The decision of the Supreme Court of Canada (SCC), is that the prohibition of doctors to accede to a request for assisted death is unconstitutional. Therefore, I am glad there may be a law –of some sort—to deal with this, although I do not think it can be examined in isolation. I am glad there will be some type of law in order to avoid the same situation as curently exists regarding abortion. There is no law, and while some may think this is a good thing, it does cause me some concern. These thoughts and concerns of mine come more slowly than I would like–they are still not fully developed. Here is a beginning. It is a beginning that began in a Facebook conversation with two colleagues.

Having no law about abortion in our country means: in  provinces that do not have pharmacare we pay for abortions but not contraception.; we practice eugenics; we cannot temporarily restrain a pregnant woman who decides to carry to term so that she will not ingest substances harmful to the child, etc., in the name of individual rights. At the same time: doctors who believe that abortion is wrong and do not wish to perform the procedures are vilified, and in some provinces might possibly face discipline if they refuse; it is now much harder to raise funds for those caring places that assist pregnant women and girls who do wish to carry to term and to relinquish their children, or those very young single mothers who need support in order to mother to the best of their abilities; there is now also a significant social stigma on those who willingly relinquish children, for whatever reason. I have heard more than one person who has had an abortion say “What choice did I have?” and yet I thought the SCC decision on the constitutionality of abortion was to provide choice.

So what does one SCC decision have to do with the other. When we focus on individual rights we do not think of communal or societal consequences. Does the new situation about doctors being allowed to take away life concern me? Yes. It terrifies me. We now spend very few of our research dollars on symptomatic relief or palliative care. Most medical schools offer little to no training about pain management. The attitude appears to be “If necessary give another drug” even though only two provinces have pharmacare, and many of the current narcotics cause hallucinations, delirium and other side effects that are not considered acceptable, as well as, other recent concerns about opioids that have emerged. (Many people with mental health issues that discontinue their medications also give side effects as the reason.) I have heard the argument that there simply isn’t sufficient pain management available, but as stated above, it is a much underfunded area of research and almost non-funded in non-pharmaceutical areas.

Today, provinces do not fund comfort care provided by massage therapists, physiotherapists, or parish nurses, and these three are recognized health care professionals–so it is not surprising there is nothing covered for any type of complementary medicine pain management when people are dying. The last federal budget didn’t even allocate one extra cent for home care, while at the same time it was preparing this proposed law. The majority of funding goes to active treatment to find cures or to enable people to become “independent productive members of society.”

If this law, that allows doctors to end life, is in effect I am sure there will be even less reason to fund any “care for the terminally ill or dying” causes—because there will always be the cheaper option. I am expecting we will begin to hear the phrase, “You know you don’t have to suffer like this,” being provided frequently as a caring alternative and eventually choosing to have  life ended will become a social expectation. Why do I think this? I’ve already heard news stories on CBC radio about growing old not being all it’s cracked up to be, and I know how shocked my previous lawyer was when I went to prepae a will and some advanced directives and said I do not want a DNR. You would have thought I’d committed mass murder by the look on her face.

I’m afraid the independence and dignity issue doesn’t really convince me either. I am contrary to most North Americans because I value humility, and prefer caring and interdependence to independence. I view independence as leading to some of our most self-centred decisions, making it easy for us to objectify life, both human and non-human and contributing to many of our social and environmental difficulties and collapses. Independence focuses on the individual and what is important to the individual. In this way it contributes to the income gap, colonialism, slavery, family violence, discrimination against people who have various levels of ability, etc. Independence is much less accepting of the imperfect. I as an individual need not be burdened and will idealize personal well-being and self-sufficiency to the point that I begin to realize that asking for help is shameful and undignified.

The two people for whom this thinking was originally intended were speaking from a faith perspective. All of us in the discussion are people of faith. As a person of faith (considered to be mainline Christian) I also do not believe the God I worship made us to be independent but to be interdependent. The writing of the Covenant and Holiness Code provide us with a means by which to live in community and not isolation. We are called to care for one another and to display the humility needed to have others care for us.

One of my heroes is Stephen Hawking. Imagine the personal decisions he has had to make and the humility he must have exercised to make them and live his life to the fullest. However, because of his case I have questions. For example, why is it that everyone cannot have his level of care? Why is it that the two people with ALS that I knew personally were not able to have voice synthesizers, as well as other aids available to Hawking? Will we deprive the 1% if we offer this type of care?

Do I want people to be forced to suffer pain with aggressive treatment after aggressive treatment for diseases that have only one outcome? Of course not. Aggressive treatment should not always be pursued. More important, once again, adequate research needs to be conducted so that pain management can be further explored.  Do I think that it’s right that people lose their dignity because they cannot care for themselves? Of course not. But how did our society get so fixated on self? In recent history we have devoted more energy to self development than caring for people. Rather than focusing on improving quality we are talking about ending life. Why is there so little research being done to deal with the consequences of accidents, diseases and aging. We have finally increased dementia research, and that is a good thing, but what about failing sight and hearing, what about arthritis, mobility issues and all the other compounding “ailments” that make life miserable, and as many would say “not worth living”. Why is growing old becoming more unaffordable?

When I cared for mother for the last few years of her life she would say that she wished she had not had her stroke, but she also was glad she had the opportunity to see and meet so many caring people and she adjusted where she found pleasure. When I cared for my father during the last few years of his life—he would also say that although he wished he had not begun to need dialysis it taught him that people cared about him. Each of my parents decided when it was appropriate to end active treatment. My mother’s death was in an era when we still wished to have people live forever, and the private care giving agency was too concerned about litigation, so that I had to argue and fight for everything she wanted. My father’s was much better because of the palliative care, home nursing we received and the willingness to adjust drugs etc. As well, we were fortunate in that we were able to pay for uncovered items such as a massage therapist and other such care.

I believe strongly that any legislation that allows for people to request that their doctors end their living needs to be accompanied by equally strong legislated caveats to ensure it is a choice and not an expectation.