A few days ago The Conference Board of Canada held the Summit on Sustainable Health and Health Care. One of the most interesting sessions in the Summit was a debate about whether or not end-of-life decisions belong to the individual. Two panellists provided expert opinions on each side of the debate very well, especially by the stories of real Canadians:
- Nagui Morco, after suffering from Huntington’s disease for eight years, decided to end his live prematurely. He was afraid that if he waited longer, he would not be capable of doing it himself and current laws in Canada did not give him any other option.
- Women in wheelchairs face long wait times (up to 4 times the average) for a mammogram because there is not enough wheelchair-accessible diagnostic equipment. This leads to late diagnosis and often worse prognosis.
- Gloria Taylor, a determined and courageous woman who suffered from Lou Gehrig’s disease, was given an “exemption” to seek assistance to commit suicide at the time of her choosing, after battling with the BC government.
- Many Canadians with disabilities are more likely to be unemployed and poor, to live in inadequate houses, and to be isolated. This often leads to depression and even suicidal thoughts.
At the centre of the controversy is the right of people to make choices about their death in extreme situations versus the need to protect vulnerable populations who, because of health disparities, don’t have the same opportunities to access health care services and have limited options to improve their quality of life.
Although suicide is legal in Canada, assisted suicide is not and it carries a jail term of up to fourteen years. Netherlands, Belgium, Luxembourg as well as Oregon and Washington states have approved Death with Dignity legislation that allows health care providers to prescribe and administer medication to end people’s lives under very specific criteria (e.g., terminally ill, less than 6 months to live, and competent to make their own decisions). In Montana, physicians can’t be prosecuted for prescribing lethal drugs to terminally ill patients and New Jersey is taking step to decriminalize assisted suicide. Interestingly, Massachusetts polled its citizens on November 6 on this same debate. The result? The motion was defeated by 51 per cent against 49 per cent (a difference of only 38,000 votes), a very close call despite all the resources invested by interested parties opposing this motion.
The international experience seems to demonstrate that it is possible to build provisions in this type of legislation to protect the vulnerable against abuse. Also importantly, there is no evidence that a large number of vulnerable and disabled people are using this legislation to end their lives. Furthermore, not all people who have been given a prescription for a lethal drug use it, which seems to suggest that the safeguard in place to protect people who might have doubts or change their decision is working. Last year in Washington, 103 people received prescriptions for lethal drugs, but just under 71 per cent used them. Similar numbers were observed in Oregon.
Support for Death with Dignity legislation in Canada has been mounting, particularly in British Columbia and Quebec. In preparation for the debate at the Summit and before and after the debate we polled participants and website visitors to assess their views on these issues. The results were consistent: over 80 per cent of the respondents in each survey believed that end-of-life decisions belong to the individual.
This suggests that perhaps it is time for Canadian policy makers to revisit the law on this matter. Open discussion of the challenges and concerns argued during the debate would help to shed light on options that would respect the individual autonomy of terminally ill Canadians while protecting the vulnerable population. Other countries like the United Kingdom, New Zealand, Australia and Ireland have already started this task. In the meantime, health and social systems in Canada have the responsibility to do what is necessary to decrease health inequities. Ensuring access to high quality health care services to all Canadians, including marginalized and vulnerable populations, would go a long way in ensuring that these individuals have access to opportunities that lead to balanced and healthier lives