Sunday, February 17, 2019

Truchon, Gladu and the euthanasia of people who are not terminally ill

This article was published on February 7, 2019.

By Dr Catherine Ferrier
President, Physicians Alliance Against Euthanasia

In recent issues of this Newsletter we have considered the dangers of different ongoing schemes for enlarging the qualifying criteria for euthanasia, to include people with dementia (by advance directive), “mature” minors (with or without parental consent or knowledge) and those for whom psychiatric illness is the sole underlying condition.

Unfortunately, by virtue of a challenge currently undertaken by Mr. Jean Truchon and Ms. Nicole Gladu before the Québec Superior Court, there is now something quantitatively much worse on the table: euthanasia for people who are not at the “end of life” (as required by the Quebec law) or for whom, contrary to what Canadian law requires, “natural death is not reasonably foreseeable”. In other words, doctors may soon be asked to “medically” kill people who are not dying.

It is evident that to permit this would allow the phenomenon to assume proportions many times that of the original context of “unbearable suffering at the end of life”. Therefore, whatever dangers were first invoked in that discussion must now be multiplied a hundredfold.

Unfortunately, the plaintiffs and their counsel do not admit that any such dangers exist. Increased suicide, for example, is impossible in their world because “Medical aid in dying” is never suicide, by definition (although any qualified and suicidal patient would have the absolute right to die using a compliant doctor in the place of poison or gun). Moreover, no matter how many “vulnerable” persons were to die for the wrong reasons, that too is irrelevant, because Mr. Truchon and Ms. Gladu are not vulnerable. And in the myopic priorities of the petitioners: if even one, single, non-vulnerable ill or disabled person wishes to die, then society has a sacred duty to provide that death, even if it means completely transforming medical culture, regardless of what mayhem may ensue.

The law, however, must not uncritically endorse the perspective of any one stakeholder. The law has a duty to balance competing interests.

Jean Truchon & Nicole Gladu
These conflicting interests and the balancing function of the law were sharply illustrated on the first day of hearings by the presence of two severely disabled individuals, vehemently opposed to the demands of Mr. Truchon and Ms. Gladu, and determined to defend their own rights: not the right to benefit from a discriminatory exception to our criminal code which would allow their deaths; but the right to an equal and non-discriminatory application of existing law to prevent those deaths.

For that is what the law against assisted suicide does: it prevents deaths. Before the Carter decision and Bill C-14, it provided this protection to everyone; and even since the law was adopted, it has still protected those who are not at the end of life; but if the Truchon-Gladu challenge prevails, the entire population of chronically ill and disabled individuals will be stripped of such protection. And that is horribly wrong.

It has been reported that Mr. Truchon and Ms. Gladu’s counsel summarily rejected any notion of lost protection, using what has so often been accepted as an unassailable argument: “each one may choose”. But if apparent choice were sufficient protection from the dangers of assisted suicide, why do we still have a law at all? Why do “normal” people still require protection? The answer is obvious: Because the existing law does in fact provide real protection for the general population. And non-suicidal people who are ill or disabled (whether “vulnerable” or not), naturally resent this attempt to deprive them of their right to equal treatment before the law.

This is not different from many regulations in existence, such as, for example, those requiring doors to close off open elevator shafts (in spite of the fact that people may simply “choose” not to jump). We recognize that people can fall down the shaft by accident; or that in a period of existential weakness they might regrettably decide to jump; and yes, they may even be pushed. Doors prevent such tragedies. And so do our laws against assisted suicide.

Here, then, fundamentally, are the two sides to this issue: There are people who seek an exceptional “right” to jump, with the help of the medical profession; and there are those, every bit as qualified for that proposed exemption, who wish to benefit from the same level of protection accorded to every other citizen.

How, then, can we decide between these two competing and mutually exclusive views?
  1. The number of suicidal people like Mr. Truchon and Ms. Gladu is greatly inferior to those in similar circumstances who wish to continue living.
  2. It is impossible that people with the intellectual resources and networking skills of the non-vulnerable Mr. Truchon and Ms. Gladu can be prevented from dying if they really want to. Many thousands of Canadians commit suicide each year, and it is estimated that hundreds are assisted to do so. What Mr. Truchon and Mme Gladu risk, then, is not a requirement to live, but simply that society will not arrange for their deaths.
  3. Should Mr. Truchon and Ms. Gladu win, others, who will inevitably and regrettably succumb to the open elevator shaft of missing protection, will lose their lives. Our choice, therefore, is between providing a more convenient death for a few, or protection of ongoing life for many more.
  4. Fair minded people must realize the reality of intimidation, coercion – or even mere suggestion – originating from overwrought family, overburdened caregivers, and yes, perhaps blatantly greedy heirs; recognize also the danger of passing self-doubt, or existential despair, translated into state-sanctioned, medicalized suicide. We believe that what the legislators considered an acceptable weight of tragedy, in a compromise involving only those wishing to die more quickly and less painfully at the very end of life, should certainly be considered unacceptable when applied to the much larger population of those with non-terminal illness and disability.
  5. Law is a framework under which we live. The benefits of law should be maximized for those who are alive – and for those who wish to go on living.
From these several facts, we arrive naturally at the conclusion that the existing law (bad as it may be) should remain as it is without further expansion. Mr. Truchon and Ms. Gladu will die, as all people die, and probably much sooner, by their own hand or by the hand of others.

But when they leave this world, they must not be permitted to bequeath to us a framework that works to the detriment of those who have chosen to remain behind.

Make euthanasia unimaginable.

Catherine Ferrier
President, Physician Alliance Against Euthanasia.

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