Physician Assisted Death In Canada: Controversies And Debates

Controversies around physician-assisted death

Write about the Physician Assisted Death in Canada.

Physician-Assisted Death (PAD) is a controversial issue not only in Canada but globally. Canada has struggled with legislation of physician-assisted death since the 1840s. A case in point happened in Alberta in 1941 when Dorothy Ramberg and Victor decided to murder their 2-year old boy who had been diagnosed with cancer. This issue is controversial because it poses two fundamental ethical questions. One, is it right for a patient to demand a physician-assisted death? Two, is it moral for a doctor to help a patient in physician-assisted death? This research seeks to answer the question whether the Federal government should, or should not, pass legislation that would provide citizens with safe access to physician-assisted death in Canada. Physician- assisted death/suicide refer to a form of euthanasia in which a doctor intentionally provides the means to die to a patient and leave the patient to complete the action. However, these means to die must be explicitly requested by the patient. Thought section 7 of the Canadian Charter of rights and freedoms state every individual in Canada has rights to liberty, life, and security the country remains in crossroad whether to legalise or illegalise physician-assisted death (Kim and Trudo 337). 

Legalising physical-assisted death is a direct contravention of the Hippocratic Oath. The Oath was formulated solely to prohibit listening to requests of physician-assisted death and to fight the vice taking the life of a patient. Actually, the Oath is meant to enhance better health care, sufficient support systems and government’s responsibility in safeguarding human life. Hippocratic Oath was therefore meant to guard the life of the patient and to kill the patient. The Oath is explicit that a physician should not provide material to a patient with the intention of killing them (Behuniak 17). Hence, a doctor should not supply his/her patient with lethal drugs or other materials to assist the patient in committing suicide. Legislating physician-assisted death is thus an ultimate attack on the character and credibility of doctors. Physical-assisted death severely damages reputation of a physician and ultimately discredits him or her.

On the other hand, failure to legislate physician-assisted death is against the fundamental right of self-expression. Every patient has a fundamental right to a medical decision as a form of self-expression and expressions of personal autonomy should be respected. Physician-assisted death is, thus, a reliever to a terminally ill patient who is in severe pain and with no hope of recovery. The government should, therefore, acknowledge that such patients have right to choose when to die (Landry, et.al., 1494).Law to recognize this right to die through physician-assisted death should; however have some limitations. For example, only the terminally ill patients who are in severe pain should have the accesses physician-assisted death services. Besides, their health condition must be assessed by three qualified doctors who should certify that the patient has less than six months to survive. Furthermore, a patient must be an adult of sound mind who can make autonomous decision to self-administer the lethal drug or not. Similarly, a physician should not be allowed to administer the drug to the patient rather the patient should be allowed to self-administer the lethal drug. 

Legalizing physician-assisted death

Equally important why physician-assisted death should be legalized is because the Supreme Court of Canada has set precedence in the case of Carter v. Canada. Following this case, Supreme Court of Canada ruled that well-informed adult who has the ability to consent and may be suffering from "irremediable and grievous" medical condition have the right to request for physician-assisted death (Karsoho 194). The Parliamentary Special Joint Committee that was formed to investigate the issue agreed with the Supreme Court of Canada. However, this committee opined that the criterion of who should request for physician-assisted death should be diversified. In fact, the criterion was extended to include those suffering from non-terminal illness and those suffering from a psychiatric disorder. This precedence set by the Judiciary and the Parliament committee demonstrate respect to the right of self-expression and expression of personal anatomy. In fact, in the case of Carter v Canada, the Supreme Court of Canada emphasised the value of person's autonomy or self –determination. Court decision ensured that self-determination is critical when making important medical decisions. Therefore, this right ought to include decisions to request for physician-assisted death. The right to self-determination is thus compatible with liberal democracies like Canada (Menzel, et.al., 468).

