Doctors Push the PAS Envelope

Over at his “Human Exceptionalism” blog, Wesley Smith has had a steady stream of recent posts about physician-assisted suicide (PAS), also called “physician-aid-in-dying” or “medical-aid-in-dying” (MAID).  “Hat tip” to Mr. Smith for the story that introduced me to the “MAID” acronym.  It is reported that Ontario’s College of Physicians and Surgeons think that the proposed law being considered by the Canadian federal government to allow PAS has too many precautions, and would make it too hard for people to avail themselves of PAS, or “MAID.”  (I guess “PAID” was too obviously unfortunate.)

The Ontario doctors reportedly object to the following:

  • ·       A proposed requirement that each request for aid in taking one’s own life be approved by two physicians who are independent of each other and have no business relationship.  What could be wrong with that?  In parts of Canada, the doctors are all part of the same group, making it hard to find two who are not linked by a business relationship.  Were the object ethical, I would sympathize.  But I don’t find PAS ethical, and would counter that the structure of Canadian medicine might foster a kind of “groupthink” that would make truly separate, independent assessments—the apparent goal of the restriction—elusive.

Then again, maybe this is just a consequence of medicine’s ceasing to be an independent, learned profession, but rather an employment arrangement.

  • ·       A proposed requirement that two independent witnesses sign each request for assisted death.  What could be wrong with that?  The witnesses would not be allowed to be people who might materially benefit from the requester’s death, or who are family members or caregivers of the requester.  So “complete strangers” would have to be involved in a difficult discussion and decision.   One may sympathize with the objection.  The people most likely to know a dying person’s wishes are likely to be close to that person.  Forcing the person to broaden the conversation would arguably be an affront to dignity in itself.  Further, one would not want to create an incentive for outside parties to promote themselves as “suicide certifiers,” an arrangement that would just magnify potential mischief.  And one would not want to create an incentive to pressure third parties into complicity with the evil that I argue PAS constitutes.  But the aim of the proposed restriction appears to be to prevent people close to a dying person—prospective heirs, burnt-out loved ones—from giving the person a “push,” so to speak.  And, as requests broaden—as they have in Europe—from terminally ill to depressed people, it would be good to have a way for someone to step up and block the “push,” and urge life, not death.

In my view, the discomfort with this proposed restriction simply illuminates the fact that PAS is not a step that civilized, humane society—or the profession supposedly devoted to proper care—should be willing to take.  Dragging the decision into the light merely exposes just how questionable the practice is.  The Ontario doctors might say, “a request for PAS is rather more momentous than getting a document notarized.”  To that, I guess I’d say, “precisely.”

  • ·       The proposal to limit PAS in Canada to people in advanced decline from severe illness that makes natural death “reasonably foreseeable.”  What could be wrong with that?  The Ontario doctors say it’s too imprecise.  It’s impossible to predict when someone will die.  So doctors won’t know how to interpret it, will interpret it differently, or might shy away from granting requests because of the uncertainty.

Again:  precisely.  The inability to predict the time of death is one reason why medicine should be (remain?) about caring for sick and suffering people, including with proper palliative care, and helping make what remains of life as humane as possible.  We should not step over into the active hastening of death.  Not sure how to implement PAS guidelines?  Don’t participate in PAS!

Unless one advocates complete “autonomy” in PAS, and would have doctors rubber-stamp every request—assuming, all the while, that every request is freely and knowingly offered.

The Canadian provision was proposed in response to a mandate last year by Canada’s Supreme Court that the government must recognize a right to PAS by June 6, 2016, or the Court will just impose it, according to less restrictive terms than in the proposed law, meaning that even if the law is enacted, it will probably be struck down by Canada’s high court. 

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Mark McQuain
Mark McQuain
5 years ago

I have said this before within this blog but doctors should not be anyone’s choice for aid/assistance in suicide. We are trained to avoid actions/errors that cause death. Part of the trust relationship between patient and physician has been historically promising to avoid causing harm. Iatrogenic (and certainly intentional) death, until recently, was considered one of the ultimate harms.

If by “aid in dying” one means palliative care to maximize comfort as one is dying then I agree this should be a physician, as it often takes great skill to provide palliative care without hastening the patient’s death.

It takes a different skill set to kill someone.