12 Problems With Assisted Suicide 

Excerpt from the brief submitted to 
The Special Senate Committee on Euthanasia and Assisted Suicide (Canada) 
by Dick Sobsey Ph.D.
University of Alberta

 

1. While advocates of assisted suicide suggest that this would provide people with autonomy and personal control, in many cases, people with illnesses and disabilities would have these decisions made for them and imposed on them. As a  result, while some people are being denied access to death now, many more would be denied access to life under  physician-assisted suicide. Statistics from Holland (e.g., olde Scheper & Duursma, 1994), where physician-assisted suicide has been allowed for a number of years, suggest that more people are "assisted to die" without any explicit request (N = 1000) than those who request assisted suicide (N = 400).

2. In many cases, people with illnesses and disabilities would be poorly informed about their conditions and their future prospects. Therefore, the decision to engage in assisted suicide could not be made rationally. Currently, many patients with serious illnesses are poorly informed about their conditions and prognoses. Without this information, they cannot be expected to make informed decisions about suicide. Often, people are given unclear or misleading information about their prognosis or how long they are expected to live because health care providers simply do not know or are wrong in their expectations. As discussed later in this brief, studies that examined the accuracy of medical predictions suggest that physicians rarely know who will die or when they will die. The only time that physicians can predict when death will occur with any degree of certainty is when it is so close that euthanasia would make little difference.

3. People with illnesses and disabilities would be influenced and coerced by many others and by circumstances. Research shows that the information given to patients and their families and the manner in which it is presented often manipulates the decisions about vital matters. In some cases (e.g., the MacAfee case discussed in this brief), people chose suicide because there is a lack of appropriate services or inadequate accommodations and not because of their physical conditions.

4. People with illnesses and disabilities are able to make decisions about suicide but physically unable to carry out those decisions. In fact, very few people have disabilities or illnesses that make it impossible for them to commit unassisted suicide. The great majority of people with illnesses or disabilities are perfectly capable of committing suicide by the same means employed by other individuals. Many of those whose physical condition would make it impossible for them to commit suicide without help are also unable to make the decision for themselves (e.g., in a coma). Some people with advance neurological disease or high level spinal cord injuries may be physically incapable of holding a gun or drowning themselves, but even these individuals have a right to refuse food or treatment under current law. While such a method of suicide may be less preferred, it is nonetheless effective. There may be cases where no method is available to a fully competent person, but if such cases exist, they are extremely rare.

5. Access by people with illnesses and disabilities to physician-assisted suicide would be vastly different to the right of other Canadians to commit suicide by other means. While suicide is legal in Canada, the government deliberately controls many dangerous drugs and devices that might be employed in suicide in an effort to discourage it. Discomfort with the means that are available acts as an important deterrent to suicide for all Canadians. Providing deadly drugs, medical expertise, and personal assistance to one segment of society while denying it to another segment of society goes beyond the intention of equal access and provides differential encouragement for suicide.

6. Safeguards through the involvement of the health care professionals would not be equivalent to legal due process safeguards. While most physicians and other health-care professionals are ethical and humane individuals, there is no reason to believe that their inclination, training, or experience prepares them to exercise life and death power more wisely than any other group of individuals. The involvement of vast numbers of physicians in selecting victims for gas chambers during World War II provides a grim reminder that being a physician is in itself no guarantee that an individual will act morally to protect life. The fact (discussed later in this brief) that large numbers of Dutch physicians continue to falsify death certificates, defy procedural safeguards, and go beyond the limits of legalized euthanasia, engaging in a wider and wider circle of death-making practices, suggests that better safeguards would be required for any Canadian legislation legalizing physician-assisted suicide.

7. There is reason to suspect that such practices would be based on devalued views of people with disabilities and serious illness. Studies of violence against people with disabilities indicate that they are commonly the targets of violence, that crimes against them are perceived as less serious than similar crimes against other citizens, and that negative and ambivalent attitudes about people with disabilities that suggest that their lives have less value are at the root of these problems (Sobsey, 1994). The belief that illness and disability are valid and rational reasons for suicide and that other social and interpersonal problems are not rational reasons reflects society's fundamentally biased attitudes toward disability. If our society chooses to legitimize this myth through a categorical discrimination in suicide law (i.e., permitting assistance only for people with illnesses and disabilities), it will reinforce and strengthen these biases.

8. There would be great potential for the abuse of assisted-suicide provisions, and often, there would be an inherent conflict of interest between the health-care and death-making roles of physicians and other health-care professionals. The interests of health-care providers, families, and patients are often in conflict. For example, cost control has often entered into discussions on euthanasia (e.g., Emanuel & Emanuel, 1994). Hospitals and other institutions may be predisposed to encourage physicians to gain the consent of some patients as cost-control measures. If patients' deaths are to hastened to save money, this is triage and not mercy killing or assisted suicide.

9. It would be difficult to differentiate murders of people with illnesses and disabilities from assisted suicides. The difference between homicide and assisted suicide depends on intentions and other subtle factors that are difficult to prove absolutely. When this is combined with the application of assisted suicide only to people with illness or disability, it means that people with illness or disability in Canada would not have equal protection of their lives, which is a fundamental breach of the Charter of Rights and Freedoms.

10. The limits of such assisted-suicide provisions could not be constructed clearly enough to prevent gradual broadening to include other even less acceptable practices. If assisted suicide was limited to cases where there were no signs of clinical depression, there was no potential conflict of interest, and a fully competent person made a decision for his- or herself, it would rule out more than 99% of the actual cases requiring assisted suicide. If it is permitted in such cases, the reality of the practice will be a slippery-slope on which society approves of rare instances of "assisted-suicide" but gets nonvolunatry euthanasia and outright homicide.

11. Specific legislation defining appropriate and inappropriate conditions for euthanasia will not end ambiguous or inappropriate uses of euthanasia or assisted suicide. Current legal ([[section]] 241(b) Criminal Code) and ethical (Hippocratic Oath clearly prohibits any form of counseling or assisting suicide) prohibitions are quite clear, but even so, they have not eliminated difficult decisions. Creating legal and ethical exceptions will only increase the ambiguity and provide a greater rationale for other illegal and unethical exceptions.

12. Illness or disability is no more rational a reason for choosing suicide than any other reason. Our belief that we should prevent most suicides while encouraging and assisting suicide for some individuals represents our own biased views of illness and disability. For example, an individual convicted of the murder of a child may face life in prison and social disgrace. Such an individual faces a poor quality of life and may express the wish to commit suicide. Yet society does not endorse suicide for convicted criminals and takes an active role in preventing suicides in prison. Suicidal prisoners are often deprived of belts and even shoelaces to prevent hanging. Why should we label the suicide of such a prisoner as irrational and try to prevent it while we label the suicide of an individual with illness or disability as rational and offer assistance to carry it out?