Tuesday, 17 February 2015

Let's talk about the "right to die" decision

As I have said many times before, I am no stranger to death. I have been at the bedside of many who are dying and who have died in my presence.

I have learned that death is not as dramatic nor as colourful as it is portrayed in the media. More often it is quiet, peaceful, with life slipping away.

It is from that framework then, that I approach the recent decision of the Supreme Court to uphold the appeal of Carter vs. Canada. Sometimes called the “Right to Die” decision, it has been controversial over the last few years as the case has wound its way through the courts.

I always try to read the actual decision before coming to any conclusions. That is aided these days by the immediate publication of all decisions of the Supreme Court electronically. Just search for the case name and you can read it, too.

Our Supreme Court writes clear and unequivocal decisions. There is a lot of legal footnoting; after all these are very serious matters. But the actual decision itself is well written and easy to understand.

  First, Carter vs. Canada does not give anyone the right to request the right to die at any time, nor does it obligate a physician to perform that task. In fact, the decision is very restrictive in it’s conditions, applying to a specific set of circumstances. The court also places a time line of one year on Parliament to respond to the decision of the Supreme Court.

What the court has actually done is, I believe, consistent with the movement of the framework of Canadian law away from an emphasis on “Thou shalt not..” making an act illegal, to a permissive understanding of the law, which says something is allowed except under specific circumstances.
In that way Carter vs. Canada is echoes the approach the court has taken on abortion; it is a medical matter, not a criminal matter.

The court has also acknowledged that physicians are not of one mind on the issue. The court makes clear that “...In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.”

The court goes on to say “...that a physician’s decision to participate in assisted dying is a matter of conscience and, in some cases, of religious belief. They go on to say “...the Charter rights of patients and physicians will need to be reconciled.”

The court has not interfered with the responsibility of Parliament. Instead they have clarified a critical issue and laid the responsibility for drafting appropriate language and legislation on the desks of our elected representatives.

The next step is really ours. We need to ask our elected representatives at both federal and provincial levels some very tough questions about end of life care.

I have seen good death through effective palliative care. Unfortunately, quality palliative care in Canada is patchy at best. Because there is no national strategy in place, we can not provide a common level of dignity and care for the dying across this country.

That has to change.

In the next year we will be facing an opportunity to have conversations with our elected representatives at the federal level as they seek re-election. I believe this issue should be raised as part of that conversation.

One day we will all die. But we can change the way we respond to death and dying right now. Carter vs. Canada gives us the opening for the conversation.

Let’s talk.