Assisted Suicide (Carter V Canada)

In February of this year, the Supreme Court of Canada unanimously decided that an absolute ban on assisted suicide is unconstitutional.

In September of 1993, I was 11 years old and just starting 6th grade. At the same time, a woman by the name of Sue Rodriguez was fighting in front of the Supreme Court for the right to assisted suicide, an act she could not perform herself because of her debilitating ALS. I had never heard of assisted suicide before, nor had I really contemplated the end of life or the suffering of others. I was mostly interested in baseball cards and girls, but Sue Rodriguez lost her case, and all of a sudden I was outraged.

By the end of that year, my teachers grew bored of my endless essays on the topic. I spouted human rights and dignity. I spoke of pain and suffering. I often quoted Sue Rodriguez in asking “whose body is this?” In short, I was an annoying kid, but I had very strong beliefs; beliefs that I still mostly hold today.

So in some respect, I was surprised at the significant sadness I felt when I heard of the Supreme Court’s decision in Carter vs Canada. This was a decision I had always felt was legally and morally correct. It should have felt like a victory, but it just filled my heart with sorrow. I wasn’t hearing a victory for human rights and personal freedoms. I was just hearing a disheartening cry for help.

I have spent more than half of the two decades between these decisions training to become a physician. Although I now practice emergency medicine, my passion throughout medical school was always palliative care. I spent most of my elective time with the palliative care team. Amongst the exhausting grind of medical training, my time in palliative care was rejuvenating. To many, that may sound strange, but I am sure that anyone who has witnessed good palliative care will understand me.

So many things we do in medicine have such a small impact. I can talk for hours about diet and exercise, knowing that most patients will never be able to make a significant change. I arrange rehab for patients, only to see them back in the department drunk and injured again. As a family doctor, I was devoted to preventative medicine, tackling diabetes, hypertension, and cholesterol, but it was impossible to know if I had ever actually helped a particular patient.

My days in palliative care were such a refreshing change. We would start the day rounding on newly referred patients, with pain, or nausea, or shortness of breath so severe their regular doctor could not find a way to help them. We would talk to the patient and listen to their hopes and goals. Then we would start an aggressive treatment plan. When we finished our day by rounding on the same patients again, every patient would feel better. We were making instant, impactful changes. I had never seen patients so grateful. Nothing else I do is as rewarding.

What this time in palliative care taught me is that we can treat suffering, but sadly, it is something that we frequently do poorly. So when I hear the arguments for assisted suicide, I no longer hear the logic about personal liberty and the right to choose. Instead, I hear a faulty premise. I hear patients that are suffering, who think that the only way to stop their suffering is death. That is heart breaking, but I think it is wrong. Suffering can be treated. Suffering must be treated, and we must do a better job of treating it before we ever consider death as the answer.

When an individual presents to the emergency department with suicidal thoughts, we don’t discuss their personal rights. We recognize their suffering and we do everything in our power to help them. We must similarly recognize suicidal ideation in the terminally ill as a sign of suffering and do everything we can to treat it.

I won’t debate whether assisted suicide is right or wrong. I think that is the wrong question. The better question is: how can we help these individuals, who are obviously in desperate need? We need to demand better palliative care in this country. If done properly, I think much of the desire for assisted suicide would quickly disappear.

Author: Justin Morgenstern

Emergency doctor working in the community. FOAM enthusiast. Evidence based medicine junkie. “One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all he has been in the wrong.” - William Osler

2 thoughts on “Assisted Suicide (Carter V Canada)”

  1. i agree that we should treat suffering moreover as physicians we don’t do a great job recognizing it or if we do understanding that it isn’t simply part of a disease process. I look at assisted suicide as an option (which i unfortunately don’t have in the state I live in the US) and maybe someone doesn’t want to suffer at all, I feel it’s their right to choose. Death with dignity is far better than death with suffering in my opinion. I will say that there needs to be a limit on assisted suicide and appropriate screening for ppl with medical illness but to be honest, mental illness in and of itself is constant suffering — it the reason we see these pts repeatedly in the ED. I don’t know the law there but should they not be able to have the same assistance if there mental illness is debilitately like any other significant disease (maybe they can again don’t know the law)? Tough stuff but you can’t cure suffering in some of these pts and in those causes thankfully they have the right to decide if they want to suffer with tx or cure their suffering via death, I envy your patients that they at least have the choice.

    1. Thank you so much for your comment. This is certainly a difficult issue, and my post has already provoked a number so similar responses from my friends and family. It seems that almost everyone has a relation that they believe would have been better served at the end of their life by assisted suicide.
      The issue is complex, and I am struggling to find the ideal solution. I have always theoretically agreed with the death with dignity movement. However, practically, I think that the general premise that you raise that contrasts death with dignity to death with suffering is flawed. I have yet to encounter a terminally ill patient with suffering that a palliative care team could not address. Sadly, that does occasionally require doses of medicine that results in death. However, if the goal is relief of suffering, we will be able to help a large number, while a few may die. However, if the goal is simply death, you rob everyone of the possibility that we could cure their suffering without requiring death.
      This of course does not address the mental anguish that goes along with losing control of your own destiny. The simple act of de-criminalizing assisted suicide, so that it is an option, might relieve that anxiety in many who don’t actually exercise the option. On the other hand, none of us has control over how we will ultimately die. There will always be degree of randomness in human life, and I am not sure that death is the answer to these more abstract fears.
      I am happy for the recent legal decision in Canada, because I think that it will provoke a necessary conversation about end of life care in this country. However, I worry that a narrow focus on assisted suicide might send the message that there is no way to address suffering at the end of life. A robust palliative care system is step one. Legal and ethical debates about assisted suicide should be step 2.

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