Coyne: If assisted suicide is a right, how can it not be for all?

Supporters rally outside the Supreme Court of Canada on the first day of hearings into whether Canadians have the right to seek help to end their own lives on Oct. 15, 2014 in Ottawa. ADRIAN WYLD/THE CANADIAN PRESS Photo: ADRIAN WYLD/THE CANADIAN PRESS

The case now before the Supreme Court challenging the laws forbidding assisted suicide and euthanasia is an opportunity for us all to have an adult conversation about this sensitive issue, which for too long many have chosen to avoid.

True, the Supreme Court has previously decided on the legal and constitutional questions involved, but that was more than 20 years ago; much has changed since then, not including the law or the Constitution. Given Parliament’s obstinate refusal to take up the matter in the four years since it last voted, 226 to 59, against legalizing the practice, it has fallen to the Court to decide in its place. Which very probably means it will soon be in the court of public opinion, assuming it is not already.

In the debate to come, it will be important to keep in mind that the issue of assisted dying is, at its core, one of personal autonomy, of the right to die with dignity, and not to get caught up in discredited concerns about slippery slopes, inadequate safeguards, and the like. Ancient taboos on the taking of human life may once have served, but with the insights available to us today we are surely able to come up with a more nuanced approach to end-of-life issues than the simple absolutes of old would allow.

As the plaintiffs have argued before the Court, current law affords the able-bodied a right that is denied to some disabled people, namely the right to kill themselves, so far as the latter group are physically incapable of doing so on their own. It does so, they argue further, based on a formalistic moral distinction, between killing yourself and someone else killing you on your behalf, that is meaningless in practical terms — as meaningless as that between natural causes and human action. We already allow people to die, that is, via “do not resuscitate” orders and the like, when it is evident they are past saving. What is the difference, they ask, if instead we actively hasten their end?

Some will find this a horrifying prospect. But if we are prepared to look at the matter with clear, unblinking eyes, we will see it quite differently. It is not as if it is somehow open season on the disabled. Proponents of legalization have been insistent that the practice would be surrounded by the most stringent regulations. For example, legislation already passed in Quebec requires the patient seeking “medical aid in dying” — by lethal injection, it is planned, to be administered by a licensed physician — to be an adult, of sound mind, in the last stages of an incurable illness, and in constant, unbearable pain. So let us have none of these nightmare scenarios of the elderly and infirm being dispatched against their will.

Mind you, under the Quebec law the pain could be “physical or psychological.” And the patient doesn’t actually have to be incapable of killing themselves or even disabled: just in “an advanced state of irreversible decline in capability.” So we have expanded the definition somewhat from our initial argument. But that only makes sense. Would we extend a right to the disabled we would deny to everyone else?

For that matter, in those European countries that permit the practice — Belgium, the Netherlands, Luxembourg and Switzerland — there is no requirement of terminal illness, either. Again, this is only logical: A disease can cause unbearable suffering without being fatal. Neither would it seem necessary that the suffering be disease-based. For example, Belgium has lately extended the right to euthanasia to prisoners serving life sentences.

Indeed, viewed from this perspective we might well ask whether the Quebec law goes far enough. Is it strictly necessary, for example, that a doctor perform the procedure? What if a willing doctor cannot be found? What if a province won’t cover it under medicare? Steven Fletcher, the Conservative MP whose private member’s bill would likely serve as the model for federal legislation, has suggested it could be done by a doctor “or some other able-bodied person.” At the least, a nurse? Paramedic? Pharmacist?

Supporters rally outside the Supreme Court of Canada on the first day of hearings into whether Canadians have the right to seek help to end their own lives on Oct. 15, 2014 in Ottawa. ADRIAN WYLD/THE CANADIAN PRESS

Similarly, should the right to a painless death really be restricted to adults? As Eike-Henner Kluge, former director of ethics and legal affairs for the Canadian Medical Association, has argued, this is an obvious example of age discrimination. Here again Belgium has shown the way, amending its legislation this year to allow children to seek help in killing themselves, albeit with the consent of their parents or guardians. That’s probably unavoidable, though it is natural to ask whether parents who could refuse their children that request, if the alternative were constant and unbearable physical or psychological pain, should really be left in their charge.

Likewise the requirement of mental competence. This sounds reasonable, until we realize that by excluding the mentally incompetent from the right to be euthanized, on the grounds of their presumed inability to consent, we are sentencing them to years, even a lifetime, of unbearable pain. As Kluge argues, “their rights would still be less than those of other persons: They would be condemned to suffer when a competent person would not.” It is hard to imagine the Supreme Court would permit this to continue, when the inevitable  case was brought. (Not surprisingly, this constraint, too, is being relaxed in Europe.)

The more clearly we think about the issue, the more we will realize how incomplete, how inconsistent current models of legalization are. This is not a matter of slippery slopes, but of respect for personal autonomy and equal rights for all. The euthanasia most people have in mind — severely disabled adults, at the end of their lives, making a conscious choice in the absence of other alternatives — is not in fact what is at issue.

Indeed, if we are honest with ourselves, we will see that what we are really talking about here is not the rights of the disabled, but the normalization of suicide, as the rational alternative to suffering. No longer something to be discouraged, stigmatized as an act of individual aberrance, it will henceforth be a social act in which others are expected to assist. Just so long as we acknowledge that that is what we are doing.