The ultimate choice: A matter of life and death

They are good friends. Both have gone through the ordeal of looking after dying parents. And both are warm, caring people you would be proud and privileged to know.

Harry van Bommel is 43, in the midst of life, with a wife and two tykes.

Marilynne Seguin, a registered nurse, is 60, and is dying of a combination of illnesses.

And they find themselves on opposite sides of an argument that is engaging Canadians from one end of the country to the other. The question: Should euthanasia or assisted suicide be legalized?

With every passing year, as baby boomers start to think of their own mortality, the issue becomes more pressing. Polls show approximately 75 per cent of Canadians approve of assisted suicide, yet politicians have been reluctant to act.

It’s an issue that has rarely been out of the nation’s headlines: In 1996, after failing to get Prime Minister Jean Chretien to change the law against assisted suicide, Austin Bastable, a Windsor, Ont., multiple sclerosis victim, died assisted by Dr. Jack Kevorkian. And Sue Rodriguez, suffering from Lou Gehrig’s Disease (ALS), engaged the nation’s sympathy in 1993 when, after failing to get Supreme Court approval for assted suicide, she found a doctor willing to end her suffering.

Although a murder charge against Halifax respirologist Dr. Nancy Morrison in the death of a cancer patient was dropped this year, it was a stark reminder that Canada’s law against mercy killing still has teeth.

This question of whether we should have the right to end it all when life becomes unbearable taps into some of our deepest-held beliefs. Yet people on both sides of the issue, like Seguin and van Bommel are motivated by good intentions.

So perhaps it’s time to take a fresh look at the controversial issue, beginning with the areas with which supposed opponents like van Bommel and Seguin are in broad agreement.

By way of background: van Bommel was 24 and studying French at Laval when he was called home to look after his dying mother. Later, he nursed both his 91-year-old grandfather and his father during their last days.

These experiences transformed him. There was laughter, and "we became a lot closer: We were able to say things we had not been able to find words for before." Where at university he had favoured euthanasia, he now saw it as a selling out on this last, potentially rich chapter of life, and he helped found the Canadian Palliative Care Association (CPCA).

Seguin has written movingly in her book, A Gentle Death, of having no answers when, as a student nurse in 1956, a paraplegic – a young man involved in a diving accident – appealed to her to help him end his life. The experience of seeing patients suffering agonizing deaths led her to become a founding member and until illness intervened, executive director of Dying with Dignity.

Like van Bommel, she believes dying people need to talk about their fears. She thinks, as well, that assisted suicide can be part of these discussions and, once acknowledged, it is rarely resorted to. She has counselled more than 2,000 people who were dying – only about three per cent of whom chose to end their lives.

Care of the dying has come a long way since the advent of the hospice/palliative care movement in the 1970s. On that Seguin and van Bommel are in agreement.

"Effective pain and symptom control can work," says Van Bommel. "We know everything we need to know." All that’s lacking, he says, is knowledge of pain control on the part of many family physicians.

"I think palliative care is fantastic," says Seguin. "However, I feel the reality of the care falls far short of the promise. People are told they will be pain free, in control of their lives and they will never be abandoned. Yet when you remove ultimate choice (whether or not to die), you have abandoned them."

What about that claim that palliative care means no pain? Dr. Jacqueline Fraser, medical director of the palliative care unit at St. Paul’s Hospital, in Vancouver, and president of the CPCA, says, "For terminally ill patients, pain can be controlled 90 to 95 per cent."

But Seguin quotes another pain expert as saying that in 20 per cent of cases, pain cannot be controlled. Whatever the reality, both she and van Bommel agree pain may not be the number one issue.

When asked about their concerns, says Seguin, people say dignity and the freedom to choose, personal support and not being a burden on their families all come ahead of freedom from pain. In her own case, she has set aside medications, and knows what to do if and when life become impossible. "But if my illness allows me to maintain my dignity, I will probably die a natural death."

Again, van Bommel is sympathetic: "Understandably," he says, "many people would rather die than lose their personhood. We can all identify with the need for self-respect."

They agree as well that, if euthanasia is legalized, only a very small percentage of people will take advantage of the change. Oregon, the first state to pass a physician-assisted suicide law, has had only two cases of assisted suicide at the time of writing, and, with physicians there more aware of patient rights, more people are dying at home – surrounded by the familiar – instead of an impersonal institution.

Euthanasia is going on now, says Seguin. "If the law was changed we would see no increase in the number of cases. The only difference would be they would be recorded." But she sees the issue as one of human rights — having control over your own destiny. And when people know they can exercise that right, she says, they feel peace of mind.

Seguin is as concerned as Harry about some of the rocky sideroads the euthanasia issue has taken.

Of Kevorkian, Dr. Death, she says "I don’t see much dignity in letting someone kill themselves in the back of a van or in a motel room, to be found by strangers." The best way to prevent that sort of thing happening in Canada, she says, is to change the law.

Respect for the rights of the disabled is probably the knottiest question in the euthanasia debate; people like actor/director Christopher Reeve and physicist Stephen Hawking have given us a new view of the struggles and achievements of the handicapped.

Many disabled, though, fear that what they regard as the lenient treatment given Saskatchewan farmer Robert Latimer, convicted of killing his daughter, Tracy, 12, who had cerebral palsy (but exempted from the mandatory 25 year prison term) as an indicator of dangers to come.

"I do not support euthanasia or assisted death being decided by another person," says Seguin. It should only happen where the person is mentally competent to make the decision, she insists.

Yet even Harry van Bommel believes euthanasia will inevitably be legalized in Canada. Pressure from baby boomers, what he calls "the worried well", will be irresistible (although he believes it will subsequently be revoked when people understand the consequences).

So it is in the interest of Canadians on both sides of the issue to seek common ground and, like van Bommel and Seguin, conduct the debate with civility and regard for beliefs.

"Harry is a very nice man," says Seguin.

"She’s a fine woman," comments Harry.