Experts on recommendation to legalise euthanasia in Canada

Last week, the Royal Society of Canada released the final report of their expert panel on end-of-life decision making. The report lists several recommendations, among them that assisted suicide and euthanasia be legalized. The report is available here.

Our colleagues at the Science Media Centre Canada collected the following comments:

Wayne Sumner, Emeritus Professor of Philosophy, University of Toronto, author of “Assisted Death” (Oxford University Press, 2011)

What are your thoughts on the report?

“I’m completely in favour of the policy recommendations, with one or two reservations, but I’ve already defended similar policy recommendations in print, myself. I was very glad the panel came down on the side of legalization. The only reservation I have is their decision to base the ethical and legal recommendations solely on the value of autonomy, because it has implications for the shape of the policy.

“Some jurisdictions like the Netherlands have grounds for euthanasia that are based more on patient suffering, with the requirement that the patient must have an incurable disease and be experiencing significant suffering. Because the expert panel decided the primary value was autonomy, that [requirement for suffering] doesn’t turn up in the recommended policy. In fact, if you read the report, there’s not even any requirement that you have to be ill.

“It’s logical, if what matters most is autonomy, that patients have a right to request an ending to their life. But if you look at it slightly differently, the case in favour of a liberal policy can be based not just on autonomy but on relief of suffering as an independent value, and that allows you to draw the line a little narrower and require significant suffering. So I have a slight difference with them on that.

Do you think the panel has accounted for concerns that legalizing euthanasia and assisted suicide would be a ‘slippery slope’?

“In recommending a policy that is so broad and liberal, they’ve actually included some of the classes of people who might be at the bottom of that slope. So… they’ve already dealt with the slippery slope argument.

Tracey Bailey, Executive Director, Alberta Health Law Institute

“I would start by saying there are a number of excellent points made, and particularly from a legal perspective, the comment that we need legal clarification around the withdrawal and/or withholding of potentially life-sustaining treatment without consent. I could say much more on that. One of the key points I would take issue with, however, is the statement made that “autonomy is a paramount value in Canadian public policy”. It is a value that could be said to be important and has been enshrined in a number of ways in Canadian law. However, to state that it is paramount is, I would suggest, perhaps inaccurate but is at the very least misleading. It is but one of a number of values of great importance to Canadian society, at least if we use the laws of Canada as a measuring stick. Protecting the best interests of vulnerable individuals, beneficence, non-maleficence and justice are just a few other values that are of utmost importance and that have been incorporated into our laws around health care decision-making as well.”

Bernard Dickens, Professor Emeritus of Health Law and Policy, University of Toronto.

“I think it’s appropriate without going too far… The report is a very valuable study of the state of certainty and uncertainty, and a good review of other jurisdictions. It should start some compassionate discussions.

“The criminal code requires a mandatory minimum sentence of life for murder, with 25 years till parole for first degree murder and 10 years for second. It’s dysfunctional because it binds the hands of prosecutors.

“The report I think is well-balanced, cautious, but does recommend that that attempt to end one’s life can be rational.

“It doesn’t leap into dealing with mature minors. They’ve had a couple of 13, 14, 15 year olds who have refused blood transfusions and in some cases that’s been accommodated. But it doesn’t go further than that.

“It makes competence a condition. It deals with people who maybe aren’t competent now, but issued advanced directives when they were competent. It doesn’t accommodate people who have never been competent or never expressed any wishes and are now incompetent.”

Margaret Sommerville,  Founding Director, McGill Centre for Medicine, Ethics and Law, Samuel Gale Professor of Law

“The Report does not present a “balanced review of various pros and cons of decriminalization of physician-assisted death from well-reasoned ethical and legal standpoints”. Rather, as noted above, it presents the case for legalizing euthanasia and assisted-suicide.

“The Report considers issues almost entirely at the level of the individual. There is almost no discussion of the impact of legalizing euthanasia and PAS at the institutional level – in particular, impact on healthcare institutions and professions – or at the societal level, in particular, on important shared values such as respect for life. In fact this value is not discussed, an extraordinary omission considering the topic of the report.

“The discussion of the practices in jurisdictions that have legalized or allow euthanasia and assisted-suicide are seriously deficient and very selective so as to minimize the Reports coverage of abuses, expansions of justifications for the practices, and other problems or controversies.

“The authors make an assumption that individual autonomy is always the prevailing value and construct their case for euthanasia and PAS from there. They do not consider that for many people some other value might prevail – for example, respect for human life and that we don’t kill each other except when unavoidable to save life – and what line of argument and decision outcomes that would result in. In short, the authors have adopted a basic assumption, from which they state that everything else they accept and recommend flows, without adequately justifying doing so and not even mentioning the possible alternatives. To repeat, what about the value of respect for each individual human life and human life in general? The authors refer to the Charter as the proper source of our shared values: Apart from any other claims on behalf of the value of respect for life, we can even find it in the Charter.”

“The section on dignity, which the authors recognize has been an important concept in the euthanasia debate, is especially biased to the pro-euthanasia arguments and inadequate. In particular, a 2008 major and very comprehensive research report on the concept by the US President’s Commission on Bioethics is not even mentioned.”