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Protecting Choice and Safeguarding Inclusion: Finding Common Ground on Physician-Assisted Suicide

October 26, 2015 - - Physician Assisted Suicide

By Dr. Michael Bach, Executive Vice President, CACL

This month the Canadian Association for Community Living (CACL) launched a campaign to build common ground among Canadians on a system of safeguards for physician-assisted suicide in Canada. While our Association went to the Supreme Court of Canada to argue that the risks posed for vulnerable Canadians were too great, we accept the Court’s decision in Carter v. Canada and respect that a majority of Canadians want this choice to be available. We have also heard Canadians, and health professionals in particular, express concerns about potential risks for vulnerable Canadians. We all agree that we need a robust safeguard system to ensure that people for whom there are other options available are not induced to taking their own lives.

Over the past number of months CACL has consulted in our community and with legal and policy experts to consider what safeguards could best ensure people have their right to choice and at the same time make sure people who are vulnerable are identified and other options explored. Essentially, we think the challenge is to have a clear process with the right checks and balances to decide who is on one side of the ‘Carter line’ and who is on the other – who will die this way, and who will get other options; who has the capacity to decide and who does not; who is vulnerable to being induced to commit suicide and who is not. We think leaving that decision up to physicians all on their own is too much to ask, for three main reasons.

No going back, need to get it right

First, this decision will have lasting consequences, not only for the person, but for the person’s circle of family friends and broader community, including those who make the decision. You can’t take it back once it is done. We need to be very sure that we get it right.

Public, community consequences

Second, we respect that physician-assisted suicide is a private choice for those directly involved. However, it is one that has enormous public consequences. Every time someone dies intentionally this way, it helps to set a standard for where the ‘Carter line’ should be drawn in the future, the kinds of lives that the community comes to understand constitute sufficient reasons for choosing to die rather than live. Others, those left behind, come to see their own lives, and the lives of others, according to these standards. Leaving it up to a physician or two to set these community standards is too much to impose on one of the most trusted professions in our society; they should be set and agreed upon by the community itself.

For each request, need to consider alternatives

Third, giving informed consent is about more than having decision-making abilities. Being informed will require having information about and access to any alternative courses of action that might be available – whether medical interventions, community support services, or palliative care. Having someone to assist in exploring these alternatives will be essential in determining if a patient who is requesting assisted suicide may in fact be vulnerable, as defined by the Supreme Court.

For all of these reasons our proposed safeguards include mandatory vulnerability assessment by qualified professionals with information about community-based alternatives, and advance independent review and authorization by an independent board, appointed for the purpose of making these decisions. Physicians should determine whether a person meets the medical criteria. But given the public consequences, an independent board should decide what side of the line a person is on. Communities are responsible for protecting choice and safeguarding inclusion of all of its members. Let’s make sure they have the tools to do so when it comes to regulating physician-assisted suicide.

To learn more about our proposals and to support our campaign for protecting choice and safeguarding inclusion, please visit our campaign page by clicking here