The deVeber Institute
for Bioethics and Social Research

A recent statement from the Quebec College of Physicians proposes that euthanasia be included "as part of the appropriate care in certain particular circumstances." Such a development would require legalization of euthanasia by amending the Canadian Criminal Code to distinguish euthanasia from homicide.

This development is deeply concerning given the possible negative outcomes of such a decision. Besides the most obvious concern – that being the fact that euthanasia is the intentional killing of human life - another alarming problem with the legalization of euthanasia is that even when the most rigid of so called “safeguards” are put in place they can always be side stepped; even the most rigid and carefully worded euthanasia law can never offer protection to vulnerable citizens. By way of example, legalization of physician assisted suicide, and specifically euthanasia in the Netherlands, has led to many abuses. Also, the legalization of physician assisted suicide in Switzerland has resulted in such negative consequences as the practice of “suicide tourism”. Switzerland frequently allows non-residents to receive a physician’s assistance in committing suicide, hence the term “suicide tourist”. Canadians are included among those non-residents who have solicited this assistance. Granted, the Quebec College will attempt to propose safeguards to prevent such abuses when the College drafts its proposal, due November 2009. However, even with the presence of similar safeguards already in place in the Netherlands and Switzerland, boundaries have been disregarded. This has been evidenced by prevalent instances of non-voluntary and involuntary euthanasia and suicide tourism respectively. – what are the instances?

Euthanasia has been described by opponents as a process which puts the patient “out of our misery.” This statement pointedly implies that there are influences beyond the patient’s respective autonomy which prompt her or him toward a euthanasia decision. The Quebec College has proposed thateuthanasia will only be administered with the patient’s explicit consent. However, even proponents of euthanasia recognize that a patient’s decision is heavily influenced by those surrounding her or him, including family and friends. Specifically acknowledged is the possibility of coercion toward euthanasia by the patient’s next of kin based on the patient’s perception of being a burden to those who feel responsible for the care of the patient. The arguments motivating the College’s decision to endorse legalizing euthanasia may on the surface appear to be altruistic: the option of euthanasia in end of life care may ease the burden of the family in caring for a loved one and may give the patient the peace of mind that they are not inconveniencing their family. However, if a patient is presented with the option of a hastened death, and if their perception of the alternative to such a hastened death is that they are a burden to their next of kin, then the motivation toward euthanasia ceases to be altruistic and becomes a decision fuelled by coercion.

A significant argument presented by the College in favour of legalizing euthanasia is the supposed presently occurring practice of passive euthanasia.

“Sometimes, the pain is so unbearable that the amount of painkillers or analgesics used to control it can be fatal. And this, according to the Quebec College of Physicians, can be viewed as a form of euthanasia.”

This argument, however, may not be entirely informed. Examination of a patient’s analgesic doses at the time of death might lead one to conclude that a lethal dose had been administered. However, an overdose for a healthy individual does not constitute an overdose for a terminal-cancer patient. Terminal-cancer patients build up a tolerance to the analgesic and would thus require an intentionally excessive dose of analgesic in order to die from the analgesic. Such instances are rare. Even if such an overdose was accidentally administered, there remains an important distinction between accidental overdose, and euthanasia. The legalization of euthanasia will result in an end of life care system tainted by practices emphasizing the intent to kill. Contrastingly, in the very unlikely event of an accidental overdose, the intent is only to relieve pain, not to kill.

A London, Ontario based palliative care professional proposes an end of life care system where euthanasia would not even be desirable. Where appropriate palliative care is practiced – care which is multifaceted and draws upon the expertise of an interdisciplinary care team – the patient’s passing can be made easier and even “beautiful.” Many professionals in the field of palliative care recognize that strong attention must be paid to the patient’s every need. These needs are emotional, physical, psychological, and spiritual in nature. Where all of these needs are addressed by qualified professionals and family members, a patient is able to enjoy her or his last months, weeks, and days in this life. The desire to hasten passing may subside in light of how valuable this time of life remains.

In instances where a terminally ill patient dies from causes other than her or his illness, dehydration and/or starvation are frequently the cause. Sometimes this occurs when a patient’s IV or feeding tube are removed because that patient is so close to natural death that sustenance becomes a burden to her or his failing body. However, there are other instances when a patient may be months away from a natural death, and sustenance is removed, thus hastening death via dehydration. The latter instance is an example of passive euthanasia. The legalization of euthanasia should be of great concern to palliative care patients as such a development might allow passive, involuntary, and/or non-voluntary euthanasia to be culturally acceptable. This has been the case in the Netherlands in spite of supposed safeguards.

A Foundational Medical Ethic is that of Proportionality, where the potential for good care outweighs the possibility of harm. Certain medical procedures inflict a degree of harm upon a patient, however, with the intent of an exponentially more positive outcome. The ethic of Proportionality is ignored in the practice of euthanasia because a hastened death is presented as a “good” for the terminally-ill patient. There is no existing evidence, however, that would indicate that the results of a hastened death are greater than those of a natural death. Disregard for the ethic of Proportionality leads to an ultra-utilitarian approach to medicine where the proposition of a radical autonomy trumps the ethical framework and safeguards practiced by trained professionals.

Another pressing concern is that, should the euthanasia agenda advance at the insistence of the Quebec College of Physicians, the patients of Quebec physicians will naturally lose trust in the medical profession. Already in the Netherlands, patients are advised to wear bracelets notifying medical professionals they do not desire euthanasia. In spite of such measures, however, prevalent occurrence of involuntary and non-voluntary euthanasia continues to plague the health care system in the Netherlands. The legalization of euthanasia would not be a step forward in the advancement of care for end-of-life patients. Euthanasia would instead foster an attitude within the medical profession that at a certain point a patient’s life is not worth living and a hastened death should be offered. Far from aiding palliative care patients, euthanasia places tremendous emotional and psychological pressure on the patient to “not be a burden” to their family or to their care providers. The legalization of euthanasia would strip away the valuable last months of life for end of life patients where, with the help of caring professionals, patients are able to make their last days meaningful and even “beautiful”. For this reason and others, Euthanasia should be viewed not as a “good” for Quebec and Canada but rather as a serious threat to ethical, quality patient care in this country.

Definitions:

Euthanasia: The active, intentional termination of a patient’s life by a doctor who thinks that death is of benefit to the patient.

Active Euthanasia: The intentional taking of a patient’s life by a doctor who thinks that death is of benefit to the patient.

Passive Euthanasia: The cessation of medical treatment and provision of sustenance with the intent of hastening death long before natural causes would kill the patient.

Involuntary Euthanasia: Euthanasia carried out against the wishes of a competent person.

Non-Voluntary Euthanasia: Euthanasia carried out on incompetent patients such as babies or patients with dementia.

Assisted Suicide: The termination of a patient’s life by the patient through medication prescribed by a doctor.

Suicide Tourism: The travel of tourists to regions where euthanasia is legal with the hopes of receiving euthanasia.