"The Worst Possible Outcome"
Are the Wynne Liberals stalling after the Supreme Court's assisted suicide decision? One month after the Supreme Court of Canada struck down the ban on physician assisted suicide in specific cases, speculation runs rampant, doctors remain cautious, and some say the Ontario Liberal government refuses to lead the debate.
By Justin Schmitz
In February, the Supreme Court struck down the ban on physician-assisted suicide on the grounds that a competent adult, suffering from a grievous and irremediable medical condition, cannot be denied the right to make decisions concerning their own bodies.
“The prohibition on physician‑assisted dying infringes the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice,” the court wrote in its decision.
The court also determined that repealing the ban on assisted suicide could lead to unintended consequences, such as, in the case of patients suffering from depression.
“There are many possible sources of error and many factors that can render a patient “decisionally vulnerable” and thereby give rise to the risk that persons without a rational and considered desire for death will in fact end up dead.”
It’s in these cases that the boundaries of assisted suicide, such as what constitutes informed consent and whether doctors are allowed to directly participate in ending the lives of their patients, have yet to be defined, let alone legislated.
The Supreme Court's ruling has been suspended for 12 months to allow governments enough time to amend their laws, and decide how best to integrate assisted suicide into their medical system.
Cara Zwibel from the Canadian Civil Liberties Association (CCLA) says there will likely be two levels of government addressing this.
But nearly two months into the waiting period, the Ontario government remains silent.
And in its absence, many organizations with a stake in the future of physician-assisted suicide in the province, struggle to have their voices heard.
Opinions run the gambit from those firmly in support of the Supreme Court's decision to those who flat out oppose physician-assisted death.
Supporters point to arguments like that made by the CCLA's Ms. Zwibel, who emphasizes that "the right to life includes human dignity and that incorporates decisions about when you might want to end your life."
While Ontario ponders, there is one province that has already taken steps to institutionalize assisted suicide — Quebec.
Its legislation outlines the conditions under which a patient may request a continuous dose of toxic sedation, ultimately leading to death.
But Hugh Scher of The Coalition Against Euthanasia takes issue with the Quebec legislation passed last June, as well as the Belgian system it’s modeled after.
But what about Ontario's disabled community? Does the Supreme Court's definition of an irremediable medical condition extend beyond life-threatening illnesses to include chronic disabilities?
Scott Allardyce, of Citizens With Disabilities Ontario (CWDO) says they need protections specifically laid out.
“Persons with disabilities who do not wish to be killed or to commit suicide must have adequate protection under any legislation or policy change."
The CWDO says the Ontario government is responsible for the well being of its most vulnerable citizens, and wants a clearly defined list of conditions that must be met before assisted suicide is implemented.
They include mandatory psychological assessments of any disabled Ontarian giving his or her consent to commit assisted suicide; that consent must be given by the individual themself, not their guardians; and finally that a member authorized by the court be present while consent is given.
While the debate continues to rage, polling data from The Canadian Medical Association (CMA) indicates that only one in five Canadian doctors would actually be willing to participate in physician assisted suicide if it were to become fully legal.
Dr. Kerry Bowman, bioethicist from the University of Toronto, cites the open ended nature of the Supreme Court decision as the reason Ontario doctors are feeling uncertain about physician assisted death.
Most notable, the thin line between euthanasia, where doctors take an active role in ending the lives of their patients when the doctor deems it necessary, and assisted suicide, where consent is given beforehand.
Margaret Somerville, the founding Director for the Centre for Medicine Ethics and Law at McGill University, argues that personal morality or ethics plays an important role.
She argues that it's the moral implications of taking a patient's life that are preventing doctors from fully supporting the court's decision.
"It's a tragedy, now it's legal to kill people."
"What do you think will happen 12 months from now with no laws?"
Dr. Somerville believes that there need to be significant changes to how assisted suicide is currently defined, in that, as currently laid out by the Supreme Court, it would permit what she would consider, first degree murder.
"You don't need a spiritual argument. We are moral animals, and we care about each other. We are not simple products in a supermarket to be checked out of life."
Dr. Somerville expressed concern that assisted suicide might become a cost saving measure, and replace the more expensive, palliative care.
There is one voice that remains strangely absent from the proceedings, the one voice that could banish speculation and bring clarity to the debate: the Ontario government.
NDP health critic France Gelinas had this to say about how Ontario MPPs are treating the issue of assisted suicide at Queens Park: "I have approached my colleagues about this issue but they run away as fast as they can. There should be something in the pipeline, but there isn't."
Ms. Gelinas is concerned that if nobody takes the lead on an issue as polarizing as this, you end up with the worst possible outcome, because everyone's voices, even those from the most extreme sides of the debate, are carrying the same weight, and that can be damaging.
Ms. Gelinas insists that the provincial government is the only organization with the resources needed to conduct the research necessary to devise the best course of action, but that any new potential legislation is a long way off.
So at the end of the day, the question remains: will the Ontario Liberal government step up to lead the province through the murky waters of physician assisted suicide?
Or are we looking at another 11 months of silence, and after the one year deadline runs out, there will be simply no law, and therefore, anything goes?