The average citizen, and perhaps even the average physician, may view death with dignity, a good death, aid in dying, compassionate care of the dying, and physician-assisted suicide as of the same species (BCMJ 2014;56:6). But criminal law draws sharp distinctions between suicide, mercy killing, assisted suicide, and death resulting from the nonprovision or withdrawal of treatment. Detractors of physician-assisted suicide appeal to various state interests, moral imperatives, and practical considerations. What if the patient does not die immediately? Do we proceed to euthanasia-assisted suicide? In countries where physician-assisted suicide has been available for years, it is known that 18% can initially fail or linger for hours or days. How many months will be assessed as final months--an arbitrary choice to begin with--and who gets to decide?
The fact that a slippery slope exists is undeniable. It is the steepness of the slope that we are debating and trying to control. The Netherlands started in the late 1970s with physician-assisted suicide and belatedly progressed to statutory recognition of the process and euthanasia-assisted suicide, which a recent survey reported outweighs physician-assisted suicide by far as a method for terminating life, and now includes mental illness and a worthless life, so long as the correct boxes are ticked. Emphasis is changing from a specific medical diagnosis to the importance of statutory control and oversight. In Belgium the process has been far more rapid, with statutory implementation in 2002 and a more recent inclusion of neonates and children. Again, the euthanasia option dominates by far. If physician-assisted suicide is seen as a Charter right, what are patients trying to say? That they may have the opportunity and the means to take their own life (terminally ill patients do not die with empty medicine cupboards), yet they prefer not to do so in the solitary confines of their bedroom and alone. They will request the presence of a physician, thereby legitimizing the act as well as giving it social and public acceptance. Or are patients confusing physician-assisted suicide with euthanasia--requesting legal sanction for suicide yet expecting a doctor to physically terminate their life on request?
Anyone debating this issue, be it for or against physician-assisted suicide, needs to make sure the public understands the depth of the conversation.
--Kobus de Jager, MD
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