Jan Wong: assisted suicide may be controversial, but my generation wants a say in how we die
If my generation gets its way (and we usually do), the agonizing assisted suicide debate will soon be over. We want a say in how we check out
Slow death is one of the scariest phrases in the English language. At 61, I’ve already begun contemplating the many terrible ways I might die. While a quick demise can rob us of the opportunity to bid a proper farewell, I’d choose that over a debilitating, vegetative, painful and costly high-tech state of non-being. And many others among my generation feel the same way. We belong to the giant, pushy, opinionated boomer demographic, and we will inevitably impact the Canadian way of death.
A recent Environics poll found that the majority of Canadians—an emphatic 69 per cent—believe assisted suicide for the seriously ill should not constitute a crime. And yet our laws remain stuck in the last century. Quebec’s National Assembly recently tabled legislation that would allow doctors to help terminally ill patients kill themselves if they’re in unbearable physical or psychological pain. The bill has already received all-party consent. If it passes, Quebec will become the first province in Canada to legalize physician-assisted suicide and one of only a few jurisdictions in the world (including Switzerland, the Netherlands and three U.S. states: Oregon, Washington and Vermont). The proposed law would pit Quebec against the federal government, which considers assisted suicide a violation of the criminal code.
The main argument against is the slippery slope—the terminally ill will feel pressured by impatient heirs or want to avoid being a burden to their doctors and family members. If we legalize it, the thinking goes, soon we will have a veritable tsunami of people killing themselves at the behest of others. The statistics show otherwise. In Oregon, for instance, only one in every 422 deaths in 2012 was an assisted suicide.
The idea of involving the family doctor always struck me as unnecessary. After all, DIY death should be easy: send a suicide letter by overnight post to your local police station (so no one else will be blamed and they’ll know to dispatch an ambulance before you rot). Then glug down a bunch of sleeping pills or tranquilizers with vodka. But some patients reach a point where they are no longer able to lift a bottle of pills. Such was the wrenching experience of Donald Low, the chief microbiologist at Mount Sinai Hospital who came to prominence during the 2003 SARS crisis. When he was diagnosed with a brain-stem tumour last February, Low knew there was no cure. Toward the end he became extremely anxious because, as a doctor himself, he also knew the tumour would rob him of his cognitive abilities, paralyze him and put him into a coma.
His widow, Maureen Taylor, a physician assistant and medical journalist, says they thoroughly researched the options—including overdosing on a sedative such as Ativan—but concluded they were unreliable. “You may fall asleep before you can take enough,” says Taylor. “And death will not be quick. It will take many, many hours. And you might start vomiting. What is a loved one supposed to do?” Low wouldn’t allow Taylor to assist and risk being charged. Section 241(b) of the criminal code states that anyone who helps someone else commit suicide can be imprisoned for up to 14 years.
The couple also considered morphine, which in high dosages suppresses breathing. That route was closed to them because Low was not in pain. “I told him, ‘You know, Don, maybe you should fake the pain, so you can stockpile some morphine.” But Low didn’t want to lie to his physicians. During his final days, his palliative care doctor would readily sedate him to help keep him calm but couldn’t and wouldn’t give him large doses of morphine in the absence of pain.
Taylor says Low’s death drug of choice was Seconal, a barbiturate used for assisted suicides in the U.S. It’s hard to come by in Canada, so he reached out to an old American friend. That doctor demurred because he didn’t practise palliative care or oncology, and feared a prescription would be a red flag and could cost him his licence. None of Low’s Toronto doctors would help him die on his terms. “All of them knew Don’s wishes: I would like you to help me end it early,” Taylor says. “They were all in favour of not extending his life.” But they would not proactively shorten it. “People would say to me, ‘Oh, come on, you know the right doctors,’ ” says Taylor. “But I certainly could not get it done for Don.”
Eight days before his death this past fall at age 68, Low recorded a video excoriating Canadian law for forcing unnecessary suffering on terminally ill patients. “I’m just frustrated with not being able to control my own life, not being able to make the decision myself when enough is enough,” he said. In the end, Low did not get the death he wished for, but he died in his wife’s arms and was not in pain.
About six weeks later, the debate over assisted suicide was back in the news when an elderly Etobicoke couple jumped from their 18th-floor penthouse apartment in a double suicide. Both suffered from severe health problems, including chronic pain. If doctor-assisted suicide were legal in Canada, perhaps people wouldn’t need to resort to such desperate measures.