 Conversely, legislating physical-assisted death on the grounds of respect to the right of self-expression and compassion is unethical and insensitive to some patients. It is insensitive because physical torment of a patient is limited to six months. If a patient is terminally ill and in unbearable physical pain then why stipulate the time of such uncontrollable physical torment to six months. Why think ending the life of a patient is equivalent to ending their sufferings (Yao 385).  Furthermore, if the pain is unbearable, why then restrict such a patient to six months before requesting for physician-assisted death; Is it not a grave disservice to some patient? Besides, physicians should utilise the available palliative care to ease the pain of their patients. The existing medical and social care should address physical, psychological, and the spiritual pain the patient may be undergoing rather than concentrating on the physical pain. Similarly, the essence of training physicians is to offer hope and to make a patient feel better. Therefore, assisting patient terminate life is in contradiction of why the very doctor was trained.

Similarly, legalising physician-assisted death is likely to erase patient's confidence in the palliative care. This because there is no ethical distinction between ethical end-of-life practices which involves withdrawing or withholding treatment or administering palliative sedation and the physician-assisted death. Furthermore, in Canada, there lack a technical body which is competent to oversee the practice of physician-assisted death (Collins and Brendan 186). Hence, currently, doctors involved in the vice lack proper training and practice without stipulated standards of practice. There also lack an expert to manage physician-assisted death in a case of adverse happening. Attempt to legalise physician-assisted death thus introduce unnecessary challenges to the palliative services. Anxiety will arise from the fact that physician-assisted death is restricted for the terminally ill patient. As such, the terminally ill patients under palliative care have a reason to anxious thus causing the psychological suffering.      

Ethical concerns regarding physician-assisted death

Undoubtedly, every patient has a right to self-determination which is critical in making medical decision. Patients have the ultimate right to express their informed and free consent on issues touching on their health (Yao 386). On the other hand, health facilities have an obligation to listen and honour patients’ informed and free consent regarding their health. Medical should honour this right of the patient to the extent it is considered moral and acceptable. According to the Supreme Court of Canada, the patient’s desire to die should be respected by health professionals; because the right to self-determinism/autonomy entails the right to request for physician-assisted death (Karsoho 194). Despite claiming that request for physician-assisted death is a fundamental right it is clouded by so much restriction which is contrary to the nature of fundamental rights. If it were fundamental as it protagonist insists, then it would not have restrictions. Patient with terminal or non-terminal illness then should have easy access to the services of physician-assisted death it was such fundamental.

Equally, if the right to autonomy were fundamental, there would be no need for society to determine when a patient can invoke this right. The society has limited this right to be exercised only when a patient is in severe physical or mental pain. The question which arises is, does terminal illness, physical pain, disability or psychological disorder confers a greater right to self-autonomy or self-determinism? If this is the line of thinking then, personal decision to commit suicide should be recognised as an inherent right and thus legal. This will be in agreement with the autonomy principle which grants an individual the right to choose when to die or to terminate his/her life. As such, people should have the inherent right to commit suicide as they wish.

It is thus clear from the previous argument that legislation that allows right to die to a section of people in the society and not to others is discriminatory and attack to the nature of autonomy. Why is it then if legislation on physician-assisted death was to be enacted it will only grant the right to die to the disabled, terminally ill or those suffering fro psychological disorder. A reasonable law never discriminate. Legislation of physician-assisted law infers that some are less worth living than others. Furthermore, it will imply that doctors will have the right to decide who deserve to live or to die. This will in turn damage the patient ability to make an autonomous choice regarding his/her health (Orentlicher, et. Al., 260). If the fundamental right to autonomy was to be upheld, then the government should abolish any form of sanction concerning this right. Physician-assisted death, therefore, should be accessible to all citizens regardless of their health. Legislation that hinders some citizens to request for physician-assisted death is an attack on the rights of citizens to accesses medical services. Sarcastically, legalising of physician-assisted death poses a significant threat to the right of autonomy.

From the essay, it is explicit that the debate on whether to legalise or not to legalise physician-assisted death is a controversial one.  This discussion leaves the government at cross roads whether to support physician-assisted death or to support better health care and adequate supporting systems to the patients. It is my considered opinion that human life is sacred and as such it belongs to God. Hence, it should be cared for, and nurtured concerning its dignity. In a situation where life is threatened by injury, terminal illness or disability it should be guarded and not terminated. Physicians, family members and those involved in palliative care should utilise the existing medical and social support systems to aid the patient to ease his/her pain. On the other hand, the essence of training doctors is to aid the patient to feel better and not to terminate them. Besides, family members and friends undergo great agony when they witness a person they love and treasures assisted to die by a doctor who they trusted to make him or feel better. Therefore, instead of physician-assisted death family members and friends with the assistance of the physician should research and implement a palliative care which will aid to alleviate the pain of their patient. Only such care can authentically help the patient to maintain autonomy and not the choice to die.

