Quebec legalizes euthanasia

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In June 2014, Quebec became the first juris­ thanasia. Entitled “An Act respecting end-of-life care,” the bill passed by a substantial majority in a free vote in the National Assembly. Que­ bec joins three American states—plus Belgium, Netherlands, Luxembourg, and Switzerland—in legalizing some form of assisted dying. The new law would allow a doctor with the consent of the patient to administer medication to cause death.

The euthanasia debate in the Canadian state has been periodically re-ignited by high profile cases. More than 20 years ago, a former leftwing NDP MP, Svend Robinson, campaigned eloquently for a British Columbia woman, Sue Rodriguez, who in the terminal phase of Amyo­ trophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease) wished to end her life.

The decision of the Quebec government re­ flects a shift in public opinion. In the presence of intractable suffering, a strong majority across the Canadian state supports the option of eu­ thanasia or assisted suicide. Not surprisingly, support for legalization is highest in Quebec. At­ titudes are consistently more liberal in Quebec than in the rest of Canada on many contested health and social questions, from abortion to the treatment of youth offenders.

In contrast, physicians in their majority have traditionally opposed euthanasia. This reflects in part the conservative mentality in the pro­ fession. More significantly, the Hippocratic in­ junction to “do no harm” was understood as an obligation to always preserve and extend life. However, medical and social investment in endof-life care has modified this view. The palliative care movement has brought death and dying out of the shadows. This has resulted not only in better techniques to relieve suffering, but an appreciation of the limits of medical intervention and an affirmation of the needs and wishes of the dying patient.

Professional opinion has shifted. For example, the Canadian Medical Association in a recent statement on euthanasia recognized that a more open approach was necessary, even if it stopped short of recom­ mending de-criminalization.

It remains to be seen whether the Harper regime in Ottawa will launch an appeal. The federal govern­ ment fully backs the ban on euthanasia in the (fed­ eral) criminal code. Quebec is determined to defend the new law, based on provincial jurisdiction over health care.

In any case, there will certainly be a court challenge from anti-euthanasia forces in Quebec. The Canadian Supreme Court is also set to rule on another case of assisted suicide, which will expose the federal crimi­ nal statute, once again, to legal scrutiny. The Court’s last ruling in 1993, upheld the constitutionality of the ban on euthanasia. In the meantime, however, both public and medical opinion has shifted, as has the composition of the Court.

Were the Supreme Court to rule in Ottawa`s favour, this would pose a direct challenge to the new Quebec law, and in the process raise the question of Quebec`s national rights.

Euthanasia is a contentious issue, bringing out a variety of strongly held opinions, both personal and philosophical. It can divide those who would other­ wise make common cause. For example, the Mon­ treal-based Physicians for Social Justice, staunch de­ fenders of publicly funded health care, are vehement­ ly opposed to the new provincial euthanasia law.

Not surprisingly, the anti-abortion lobby, together with the Roman Catholic Church and various Prot­ estant sects, are opposed to de-criminalizing eutha­ nasia. But many who are not influenced by religious doctrine fear that sanctioning euthanasia will prove to be the “slippery slope to a generalized “cheap­ ening” of human life leading to abuse of vulnerable groups such as the elderly and disabled. The eugen­ ics movement of the first part of the 20th century, reaching its apogee in the crimes of the Nazi era, is often invoked. However, those who favour legaliza­ tion can also stake a claim to compassion, arguing that assisted dying provides relief of suffering and embodies respect for individual choice.

What position, if any, should socialists adopt on this question, and how should we participate in the de­ bate? A first step should be to support de-criminal­ ization. Euthanasia already occurs outside the law. Legalization would bring the whole question into the open and allow critical inquiry to shed light on prac­ tice.

In several studies, a substantial proportion of pal­ liative care patients wanted to have the choice to end their lives if their condition became unbearable. Yet, in those jurisdictions where euthanasia has been legalized, the option is exercised infrequently (less than 1% of deaths in Oregon, for example).

References to Nazi atrocities should not be ripped out of historical context. With the exception of some libertarian currents, today`s right wing is opposed (Left) “The Angel of Death” by Evelyn De Morgan, 1881.

to legalizing euthanasia. Expanding end-of-life options, up to and includ­ ing assisted suicide, is part of a trend toward greater individual rights and less control by the state and organized religion, a trend that socialists and the labour movement should support.

At present, only a minority of pa­ tients (25-30% in Canada) have ac­ cess to specialized palliative care at or near the end of life. The claim is made by some that legally sanctioned eu­ thanasia would divert attention from the need for more services, or could even lead to cutbacks to palliative care. Cutbacks, in turn, could increase the pressure to euthanize, whether from health care providers, patients or their families.

The potential for abuse should be squarely faced. A criticism of the new Quebec legislation is that it opens the door to abuse because it gives exclu­ sive power to doctors to authorize and carry out euthanasia. Indeed, for this reason, many palliative care physi­ cians are uneasy about the new law.

With or without de-criminalization, there is potential for abuse. We have only to recall the events at New Or­ leans’ Memorial Medical Centre during Hurricane Katrina. Twenty-three pa­ tients were apparently euthanized by medical staff after evacuation was re­ fused by Tenet Healthcare, the owner of the hospital. Under duress, all of the class and racist assumptions endemic to capitalist society came to the fore, and combined with the arbitrary power of the medical profession, and a profit-hungry corporate health care conglom­ erate, and resulted in the killing of vulnerable pa­ tients (cf: “Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital,” by Sherry Fink, Atlantic).

Making the case for de-criminalization, the Cana­ dian ethicist Arthur Schafer points out that “not all slopes are slippery.” He notes that the gradual accep­ tance of so-called “indirect” and “passive” euthana­ sia (withholding or withdrawing life support and the priorization of symptom relief even if it might hasten the patient’s death), far from brutalizing end-of–life care has been accompanied by a greater sensitivity to patient needs and respect for their autonomy. He argues persuasively that “Canadians (and Quebecois) should be able to choose from among a full range of options, including first rate palliative care and phy­ sician-assisted suicide … with proper safeguards to ensure openness and accountability” (“The Great Ca­ nadian Euthanasia Debate,” A. Schafer, The Globe and Mail, Nov 5, 2009).

What would constitute “proper safeguards” may therefore become an important issue. But it should not alter the position in favour of de-criminaliza­ tion. We should agree with Schafer, that there is no contradiction in fighting for greater access to high-quality palliative care, with euthanasia as a last re­ sort where the overall goal is to provide “death with dignity.” n Robbie Mahood is a physician in Montreal.

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