, I am reluctant to endorse too wide-ranging a set of criteria for permitting assisted death.

    2. Lorne, have a look at Oregon's Death with Dignity Act and the experience of that state since it was enacted. They don't use the 'doctor assisted' approach as such. More like the glass of hemlock at bedtime sort of thing and it is restricted to those with terminal conditions in the final stage (6 months left or less) of life. This idea of having to have a doctor put you down has the uncomfortable quality of veterinary practise, at leas to me.

    3. Thanks, Mound. I shall check that out.