Chapter 51: The Right to Live, the Right to Die
I am Charlie, I am Joan, I am Kathleen, too.
The bizarre and contradictory attitude society has toward the value of older lives was fully on display at three events that occurred over the past year. The first took place late last August when the comedian Joan Rivers, 81, died in a New York City clinic while undergoing a routine endoscopy to treat voice hoarseness. Lost in the outpouring of condolences that ensued was the strong possibility that her death was the entirely unnecessary result of medical error of physician inattention during the procedure. A subsequent investigation by the federal Centers for Medicare and Medicaid Services found the attending doctors “failed to notice her deteriorating vital signs for at least 15 minutes before she went into cardiac arrest,” and that one of them had taken cellphone pictures of Rivers while she lay anesthetized on the table. Despite that, reading the papers and the Internet, I was first surprised and then amazed by the fact that not many seemed to be pointing out that a tragedy had occurred, the cutting short in full flood of the vibrant career of an active artist who was as creatively busy as she’d ever been (she’d performed onstage the night before the procedure). Had Rivers been 41 instead of 81, the story would have been the Scandal of her medical treatment; but her age turned what should have been outrage into an occasion for in memoriam. “Well, at least she lived a full life,” I heard more than one person say. Which, of course, was nonsense; her death was still every bit as scandalous, but being 81 had somehow devalued her life.
The second event took place just this past January, when Islamist terrorists attacked the offices of the Paris-based satirical magazine, Charlie Hebdo, which had published cartoons of the prophet Muhammad. They murdered 12 people, principally cartoonists and columnists. What struck me when I read the reports were their ages. Outside of the editor, Stéphane Charbonnier, 47, their average age was 71. When I mentioned this to other people, they were at first surprised that a bunch of old guys (the oldest 86) could have been sufficiently current and significant enough to be targeted by the most evil force on earth today; and then, philosophically, they would all add versions of “Well, at least they had a good run.” Again, it seemed, the older you got, the less anguish you were worth.
The final event, the one that brings the double standard into full view, is the most recent: the landmark unanimous decision issued by the Supreme Court of Canada in February, which upheld a ruling by the B.C. Supreme Court in a case involving an 89-year-old woman named Kathleen Carter and overturned the previous total ban on doctor-assisted suicide in Canada. The decision – which I personally consider a long-overdue triumph – provoked an immediate flood of protest from predictable constituencies, who were suddenly hyper-concerned about elderly people being tricked or pressured into ending their now suddenly precious lives. Society, it would seem, undervalues our lives when Oldies meet untimely deaths and overvalues them when the Oldies themselves seek timelier, more merciful deaths of their own choosing.
The Supreme Court has given the federal government a year to draft an assisted suicide law that’s consistent with the new ruling. The government has a number of alternatives. It can write a law that’s consistent with the spirit of the court’s decision and which benefits from the real experience of jurisdictions around the world where assisted suicide is already practised. It can write no law at all so that the onus devolves onto the provinces, where the constitutional responsibility for health lies, somewhat like Quebec, with no clear federal stance, somewhat like abortion. Or it can write a law that’s so hedged and controlling, it frustrates the aim of the decision itself.
Currently, physician-assisted suicide is legal in the Netherlands, Belgium, Luxembourg, Switzerland, Germany, Albania, Colombia, Japan and in the American states of Montana, New Mexico, Washington, Oregon and Vermont. There are regional variations in the laws – concerning, for example, who can request the service, under what circumstances it can be performed and whether the patient must physically participate – and in the actual experience and results of these different approaches. We can go to them and find out if the “Slippery Slope” actually exists and whether vulnerable populations like the handicapped and the elderly have indeed been victimized.
