The total pain of dying: is euthanasia a form of medical care?

Author:Blair, Louisa

Ever since industrialization brought about urban living and the breakup of extended families, increasing numbers of Quebecers have been dying in hospitals and alone, instead of at home and surrounded by their families. Let us consider a few numbers:

* More than a third of Quebecers now live alone, compared to 12 per cent in the early 1970s.

* In 15 years, 26 per cent of Quebec's population will be over 65, compared to 16 per cent in 2012, so there will be a lot more dying going on soon.

* Depending on the region, 40 to 80 per cent of those who need palliative care do not currently receive it.

* There are 110 fewer palliative care beds in Quebec than the government-regulated ratio of 1 per 10,000 population requires.

* Although 75 per cent of Quebecers would prefer to die at home than in an institution, only 10 per cent do die at home (the lowest proportion in Canada). (1)

As these numbers show, the question of how we die has now become, both technically and morally speaking, an urgent one. Bill 52, an Act Respecting End of Life Care, was a response to this emergency. The introduction to the bill states that its purpose is to "ensure that end-of-life patients are provided care that is respectful of their dignity and their autonomy." But in addition to talking about the right to palliative care, the bill included medical aid in dying as one of the forms of respectful end-of-life care Quebecers would be offered. Another term that appeared was terminal palliative sedation (a slower form of euthanasia than lethal injection).

The Quebec Palliative Care Association asked the authors of the act to remove the word palliative and call a spade a spade. The authors had also avoided the term euthanasia, as well as physician-assisted suicide. With Quebec's reputation for having one of the highest suicide rates in the world, they didn't want to be seen to be endorsing suicide. But this forest of euphemisms could not conceal the fact that Bill 52 would have given us the right, under certain conditions, to oblige a doctor to kill us. Whether the request respected the conditions prescribed by the act was considered a medical judgement.

Doctors have never before been asked to see ending a patient's life as medical treatment, or to judge whether a patient's request for euthanasia should be complied with or not. For 2,400 years doctors have taken the Hippocratic oath, by which they swear "I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect." Oddly, the onus is on those who defend the norm, i.e. the refusal to kill. The breaking of an age-old taboo against physicians taking human life may seem appropriate in our rational and scientific age. Yet the stories told to justify it are laced with emotion and anecdote, while opposition to it is often reasoned and dry, and and makes for poor TV.

I work with a medical research team that is studying shared decision-making between doctor and...

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