Canada gives assisted suicide go-ahead
Canada appears set to join a growing group of nations where doctor-assisted suicide is legal following a landmark ruling by its top court.
In a unanimous ruling, the Supreme Court of Canada found that laws prohibiting physician-assisted suicide “infringe the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice”.
It said mentally competent adults suffering intolerable physical or psychological distress as a result of a severe and incurable – but not necessarily terminal – medical condition, have the right to a physician’s help to die.
The judgement means that federal laws passed last year allowing doctors to help patients to kill themselves, due to come into effect from the end of 2015, will not face any further legal challenge.
Instead, anti-euthanasia campaigners are turning their attention to ensuring the laws are re-drafted to be framed as narrowly as possible.
Canada’s move toward doctor-assisted suicide comes amid mounting attention to the issue both in Australia and abroad.
A Senate committee late last year reported on Dying with Dignity legislation proposed by Greens Senator Richard Di Natale, and the Tasmanian parliament narrowly defeated voluntary euthanasia legislation in 2013.
In its submission to the Senate committee inquiry into Senator Di Natale’s Exposure Draft of the Medical Services (Dying with Dignity) Bill 2014, the AMA said it opposed making it legal for doctors to prescribe and administer an end of life substance.
“We believe that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life,” the AMA submission said, adding that activities like euthanasia and assisted suicide breached the fundamental ethical principles underpinning medical practice.
The AMA said it was consistent with good medical practice for doctors not to initiate or continue life-prolonging measures, or to provide treatments that had as their primary purpose the alleviation of symptoms, but which may have the secondary consequence of hastening death.
“Withholding and/or withdrawing life-sustaining treatment allows the course of the person’s illness to progress naturally, which may result in death,” it said. “In addition, the administration of treatment to relieve symptoms which may have the secondary consequence of hastening death is undertaken with the primary intent to relieve the patient of distressing symptoms.
“It is important that these practices, which are ethically acceptable…are not confused with activities that constitute euthanasia or physician-assisted suicide.”
AMA Vice President and emergency physician Dr Stephen Parnis said caring for people approaching the end of their life was at once one of the most difficult and yet rewarding aspects of being a doctor.
But Dr Parnis said effective, on-going communication between doctors, patients, families and carers was key to making a patient’s final days as comfortable, calm and stress-free as possible.
“As doctors, we understand and acknowledge that most of us will eventually succumb to the effects of chronic disease, and that medical care is as much about disease control and symptom relief as it is about prevention and cure,” he said. “How we care for our patients as they approach their death can be among the most difficult yet rewarding aspects of our professional lives.”
Dr Parnis said it was important that patients prepare advance care plans to inform doctors, families, and carers about their preferences in the event they lose decision-making capacity.
He said patients with limited or impaired capacity should be encouraged and supported to participate in treatment decisions, consistent with their level of capacity at the time.
Among the most frequently voiced concerns are that people with diminished mental or physical capacity may be railroaded into agreeing to assisted dying.
But Canada’s Supreme Court this was not an overriding concern.
“We agree…that the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards,” the court said in its judgement. “A theoretical or speculative fear cannot justify an absolute prohibition.”
Published: 02 Mar 2015