Legalization of Assisted Suicide and Euthanasia: Foundational Issues and Implications (original) (raw)
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Euthanasia and Assisted Suicide in Canada
This paper draws attention to euthanasia, which is illegal in Canada, and highlights efforts that have been taken for a few decades to legalize it and, based on foreign experience on legal euthanasia, explains what implications legalization might entail. The arguments voiced in support of legal euthanasia are not persuasive since it seems that critical patients in most cases want pain relief through whatever means, but not at the price of their lives. However, by using misinformation and scare tactics, proponents may misguide people and lure them into supporting legal euthanasia. The paper concludes that the government should pursue more clear and decisive measures aimed at keeping euthanasia illegal and proposes some steps to be taken in the healthcare system that would discourage further advances of the euthanasia movement.
Supreme Court of Canada orders legalization of physician assisted suicide and euthanasia
This paper offers a retrospective analysis of the Supreme Court of Canada decision legalizing physician-assisted suicide and physician-administered euthanasia (EAS). The analysis is informed by later controversy about providing EAS for mental disorders and by the development of practice environments increasingly hostile to objecting practitioners. It explores the meaning of irremediablilty in the trial court and Supreme Court decisions, the contested status of EAS in relation to medical practice and health care, and claims that Canadian courts have determined that there is no ethical difference beween EAS and accepted contemporaneous end-of-life practices like withdrawing inefficacious or disproportionately burdensome treatment.
British Medical Bulletin, 1996
This chapter describes some dominant trends of American and Canadian law in relation to treatment refusal, physician-assisted suicide and euthanasia Although common law in both countries recognizes the right of patients to refuse treatment, problems have arisen, especially in the US, over treatment refusal on behalf of incompetent patients.One response has been to enact advance-directive legislation, promoting the use of living wills and proxy appointments. Courts have also specified criteria for withholding and withdrawing treatment from incompetent patients.The notion of a 'right to die' developed in court cases on treatment refusal, is now being invoked to support the legalization of assisted suicide. Courts are generally reluctant to recognize an extention of this right Debates and court cases following the recent initiative to legalize assisted suicide in Oregon and the Sue Rodriguez case in Canada's Supreme Court which resulted in a special report of a Canadian Senate Committee, are of major importance for the development of law in this area.
In December, 2013, the Canadian Medical Association (CMA) Board of Directors decided to shape the debate and law concerning euthanasia and assisted suicide and revisit CMA policy opposing physician participation in the procedures. By the summer of 2014 it was clear that the overwhelming majority of physicians supported the existing policy. However, it appears that the Board decided the policy should be changed before the Supreme Court of Canada decided the case of Carter v. Canada. The Board sponsored an ostensibly neutral resolution affirming support for the right of physicians to follow their conscience in deciding whether or not to provide euthanasia/assisted suicide if the law changed. The resolution was overwhelmingly approved. Unnoticed at the time was that the resolution was not conditional upon eligibility criteria, such as decision-making capacity or terminal illness. The CMA intervention at the Supreme Court of Canada in the Carter case emphasized that existing CMA policy against euthanasia and assisted suicide would be changed to reflect the resolution. It conveyed the message that the Association would support physicians who decided to participate in euthanasia or assisted suicide no matter how broadly the Court or legislatures might cast the rules governing the procedures. The Board reversed CMA policy about two months before the Court ruled. It formally approved physician assisted suicide and euthanasia, subject only to legal constraints. The policy did not exclude minors, the incompetent or the mentally ill, nor did it limit euthanasia and assisted suicide to the terminally ill or those with uncontrollable pain. It classified both as "end of life care," promising support for patient access to the procedures should they be legalized. Support for physicians refusing to participate in euthanasia or assisted suicide was qualified by the statement that there should be no "undue delay" in providing them. Implicit in all of this was a new ethical paradigm: that in some circumstances, physicians have a professional obligation to kill patients or to help them kill themselves. The new policy effectively wrote a blank cheque for the Supreme Court of Canada to legalize euthanasia and physician assisted suicide on any terms acceptable to the judges. After the Court struck down the law CMA officials expressed concern about the criteria set by the Court. It was implied that the Supreme Court was to blame for anxiety and profound discomfort among Canadian physicians because it had imposed upon them an obligation to kill, contrary to centuries of medical ethics and practice. However, the concerns voiced by CMA officials after the Carter ruling existed when the CMA intervened in the case, and the CMA did not raise them then. In fact, the Supreme Court gave legal effect to a policy the CMA had already adopted, and the criteria the Court set for the procedures were actually more restrictive than anything the CMA had proposed. The Court cannot be blamed because CMA leaders were ill-prepared to deal with the consequences of a ruling entirely consistent with their own policy. The consequences fell most heavily upon physicians who refused, for reasons of conscience, to provide euthanasia and assisted suicide or to collaborate in providing the services by referral or other means. Since Carter, the debate in Canada has been largely about whether or under what circumstances