Dr. Ira Byock, a specialist in palliative care, a progressive Democrat and an opponent of assisted suicide laws has stated, “When doctor-induced death becomes an accepted response to the suffering of dying people, logical extensions grease the slippery slope.” (1)
Supporters of such laws have written, “It is reasonable to proceed incrementally…Thus, the restriction of physician assisted death to terminally ill patients should not necessarily be regarded as a permanent restriction.” (2)
During his recent campaign, Justin Trudeau, Canadian prime minister, explained why his government would not be appealing a Quebec Superior Court decision that struck down a requirement in federal and provincial assisted suicide and euthanasia laws that a person’s natural death be “reasonably foreseeable” before he or she can obtain doctor assisted death. (Note: In Canada, thousands have died by active euthanasia, while a tiny minority have used assisted suicide.) Trudeau said, “We recognize that court cases would come in, that people would be evolving as a society. We will move forward in a responsible way with legislation that responds to that.”(3)
The perspectives differ but the idea expressed is the same. Restrictions in the scope of assisted suicide laws can be blown through. They are there to help people accept the idea that part of a doctor’s role is to provide some patients with the means to die. “Aid in dying” laws will inevitably impact people with disabilities. The fight against legalized assisted suicide is indeed our fight. Canada is a cautionary tale.
The Quebec case was brought by Nicole Gladu, age 74 and a former journalist, and Jean Truchon who is 51 and has a degree in literature. The Montreal Gazette described their situation luridly. “Gladu and Truchon are ill and their health will never improve. They are trapped in bodies whose functions deteriorate every day. Gladu’s spine is twisted, she’s bound to a wheelchair and she only has the use of her right arm. Truchon moves with the aid of an electric wheelchair controlled by his mouth and he struggles to speak clearly. Over time, their illness will kill them, but because that death may not be imminent, neither was eligible for medical assistance in dying under provincial and federal law.” (4)
In more straightforward terms, Gladu and Truchon are people with childhood disabilities who now have age related issues. Gladu had polio at age 4 and at age 47 was diagnosed with post polio syndrome, which is a poorly understood condition that causes tiredness, weakness and breathing problems in some persons years after having polio.
Truchon was born with significant cerebral palsy. After university, he lived independently until several years ago, when spinal stenosis progressively decreased the function of his better arm. (5) Older adults with CP appear to be at unusual risk for spinal stenosis, i.e. the narrowing of the spinal column causing pressure on the cord. (6) Indeed it has been suggested that cervical spinal stenosis is a “hidden epidemic” in the aging CP community. Prompt identification and treatment is needed to prevent major consequences. (7) (For my experience with a delay in diagnosis of cervical stenosis, click https://www.eparent.com/exceptional-blog/the-surprise-of-cervical-spinal-stenosis/ ).
Managing disability and aging is far from a recognized public health priority. Neither is it high on the radar of most advocacy groups. Yet, given the number of people with disabilities who are baby boomers and generation X, disability/ableism will increasingly intersect with age/ageism. Without our activism, society could go any which way in its response.
At the 2017 press conference in which they announced they would challenge the restriction in the scope of the Canadian assisted suicide/euthanasia laws to persons whose death was reasonably foreseeable, Gladu said the act of breathing was taking most of her waning energy while Truchon indicated that he couldn’t face the prospect of life confined to an institution. (8)
The Superior Court of Quebec in a decision written by Judge Christine Beaudoin accordingly ruled the restriction “infringes life, liberty and security of the person guaranteed [by the Canadian Constitution]…to Mr. Jean Truchon and Ms. Nicole Gladu, in a manner inconsistent with the principles of fundamental justice…the reasonably foreseeable natural death requirement deprives both individuals and claimants of their autonomy and their choice to end their lives at the time and in the manner desired.”
Daniel Weinstock, a Canadian constitutional scholar noted in commentary on the ruling that “It may seem paradoxical to say that something that is going to abridge the life of a person affects their right to life, liberty and security. But it has become a standard Canadian constitutional argument that having to continue to live in conditions that one deems unacceptable, in virtue of their suffering, is a violation of one’s right to a certain quality of life.”(10)
What is being ignored is social reality. Truchon wants to die because his liberty and autonomy has been taken away from him. He lost the use of his better arm and now he is relegated to an institution due to lack of adequate in-home support. Although their conditions are different, his case is similar to that of Sean Tagert, a Canadian with ALS who wanted to live and be close to his young son for as long as possible but “chose” assisted suicide because he needed in-home services aides for four more hours a day than the government would authorize in order to stay home. (11)
One arm, four extra hours of aides, management of breathing difficulties that are relatively common and can be treated with noninvasive breathing supports – Can we let these things be used to justify medically approved and doctor induced death? It is Orwellian to call this security.
At the post ruling press conference, Gladu and Truchon seemed pleased with the decision. A court win is, after all, a court win. However both, fortunately, indicate that they are putting off plans for death, though their attorney Jean-Pierre Ménard said “This ruling — for the thousands of people living in despair — is like some light at the end of the tunnel”. (12) In other words, he seem to think that thousands of Canadians with disabilities will gratefully die.
The disability resistance is strong in Canada and they will prove him wrong.
As for us in the United States, we should realize that ideas and trends don’t observe borders. The Canadian trend is consistent with the mission of the broader worldwide euthanasia movement. We must broaden the opposition to legalized assisted suicide within the disability community and this is so, regardless of how the bills are written. We are at a crossroads.
Footnotes
- https://www.nytimes.com/roomfordebate/2014/10/06/expanding-the-right-to-die/doctor-assisted-suicide-is-unethical-and-dangerous
- Gunderson, Martin and Mayo, David J. “Restrictions for Physician Assisted Death to the Terminally Ill”, Hastings Center Report , November-December 2002
- https://nationalpost.com/pmn/news-pmn/canada-news-pmn/trudeau-defends-use-of-two-planes-calls-tory-criticism-a-far-right-tactic
- https://montrealgazette.com/news/quebec/quebec-patients-to-take-their-time-after-winning-right-to-die
- http://www.slaw.ca/2019/09/17/challenging-the-quebec-end-of-life-legislation-and-medically-assisted-dying-in-truchon/
- https://www.aacpdm.org/UserFiles/file/fact-sheet-spine-072415.pdf
- https://onlinelibrary.wiley.com/doi/pdf/10.1111/dmcn.19_13512
- https://www.theglobeandmail.com/news/national/montrealers-file-legal-action-contesting-restrictions-on-assisted-dying/article35308414/
- https://www.cbc.ca/news/canada/montreal/medically-assisted-dying-law-overturned-quebec-1.5279067
- https://montrealgazette.com/news/quebec/quebec-court-invalidates-some-requirements-for-assisted-death
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882029/
- https://montrealgazette.com/news/quebec/quebec-patients-to-take-their-time-after-winning-right-to-die
As a person with Cerebral Palsy it terrifies me that people like me are targets for assisted suicide for aging. I didn’t know about spine problems and CP so thanks so much for posting about it!