Mark Pickup responds to the Canadian government concerning euthanasia and assisted suicide.

The following blog post was written by Mark Pickup in response to a request by the federal department of justice for information in relation to the upcoming BCCLA Carter case. The Carter case is an attempt to remove, through the court, the protections in law from euthanasia and assisted suicide.

Mark's blog comment has gained international attention and was received a comment by bioethicist Wesley Smith.

This is a reprint of Pickup's original blog comment:
----------------------------------------------------

Firstly, I want to thank you for hearing my concerns about efforts by the British Columbia Civil Liberties Association to strike down Canada’s laws against assisted suicide and euthanasia. This memorandum is meant to recap my input during today’s discussion.

Being chronically ill and disabled with degenerative multiple sclerosis (MS) I am deeply concerned about the disastrous impact a successful challenge would have on people such as me.

You posed the question: “How do my concerns about assisted suicide interact with my religious beliefs?” Is the purpose of the question is to determine whether I am able to separate the context of my religious life from dialogue within a secular sphere of legal or public policy discussions? My answer is an unequivocal Yes.

Your question is shrewd and strategic. I am aware that there is a tendency amongst proponents of euthanasia and assisted suicide to try and relegate opposition by Christian citizens to the backwaters of public policy debate. Let me be blunt and clear: It is thinly veiled anti-Christian bigotry intended to silence or nullify views of Christians as irrelevant to public discourse. I utterly reject such tactics and refuse to be conveniently shuffled off to the sidelines. I may be a Christian but I am also a Canadian citizen with responsibilities and rights.

I bring to public discourse decades of advocacy for disability inclusion into the social fabric of Canadian life. My perspective is of someone experienced with community development combined with the perspective of having a progressive disability.

Assisted suicide is intended for people like me. I have a vested interest in where the Carter/Taylor challenge may lead if successful.

My citizenship rights entitle me (and other Canadians with disabilities) to equal protections of the law. The first Legal Right mentioned in the Canadian Charter of Rights and Freedoms (as well as Article 3 of the United Nation’s Universal Declaration of Human Rights) is the Right to Life. There is no mention of a Right to Death. Human rights must protect life not death. Death does not need protecting; it is an eventuality that will visit everyone regardless of what any law might state.

Canada’s Charter does mention in Section 7 the right not to be deprived of security of the person but it is qualified and not sufficient to override laws on euthanasia or assisted suicide. Why? Because by doing so it will jeopardize “principles of fundamental justice” for present and future vulnerable populations.

THE COMMON GOOD

In the unanimous 1997 U.S. Supreme Court ruling for states right to prohibit assisted suicide, former Chief Justice, William Rehnquist, wrote “An examination of our Nation's history, legal traditions, and practices demonstrates that Anglo-American common law has punished or otherwise disapproved of assisting suicide for over 700 years”.[1] The Hippocratic Oath, dating back thousands of years, forbade euthanasia by physicians. It would take great arrogance and self-centredness to demand that all this change to accommodate me, or any other individual. Nations must nurture the ideal of collective interdependent community. Accepting euthanasia not only works against this ideal, it rejects wisdom of the ages and embarks into dangerous public policy direction and practice.

Acceptance of assisted suicide places personal autonomy as paramount. This must be rejected. Autonomy is diametrically opposed to the concept of community. As John Donne stated in the 17th Century, “No man is an island entire unto itself”.

If I choose assisted suicide it will not affect just me: It will affect my wife, children and grandchildren. It will affect my community by not teaching the importance of inclusion and accommodation of people with terminal, chronic illnesses or severe disabilities. It will affect my physician because I will ask her to cease being a healer and become my executioner or participate in killing me. And in a small but certain way, my assisted suicide would help to coarsen the collective public conscience and further entrench the notion that there is such a thing as lives unworthy of life ― so unworthy that society will end or help to end those lives.

Assisted suicide threatens to turn back the clock of inclusion that disability advocates and their allies fought so hard to gain throughout many decades. Assisted suicide is a cheap and short-sighted compassion that ends in the ultimate exclusion of the tomb.

MEANING AND WORDS

“When I use a word,” Humpty Dumpty said
in rather a scornful tone,
“it means just what I choose it
to mean―neither more nor less.”
“The question is,” said Alice,
“whether you can make words
mean different things.”
“The question is,” said Humpty Dumpty,
“which is to be master―that’s all.”[2]

The word kill inflames discussion but it is an accurate description of what we are talking about. Euphemisms like “liberation” or “exit” or “gentle landing” are intentionally meant to obscure the harsh reality of assisted suicide and euthanasia. They are not useful to discussion. In such serious matters as life and death we must not sanitize language or change the meaning of language because it confuses important concepts and ideas.

Death with dignity: You will hear euthanasia advocates talk about “a right to death with dignity.” Where is such a right enshrined in law? There is no “right” to death with dignity. Death with dignity is not something that is bestowed upon someone with poison when they are at their lowest point. That is not dignity, it is a profound abandonment. Dying with dignity is a process not an event. It is the natural conclusion of having lived with dignity. It has been my experience that people do not die with any more dignity than they live with.

