Physician-Assisted Suicide: A Recap of the MJLH’s 2013 Colloquium

Posted By Laura Crestohl – Feb. 28, 2013

Part 1 of the colloquium recap will focus on the morning panel presentations, while Part 2 will cover the afternoon debate between McGill Professors Weinstock and Sommerville titled “Is legalizing physician-suicide a good idea?”.

The McGill Journal of Law and Health held its annual colloquium on February 2nd, on the topic of physician-assisted suicide. The colloquium began with a panel featuring Grace Pastine, of the British Columbia Civil Liberties Association (BCCLA), who represented Gloria Taylor in a recent case in BC, Dr. Manuel Borod from the McGill University Health Centre (MUHC), Suzanne Philips-Nootens from the Faculty of Law at the University of Sherbrooke and Alex Schadenberg, executive director of the Euthanasia Prevention Coalition.

The panel started with McGill graduate student Keith Lenton giving a short introduction as to the law on physician-assisted suicide as it now stands in Canada. Lenton mentioned important moments in the continuing development of this area such as:

  • Rodriguez v British Columbia (Attorney General): a 1993 Supreme Court case in which Sue Rodriguez, suffering from amyotrophic lateral sclerosis (ALS), challenged the criminal code provision prohibiting physician-assisted suicide. She claimed the provision was an infringement on her Charter rights to life, liberty and security of the person (s 7), and equality (s 15). The court ruled against her in a 5-4 split decision.
  • Carter v Attorney General of Canada: A BC case being appealed to the Supreme Court wherein the BC Supreme Court (BCSC) and Court of Appeal (BCCA) granted Gloria Taylor a constitutional exemption so she could die with dignity, while the government could change the law to conform with the Charter.
  • Quebec’s Dying with Dignity Report by the Menard Committee: released in January 2013, the report recommends that the government reassess its position on end-of-life care and recognize a right to medical aide to dying.


Why Now? — The Gloria Taylor Case

The first panelist, Grace Pastine of the BCCLA, spoke of her experience representing Gloria Taylor, a BC resident who suffered from ALS  who fought for the right to physician-assisted suicide. Pastine said that she felt the time was right to bring the subject back to the courts for various reasons, including:

  • the availability of more social science evidence  from other jurisdictions who had legalized physician-assisted suicide (such as Oregon and Belgium);
  • the public opinion on the subject, which she felt had changed since the Rodriguez case;
  • the development of Charter jurisprudence and new  legal principles such as fundamental justice and gross disproportionality.

The BCSC and the BCCA both ruled that the provision prohibiting physician-assisted suicide was unconstitutional. Justice Smith of the BCSC found that the harm the provision caused was grossly disproportionate to the safety it was supposed to protect.


Where’s the Slippery Slope?

The subsequent panelists’ sessions focused on providing definitions of words commonly used around assisted suicide, and attempting to clarify and distinguish them from one another.

The second speaker, Suzanne Philips-Nootens, a leading medical ethicist, discussed the findings of the Dying with Dignity Report while also discussing international developments. You can find out more about her research here.

She placed emphasis on the fact that the Dying with Dignity report especially highlighted the importance of prioritizing palliative care and advance directives.

Philips-Nootens spoke about the “slippery slope” associated with physician-assisted suicide that has already presented itself in countries like the Netherlands and Belgium, where physician-assisted suicide has been legalized. Philips-Nootens argued that In those countries, assisted suicide is becoming available in cases  where :

  • people are not terminally ill, but rather “tired of living”
  • the request is occurring too soon
  • people develop disabilities
  • there is no immediate risk of dying

Euthanasia and Palliative Sedation–Are They Different?

Dr. Manuel Borod from the McGill University Health Centre (MUHC) began his session by defining “palliative care” from the WHO definition, which

  • sees dying as a normal process
  • neither hastens nor postpones death

Borod distinguished the term “euthanasia” from other terminology associated with end-of-life care. First, he emphasized that withholding or withdrawing treatment are not synonymous with “euthanasia.” He also highlighted the vagueness of the term “near death,” which could signify different conditions depending on the patient.

Another term he discussed was “palliative sedation,” which deliberately induces and maintains a patient’s sedative state in end-of-life care. 95% of the specialists in Quebec support palliative sedation as end-of-life care, but they have split opinion on whether palliative sedation itself qualifies as euthanasia.

Borod concluded his talk by arguing for having input from people who are directly affected by issues of assisted suicide, rather than healthy people, stating that most patients prefer to be kept alive.  Finally, we are “talking about the wrong issue” by focusing on assisted suicide, when we should ask: “why do we keep people alive?”

Alex Schadenberg from the Euthanasia Prevention Coalition wanted to clearly differentiate the terms “sedation” and “euthanasia”. He stated his point with an anecdote of drinking a lot of scotch with a friend in Scotland, leading to a state he described as “sedated.” “But we were not euthanized that night,” he added.

He also emphasized the act of “killing” in euthanasia, by stating that most euthanasia today is now conducted by legal injection. He also stated that it is a “modern fallacy” to believe that there is no difference between “killing a person” and “letting a person die.”

Schadenberg spent most of his talk discussing euthanasia in Belgium, alleging the existence of assisted suicide that were administered by unsupervised nurses. He warned that Quebec is most likely to follow suit, since it is using the same definitions for terms such as “assisted suicide.”

For the first time, the online team recorded the symposium on social media by live-tweeting the event. A collection of all the tweets from the day can be found on Storify. Visit the Journal’s Facebook page to see photos from the event.

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