physicians and institutions should be allowed to refuse to provide or facilitate the services. While it is generally agreed that physicians should not be compelled to personally provide them, there are strident demands that physicians unwilling to kill their patients or help them commit suicide should be forced to refer patients to someone who will. This review demonstrates that the CMA Board of Directors focus in 2014 was on the role physicians would play in providing euthanasia and assisted suicide should the law change. The Board knew that the overwhelming majority of Canadian physicians would refuse to participate in euthanasia or assisted suicide. The fundamental conflict presented by imposing an obligation to kill upon unwilling physicians was foreseeable and had been foreseen by CMA officials. Attacks upon physician freedom of conscience, particularly with respect to referral, were predictable. However, the Board failed to consider physician freedom of conscience in relation to assisted suicide and euthanasia except the extent that it could be used to further its policy goals. As a result, after the Carter ruling, CMA officials were quite unprepared to mount a cogent, articulate and persuasive defence of physician freedom of conscience, especially in relation to referral. They discovered that state authorities and the public were often unreceptive and even hostile to physicians unwilling to arrange for patients to be killed by someone else. Negotiating at a significant disadvantage of their own making, they were desperate to find a policy "acceptable to the regulators" and to objecting physicians whose fundamental freedoms they had rashly jeopardized. The CMA has since produced a strong defence of physician freedom of conscience in relation to referral for euthanasia and assisted suicide, and sound protection of conscience provisions have been incorporated into a revised CMA policy on the procedures. However, by the time these statements appeared, objecting physicians were on the defensive in a treacherous and even hostile environment, compelled to launch an expensive constitutional challenge to defend fundamental freedoms of conscience and religion. The outcome of that case will determine if they will be able to continue to practise medicine if they refuse to collaborate in killing their patients. The World Medical Association (WMA) national medical associations are free to decide to change their policies on physician participation in euthanasia or assisted suicide. This review demonstrates that they should not follow the example of the Canadian Medical Association if they wish to safeguard the fundamental freedoms of physicians and health care workers.
Redefining the Practice of Medicine: Euthanasia in Quebec
An Act Respecting End-of-Life Care ("ARELC") is intended to legalize euthanasia by physicians in the province of Quebec, a legally contentious project because of Canadian constitutional law. This paper does not take a position on the desirability of euthanasia or assisted suicide, but reviews ARELC in detail from the perspective of physicians who do not wish to be involved with such procedures for reasons of conscience. The Contents following this summary outlines the paper, which consists of nine parts and three appendices. Each part opens with an abstract.
The Ethical and Legal Desirability of Physician Assisted Suicide and Active Voluntary Euthanasia
The question of whether a framework legalising physician assisted dying ought to be adopted in the UK engages conflicting ethical ideologies towards the value of life and the rights of individuals. Currently the law in the UK prohibits ‘mercy killing’, absolutely on the grounds of murder, irrespective of permission or good will . The law surrounding assisted suicide is however enshrined in Statute as a particular offence. The Suicide Act 1961 criminalises “an act capable of encouraging or assisting the suicide or attempted suicide of another person” . This law is unique in that it renders an accessory liable to conviction when the principal individual does not themselves commit a criminal offence . However, following a number of high profile cases involving individuals with debilitating illnesses who wished assistance in committing suicide and a growing public consensus on the desirability of pro-assistance legislation , Parliament is reviewing Lord Falconer’s ‘Assisted Dying Bill’ which aims to legalise the practice in limited circumstances. In this essay it will be asserted that the ethical desirability of legalising physician assisted suicide (PAS) and active voluntary suicide (AVE) rests upon the value of life and the ethics of suicide itself. Consequently, before any consideration of the ethics on legislation can be accurately made it must first be shown whether suicide itself can be ethically justified. This essay will address this issue by considering the conflicting ethical concepts of the inherent sanctity of life and theories on the importance of autonomy and self-determination. Upon concluding that it is indeed the latter aspects of human life that give it value, it will be argued that an ethical continuum exists that allows for the extrapolation of the ethical justifiability of suicide to PAS and AVE.
Legalizing physician-assisted suicide and/or euthanasia: Pragmatic implications
Palliative & supportive care, 2015
Objective: Despite the availability of palliative care in many countries, legalization of euthanasia and physician-assisted suicide (EAS) continues to be debated-particularly around ethical and legal issues-and the surrounding controversy shows no signs of abating. Responding to EAS requests is considered one of the most difficult healthcare responsibilities. In the present paper, we highlight some of the less frequently discussed practical implications for palliative care provision if EAS were to be legalized. Our aim was not to take an explicit anti-EAS stance or expand on findings from systematic reviews or philosophical and ethico-legal treatises, but rather to offer clinical perspectives and the potential pragmatic implications of legalized EAS for palliative care provision, patients and families, healthcare professionals, and the broader community. Method: We provide insights from our multidisciplinary clinical experience, coupled with those from various jurisdictions where EA...