Compassion and Choices is an American organization dedicated to improving care and expanding choice at the end of life.
Dying with Dignity is a similar organization based in Canada, and is dedicated to improving the quality of dying and to expanding end of life choices in Canada. They declare themselves to be “Canadians’ voice for choice at the end of life.”
Better care, increased choices, and dying a dignified death – these are things we all want in our old age. But words can be misleading. Both of these organizations maintain that end of life choices must include physician assisted suicide (PAS), an option they define as a “compassionate choice”.
But what does true compassion entail? Is PAS really a compassionate choice that upholds a person’s dignity?
In April 2010, 74% of the Canadian Parliament voted against legalizing euthanasia and assisted suicide. Soon after the vote, the Parliamentary Committee on Palliative and Compassionate Care (PCPCC) was created, a committee that is “dedicated to promoting awareness of, fostering substantive research and constructive dialogue on palliative and compassionate care in Canada.”
This past Tuesday, November 9th, the committee held a hearing in Victoria which featured multiple presenters speaking on elder abuse and the need to change our current medical framework to provide better care for the elderly. All the speakers had a passion for building a better health care system to support our aging population.
One of the most pressing questions to be answered was: should this system include euthanasia or physician assisted suicide (PAS)? Many speakers saw a potential need for PAS, but “not yet”: we must first build a better palliative care system, and then assess the need for PAS down the road. We must note the difference between euthanasia and PAS. Euthanasia is defined as when one person, usually a medical professional, directly and intentionally ends the life of individual. Assisted suicide is defined as the aiding, abating, or encouraging by an individual to another individual such that the victim is able to end their own life.
According to Wanda Morris, a spokesperson for Dying with Dignity, compassionate care must include PAS, and ensuring this choice is available is the fundamental principle in providing a person with a dignified death. Let us look to see what this compassionate choice really involves before we succumb to this deceptive use of “choice” and “compassion”.
Organizations that advocate for legalizing PAS state that end of life decisions are a matter of autonomy, and “the only way that every person can be assured of [their] dignity is through legally protected choice.” But our autonomy and dignity is not solely dependent on our ability to make choices. If this were the case, then any request to die would have to be respected, including ones from people who are close to death, and ones based on momentary feelings or clinical depression. Therefore those who are not terminally ill would have to be allowed to choose to die. What then would stop a teenager from making the legally protected choice to have assistance in ending their life when they are depressed after a bad break up? Would we call it compassion that allowed that individual to be killed and not counselled?
If such actions are justified merely because one must be allowed to exercise their autonomy in making a choice, who then will have the authority to draw the line and say that some choices are wrong? Under the illusion of “choice” we would be creating a society that legally allows individuals to harm themselves or other human beings.
And does the power to make these choices reside solely with the patient, or will outside influences affect the decision made? Whether intentionally or subconsciously, pressure may be placed on those who are ill, disabled, or elderly, influencing their choice on whether or not to further burden their family or health care system. Studies reveal that where euthanasia and PAS are legal there have been abuses, and people have not been cared for appropriately.
A recent study [i]regarding euthanasia practice in Belgium found that 66 of 208 euthanasia deaths were performed without explicit request or consent. Is this compassionate? None of these people had a choice in their premature death.
In Oregon in 2007, 49 people[ii] were reported to have died by assisted suicide. None of these people were offered a psychological or psychiatric assessment. Furthermore, a study[iii] published in October 2008 showed that 26% of people requesting assisted suicide were depressed or experiencing feelings of hopelessness. Is society showing these people compassion by allowing them complete access to death, or would it be more compassionate to give them life-affirming options that reveal their dignity is not dependant solely on their choices?
One of the principal precepts of medical ethics is, “first, do no harm.” The majority of society adheres to this principle, and agrees that intentionally killing is wrong. But when the killing is disguised with terms such as “choice”, “dignity”, and even “compassion,” people lose sight of the tragic reality of the deed being done. True autonomy is an essential component of human dignity, but it does not include the freedom to do harm.
Dignity can only be affirmed, realized, and answered through true compassion. This compassion recognizes and instils the beauty and inherent value of life in those who have forgotten it, or who have been otherwise convinced that their lives no longer possess it. True compassion must include better palliative care for the dying; this is something all the speakers wanted, as do Canadians.
In a recent Environics group survey[iv] , 71% of the respondents stated that the government needs to place a greater priority on improving palliative care rather than legalizing euthanasia. In addition the study found that support of legalized euthanasia is decreasing. 63% of the respondents were afraid that the elderly would feel pressured into being euthanized in order to avoid health care costs, and 78% were afraid that individuals would be euthanized without giving their consent. As we can see by the studies in Belgium, these abuses can easily turn into a reality.
Is physician assisted suicide a compassionate choice? I would conclude that it is not. We must not get caught up in the euphemistic terms of “choice” and “compassion”. People who kill themselves or have others do so in order to gain a “dignified” death have in fact lost their sense of dignity and self worth. The dignity of a human being is not dependent on our state of pain or level of ability. Dignity is something that is inherent to all people, and the only way to affirm it is not to kill the sufferer, but rather to support and protect the individual by providing life-giving, compassionate choices, and doing our best to alleviate their suffering. A society that kills the most vulnerable in our society, the frail, suffering, and lonely, effectively confirms these people’s thoughts that their life is no longer worth living; such a society shows itself to be uncompassionate.
[i] Kenneth, C., et al (2010). Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey. Canadian Medical Association Journal. 182 (9).
[iii] BMJ-British Medical Journal (2008). Assisted Suicide Laws May Overlook Depressed Patients. ScienceDaily. http://www.sciencedaily.com /releases/2008/10/081007192534.htm