News and Views
The Euthanasia Movement: From Québec to Canada and
Why it Matters to You
Michael M. Li, BSc (1T2), Faculty of Medicine, University of Toronto
O
n May 13th 2009, Bloc Québécois MP Francine Lalonde
introduced a private member’s bill to legalize physicianassisted suicide and active euthanasia in Canada for
those who are terminally ill or who are suffering pain “without
any prospect of relief.”1 Far from being a callous politician too
removed from the real world to understand the ethical ramifications of her actions, Mrs. Lalonde herself has been battling
cancer for the last two years and consequently provides a unique
voice arguing for what she sees as providing all Canadians with
the fundamental right to live or die with dignity.2,3 Despite vocal
opposition from groups such as the Euthanasia Prevention
Coalition, Bill C-384 received its first hour of debate on October
2nd 2009, where two MPs spoke out in favour and six MPs spoke
against it.4 The bill is currently awaiting a second and final hour
of debate before voting occurs on December 2nd, and as of the
publication of this journal it will already have had the distinction
of being the furthest any piece of legislation supporting active
euthanasia has gone in the Canadian legal system.5
It should be noted that this absolutely cannot be dismissed as
an isolated incident from a single individual (though admittedly,
this is the third time that Mrs. Lalonde has introduced such a bill,
with previous attempts in 2005 and 2008). Consider that at a very
recent press conference (November 3rd, 2009), the Collège des
médecins du Québec (CMQ) formally announced their support
for physician end-of-life decisions that could legally be construed
as forms of euthanasia.6 In particular, Dr. Yves Montagne, president of CMQ, noted that “… there are exceptional situations
where agony and suffering persists and where physicians are asked
to act in certain ways that could be interpreted as being prohibited by the Criminal Code. We are of the opinion that many of
these actions constitute appropriate medical care.”6 This is the
first time that a Canadian physicians’ organization has spoken out
in favour of euthanasia – in stark contrast to the Canadian
Medical Association (CMA), which currently has a policy directly
in opposition to active euthanasia and assisted suicide6 and which
has spoken out in opposition of Lalonde’s Bill C-384.3
Before we can delve into the significance of these two events, it
behoves us to outline the history of euthanasia-related legislation
in Canada and its current legal status today. In particular, the
Canadian discussion on end-of-life care has been driven by the
recent rise of debilitating, chronic, and incurable conditions
(such as ALS and AIDS), coupled with medical advances that significantly prolong, but not necessarily improve, the lives of these
patients.8 In many ways, Québec has been at the forefront of this
discussion; this is highlighted by what most people know as the
Nancy B. story. Nancy was a young Québecois woman who suffered from Guillain-Barré syndrome, a devastating autoimmune
disease of peripheral neuropathy that had left her nearly paralyzed and unable to breathe without a respirator.8,9 When she had
learned that her condition was irreversible, she indicated to her
healthcare team that she wanted her ventilator disconnected so
that she could pass away naturally. Insofar as she was a patient
6
refusing treatment, there was solid legal backing for her decision,
even if it meant her death.8 However, given her near-complete
paralysis, she was in the unique and unfortunate position of not
being able to stop the ventilator herself, leaving healthcare workers liable to charges of assisted-suicide under the Criminal Code
should they intervene to help.9 Refusing to accept this reality,
Nancy B. took her case to court, resulting in the seminal decision
of 1992 (Nancy B. vs. Hotel-Dieu de Québec et. al, Québec
Superior Court) which allowed for the legal withholding of needed medical treatment – in essence, the Canadian legal basis for
passive euthanasia.8,9
According to Dr. Arthur Schafer, famed Canadian bioethicist
and director of the Centre for Professional and Applied Ethics
(University of Manitoba), passive euthanasia as a concept has
been fully embraced and accepted by Canadians and consequently it is now simply “appropriate care,” which does not carry the
moral baggage.10 Similarly, what was previously known as indirect
euthanasia (applying medical treatments which are supportive
but are known to shorten life) is now simply termed “palliative
care” and he points out that in Canada’s healthcare system today,
“a physician who denies adequate pain relief to a dying patient
because of fears that the analgesic might cause death would be
considered unprofessional.”10 Nevertheless, indirect euthanasia
has not been explicitly approved in the Canadian Criminal Code,
despite its widespread acceptance in the medical community.8
Perhaps most insightfully, he notes the lack of basis for the slippery-slope argument used by opponents of passive euthanasia in
the past – physicians today have not been dehumanized by the
ability to withdraw treatment.10 In fact, he argues that the very
opposite is arguably true as physicians now pay special attention to
the unique needs of individuals with regards to their end-of-life
decisions, and that physician-assisted suicide is the logical next
step in improving patient care.10
Given the historical approval of these ‘lesser’ forms of
euthanasia, one might wonder why it has taken so long for
Canada to see legislation on active euthanasia. One of the main
reasons for this delay is that active euthanasia, alternatively
described as physician-assisted suicide, is open to attack on
numerous grounds – such as for being an immoral act (of
either murder or abetting suicide), for going against physicians’
traditional oaths to “do no harm,” and for giving excess power
to the government with regards to controlling the lives of
patients. Many still remember the tragic case of Tracy Latimer
in 1993, who suffered severely debilitating cerebral palsy until
her father killed her with carbon monoxide at the tender age of
12.8,11 Convicted of second-degree murder in 1994, Mr. Latimer
defended his actions by pointing out that “[it] was a torture
issue. It was about mutilation and torture for Tracy [due to her
medical treatments]”.11 Police who had spoken to Mr. Latimer
described that “his priority was to put her out of her pain.”8
Though Mr. Latimer was granted a retrial in 2001, he was once
again convicted of second-degree murder.8,11 No one can know
UTMJ • Volume 87, Number 1, December 2009
News and Views
The Euthanasia Movement – From Quebec to Canada and Why it Matters to You
if the decision would have been any different had a physician
acted in his stead, but it would seem unlikely.
