Care, compassion, respect

Physician-assisted death (PAD) is a controversial subject in Canada, but it shouldn’t be. Polls show that Canadians support PAD almost as much as they support sunlight and clean drinking water.1 PAD is now legal in many jurisdictions, and we have a large body of evidence to address fears about slippery slopes.

When PAD was legalized in Europe, it did not become the default option for dying patients; it generally remained stable while palliative care grew dramatically.2 According to the Economist, the five countries that have legalized PAD are world leaders in the “[b]asic end-of-life healthcare environment,”3 while Canada sits in the middle of the pack. According to the Center to Advance Palliative Care, all three US states that have legalized PAD by statute rank in the top eight for availability of palliative care services in hospitals.4

The vulnerable do not appear to be pressured into accepting PAD — in fact, most patients who receive PAD are wealthy, educated and supported by family members and health insurance.5^,6 I would call them “privileged,” but then I remember their suffering.

I don’t support death. I enjoy my life, and I work very hard as a critical care physician to keep patients alive — when I can. But I accept that there are times when I can’t. And there are times when I can keep people alive, but not in a state that they would value. I respect their right to know when they’ve had enough, and I don’t see why they should have this right only when they are dependent on life support.

Therefore, my support for PAD is based on an ethic of care, and the desire to help people achieve the death that they want. I’m not advocating for universal PAD, but universal choice. This debate calls for humility and a willingness to listen to our patients.