WINNIPEG — With the introduction of a new law defining how Canadians may seek medical help to end their lives, the country continues on a road of irreversible change.
“We’ve gone from a country that has said ‘no’ under any circumstances, to ‘yes’ under some circumstances,” clinical ethicist Pat Murphy told a gathering at St. Charles Church in Winnipeg April 14, the eve of the tabling of the proposed legislation.
Murphy, part of the Health Care Ethics Service at St. Boniface General Hospital in Winnipeg, said mixed in with the challenges of changing law is confusion around the meaning of euthanasia, physician-assisted suicide and the role of palliative care.
To begin with, she said, there are dozens of terms used for physician-assisted death, from euthanasia to mercy killing to hastening of death. “There’s all kinds of terminology but they are not all equivalent, and that may be our greatest challenge,” Murphy said. She said such misconceptions “are evident in the general public, the Roman Catholic community and the community of health care professionals.
“Palliative care as a discipline is not to cure illness,” Murphy said. “The focus is on addressing the management of symptoms. The palliative care intention is to give someone a good life while they are dying.” But she has been told by family members of the terminally ill, “Don’t try to smother us with the palliative care pillow; we know what’s really going on.”
Murphy said palliative care allows death to occur by not attempting to prevent the advance of a fatal illness. “It is to distinguish between natural causes — what nature does to us — and human causes — what we do to each other.”
Murphy spoke of the difference between physician-assisted suicide, when a patient is given a lethal prescription to take themselves, and euthanasia, where a physician or other person administers the fatal dose.
She said the good news is that in jurisdictions allowing physician-assisted suicide, more people request it than go through with it. The patient is reassured just having the ability and knowing that the final decision is theirs.
The U.S. states of Oregon, Washington and Vermont have legalized physician-assisted suicide, while Belgium, the Netherlands and Luxembourg allow euthanasia or assisted suicide with the aid of another person, not necessarily a physician.
Murphy said in a famous and disturbing case in Belgium, where there is no requirement for a person to disclose their plans to anyone, a family was told after the fact that a loved one had ended their life, and the same could happen in Canada. “We do honour people’s privacy and their autonomy, but the human cost is profound,” Murphy said.
As to the difficulty surrounding such situations, the Health Care Ethics Services at St. Boniface Hospital are available 24 hours daily for patients, family members and health care providers. The service began in 1993 as a resource to all health care facilities and programs owned and operated by the Grey Nuns of Manitoba.
Murphy said there will be other legal aspects around what the federal government is now calling Medical Assistance in Dying (MAID). “How should their death be recorded?” she asked. Some jurisdictions list the cause of death as the illness that led to their decision to terminate their life. Others plainly state cause of death as euthanasia or assisted suicide. Whether life insurance remains valid is another question.
Murphy said Power of Attorney will have no effect because the person choosing MAID must be competent and clearly consenting when the decision is made. She said health care directives in Canada do not allow for MAID but some jurisdictions have introduced it.
Murphy said that even proponents in countries where euthanasia or assisted suicide have been allowed for years say it has “gone off the tracks” by being accessible to those who are simply lonely or isolated.
“It behooves us to ask, do we want to live in a country where people in loneliness or isolation are having their lives ended?”
Murphy’s presentation was the first of a three-part series on Euthanasia and Physician Assisted Suicide and the Effect on the Family at St. Charles Church. On April 20, Msgr. Maurice Comeault spoke on Redemptive Suffering, and on April 27 Dr. Mike Harlos will speak on Palliative Care and psychiatrist Dr. Stewart Wakeman will speak on the Vulnerability of the Mentally Ill.