Arguably, the most concerning claim is the one put forth by
disability advocates. Many contend that allowing for euthanasia
based on a subjective assessment of “suffering without relief”
could lead to physicians broadly interpreting any disability as a
cause for undergoing euthanasia.12 In effect, they argue, this
would provide for a legal basis to “mercy killing” disabled
patients based on the judgement of non-disabled strangers.12 It
is in this context then, that Conservative MP Steven Fletcher, a
C4 paraplegic after a motor vehicle crash in 1996, has chosen to
abstain from voting on the C-384 bill, despite having indicated
support for euthanasia in the past.13 As a disabled person and as
someone suffering immensely from disability (he describes that
after his accident, he felt pain that “would make you welcome
death”), Mr. Fletcher uniquely sits on both sides of the fence in
the debate. As he succinctly puts it, “In one direction, people
could be killed because others think their pain is intolerable –
just as disabled advocates claim. But there is another direction,
too, whereby people can be forced to live in pain that truly is
intolerable.”12
Perhaps the best picture of the Canadian situation is given by
assessing the prevailing attitudes of the public or physicians and
of those who would benefit from (or be hurt by) euthanasia legislation. In 2004, an Environics poll found that 68% of Canadians
supported euthanasia and a second poll in 2009 put that number
at 61%, though the latter was funded by the pro-life LifeCanada
organization.15 Similarly, an Ipsos Reid survey of Canadians in
2007 found that 76% of respondents supported the “right to die”
(a softer expression).8 The fact that a pro-euthanasia majority
exists in Canada is well-known and has been true for the last 14
years, highlighting the challenges in bringing this controversial
topic from the dinner table to the legislative table.8 Perhaps more
telling are the reservations the public has about euthanasia – in
the 2009 Environics poll, a significantly higher proportion wanted to see government spending on palliative care (69%) as
opposed to on legalizing euthanasia (18%).15,16 Furthermore,
56% worried that if euthanasia is legalized, elderly persons would
feel pressured to under go euthanasia to reduce healthcare costs,
while 70% worry that sick, disabled, or elderly persons would be
euthanized without their consent.15,16 Such concerns are echoed
by Dr. Margaret Somerville, director of the Center for Medicine,
Ethics and Law (McGill University), who opposes C-384 and pithily states, “It is so important not to have the precedent of killing
each other in society.”3 Information on the opinions of Canadian
doctors is more limited, but a survey of Québec medical specialists in 2009 by Ipsos Descarie found that 75% supported legal
guidelines for euthanasia.17 Most specialists (73%) stated that
they believe the question of euthanasia is an ethical or moral one
and only for 13% is it a purely legal matter.17 Having said that, the
question arises as to whether these physicians partially support
euthanasia on a purely practical basis, as a startling 81% of them
reported seeing their colleagues provide euthanasia to patients.17
Overall, given the high rates of approval for legalized euthanasia
by these Québec specialists, the recent FMQ policy statement
appears to merely be a reflection of the views of its members.
It is still much too early to say whether Mrs. Lalonde’s most
recent attempt at euthanasia legislation will result in any meaningful change. But it appears clear that the steadfast beat of the
euthanasia drum is getting louder and closer, and it is inevitable
that more physicians and their organizations will speak out in
UTMJ • Volume 87, Number 1, December 2009
favour or against it. Everyone will ultimately have their own personal views on whether physician-assisted suicide should be
legalized. Nevertheless, it is prudent for physicians and patients
alike to be well-informed about the political and societal climate
surrounding end-of-life care. It is not unforeseeable that
provinces with higher support for it (i.e. Québec) will make
steps in moving towards legalized euthanasia, with or without
the backing of the federal government. Having knowledge of
the background and current state of end-of-life legalities on
both a national and local level will aid those in healthcare with
the oftentimes challenging decision-making process in helping
patients live and die with dignity.
References
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