THERE are few subjects that are more controversial and complex than euthanasia.
Euthanasia and assisted suicide are illegal in all provinces and territories in Canada under the criminal code, at least for now. After two government reports and extensive public consultation, Quebec is considering the legalization of euthanasia (not assisted suicide). Quebec is proposing to make it legal for doctors to help the terminally ill die, if they want to, under exceptional circumstances.
Recent polls show that 70 per cent of Quebecers and a majority of the province's doctors support the decriminalization of euthanasia. Others aren't so sure. In 1994 the annual convention of the Canadian Medical Association voted to "specifically exclude" its members from participation in euthanasia or assisted suicide. And the criminal code of Canada makes it an indictable offence to counsel, aid or abet anyone to commit suicide.
British Columbia has had guidelines in place for the last decade around not prosecuting doctors, in most circumstances, who medically assist people to end their own life. Since 1972 attempted suicide has not in itself been a criminal offence in Canada.
There is widespread confusion as to what euthanasia signifies. Does it mean patients having the right to unplug the respirators, unhook the tubes and halt the medication? To the surprise of many, there are no legal barriers to such steps being taken right now and very little opposition to it from within the medical profession.
There is a huge difference between that and active euthanasia, which is an action or omission that directly and intentionally causes the death of another person, or assisted suicide whereby a person must take deliberate steps to bring about his or her own death. There is very little support for the practice of deciding on behalf of a patient who is unable to give consent that further medical treatment is useless and ought to be withdrawn.
Much of the opposition to legalizing euthanasia and assisted suicide flows from a concern that abuses will almost surely arise. Every jurisdiction in America and Europe that has brought in rules around euthanasia insists that the rights of the most vulnerable people in society are protected under their end of life legislation. Whether that's true or not is the subject of a raging debate and fodder for another column.
Another key issue has to do with pain control. Many people are fearful of being kept alive in a state of intolerable pain and support the legalization of euthanasia for this reason alone. Doctors and nurses in palliative care have observed that pain can be controlled in almost all patients. In my experience that belief is not shared by most people in the community.
Finally the great majority of those caring for the dying believe that progress in palliative care and pain management would slacken if euthanasia became accepted legal practice. Whether you agree with the direction Quebec has taken here or not - and we are still waiting for the federal government to weigh in here - one thing is clear: the genie is now out of the bottle and all of the other provinces and territories in Canada are now overdue to hold a debate on the issue.
