DEBATE: Should assisted suicide be legalized in Canada?

The argument that assisted suicide is happening anyway, so let's legalize it, is not valid. Murder, sexual assault, robbery, and so on happen anyway and no one suggests legalizing them. Why? Because we believe they are inherently wrong. We don't regulate inherently wrong actions, as Mr. Ogden proposes for assisted suicide – we prohibit them.

So, the fundamental question is whether it's inherently wrong to kill another person (euthanasia) or intentionally to help them to kill themselves (assisted suicide). If so, they cannot be justified, even by motives of mercy and compassion. For millennia, societies like Canada have said they%u2019re wrong. To change that by legalizing them would be to cross the Rubicon and eliminate an essential protective barrier that is necessary if we are to maintain respect for every individual's life and for human life, as a whole. Humans have a natural instinct against killing each other, which is protective, and we override this at our ethical peril.

Even utilitarians, who do not believe these interventions are inherently wrong and base their ethics on whether benefits outweigh risks and harms, should reject them, because their harms far outweigh their benefits, especially on the slippery slope they open up. We can clearly see that in the Netherlands' 30-year experience of euthanasia. Indeed, the politician responsible for shepherding through the Dutch legislation legalizing euthanasia recently admitted publicly that doing so had been a serious mistake, because, once legalized, euthanasia cannot be controlled. And if, as Mr. Ogden claims, people are not obeying the law now, why would they obey conditions placed on assisted suicide? The Dutch experience shows many do not.

Moreover, adequate palliative medicine services eliminate the need for legalized euthanasia or assisted suicide. We have ethical obligations to provide these: We must kill pain and suffering, not the person experiencing them.

Parliament decriminalized suicide in 1972. But, as Hansard clearly shows, it did this in order to prevent suicide, not to allow it. The goal was to encourage people who had attempted suicide to seek medical treatment. Many avoided doing so, for fear of being criminally charged. In contrast, the primary purpose of decriminalizing assisted suicide is, as Mr. Ogden advocates, to make suicide more readily available. In short, decriminalizing assisted suicide would have the opposite effect from decriminalizing suicide: it would increase the number of suicides.

Mr. Ogden claims suicide is legal and that I have agreed that there is a right to commit suicide. He is wrong on both counts.

There is an important distinction between decriminalizing and legalizing suicide. If suicide were legalized, people would have a right to commit suicide and others would have a duty not to interfere with their exercise of that right. That means a broken-hearted 19-year-old woman who attempts suicide and is brought to the emergency room and refuses treatment should not be treated. That does not reflect current practice or law.

In saying I have agreed there is a right to commit suicide, Mr. Ogden uses the pro-euthanasia strategy of trying to legalize euthanasia and physician-assisted suicide through confusing them with actions that are not euthanasia or PAS. First, he lists rights that I, and the vast majority of Canadians, do support, e.g., rights to refuse treatment, food and fluids, and life support, and, I would add, rights to totally adequate pain management. Then he proposes that in recognizing these rights, we are already practicing euthanasia, so we should come out of the medical closet and legalize it. But acting to respect these rights is not euthanasia or PAS.

We are careful in law school to teach future lawyers the dangers of taking a statement out of context to try to win an argument. Mr. Ogden's statement that I said, "I am prepared to accept that [euthanasia] is a personal, individual, moral judgment," before no less than a Senate Special Committee, is such a statement. What I said was, in fact, the opposite. I said that if euthanasia were just such a judgment, it could be left to the individual; but it's not such a judgment, because it involves our most important shared values, especially respect for each and every human life and human life, in general, and would harm foundational societal institutions, in particular, law and medicine.

We can safely assume that, when deciding to decriminalize suicide, parliamentarians made a conscious decision not to decriminalize assisted suicide. The only feasible explanation for this difference is that they wanted to prevent as many suicides as possible and believed this approach was the best way to achieve that outcome.

And, again, Mr. Ogden confuses legal end-of-life decisions, with ones that would be criminal. To repeat, withdrawing medically futile treatment is not euthanasia, and is ethical and legal. In contrast, the Groningen protocol allows parents of a disabled newborn baby to request euthanasia, which would be a crime in Canada.

As to Oregon's suicide rate, see Oregon Suicide Rate Tops U.S., By Far, which states: "Oregon's suicide rate is a stunning 35 per cent higher than the national average, a new state report out Thursday said."

The pro-euthanasia case is argued almost entirely at the level of individual rights to autonomy and self-determination – the "right to choose." (The exception is when euthanasia is advocated on the basis of cost-saving, which even many pro-euthanasia supporters find an unacceptable justification.) But, we need to understand, and take fully into account, the wider harms that legalizing euthanasia and physician-assisted suicide would do to important societal institutions, in particular, medicine, and values, and, as a result, to patients and society. This is a major reason to reject these procedures.

A fundamental value and attitude that we reinforce in physicians and nurses, is an absolute repugnance to killing patients. It would be very difficult to communicate such repugnance to them in the context of legalized euthanasia.

Physicians' and nurses' absolute rejection of intentionally inflicting death or being involved in its intentional infliction is necessary to maintaining people's and society's trust in both their own physicians and the profession of medicine as a whole. This is true, in part, because physicians and nurses have opportunities to kill that are not open to other people.

Physicians and nurses need a clear line that powerfully manifests to them, their patients, and society that they do not inflict death. Both their patients and the public need to know with absolute certainty – and be able to trust – that is the case. Anything that blurs that line, damages that trust, or makes physicians or nurses less sensitive to primary obligations to protect and respect life is unacceptable. Legalizing euthanasia or physician-assisted suicide would do all of these.

The euthanasia debate is a momentous one. It involves our individual and collective past (the ethical, legal, and cultural norms that have been handed down to us as members of families, groups, and societies); the present (whether we will change those norms); and the future (the impact that this would have on those who come after us).

In debating euthanasia and assisted suicide we need to ask many questions, but three of the most important are: Would their legalization be most likely to help us or hinder us in our search for meaning in our individual and collective lives? How do we want our grandchildren and great grandchildren to die? And, in relation to human death, what kind of values and culture do we want to pass on to future generations?

I propose that the best answers to all the questions I have just posed, and to many others that could and should be asked, strongly indicate that we should not legalize euthanasia or physician-assisted suicide.