Stuart Chambers discusses an oversight in the Report by the Special Joint Committee on Physician-Assisted Dying.

__________________________________________

The Special Joint Committee on Physician-Assisted Dying recently released its Report titled Medical Assistance in Dying: A Patient-Centred Approach. The Report has received much praise for being inclusive and comprehensive. For instance, Jocelyn Downie, a Professor in the Faculties of Law and Medicine at Dalhousie University, recently mentioned in Impact Ethics that the Report’s 21 recommendations “address all of the critical issues relating to access to assisted dying.”

The recommendations are certainly broad in scope and suggest assistance in dying for individuals with “terminal and non-terminal grievous and irremediable medical conditions that cause enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” Put simply, death can be intentionally hastened for cases involving illnesses or ailments that gravely threaten the existential being of the patient. However, one crucial detail is conspicuously absent from the Report: the methods of death-hastening.

Edvard Munch – Starry Night

Perhaps a conscious, consenting, and able-bodied adult could end his life by swallowing prescribed medication or even by pressing a button that delivers the same fatal dose intravenously. A dying patient could leave an advanced directive instructing medical personnel to terminate her life, just in case she lapses into a coma, becomes paralyzed or experiences some form of dementia. Assistance would then involve a medical practitioner who would have to fulfill the request using a lethal injection. According to the Report’s logic, these kinds of scenarios appear quite plausible, but one cannot draw any definitive conclusions.

Surprisingly, acts that hasten death are implied but not explicitly outlined. Instead, a generic term central to the Report’s mandate—medical assistance in dying—is used as a placeholder. Because it is an open concept, medical assistance in dying tends to obscure, rather than illuminate, the kinds of death-hastening measures patients can access. The layperson understands what “lethal injection” or “prescription overdose” means, so why not elaborate on the specifics of medical assistance in dying by highlighting acts of commission used in other jurisdictions, such as the Netherlands or Oregon?

Types of death-hastening methods are of particular interest in the following circumstances: once a diagnosis takes place; once a previous request is made; and once the patient is incapable of performing the final act. Since any context involving loss of autonomy invites allegations of potential abuse or the “slippery slope,” greater transparency surrounding methods of death-hastening would have been a welcomed addition to the Report.

For example, a more direct recommendation would have noted, “In cases where the patient is diagnosed, makes an advanced request, but later becomes incapacitated, the physician could perform the final death-hastening act by lethal injection,” or “terminal sedation could become the default method for incompetent patients.”  Without providing examples that showcase how people might die, the public is left wondering which death-hastening practices will be made available.

In June 2016, the Federal Parliament will no longer be dealing with recommendations. They will have to own the issue of an intentionally hastened death outright. At that point, the government will have to clarify what kinds of methods are legal and under what circumstances, especially for the most controversial cases. These include adults who can no longer make a rational choice—dementia sufferers, Alzheimer’s patients, and comatose victims—but who were unequivocal in their prior requests for assistance in dying. If patients can be euthanized by a third party—even after they have become non-rational or non-sentient beings—then this needs to be affirmed in clearer language.

Hence, the larger question still remains: Which methods of death-hastening can be used to intentionally end the life of both competent and incompetent patients? Time is running out on the Liberals who will soon have to come clean with all the details concerning the most controversial aspects of end-of-life practices.

__________________________________________

Stuart Chambers is a professor in the Faculties of Arts and Social Sciences at the University of Ottawa.