Dr. Chris Simpson, newly installed president of the Canadian Medical Association, made the comments in advance of a landmark Supreme Court of Canada hearing expected to add fuel to the emotional end-of-life debate gaining urgency across Canada.
Simpson said there are enough doctors in Canada willing to perform doctor-hastened death, if the federal ban outlawing euthanasia were lifted.
But doctors first need safeguards to protect the vulnerable and a strategy to urgently shore up palliative care “so that this is not seen as a first, or second or even third choice, but a choice that’s appropriate for people after all other reasonable options are exhausted,” he said.
In recent days two high profile cases starkly illustrate how profoundly personal that choice is, he said.
The death of Gillian Bennett last week sparked waves of emotion after the 85-year-old great-grandmother, who was in the early stages of dementia, shared a deeply poignant and powerful suicide note on her blog, www.deadatnoon.com.
The Vancouver Sun reported how Bennett dragged a foam mattress from her home on Bowen Island, B.C. to a favourite spot facing a craggy rock cliff, and then killed herself with a dose of barbiturates mixed with water, her husband at her side.
“Ever so gradually at first, much faster now, I am turning into a vegetable,” Bennett wrote before she died.
On Monday, Maureen Taylor, the widow of Dr. Donald Low, urged the Supreme Court “to acknowledge that this is a right of all Canadians who want a choice in how they die.”
In an impassioned videotaped plea for doctor-assisted death shot days before his death last year, Low, a microbiologist who became a public face of the SARS crisis in 1993, accused Canada of not having the maturity to take on one of the most emotionally charged issues in medicine.
Euthanasia is considered murder under Canada’s Criminal Code, an offence punishable by up to 14 years in prison.
Low worried he would end up paralyzed and have to be carried from bed to the bathroom, that he would have trouble swallowing and eating. “What worries me is how I’m going to die,” he said in the video posted to YouTube.
The images of Bennett and Low take the euthanasia debate out of the abstract, Simpson said. “It really helps inform a more respectful discussion,” he said, adding the CMA heard similar anecdotes across the country during a series of town hall meetings with Canadians on end-of-life care.
“It’s just such a deeply personal moving story,” he said. “The more of those kinds of stories that we hear, the easier it becomes to establish a respect for another point of view.”
Simpson, chief of cardiology at Queen’s University in Kingston, said palliative care must be made a priority. But there are some forms of suffering even the best end-of-life care can’t alleviate, he said, including some cancer deaths and diseases such as Lou Gehrig’s disease that can lead to uncontrollable pain, breathlessness and the “psychologically terrifying” feeling of being “locked in”, where intellectually the person is aware of everything but unable to move or communicate.
“Those are some examples of things where, we would all agree if we were in that situation we would be looking for potentially other solutions,” he said.
Some of the most eloquent advocates for euthanasia and assisted suicide have been doctors themselves,” he added. “When we become patients ourselves, it’s a great leveller. We all know what we would want for ourselves.”
At its annual policy-setting convention last week, the CMA fundamentally softened its long held stance against euthanasia and assisted death, voting that doctors should be free to choose whether to help patients kill themselves, should the law change.
Some doctors have argued physicians should be taken out of the equation entirely and that the CMA should lobby for some other group of “euthanologists.”
But Simpson said doctors are the group patients trust most. “I don’t think we want to be reneging on our responsibilities to serve our patients, either.”
The Supreme Court will hear oral arguments Oct. 15 in a landmark case involving two B.C. women, Kay Carter and Gloria Taylor.
In 2011, Carter’s children, along with the B.C. Civil Liberties Association launched a lawsuit on their mother’s behalf. Kay Carter suffered from spinal stenosis, a degenerative condition that confined her to a wheelchair and left her in chronic pain. She died by lethal injection in Switzerland in 2010.
Gloria Taylor, who had Lou Gehrig’s disease, won a court-sanctioned exemption from federal laws banning assisted suicide when a B.C. Supreme Court judge ruled the law infringes on the rights of disabled people.
A provincial court of appeal overturned the decision. In January, the Supreme Court agreed to hear an appeal of the case. Taylor died of a severe infection in October 2012.
Simpson, who will be appearing before the Supreme Court, said that the CMA will be neither “pro nor con” and that as long as euthanasia and doctor-assisted death remain illegal “we’ll be advising our members not to participate in it.” Should the legal landscape change, “Our new policy will be to allow physicians to follow their conscience” within the confines of the law.
Any change in law would have to come with safeguards against abuse and must protect the rights of patients and doctors, he said.
Most doctors aren’t opposed to the notion of patients being able to choose how and when they die, “but they’re uncomfortable with the role they’re being asked to play, Simpson said.
“That discomfort comes a lot from this uncertainty: Am I going to be compelled to do it if I don’t want to do it? Am I going to be asked to make decisions that I’m really uncomfortable with?”
“I have a lot of great respect for people who say that, I simply want the choice. I want to be in control. I don’t want to lose that control and I don’t want to suffer in pain,” Simpson said.
Asked whether he would want the option of doctor-hastened death at the end of his own life, he was more circumspect.
“I don’t know what I would do in that situation, is the absolutely honest answer,” he said.
“But I think I would probably fall into line with the way most Canadians think, which is, if the choice is there, that helps me maintain control over my own destiny.”