It's time to clear the air on euthanasia and assisted suicide

Neil McKenty

March, 2010

This fall the Charest government will consult Quebecers on euthanasia. Is it ever necessary? Is it morally wrong? Is it murder? Should it be a crime? Should doctors assist those who want to die?

These are a few of the knotty questions that must be faced in a discussion of euthanasia. Another involves the difference between euthanasia and assisted suicide. If another party performs the last act that intentionally causes a patient’s death, that constitutes euthanasia. For example, giving a patient a lethal injection of morphine or suffocating her with a pillow would be considered euthanasia.

On the other hand, assisted suicide has taken place. So it would be assisted suicide if some one swallows an overdose of drugs that has been provided by another person for the purpose of causing death. When a doctor provides the means to die, that is called doctor-assisted suicide.

There is a debate now raging in England on euthanasia and assisted suicide that is a foretaste of what Quebecers can expect this fall. Two cases illustrate some of the major issues.

The first case involved a mother named Kay Gilderdale. She was charged with the murder of her 31-year-old daughter, Lynne, who suffered from myalgic encephalomyelitis, also known as chronic fatigue syndrome. Lynn was paralyzed from the waist down, bedridden for 17 years, unable to swallow or speak, and communicated with her family through sign language.

Lynn dreaded losing what little dignity remained to her. She was in constant pain. Over the course of a year, she had written a long letter explaining why, and how much, she wanted to die.

The crisis came on a December night. Lynn tried to kill herself with morphine. She begged her mother to help her. Her mother did, then phoned their doctor to tell what she had done. She was charged with murder, but acquitted by a jury that heard of the countless times Lynn had asked her mother for help to die.

The other case ended differently. Frances Inglis administered a lethal dose of heroin to her son, Tom, who was in a persistent vegetative state after falling out of an ambulance. Inglis was found guilty of murder and sentenced to nine years in prison. One material difference in the two cases was that while Lynn had often expressed her wish to die – Tom had never done so.

These cases played out while the End of Life Assistance Bill was being introduced into Scotland’s parliament. The bill was introduced by Margo MacDonald, a highly respected politician who has Parkinson’s disease and has made it clear she does not want her husband prosecuted should she ask him to help her die.

“Dying is part of living,” she says. “It’ s the last act of your life, and if we accept the responsibility of how we live our lives, then I really fail to see where there is any demarcation of how we should die.”

Under MacDonald’s bill, assisted suicide would be available to anyone over 16 who is terminally ill or permanently physically incapacitated. It would not be available to those with dementia or other degenerative mental conditions. The suicide request must be made to a doctor and approved by a psychiatrist. This approval must be requested and accepted a second time after a “cooling off” period of 15 days. The bill also says the assisted suicide must be supervised by the approving doctor and that no one who stands to gain from the death can be involved. Close friends and family are not allowed to administer the lethal drug. MacDonald believes around 50 people a year would choose to die using this legislation.

Scottish Cardinal Keith O’Brien, a close friend of MacDonald, is opposed to her bill.

“How can Margo think like that?” he asked. “I love and respect her so much. Life is a gift from almighty god. If he can give it, he can take that gift from us. But we can’t say: ‘God, I am finished with it. I can’t cope with cancer or Parkinson’s.’”

The church also argues that such a law would threaten the weakest and most vulnerable in society. The British Medical Society opposes the bill on the ground that resources should be concentrated on palliative medicine and alleviating the suffering of the dying. Peter Saunders, a former surgeon and director of Care Not Killing, says the bill is well intentioned but dangerous, raising the possibility that some elderly or terminally ill people see it as a means of pressuring them to have an “assisted death.” A number of Church of Scotland ministers are supporting the bill. Doctors with religious or moral objections would not be obliged to help any patient take his or her own life.

What is going on in Britain and Scotland indicates some of the issues that will rise when the Quebec government consults the population on this subject next fall.

Morality and public health policy are at the heart of the controversy.

We are getting older, living longer and health care at the end of life is taking a disproportionate number of health care dollars. A full-scale public debate on all these issues will help clear the air.