All indications are that they have not. The Supreme Court itself relied heavily on the findings of trial judge Lynn Smith, who conducted a series of painstaking hearings on legal developments in other jurisdictions that had accepted and enacted assisted suicide in the years since the famous Sue Rodriguez case in Canada. The court found that the “systems worked to protect vulnerable people from unwanted death.” Controversial cases in these jurisdictions have been few and far between, and all of these have involved situations that fall outside the specifics of our Supreme Court’s recommendations, which are restricted to terminal physical conditions involving extreme suffering.2 As I wrote this column, VisionTV’s show, theZoomer, hosted an international panel of Aid in Dying experts and practitioners who were specifically asked about the “Slippery Slope” in their respective jurisdictions. One of the panellists was Oregon’s Peter Reagan, a retired doctor and medical co-director of the advocacy group Compassion and Choices, who wrote the first prescription for assisted death used in Oregon. “I don’t think there is much evidence that there is a slippery slope,” Reagan wrote in an email after the panel discussion. “What is missing in your debate here in Canada is that it is all hypothetical … Real life is much more reassuring because people are practical. What if the ‘slope’ in question actually tilts the other way? It is a funny metaphor.”
Gert Huysmans, a Belgian GP and president of the Belgian palliative care federation who regularly performs euthanasia (the term used in Belgium), added: “In my experience, every physician who deals with euthanasia (and every team, e.g., nurses) are aware that euthanasia is a serious decision … there is no ‘right’ to euthanasia, there is a ‘right’ to perform euthanasia under certain conditions, and external pressure is not accepted. This is a strong safeguard for vulnerable groups, and I think up till now this works well.”
And this from Gerrit Kimsma, a family doctor in the Netherlands, who sat on that country’s euthanasia review board for 12 years and actually testified before Canada’s Supreme Court: “… you must realize that we are talking about less than three per cent of all deaths in our country, where people consciously choose for a death of their choice in a position of unbearable suffering without any prospect for recovery. I shall be happy to provide you with more information but I cannot provide information of what is not happening.” [My italics.]
Clearly, the “Slippery Slope” is a sorry excuse of an argument. In fact, as Peter Reagan suggested, the opposite may be the case: permitting assisted suicide may make the slope less slippery. In previous chapters, we’ve already provided evidence that having the opportunity to resort to assisted and therefore assured painless termination calms people and results in only a tiny percentage of potential candidates actually carrying out the ultimate decision. Absent the hope of a merciful ending, you get cases like the elderly Toronto Jewish couple, both survivors of the Nazis in Croatia and both ill and in chronic pain, without family and without any other humane recourse, who jumped to their deaths off their 18th-floor apartment balcony in 2013. According to a neighbour who spoke to a reporter after the double suicide, “They were tired of all the pain.”
Equally unconvincing to me is the contention that, because of the slim chance of malfeasance in providing aid, we should be comfortable with sentencing thousands of people to a prolonged and miserable death. There isn’t a law in the world that doesn’t give rise to some sort of unforeseen consequence, but that doesn’t mean we overturn the entire law because of this small possibility. If someone commits suicide by hanging himself with his belt, you don’t outlaw the selling of belts. And if there are truly bad people out there willing to kill for an inheritance, staging an assisted suicide is an extremely clumsy way of doing it. To be completely unsubtle, there are more subtle ways to bump off Grandma.
For me, ultimately, it’s a question of autonomy. Precisely because we come into the world having no say in the matter, having given no permission, the result of a parental spasm, often accidental, we should have the absolute, autonomous right to decide when and how we die. Whose body, whose life is it anyway? The notion that we should suffer in death as, say, women suffer in childbirth in retribution for some kind of “original” sin provokes in me a deeply negative response. I consider it offensive that someone else’s convictions, often religious, should be able to force someone else to undergo an ordeal they don’t have to. When Joan Rivers and the veteran journalists at Charlie Hebdo had their Right to Life abruptly snatched away, it was plain wrong; and it would be equally wrong for our Right to Die, in our own time and in our chosen way, to be taken away from us. “An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy,” says the Supreme Court judgment. “The right to life is not the same as a duty to live.”
I couldn’t agree more.
Moses’ Zoomer Philosophy — which launched in ZOOMER Magazine in October 2009 — is a series of monthly essays on age and aging, and the secrets and the science to living better, longer, healthier and happier lives. The first volume of his collection is now available in e-book format on the Kobo Books website. Click here for more information.