Understanding the Policy as it Is
The current Canadian policy on euthanasia and assisted physician suicide replaces two preceding policies, Euthanasia and Assisted Suicide of 1998 and the Physician-Assisted Death of 1995. Euthanasia refers to the intentional performance of an act with a clear intention to end the life of another person, knowingly. Elements of Euthanasia
include the following: the client has an incurable sickness, the physician is aware of the clients condition, the physician performs the act with the prime motive of terminating the clients life, and the physician undertakes the act with compassion and empathy with no personal gains (Prado, 2000).
Canadians medical practitioners identify three forms of Euthanasia. They base their classification on whether the client has shown the desire to end life. First is voluntary euthanasia that involves limited circumstances where the client is competent and well informed and makes a voluntary request for his or her life to be ended. Second is non-voluntary euthanasia that implies that the client has not expressed a preference for assistance in dying. Finally, euthanasia assistance in dying could imply deliberately and intentionally supplying a patient with the information or methods, or both, necessary to commit suicide. This may include supplying lethal drugs, prescribing lethal doses of such drugs, or offering counseling regarding such drugs (Prado, 2000). Many consider euthanasia and physician assisted death as morally equivalent. However, what they fail to realize is that there is an apparent practical and legal distinction between them.
Views from the Medical Society
Euthanasia and physician assisted suicide are opposed by nearly every Canadian medical association, and prohibited by the laws and regulation of the country. An alteration in the legal standing regarding these practices would characterize a major shift in Canadian social policy and conduct. To support such a move and afterwards take part in these practices, the Canadian medical profession would need to reconsider traditional medical ethics. Physicians, academicians, the media, interest groups, the judiciary, and legislators hold diverse viewpoints regarding a modification of the current lawful prohibition of the practices (Downie, 2004). By the reason of the contentious nature of the practices, their obvious significance to physicians and their capricious effects in the area of medicine, euthanasia, and assisted physician suicide are issues that ought to be approached carefully and deliberately by the medical profession and the society.
Patient Representation in the Policy
In Canada, patients receive a major priority and an extensive care from physicians. The policy stipulates that the physician should consider first the patients well-being. This implies that caring for the terminally ill patients and individuals who face an imprecise years of suffering should be the first consideration by the physician (Sumner, 2011). Additionally, physicians must observe that, even if a cure is no longer possible, they must provide proper care for a patient, including spiritual and psychological support as well as physical comfort. Physicians should also provide information that clients need to make knowledgeable decisions regarding their medical care besides answering their questions in the right manner. Furthermore, physicians ought to respect the right of an informed client to accept or decline any form of care recommended. They should also ascertain, where possible, and recognize the wishes of their patients regarding initiation, extension, or termination of life-sustaining care. Lastly, physicians ought to inform a patient when personal values would determine the practice of the physicians medical procedures that may be necessary for the situation (Prado, 2000).
It is illegal and wrong for a Canadian physician to practice any form of euthanasia or assisted suicide. It is normally the societys right to decide whether laws prohibiting the practices should be altered. Legal, ethical, and social issues regarding this policy often require the perspective of medical professions. The Canadian Medical Association recommends that, before instituting any changes in the existing legal standing on euthanasia and physician aided suicide, some concerns must be addressed.
First, sufficient services in palliative care must be made accessible to every citizen. Physicians are expected to uphold the ideology of palliative care, which is a compulsory precondition to the consideration of permissive governmental change for all in need. Attempts to broaden the accessibility of palliative care in Canada should be strengthened (Sumner, 2011). Second, suicide-prevention policies should be preserved and reinforced where necessary. The society strongly supports suicide-preventive programs, and physicians are expected to offer measures that would help support the life of those who have attempted suicide. Third, the government ought to carry out an assessment of medical choices during dying. There exists relatively little knowledge about the nature and frequency of the medical decisions made near death, ways in which the decisions are arrived at, and the satisfaction of clients, their families, physicians as well as other medical practitioners with the process of making the decision and the outcomes of the actual choices made.
