Bioethics @ TIU

How Slippery the Slope?

Posted February 15th, 2016 by Philip Thompson

Proponents of physician-assisted suicide (PAS) and voluntary active euthanasia (VAE) tend to dismiss slippery slope arguments against their position as needless and unnecessary alarms. Ongoing events and discussions in Canada, however, suggest that the slope of assisted dying may indeed be slippery and the alarms justified.

In February 2015 the Supreme Court of Canada found that the existing ban on physician-assisted dying (PAD) violated the Canadian Charter of Rights and Freedoms. The Court initially gave the federal/provincial/territorial governments one year to pass new legislation, but later extended the deadline. As a result, PAD will be legal in Canada by June 6, 2016. Currently, the various levels of government are hammering out the details of the regulatory framework for assisted dying with the assistance of an advisory panel on PAD. Though the June deadline is still months away and the work of the advisory panel is not yet complete, some of the panel’s recommendations that are coming to light are troubling.

First, the panel maintains that “physician-assisted dying” (PAD) should encompass both PAS (the physician prescribes a lethal medication) and VAE (the physician injects a lethal medication) and should be publicly funded. The panel sees no ethically/medically significant difference between the two acts and recommends that both be permissible. Thus, Canada, from the beginning, would join the ranks of the Netherlands, Belgium, and Luxembourg in legalizing VAE. In contrast, PAS is legal in six states in the U.S. but VAE is still illegal in all fifty states.

Second, eligibility for PAD should be based on “competence” rather than “age,” theoretically removing age limits altogether. Co-chair Jennifer Gipson remarks, “Some children, especially adolescents, have the competence and the capacity to make end of life decision. What it turns on is not their age, not what their birth certificate says, but it’s really their ability to appreciate their diagnosis, their options.” While some members of the panel balk at the notion of a “competent” five or seven year old, none seem to have problems with a “competent” twelve year old, which seems to be the lower limit on which the panel has settled. Thus, from the start, Canada would be in line with the Netherlands where VAE is legal for children over the age of twelve, and potentially with Belgium that allows VAE for children without any age limit, developments that did not occur until 2014 after years of practicing more restricted VAE. In what other context does “competent adult” include children 12 years old and younger?

Third, patients requesting PAD need not be “terminal.” To have access to PAD, the Supreme Court declared that patients must have a “grievous and irremediable” condition. The advisory panel interprets this language to mean “a very severe or serious illness, disease, or disability that cannot be alleviated by any means acceptable to the patient.” The patient need not have a terminal condition. One wonders if mental conditions are included in this comprehensive redefinition.

These are not the only troubling recommendations of the committee. Another, for example, is that the “P” in PAD is not limited to physicians, but would also include a registered nurse or other health care professionals. But these are sufficient to sound the alarm. Eligibility requirements for euthanasia continue to be relaxed. Canada proposes to begin from a “relaxed” position. From PAS to VAE, from the limit of legal adult to no age limit at all, from terminal illness to any condition that makes life not worth living to the patient. Where will fixation on death end, and limits on human autonomy begin? To this writer, the slope seems as slippery as a downhill ski course!


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