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.

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.