Bill C-14, introduced in the House of Commons on April 14, is titled “An Act to amend the Criminal Code and make related amendments to other Acts (medical assistance in dying).” The phrase “medical assistance in dying” is used 72 times, and the definition in Section 241.1 states: “prescribing, providing or administering a substance that causes death.”
While every word in a legal definition matters, the language of this debate is more broadly significant. How do we as a society understand personal autonomy and the taking of one’s life? How do we distinguish between a group of teenagers on an aboriginal reserve entering into a suicide pact, after deciding that life is not worth living, from citizens with a terminal diagnosis, fearing they’ve become a burden to their families and society, who similarly decide that death is preferable to life?
The debate is hardly new, but there are distinctions that require care and precise language. Yet that the language appears to be heading in the opposite direction.
In 1991, the Supreme Court of Canada ruled in the Sue Rodriguez case that ‘assisted suicide’ (a phrase used 92 times in that decision) should remain prohibited under the Criminal Code. In the 2015 Carter decision, the court considered the same essential question but came to an opposite conclusion; it used the term ‘assisted suicide’ 23 times and the term ‘assisted death’ 24 times.
This change of language is problematic. All sides of this debate are quick to emphasize the importance of including palliative care in any end-of-life discussion. Palliative care is generally understood to refer to a multi-disciplinary approach to the relief of symptoms and pain for those with a terminal diagnosis, as opposed to a curative objective. Effective palliative care uses the knowledge of the medical system to assist people in the dying process. A good death is often a physician-assisted death.
This is something very different than assisted suicide or a medically-hastened death. Unfortunately, the term ‘physician-assisted death’ now means something the words at face value do not mean.
This is not simply a quibble about semantics.
Since the fifth century BC, doctors have been taking the Hippocratic Oath, which prohibits the taking of a patient’s life. At its core, the oath is a pledge to use scientific knowledge to treat the sick, preserving and extending life, while respecting that “there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”
Let’s leave aside for a moment the morally contentious debate and accept the court’s ruling that society has a responsibility to help those with grievous and irremediable medical conditions end their own life if they are unable to do so themselves. This could be accomplished without redefining the health system. Simply create a Criminal Code exemption for a category of persons who would could assist in the dying process in a medically responsible way, outside of the health system.
That would ensure that the public remain confident that the health system is ethically focused on ensuring continued life. Some vulnerable elderly and disabled people living where assisted suicide is legal choose to forego treatment because they worry their doctors may kill them. The fact that the Carter decision discussed “mitigating” the occasions of abuse acknowledges that abuse is real. So it is inevitable that any ‘medically-assisted death’ regime results in a new group of vulnerable people who will not get the medical care they need and deserve.
We also need to keep in mind that by requiring medical professionals to participate in the hastening of death, a segment for whom this is morally offensive will opt out of the medical system. This may include palliative care specialists. The result is a lessening of the quality of health care for all.
There is much more at stake than word choice when we have moved from the terminology of euthanasia and assisted suicide to ‘medically-‘ or ‘physician-assisted death.’
The consequences are not simply between a patient and their physician. They affect us all, so we owe ourselves an honest conversation in which words are used properly, and definition and meaning can be properly understood.
Ray Pennings is the co-founder and executive vice-president of Cardus, a Hamilton-based Christian think tank.