Policy Making
Physicians are often engaged in making judgments concerning whether to withdraw treatment, and prescribe analgesics and sedatives in doses that may abridge life. It is claimed that some Canadian physicians provide euthanasia and assisted suicide (Quill & Margaret, 2004). Therefore, an evaluation of medical decisions made at death is necessary to assess the current situations of Canadian practice, which would help establish the potential need for changes and identify the most suitable changes required. Lastly, citizens must be given many opportunities to air their views regarding any planned changes in legislation. The wishes of the people determine the law as articulated through the parliament, rather than through court decisions.
A section of law in almost every nation in the world prohibits euthanasia and assisted suicide. Changing the permissible position of euthanasia in Canada would represent a major social policy shift. Advances in medical science in the recent past have altered the character of the debate on suicide. Physicians have an increased ability to care for diseases and to lengthen life, which causes the national government to take a more active role in the issue of life and death in the health framework. Advances in medical science in the early part of the 19th century complicated the strict adherence to religious teaching. The influences of religion in any medical practice are not obvious.
Government and the Society
If the government allowed euthanasia and, or assisted suicide for knowledgeable, suffering, terminally sick clients, then there would be some legal challenges that would stem from contravention of the CCRFE (Canadian Charter of Rights and Freedoms). Extending these practices to the incompetent patients is a setback feared by many in the society. Courts may be requested to hear cases concerning euthanasia for the inept patients on the premises of advance requests or directives from alternative policy makers (Downie, 2004). Examples of such cases could include dealing with a neurologically damaged client or cases where the subject is a newborn experiencing severe innate abnormality. Psychiatrists acknowledge the likelihood that a rational, otherwise competent person may ask for assisted suicide. Such an individual may petition the judiciary for a physician-assisted death.
Political Views
By the beginning of the 19th century, physicians were engaged in the euthanasia debate. Politicians, theologians, and philosophers joined to present their views, in which much of the proposals focused on the quality of life. Majority of them, particularly political propositions were against participation in assisted suicide. The contentious issue is the right to decide when the quality of life has depreciated past the point where terminating life is tolerable (Mwaria, 1996).
Policy Matters
In North America, the most determining case on the issue of the value of life and euthanasia is the case of Karen A. Quinlan. Karen was 21 years when she suffered permanent brain damage induced by the over consumption of alcohol and drugs. She went into a coma requiring life support machines to continue living. Her parents signed a release form authorizing the physician to discontinue the use of a respirator; however, the hospital refused. The parents proceeded to court and following the ruling of the court, the respirator was disconnected in 1976. Karen spent 10 years of her life in a coma under the care of nurses in a nursing home. She was fed through tubes. Other high-profile cases involve women suffering from amyotrophic lateral sclerosis (ALS). ALS causes muscle deterioration, which is accompanied by pain without affecting the cognitive functions (Kure, 2011). The case of Gloria Taylor who was suffering from ALS represents key developments in the euthanasia laws in Canada.
Economic Factors
The available medical technology can significantly prolong the life of patients; however, the quality of life deteriorates progressively. Many Canadians are giving active contemplation to the confines they will place on their own health management or that of a family member. The high cost of health care is an additional pertinent concern. Current research indicates that most people incur the highest health care cost during the concluding days of living. There exists a fragile balance involving supporting life and restraining the health care cost (Mwaria, 1996). This will, especially be more apparent as the large populations in Canada move into older age groups, in which the cost of health care is significantly higher.
Social Beliefs
Many reasons are put forth in favor of the legalization of euthanasia. The concerns for the personal autonomy are perhaps the most common because it concerns the freedom of choice for the individual. Those who support the personal approach argument include Gloria Taylor who argues it should be her decision to receive physician assistance to end her life at a time of her choosing. It is her constitutional right to decide when the prospect of continued living is worse than the prospect of accelerated death. The philosophical defense of this argument claims that individual autonomous choices should not be infringed, but for proportionately demanding reasons. Palliative care is relatively ineffective in relieving pain and suffering, especially in the final days of life. The law violates the rights and freedoms of those with physical disability as outlined in section 15 of the CCRFE. The law allows healthy people to commit suicide; however, those with corporeal limitations cannot commit suicide (Golden & Zoanni, 2010).
