In mid 1970, the parents of Karen Quinlan won a landmark case to have their daughter taken off life support. The Quinlan case dealt with the ethics of using medically extraordinary means to sustain life following a severe brain injury when there was no reasonable hope of improvement.
With the tabling of Quebec’s Bill 52, “An Act Respecting End-of-Life Care”, assisted suicide is in the national spotlight. While euthanasia remains as controversial today as in the 1970s, the focus has shifted from keeping an individual alive to hastening an individual’s death.
The purpose of Bill 52 is “to ensure that end-of-life patients are provided care that is respectful of their dignity and their autonomy.” The Act establishes patient rights and a framework for care, including the provision for assisted suicide, referred to as “medical aid in dying”.
While I think that Bill 52 is an attempt to respond compassionately to those individuals who wish to hasten their death because of unremitting illness, I reject the notion that assisted suicide should be enshrined in legislation as part of a continuum of medical care. In my view, the autonomy and dignity arguments are flawed.
We highly value the right to control our body and our life. Yet, there is very little that we can ever completely control. Our decisions are never made in a vacuum; our interactions with others, with society, and with events influence our decision-making. The decisions we make affect not only our own self, but others as well.
An individualistic determination to control one’s death at the end-of-life exceeds the realm of personal autonomy. When we are well enough, we want to live; we eschew suicide. When physical deterioration limits our self-sufficiency, we may want to die. At that point, we may want another to do the very thing we would not do our self – take our own life. Legislation would frame this desire as an entitlement based on compassion, autonomy and dignity.
Dying with dignity is almost always referred to in connection with progressively debilitating diseases. There is an underlying presumption that progressive diseases rob the individual of their dignity as suffering increases and the body deteriorates. There is a perception that physical decline equals a loss of dignity.
This view limits the sacredness of the individual. It overlooks the emotional, psychological, and spiritual dimensions of the person. It excludes the possibility that the natural process of dying may also serve a metaphysical purpose.
Every individual has an innate and inviolable dignity that disease, suffering and death cannot erase. The dignity of the individual manifests itself in the totality of body, mind and spirit. End-of-life care must always proceed in a manner that recognizes and reverences the dignity of the whole person. The crux of the matter is how best to do that.
Experts in palliative care say that pain can be successfully controlled and managed. Yet, depending where we live, less than 30 percent of Canadians who are dying have access to or receive appropriate palliative care. Rather than focusing on assisted suicide, the creation of an accessible and universal palliative care program would help to ensure that the dying receive reverential care appropriate to the dignity of the human person.
Louise McEwan is a freelance religion writer with degrees in English and Theology.