Last Wednesday, the McGill Journal of Law and Health hosted an event titled “Physician Assisted Suicide and Bill 52: A Discourse” at Chancellor Day Hall. The event featured a discussion between Daniel Weinstock, a law professor at McGill, and Patrick Vinay, the former dean of the Faculty of Medicine at Université de Montréal, on the controversial Bill 52.
Entitled “An Act respecting end-of-life care,” the bill was passed into law by the Quebec National Assembly in June, legalizing physician-assisted suicide in the province of Quebec. Quebec became the first province to legislate the right to assisted suicide in Canada.
Weinstock, a member of the Royal Society of Canada expert panel on end-of-life decision making, defended Bill 52 on moral grounds.
He first argued that we must situate physician-assisted suicide as part of a continuum of end-of-life care along with palliative care – or care that relieves symptoms, as opposed to the actual ailment – as specified by Bill 52. He clarified that “requests for euthanasia come at the very end of that continuum for a very restricted pool of patients” only after palliative care has exhausted its viable options.
Patients then must also be sufficiently competent in their decision-making abilities. This “autonomy-based justification” of physician-assisted suicide is Weinstock’s main argument for Bill 52, and he argued that the right to make momentous life decisions by ourselves as autonomous citizens, including how one should die, follows the spirit of Canada’s constitution.
In contrast, the UK justifies its assisted suicide practices on a “well-being justification,” which states that life should be lived at a certain quality, which is not met by the suffering of the terminally ill. The problem Weinstock identified in this case is that a third party makes the call for euthanasia, maybe a health expert or a judge, which takes the decision away from the patient. This approach is incompatible with the value we give to autonomy embodied in the constitution of Canada.
As an involved member of the drafting of the bill, Weinstock finally praised the process as “exemplar law-making” involving “intense democratic debate and deliberation.”
Vinay challenged Bill 52 from the perspective of doctors in charge of palliative care. He believed the criteria specified in Bill 52 for physician-assisted suicide are difficult to enforce, such as incurability and suffering. It is never certain that the illness is incurable, and suffering is always subjective and in flux.
Speaking in French, he argued that the law will also be encroaching on the “professional liberty of exercising medicine,” by subjecting doctors to either assist the patient in dying, or referring the patient to another doctor who is willing to assist them.
Moreover, euthanasia, an irreversible act depending solely on the patient’s competent decision, is against the essence of practicing medicine in palliative care, which is continuous engagement with the patients, said Vinay.
“We must have trust and faith in the practice of medicine rather than surrendering to physician-assisted suicide,” Vinay concluded.
Even though many audience members differed on their opinions on Bill 52, the question-and-answer period was conducted respectfully, with no major tensions between opposing sides. The audience members were also diverse in their educational or professional backgrounds, and each found Bill 52 to be relevant for different reasons.
“For students in the faculty of law, it is important for us to explore these ethical questions,” Kendra Levasseur, a co-host of the event and a first-year law student, told The Daily.
Diana, a first-year nursing student, found the event particularly relevant to her program. “At the end of the day, who is going to be administering the shot?” she told The Daily.
Massimo Orsini, a co-host of the event and a first-year law student, summed up the event. “I think this is a pertinent issue, since we are always talking about the intersection of law, politics, healthcare, and health policy,” said Orsini. “It’s always important to realize how certain theoretical issues actually influence tangible legislation that has real and profound impacts on human beings and society.”
Current situation of Bill 52
Bill 52 has yet to be fully implemented, and is currently facing legal challenges from Quebec-based movements who argue on federal grounds that it infringes sections of the Criminal Code and section 7 of the Charter of Rights and Freedoms, which guarantees the right to life.
Its fate is also pending on the Supreme Court hearing of an appeal of the separate case of Carter v. Canada (Attorney General). In the Carter case, the Supreme Court of British Columbia (B.C.) originally ruled in 2012 that outlawing assisted suicide violated the rights of the terminally ill Gloria Taylor, and thus is unconstitutional.
The trial decision was appealed by the federal government, and subsequently overturned by the B. C. Court of Appeal in 2013, which upheld the existing prohibition on assisted suicide. This decision was in turn appealed and is now in the hands of the Supreme Court of Canada, which began its hearing this October.
The Supreme Court decision on Carter v. Canada is expected to be released to the public in several months.