Assisted-suicide panel failed to present balanced arguments

Margaret Somerville
December 8, 2011 © Copyright (c) The Montreal Gazette
Reproduced with Permission

Responding to the Royal Society of Canada's Expert Panel Report on End-of-Life Decision Making, which recommended the legalization of euthanasia and physician-assisted suicide, a Gazette editorial called for "a national debate on life-anddeath issues" (The Gazette's View, Nov. 24). In deciding where we stand on this issue, it's important for Canadians to understand the weaknesses of the report.

It is not "a careful, balanced review of various pros and cons of decriminalization of physician-assisted death from well-reasoned ethical and legal standpoints" - which is what was required in the panel's mandate. It's an unabashed pro-euthanasia manifesto.

That's not surprising. Many of the report's authors are well-known euthanasia advocates, as are the people whom the panel consulted.

The arguments against the legalization of euthanasia and physician-assisted suicide are almost completely absent. Moreover, issues are considered almost entirely at the individual level. There is no in-depth discussion of the impact of legalizing euthanasia at the institutional level (in particular, the impact on health-care institutions and professions, and on the law) or at the societal level (in particular, on important shared values, such as respect for life). In fact, the value of respect for life is not discussed - an extraordinary omission.

The reporting on practices in jurisdictions that allow euthanasia and assisted suicide is seriously deficient, and selective. The report's coverage of abuses, problems or controversies is minimal.

For example, the report indicates that there has been one case of the use of euthanasia on disabled babies in the Netherlands. This is probably correct in the short time since the criteria for allowing such euthanasia was formally accepted by the Dutch Society for Pediatrics in 2005. But an article in the New England Journal of Medicine documents 22 cases of babies with spina bifida being euthanized in the Netherlands prior to that; this is not mentioned in the report. Likewise, a survey of Belgian physicians who had carried out euthanasia that found that 32 per cent of those physicians had euthanized patients without their request or consent, is never mentioned.

The authors make an unjustified assumption that individual autonomy, through "informed choice," is always the prevailing value, and they construct their case from there. They do not consider that for many people some other value might prevail - for example, respect for human life that requires that we don't kill each other, except when to save life.

The essential difference between the pro-and antieuthanasia positions is that the former gives priority to individual autonomy over respect for life, and the latter does the opposite. And respect for life goes beyond maintaining the value of respect for each individual human life, important as that is, to upholding respect for human life in general. Although the authors rely heavily on implementing values articulated in the Charter of Rights and Freedoms as expressing our shared values, they overlook that respect for life is a Charter value.

The report emphasizes the burden and health-care costs of an aging population, and gives the impression that euthanasia and physician-assisted suicide will help to resolve this "problem." The authors note that euthanizing people "in advanced stages of dementia" will be an issue to be addressed in the future, and they don't reject the possibility that this might be acceptable. The report doesn't mention the results of a survey done in 2010 by Environics. The poll asked more than 2,000 Canadians what the government's priority should be: legalizing euthanasia, improving end-of-life care, or both. Seventy-one per cent of respondents said improving end-of-life care, 19 per cent said legalizing euthanasia, and five per cent said both.

Other recent Environics polls found that:

The usual "confusions" used to promote the case for euthanasia are all present in the report. The opposite arguments are not presented.

These criticisms are far from comprehensive. Many more could be articulated. Fortunately, there is a wealth of grounds on which this report can be easily dismissed.