Re: Assisted suicide vs end-of-life care

Dr Donkin is to be commended for again raising the subject of assisted suicide. It appears to be getting more coverage in the media and needs more from within the medical profession as well. His thoughtful letter does, however, contain several basic errors of fact and logic.

The parallel to the suggestion that access to assisted suicide automatically causes us to feel guilty for living when we have a serious illness that might shortly result in death is the suggestion that, because we have abortion legislation, all women—on learning they are pregnant—immediately face a guilt-ridden decision about abortion. Obviously abortion legislation has not had this effect. It has simply given us one more choice involving autonomy and personal rights. There is no logical reason to jump to the conclusion that assisted suicide legislation will pressure people to choose suicide, but it will give many the opportunity to think about it in the context of a dignified death when palliative solutions are not sufficient for their needs.

Of course, as Dr Donkin points out, caring needs to be held in high regard. And I think those doctors who support Dying with Dignity (such as myself—a member of the Advisory Council of Physicians) hold that philosophy as central. Part of caring is alleviating the many cases of terminal suffering, such as that which we saw publicly with Dr Donald Low and that which we have all seen in some of our patients.

Naturally, we need more stringent controls than those in place for animal euthanasia but, in all honesty, we are more caring, as a society, for our pets’ suffering than we are for human suffering. Dr Derryck Smith covered some of the issues in his letter (BCMJ 2014;56:12,47), written as a plea for Doctors of BC to take a leadership role on this issue. 

There is a need to also address Dr Donkin’s factual and other logical errors. First, the article written by Dr Pereira in Current Oncology[1] is a great example of pseudoscience. Publication in a prestigious journal does not guarantee factual rigidity. A follow-up article[2] in the same journal debunks his claims in great detail, specifically the infamous slippery slope argument that refers to horrors in Europe. A slippery slope on any medical or ethical legislation is dealt with through legal checks and balances and careful planning. There have been many such issues in medical care and there will be many more (for example, stem cell research), which require ethicists, lawyers, and medical advisors to tease out implications and issues and revamp the solutions periodically. The authors conclude with regard to Dr Periera’s article that, “his paper should not be given any credence in the public policy debate about the legal status of assisted suicide and euthanasia in Canada and around the world.”[2] Incidentally, Dr Pereira’s paper was used as expert witness testimony in the recent challenge to the Criminal Code prohibitions of assisted suicide and voluntary euthanasia in the Gloria Taylor case. This only goes to show how important it is to check sources, and sources of sources.

Dr Donkin’s final paragraph, offered as the right solution, is simply his subjective solution. Slippery slope arguments are commonly used to oppose assisted suicide, as in the article referenced by Dr Donkin. 

The argument that palliative care must supplant all other discussions is the ultimate emotional argument and, as important as it is, it is not always successful in ensuring a dignified and comfortable dying process.

I would like to see sensible legislation on assisted suicide over the next few years (probably too late for me!) so that we have choices in Canada and more autonomy with regard to dying with dignity.
—John Dale, MD
Nelson

References

1.    Pereira J. Legalizing euthanasia or assisted suicide: The illusion of safeguards and controls. Curr Oncol 2011;18:e38-e45
2.    Downie J, Chambaere K, Bernheim JL. Pereira’s attack on legalizing euthanasia or assisted suicide: Smoke and mirrors. Curr Oncol 2012;19:133-138.