If Canada is really concerned with dignity at the end of life then put in place a National Palliative Care Strategy to ensure all Canadians have access to state-of-the-art palliative care when needed. Ensure medical schools and nursing programs equip graduates with the skills required to provide 21st Century palliation and pain control.

Virtually all physical pain can be controlled or eliminated. Ottawa palliative care specialist, Dr. John Scott wrote an essay in which he stated:

“The World Health Organization has demonstrated that access to pain-relieving drugs, along with a simple educational program, can achieve relief in the vast majority of patients. Specialists in various parts of the world estimate these basic approaches can control 85 to 98 percent of cases. The remaining cases require more careful attention and the use of multiple drugs and therapies to achieve complete relief.”[3]

These words were written in 1995. How much better has pain management become in the intervening sixteen years?!

This brings me to a fear I have about assisted suicide acceptance. Will it be a disincentive for research into cures and improvements to treatments? After all, why invest millions of dollars into finding cures for diseases like MS or ALS when euthanasia or assisted suicide is so cheap and tidy?

Whenever I have confronted euthanasia advocates with the fact that physical pain relief can be virtually complete, they often switch to the position that they want the ability to decide the time and place of their own death. Alas! The real issue is not pain control rather control. If they can’t control the way their life is going then they want to control their death. Control.

That is hardly a reason to alter generations of societal moral consensus against killing the sick and disabled!

Equality: As ridiculous as it sounds, assisted suicide advocates will actually say that able-bodied people can commit suicide so why should Joe Shmoe be denied the same right just because he is too disabled to commit suicide. This is where clear language and clear thinking are critically important. Just because a healthy man can kill himself does not mean he has a right to kill himself. Society will try to stop him from hurting or killing himself. His loved ones may even intervene and put him in psychiatric care to prevent him from hurting himself. In cities all across Canada there are suicide hot lines meant to help prevent people from taking their own lives and get proper counselling.

Rational Suicide: Now that’s an oxymoron! The instinct to survive is natural. Committing suicide is not. Many people in psychiatric helping professions think that by definition, suicide is irrational.

In the first few years after I was diagnosed with MS, the disease was stripping me from being healthy and able-bodied to chronically sick and disabled; I was in constant danger of sinking beneath the waves of my circumstances and despairing of life. My grief was so profound, my heartache so sharp, my terror so intense – my thinking became clouded. I needed people to lift me up as valuable even when I ceased to value myself. I am so glad there was not a Jack Kevorkian around in the mid-1980s. I might have succumbed at a low point.

Quality of Life: People advocate euthanasia or assisted suicide when quality of life has been deemed to be too low. Whose standard will judge? The treating physician? The family of the sick person? The patient? Euthanasia/assisted suicide advocates usually say the patient decides. The problem is this: Quality of life is a moving target. What gave my life quality at 25 years of age is not what gives my life quality at 58 years of age. At what point do we stop the continuum for quality of life. At 25 years my quality of life revolved around being athletic and physically active with my family and enjoying an upwardly mobile career. After I was diagnosed (at the age of thirty) those things either stopped or were severely hampered.

In my grief, I did not understand that a time would come when love (not physical function) would define my standard for quality of life. In my early thirties, the joy of having grandchildren did not even cross my mind and yet today they are my joie de vivre! Some arbitrary cut-off point for quality of life would have stopped that joy before it was.

THE THREAT OF DISABILITY DISCRIMINATION

As was stated earlier, acceptance of assisted suicide and euthanasia will threaten people with disabilities. I fear it will compromise the extent of medical care offered to Canadians with severe disabilities or incurable conditions. In an era when strained provincial health budgets account for the lion’s share of governments’ spending, inexpensive euthanasia can become an attractive alternative to costly and prolonged treatments ― especially when cures are impossible. Many people with severe disabilities or incurable illnesses already feel they are a burden on others; they may see physician prescribed death as a way of freeing their loved ones – particularly as the practice becomes more entrenched.

I fear that easy euthanasia will increase cases deemed as futile care and increase DNR orders. When euthanasia or assisted suicide is readily accepted as a treatment option, will the care or the patient be seen as futile?

Quality of auxiliary hospital care is already dismal in many jurisdictions. Will physician prescribed death improve nursing home care? No. People warehoused in the worst of these miserable institutions may opt for death rather than abandonment. The proper answer is not assisted suicide, rather improvement to auxiliary care that demands to be considered as indispensable to inclusive community life. Inclusion.

Euthanasia or assisted suicide can be so attractive and easy. It is a cheap compassion that requires so little humanity from those who administer or prescribe it. Certain lives will ultimately be deemed as unworthy of life and ended with or without their consent. Guess who they will be? Moi, et les gens comme moi.

Sincerely,
Mark Davis Pickup
(I used my full name because there is another Mark Pickup who is a professor at the University of British Columbia.)


[1] Washington v. Glucksberg, 1997.
[2] Lewis Carroll, ALICES ADVENTURES IN WONDERLAND & THROUGH THE LOOKING GLASS (London: Bloomsbury Books, 1994), p. 197.
[3] Dr. John Scott, “FEAR AND FALSE PROMISES: The Challenge of Pain in the Terminally Ill” in EUTHANASIA AND ASSISTED SUICIDE: The Current Debate , ed. Ian Gentles (Toronto: Stoddart Books, 1995), p. 96.