Lack of clarity regarding physician-assisted death

After careful analysis of the arguments advanced by the both sides of the debate, it is evident that physician-assisted death should not be legalised.  It should not be legalised because it is immoral and against the basic goods of life, sociability, procreation and knowledge. Fundamentally, human person has natural instincts for self-preservation. Therefore, a low that is against this virtue of self-preservation is unethical because it is in contradiction to what is natural to man. Human beings are thus expected to be inclined to that which helps in self-preservation. Similarly, a human being as rational animals acknowledges that other fellow human beings have a natural inclination to self-preservation. Therefore, no human being should hinder the other from executing their self-preservation. Following this line of thinking is thus immoral for a doctor to administer a lethal drug or to provide suicide materials to a patient with the intention of assisting them to die.

Physician-assisted death is also against the fundamental good of the society. Human beings are social in nature, and as such, they establish social links from birth. It is thus very painful for friends and family members to see a doctor assisting one of them to die. Besides, man as a social and rational being should struggle to expend his/her social spheres. Assisted death is, therefore, contrary to this principle. In addition, physician-assisted death deprives the society the full benefits an individual may offer to the society or community. This sociological view therefore does not acknowledge assisted death as a remedy for suffering and physical pain. The remedy to suffering is found in advanced palliative care and medication. Human being as rational being is disposed to knowledge and as such human being should not choose actions which lead to self-annihilation. Human being should desire that which is good for themselves and others. Physicians are trained to offer hope hence a doctor who assists a patient to die act irrationally because he/she is not assisting the patient desire that which is good. On the same note, legalising physician-assisted death will defeat the logic why government invests huge funds in researching on terminal illness if ending the life patient is so easy. 

In conclusion, if physical pain, psychological disorder, and disability are reasonable grounds to grant the right to autonomy/self-determination then such law is discriminatory. Hence, it must be agreed that physical, mental, or psychological disorder do not offer any individual greater right to autonomy or self-determinism. Besides, if someone in pain has the autonomy to request for physician-assisted death because he/she enjoys the right of self-determinism, then every citizen has the right to end his or her life as he/she wishes because each citizen is an autonomous individual too. If physician-assisted death can be legalized, suicide too should be legalized.

Behuniak, Susan M. "Death with “dignity” The wedge that divides the disability rights  movement from the right to die movement." Politics and the life sciences 30.1 (2011):17-32. Web. 12^th April 2017. 

Collins, Andrew, and Brendan Leier. "Can medical assistance in dying harm rural and remote palliative care in Canada?." Canadian Family Physician 63.3 (2017): 186-190. Web. 12^thApril 2017. 

Karsoho, Hadi, et al. "Suffering and medicalization at the end of life: The case of physician- assisted dying." Social Science & Medicine 170 (2016): 188-196. Web. 12^th April 2017.

Kim, Scott Y., and Trudo Lemmens. "Should assisted dying for psychiatric disorders be legalized in Canada?." (2016). Web. 12^th April 2017. 

Landry, Joshua T., Thomas Foreman, and Michael Kekewich. "Ethical considerations in the regulation of euthanasia and physician-assisted death in Canada." Health Policy 119.11(2015): 1490-1498. Web. 12^th April 2017.

Menzel, Paul T., and Bonnie Steinbock. "Advance directives, dementia, and physician-assisted death." The Journal of Law, Medicine & Ethics 41.2 (2013): 484-500. Web. 12^th April 2017.

Orentlicher, David, Thaddeus Mason Pope, and Ben A. Rich. "Clinical criteria for physician aid in dying." Journal of palliative medicine 19.3 (2016): 259-262. Web. 12^th April 2017. 

Yao, Teresa. "Can We Limit a Right to Physician-Assisted Suicide?." The National Catholic Bioethics Quarterly 16.3 (2016): 385-392. Web. 12^th April 2017.