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Harvey ChochinovI like Stephen Fletcher. Our brief encounters, typically in airports or the occasional public event, are always friendly and cordial.

It is hard not to admire him. Despite suffering from quadriplegia, he has found the strength to serve his country as a Member of Parliament, at various times holding appointments as Minister of State (Democratic Reform), Minister of State (Transport), and currently as a member of the Treasury Board Cabinet Committee.

Now, Fletcher is focusing his energy on promoting “physician-hastened death” (assisted suicide), and public opinion and legislative reform starting to turn his way. In April, the Supreme Court of Canada overturned the prohibition against assisted suicide.

A recent Ipsos Reid poll found that nearly 70 percent of Canadians support the availability of death-hastening alternatives for people living with significant disabilities that might impair their quality of life. In other words, Canadians find it inconceivable to imagine themselves confined to a body that even remotely approximates the one Fletcher lives in.

I suspect Canadians are afraid of the abject vulnerably his life proves is possible. For anyone wondering why physician-hastened death makes disabled people feel vulnerable, wonder no more.

While Fletcher argues that death should sometimes trump disability, studies of people who become disabled from spinal injuries, head trauma or strokes, offer a strikingly different perspective.

Just less than 10 percent of these patients become suicidal. In his autobiography, What Do You Do If You Don’t Die? Fletcher recounts suicidal thoughts that lingered long after his catastrophic accident. Had doctor-assisted suicide been an option after his 1996 car accident, he says he would have considered checking out. Thankfully it was not.

Those of us working in healthcare understand that life-altering illness, trauma or anticipation of death can sometimes sap our will to live. In those instances, healthcare providers are called upon to commit time – time to manage distress, provide support and assuage fear that patients might be abandoned.

Arranging the patient’s death has never been part of that response. In light of the decision by the Supreme Court, we must now contemplate Canada’s future euthanologists. What professional designation will they require? What disciplines will they be drawn from? What training will they receive? What ethical and practice guidelines will they abide by? And what judicial oversight will they submit to?

Fletcher, I and Professor Margaret Somerville, spoke at a recent forum on euthanasia and assisted suicide. Fletcher said he did not want to die drowning in his phlegm and in pain. I assured him that, on behalf of Canada’s palliative care community, we would not let that happen.

He said that he did not want to be reliant on machines to keep him alive. I told him that competent Canadians, under our current laws, are entitled to refuse or discontinue treatment, including life-sustaining measures. He described autonomy as a core Canadian value. I reminded him that autonomy has its limits, particularly when it implicates the physician’s role in response to suffering.

Fletcher says he has received supportive letters from across the country from people who fear what dying will look like. With too few Canadians having access to palliative care, it is little wonder people are afraid. Offering the option to have their physician end their lives feels akin to confronting homelessness by eliminating guardrails from bridges.

Fletcher feels that safeguards, such as a ‘cooling off’ period to establish that a request to die is sincere, not coerced and sustained, are possible. If so many in your circumstance change their mind, I asked him, do we now require a two-year waiting period? His response was, “Maybe.”

To be fair, perhaps Fletcher had not considered how asking physicians to stop time could undermine their most powerful response to suffering. His voice has become an important one in how we conceive of disability, death and dying and no doubt is one that Canadians anxiously await to hear.

(Fletcher was provided the opportunity to respond to this editorial; he declined to do so).

Dr. Harvey Max Chochinov is the Director of the Manitoba Palliative Care Unit, CancerCare Manitoba, and Distinguished Professor, University of Manitoba.

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Assisted suicide

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