State Laws and View of the Social Problem
The proponents of legalizing euthanasia argue that aided suicide still occurs in Canada notwithstanding its illegality. There is also no moral significance between acts and omissions. That withdrawing treatment is an accepted practice whereas assisted suicide is illegal, is hypocrisy because the two lack any significant moral difference. The Tracy case of 1993 is perhaps the most famous euthanasia case in Canada. The father, Robert Latimer killed her by suffocation by placing her in a motor vehicle and channeling exhaust into the drivers cabin. Tracy was suffering from cerebral palsy, a condition that left her unable to walk, talk, or feed herself. Her father ended her life because he could not bear to see his daughter continue suffering. Because of his actions, Latimer faced a first-degree murder charge but was condemned for second-degree murder. Second-degree murder carries a penalty of life in reformatory without prospect of parole in the first 10 years. A series of appeals followed; however, the court finally upheld its decision. On November 2010, the Appeal division of the National Parole Board granted him full parole (Montero, 2011).
Societys view and Government Responsibility
The difference between individual differences in terms of religion and moral perspectives has led to a heated debate. Those who identify closely with religion oppose Physician-Assisted Suicide (PAS) for either their family members or themselves. Catholics and conservative Christians consider active euthanasia as more acceptable, especially when the physician plays a more active role. Those opposing PAS argue that only a complete ban on PAS is adequate to protect the vulnerable in society. A complete ban on PAS will also preserve the high value the society places on human life. The argument is that no set of safeguards is sufficient to protect the vulnerable groups and prevent serious harm. Some feminist scholars express concern that women are socialized as care gives thus may feel the need to exercise the right to die sooner than men because they are socialized differently. The argument put forth by the scholars overlooks the nature of the Canadian society (Golden & Zoanni, 2010). The Canadian society is highly individualistic; therefore, the right to PAS should never be posited as an obligation.
Individual and Society
Those against the legalization of PAS in Canada rest their fears on the view that legalized PAS would lead to abusive or mistaken killings of the vulnerable in the society. However, the available empirical evidence does not support such a view. The legitimate concerns raised by those against PAS have been addressed by regulatory regimes in countries that have legalized PAS. The safeguards in the regulatory regimes are sufficient to meet the concerns of the critics. There is no guarantee that mistakes will not happen with the legalization of PAS; however, whenever a mistake happens, it is to be deplored. The complete prohibition of PAS in Canada is producing similar if not more abusive deaths than legal PAS could ever produce (Kure, 2011).
References
Downie, J. G. (2004). Dying justice: a case for decriminalizing euthanasia and assisted suicide in Canada. Toronto: Univ. of Toronto Press.
Golden, M. and Zoanni, T. (2010). Killing us softly: the dangers of legalizing assisted suicide. Disability and Health Journal, 3, 16-30.
Kure, J. (2011). Everything under control: how and when to die-a critical analysis of the arguments for euthanasia, euthanasia-the "good death" controversy in humans and animals, Prof. Josef Kure (Ed.), ISBN: 978-953-307-260-9.
Montero, M. D. (2011). End-of-life issues in the United States after Terri Schiavo: implications for social work practice. Advances in Social Work, 12 (2), 164-180.
Mwaria, C. (1996). Physician-assisted suicide: an anthropological perspective. Fordham Urban Law Journal, 24 (4), 859-868
Prado, C. G. (2000). Assisted suicide: Canadian perspectives. Ottawa: University of Ottawa Press.
Quill, T. E., & Margaret, P. B. (2004). Physician-assisted dying: the case for palliative care and patient choice. Baltimore: Johns Hopkins University Press.
Sumner, L. W. (2011). Assisted death: a study in ethics and law. Oxford: Oxford University Press.
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