On February 6th 2015 the Supreme Court of Canada annulled the part of the Criminal Code that made physician assisted death (PAD) illegal for a “competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease, or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”
The ruling was suspended till June 2016 to give legislators time to, well, legislate on how best to legalise PAD. It is now widely anticipated that the publication of guidelines is imminent. With this prospect in mind researchers decided to try to get a feel for what physicians felt about this development; after all, we trust them to keep us alive but it is another thing entirely to ask them to kill us. The research was published in Neurology.
The researchers, mostly from Canadian universities, focussed on amyotrophic lateral sclerosis (ALS) as it is a rapidly progressive neurodegenerative disorder that has no cure; it has also been at the forefront of the PAD debate with a higher proportion of PAD patients suffering from ALS than cancer in much of the world. The researchers, then, sent out an anonymous, online survey to all 15 Canadian ALS clinics asking for all physicians and allied health professionals (AHPs) that specifically deal with ALS patients to take part. 116 physicians and 115 allied health professionals responded.
The figure above shows the breakdown of the response to being asked if they agreed or disagreed with the ruling of the Supreme Court. Clearly, the majority are in favour.
The survey went on to be much more specific, asking participants whether or not they thought PAD would be appropriate when a patient’s ALS was at an early, moderate or severe stage – the more severe the illness the more likely the healthcare professionals were to make a referral for PAD or to prescribe drugs for an assisted suicide. When asked if they would actually administer a lethal injection to someone who is no longer able to commit suicide only 31% of respondents said that they would.
The majority of both physicians (74%) and allied health professionals (67%) agreed that a second opinion and a psychiatric assessment would be necessary to gain eligibility to PAD. An even larger majority (82% of physicians and 72% of AHPs) felt that they were personally unprepared for whatever the new regime may bring and would welcome some kind of training and strong guidelines.
Whilst the survey was very thorough it does have some potential flaws. The term ‘physician-assisted’ may unintentionally convey an air of legitimacy to the practice where a more neutral term like ‘regulated death using prescription medications in ALS’ could have given different outcomes.
Most importantly, we must always keep the patient in mind. If the new law says that the patient must be capable of committing suicide then do we force people to go before they would ideally like? By making the conditions to severe do we make people suffer unnecessarily? Should it even be legal at all?
I certainly don’t claim to have any answers here; mercifully it is not a scenario I have had to deal with from any perspective. In theory I am an favour of PAD, as I sit here healthy in my 30s I don’t want to have to lose my body to a disease like ALS nor my mind to dementia. Maybe when I am actually faced with the reality of that decision I won’t be so sure, however. I do think that, as a society, these are conversations we need to be having. We can’t ignore people’s suffering, nor their right to be protected when they are at their most vulnerable. We need an open and frank discussion and that discussion needs to be mature. It would be all to easy for it to descend into an oversimplified, ideological slanging match.