Sunday, June 23, 2013

Some problems with "An Act Respecting End-of-Life Care"

Quebec proposes to enact Bill 52, "An Act Respecting End-of-Life Care", as early as September 2013. The Act will enshrine "medical aid in dying", including assisted suicide, as part of the continuum of medical care at the end-of-life. 

Medical aid in dying will be available according to a set of controlled measures specified in the Act. My understanding from watching an interview with Quebec's Minister of Social Services, Veronique Hivon, is that these measures are intended to limit abuses, while providing a compassionate and caring response to those individuals who seek to hasten their death.

Bill 52 has implications for all of Canada regarding end-of life-care. The arguments are nuanced and require careful analysis.

While I recognize that Bill 52 expresses a deep concern for those who are suffering from an incurable disease at the end-of-life, I am not convinced that legislating a form of assisted suicide is the most compassionate response of a just society.

Autonomy and dying with dignity
In my view, the two most common arguments in favour of assisted suicide - autonomy and dying with dignity - are fundamentally flawed.

We rightly value and want to protect our personal autonomy. Yet, there is very little that we can ever completely control.  Our decisions are never made in a vacuum; our interactions with others, with society, and with events influence our decision-making.  The decisions we make affect not only our own self, but others as well.  

An individualistic determination to control one’s death at the end-of-life exceeds the realm of personal autonomy.  When we are well enough, we want to live; we eschew suicide.  When physical deterioration limits our self-sufficiency, we may want to die.  At that point, we may want another to do the very thing we would not do our self – take our own life. Legislation would frame this desire as an entitlement based on compassion, autonomy and dignity. 

In an earlier post, I expressed my opinion on dying with dignity. To reiterate, dying with dignity is almost always referred to in connection with progressively debilitating diseases; ALS and Alzheimer’s, for example, are frequently mentioned.  There is an underlying presumption that progressive diseases rob the individual of their dignity as suffering increases and the body deteriorates.  There is a perception that physical decline equals a loss of dignity.

The sacredness of the invidivual

We are in danger of developing a view of life that relies too heavily on the vigor of the body and its ability to function. This view limits the sacredness of the individual. It overlooks the emotional, psychological, and spiritual dimensions of the person. It excludes the possibility that the natural process of dying may also serve a metaphysical purpose.

Every individual has an innate and inviolable dignity that disease, suffering and death cannot erase.  The dignity of the individual manifests itself in the totality of body, mind and spirit. End-of-life care must always proceed in a manner that recognizes and reverences the sacredness of life and the dignity of the whole person. 

Experts in palliative care say that pain can be successfully controlled and managed. Yet, depending where we live, less than 30 percent of Canadians who are dying have access to or receive appropriate palliative care. Rather than focusing on assisted suicide, the creation of an accessible and universal palliative care program would help to ensure that the dying receive reverential care appropriate to the dignity of the human person.

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