And yet, in stark contrast to public opinion, the medical profession is deeply divided over the issue. According to a survey published by the Canadian Medical Association last March, 44 per cent of doctors would refuse to participate in physician-assisted suicide, even if it were legal. Only 16 per cent said they would assist, while 26 per cent were unsure and 15 per cent were unresponsive. As for whether assisted suicide should remain illegal, doctors were evenly split.
Scott Wooder, a family physician in Stoney Creek and the president of the Ontario Medical Association, will not divulge his own opinion on doctor-assisted suicide. He says the decision is up to Parliament. In the meantime, he thinks we should focus on improving palliative care to better the quality of life for terminally ill patients. But what if palliative care includes (as it usually does) administering higher doses of morphine? “The criminal code goes to intent. If your intent is to relieve symptoms, then increasing the dosage is all right. But if the intent is to end life, that’s contrary to the code, and doctors can’t go there.”
Intent, of course, is not always easy to discern. Many of us have heard stories of palliative care doctors upping the morphine to keep patients comfortable, a measure that can also serve to mercifully hasten their deaths. This strikes me as something of a loophole—or at least an example of the inherent ambiguities in end-of-life care. Wouldn’t it be clearer to simply let patients decide for themselves?
, the agonizing assisted suicide debate will soon be over. We want a say in how we check out
By Jan Wong | Illustration by Graham Roumieu
Slow death is one of the scariest phrases in the English language. At 61, I’ve already begun contemplating the many terrible ways I might die. While a quick demise can rob us of the opportunity to bid a proper farewell, I’d choose that over a debilitating, vegetative, painful and costly high-tech state of non-being. And many others among my generation feel the same way. We belong to the giant, pushy, opinionated boomer demographic, and we will inevitably impact the Canadian way of death.
A recent Environics poll found that the majority of Canadians—an emphatic 69 per cent—believe assisted suicide for the seriously ill should not constitute a crime. And yet our laws remain stuck in the last century. Quebec’s National Assembly recently tabled legislation that would allow doctors to help terminally ill patients kill themselves if they’re in unbearable physical or psychological pain. The bill has already received all-party consent. If it passes, Quebec will become the first province in Canada to legalize physician-assisted suicide and one of only a few jurisdictions in the world (including Switzerland, the Netherlands and three U.S. states: Oregon, Washington and Vermont). The proposed law would pit Quebec against the federal government, which considers assisted suicide a violation of the criminal code.
The main argument against is the slippery slope—the terminally ill will feel pressured by impatient heirs or want to avoid being a burden to their doctors and family members. If we legalize it, the thinking goes, soon we will have a veritable tsunami of people killing themselves at the behest of others. The statistics show otherwise. In Oregon, for instance, only one in every 422 deaths in 2012 was an assisted suicide.
The idea of involving the family doctor always struck me as unnecessary. After all, DIY death should be easy: send a suicide letter by overnight post to your local police station (so no one else will be blamed and they’ll know to dispatch an ambulance before you rot). Then glug down a bunch of sleeping pills or tranquilizers with vodka. But some patients reach a point where they are no longer able to lift a bottle of pills. Such was the wrenching experience of Donald Low, the chief microbiologist at Mount Sinai Hospital who came to prominence during the 2003 SARS crisis. When he was diagnosed with a brain-stem tumour last February, Low knew there was no cure. Toward the end he became extremely anxious because, as a doctor himself, he also knew the tumour would rob him of his cognitive abilities, paralyze him and put him into a coma.
His widow, Maureen Taylor, a physician assistant and medical journalist, says they thoroughly researched the options—including overdosing on a sedative such as Ativan—but concluded they were unreliable. “You may fall asleep before you can take enough,” says Taylor. “And death will not be quick. It will take many, many hours. And you might start vomiting. What is a loved one supposed to do?” Low wouldn’t allow Taylor to assist and risk being charged. Section 241(b) of the criminal code states that anyone who helps someone else commit suicide can be imprisoned for up to 14 years.
The couple also considered morphine, which in high dosages suppresses breathing. That route was closed to them because Low was not in pain. “I told him, ‘You know, Don, maybe you should fake the pain, so you can stockpile some morphine.” But Low didn’t want to lie to his physicians. During his final days, his palliative care doctor would readily sedate him to help keep him calm but couldn’t and wouldn’t give him large doses of morphine in the absence of pain.
