Insights (Essays) November 2015

In the end it all comes down to choice

Palliative Care Versus Assisted Death

Duncan G. Sinclair

Palliative care versus assisted death? I don’t get it!

Many advocates of palliative care are opposed to assisted suicide and I don’t know why. They seem complementary to me.

I do get the slippery slope argument related to assisted-death. Many living with disabilities and those who care deeply for them are concerned that making death-causing drugs available to suffering people seeking to end their lives could lead to devaluation of the lives of disabled people and eventually to their unwanted deaths. The sort of eugenic thinking that the world would be a better place without people with disabilities is as repugnant now as it was in WWII. It is not just repugnant; it is wrong! One has only to think of the amazing contributions of just two Stephens - Wonder and Hawking - to realize how wrong it is.

But does assisted-death really lead to devaluation of the lives of disabled people and subsequently to their being pressured to agree to suicide? I don’t think so. Physician-assisted suicide has been around for quite a while now in a variety of jurisdictions. Studies by the Royal Society of Canada and Quebec’s Legislative Assembly provide assurance that the accumulating data contains no evidence of the feared slippery slope. There will be regulations applied here in Canada just as there are in those jurisdictions where assisted death is now available. As Canadians know well, putting on your creepers and paying close attention to the footing can enable one to stand securely on and even walk up the most slippery of slopes. If a person were to ask you for assistance in dying you surely would want to know that s/he was of sound mind, resolute in his/her decision, and genuinely suffering, physically, psychologically, or both, from some condition agreed by physician-experts not to be remediable. There is no reason to think that requiring the provision of such assurances here would not provide adequate safeguards against the abuses disabled Canadians and their loved ones fear.

Palliation, according to my dictionary, is the temporary relief of pain and suffering. Assisted suicide, of course, makes the relief permanent. Thinking ahead, when I approach death myself from some irremediable condition, I will almost certainly enlist palliative care to control my pain and alleviate suffering while I get my affairs in order, check off whatever items on my “bucket list” I am still able to do with any pleasure, and bid my goodbyes to my family, friends and neighbours. But there will likely come a point, in my case when I am bed-ridden and unable to perform independently the activities of daily living, when I will say, “enough already!” Then, the law permitting, I will choose to make permanent the relief of my pain and suffering. Certainly that would have been the scenario played out by my wife during the seven months it took her to die of small bowel cancer. Her palliative care was superbly effective and empathetic but had assisted suicide not been unlawful she would have chosen to die some four to six weeks before she did. She and I talked openly about it and agreed that in our civilized democracy the law had to be respected even though we two, like the Supreme Court, thought the particular law prohibiting assisted suicide to be wrong-headed.

I can’t for the life of me see how making available to rational people the pharmaceutical means to alleviate permanently their pain and suffering at a time of their own choosing constitutes a threat to palliative care. It may just be that providers of palliative care look on assisted suicide as a symbol of their failure to provide sufficient comfort to the dying just as too many physicians still see palliative care and death itself as unwelcome evidence of their failed efforts to treat and cure.

In the end it all comes down to choice. I can understand why some people will want to squeeze every last minute out of life no matter what its cost, measured in any terms, including their own pain and suffering. I understand also the religious reasons why many find the concept of suicide to be unthinkable. They have every right to hold their views. I will defend the right of all people facing death imminently to have access to palliative care of the highest possible quality in the home-based or institutional venue of their choice. I will defend with equal vigor the right of an individual to choose to continue palliative care until his or her death of natural causes. But for me, I want also the choice of deciding for myself when to make permanent by assisted suicide the relief of my pain, suffering, and utter loss of autonomy.

About the Author

Duncan G. Sinclair is Professor Emeritus, Department of Physiology, Fellow, School of Policy Studies, Queen’s University, Kingston, ON



Sandi Pniauskas wrote:

Posted 2015/01/12 at 08:46 PM EST

I believe that understanding assisted suicide - truly understanding - comes not only from an intimate experience, such as with your departed wife, but also for those who have witnessed the limits to the scope of palliative care practice. To allow inhumane suffering and not to defer to the patient's wishes is incomprehensible. Thank you for your article.


You must sign in to comment Sign In or Create an Account to add comments