Assisted suicide vs end-of-life care

Issue: BCMJ, vol. 56, No. 1, January February 2014, Page 6 Letters
By: Allan Donkin, MD,

Since the media has been lending some attention to the topic of assisted suicide recently, I have a few thoughts that are probably less commonly heard and would not easily be portrayed in the media, which tends to be one-sided.

Our current Western worldview elevates the ethical principle of autonomy above all others. This has not always been the case and will not always be the case going forward, as the ethical principles favored by society tend to evolve through the ages.

When it is taken to the extreme, autonomy ends up with some humans harming others in order to preserve their own autonomy. I see assisted suicide as one of the results of an autonomy-first worldview that is out of balance. 

What concerns me is the type of society that assisted suicide will lead to. When I say that, I do not mean that I am concerned about the slippery slope we might slide down over time. Though the slippery slope has been a grave concern for many when observing the developments in Europe (as one example),[1] that is not what I am referring to. I am referring rather to the direct, dramatic, and immediate change in society that will occur the very second an assisted suicide law is signed into existence. 

The immediate change is this: that as soon as assisted suicide is allowed, it becomes a choice that everyone in the entire community has to make—not just a choice that some people can make but an option that everyone else has to choose not to take.

People can no longer rest in the knowledge that their disabilities, dependency, and suffering are not their fault: that they can guiltlessly depend on the kindness and compassion of the community around them to care for them faithfully and without resentment until the very end. Instead they will be left with the knowledge that every day that they continue to depend on the care of others it is by their own choice.

If a change like this is accepted by the government and the medical profession it would be given a high level of credibility and acceptability, putting people under pressure to choose suicide.

I do not think that people will frequently be bullied into making a decision to ask for assisted suicide, but it will rather be a more subtle societal expectation that will undermine people’s true freedom of choice by making them feel that they are a burden to their loved ones and society. This effect is inescapable, and will hit hardest at the most vulnerable in society.

I would rather advocate for a society where caring is held in high regard, with no option of a person being considered a burden, or blame being placed on the sufferer. This requires a community-first worldview approach rather than an autonomy-first approach, wherein the consequences to the vulnerable are considered before the autonomy of the individual.

The right solution would involve harder work—getting involved in the lives of lonely and dying people to an extent that they feel welcome and know that their presence is valued, rather than leaving an offer of suicide continuously dangling in front of them.
—Allan Donkin, MD
Fort St. John

References

1.     Pereira J. Legalizing euthanasia or assisted suicide: The illusion of safeguards and controls. Curr Oncol 2011;18:e38-45.

Allan Donkin, MD,. Assisted suicide vs end-of-life care. BCMJ, Vol. 56, No. 1, January, February, 2014, Page(s) 6 - Letters.


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