Taylor says Low’s death drug of choice was Seconal, a barbiturate used for assisted suicides in the U.S. It’s hard to come by in Canada, so he reached out to an old American friend. That doctor demurred because he didn’t practise palliative care or oncology, and feared a prescription would be a red flag and could cost him his licence. None of Low’s Toronto doctors would help him die on his terms. “All of them knew Don’s wishes: I would like you to help me end it early,” Taylor says. “They were all in favour of not extending his life.” But they would not proactively shorten it. “People would say to me, ‘Oh, come on, you know the right doctors,’ ” says Taylor. “But I certainly could not get it done for Don.”
Eight days before his death this past fall at age 68, Low recorded a video excoriating Canadian law for forcing unnecessary suffering on terminally ill patients. “I’m just frustrated with not being able to control my own life, not being able to make the decision myself when enough is enough,” he said. In the end, Low did not get the death he wished for, but he died in his wife’s arms and was not in pain.
About six weeks later, the debate over assisted suicide was back in the news when an elderly Etobicoke couple jumped from their 18th-floor penthouse apartment in a double suicide. Both suffered from severe health problems, including chronic pain. If doctor-assisted suicide were legal in Canada, perhaps people wouldn’t need to resort to such desperate measures.
And yet, in stark contrast to public opinion, the medical profession is deeply divided over the issue. According to a survey published by the Canadian Medical Association last March, 44 per cent of doctors would refuse to participate in physician-assisted suicide, even if it were legal. Only 16 per cent said they would assist, while 26 per cent were unsure and 15 per cent were unresponsive. As for whether assisted suicide should remain illegal, doctors were evenly split.
Scott Wooder, a family physician in Stoney Creek and the president of the Ontario Medical Association, will not divulge his own opinion on doctor-assisted suicide. He says the decision is up to Parliament. In the meantime, he thinks we should focus on improving palliative care to better the quality of life for terminally ill patients. But what if palliative care includes (as it usually does) administering higher doses of morphine? “The criminal code goes to intent. If your intent is to relieve symptoms, then increasing the dosage is all right. But if the intent is to end life, that’s contrary to the code, and doctors can’t go there.”
Intent, of course, is not always easy to discern. Many of us have heard stories of palliative care doctors upping the morphine to keep patients comfortable, a measure that can also serve to mercifully hasten their deaths. This strikes me as something of a loophole—or at least an example of the inherent ambiguities in end-of-life care. Wouldn’t it be clearer to simply let patients decide for themselves?){kind=link}
I wish that the federal government (Harper) would have either the guts to do what is right and initiate country wide discussions on this subject or change the criminal code to legitimize dying with dignity. We are not asking everyone to participate, just that the option is there for us when and if our quality of life deteriorates such that it become an option to be considered. We all want to live a long long life but want choice when the end eventually comes!
The next federal election is set for October 19, 2015. We must be there at each and every “all candidates public forum” that happens across the country. The question that needs to be addressed during or after these meetings is: “Do you or your party support Dying with Dignity and if not why not?” Let’s make this an election issue.
Palliative/end of life care are very different from physician assisted suicide. 69% of Canadians believe that physician assisted suicide should be legalized – but what let’s ask ourselves how we are defining and understanding physician assisted suicide, euthanasia, and palliative care. Let’s consider what this belief is based in and compare it to the current availability of care support. Studies indicate that only 10% of Canadians who could benefit from palliative care have access to services – with the vast majority of patients/families wishing that they had been directed to palliative support earlier in their illness trajectory. This 10% will also depend on what type of illness you have (cancer patients receive palliative care more frequently in comparison to individuals with neurodegenerative disorders or dementia) and where you live in the country (urban vs rural).
Looking at education, it’s surprising to note that health care education in Canada does not require extensive focus on palliative care and issues with death, dying, bereavement and loss. Ask the doctors and nurses (ask the health care students as well) how much training they have acquired in school and how comfortable they are in addressing concerns related to death and dying.
If, as a country, we are going to bring forward the discussion of physician assisted suicide, we need to talk palliative care first. We need to create dialogue about advanced care planning with the people in our lives and those involved in our care. We must push for more services within the community that will support people at the end of their lives so the fear of isolation, being a burden, suffering intractable symptoms or living their lives undignified can be assuaged.
Ultimately, this discussion will be about the quality of our lives and for our loved ones. This is the conversation that must happen. What’s interesting to note is that Dr. Larry Librach, a leader in palliative care, was diagnosed with and died from pancreatic cancer in the same year as Dr. Low. He also released a video expressing the need for enhanced and accessible palliative care, however his message has not been carried by the media in the same way as Dr. Low’s message.