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Euthanasia and Assisted Suicide are perhaps the most controversial topic possible, as more states are including “Assistance with Dying” among accepted medical recourses. Patient choice remains the most difficult aspect to guarantee, given the financial burden that accompanies the treatment of chronic illness or disability. In a private health care system, a patient may base her/his decision on the financial well-being of self or next of kin, effectively being forced to choose between time and money. Cancer, HIV, and MS, for example, represent some very painful examples of expense in proportion to suffering and longevity.  In a public health care system, the question of ethics springs eternal: when cost of treatment outweighs the patient’s worth as a medical guinea pig, end of life decisions may not reflect the patient’s wishes at all.

The inverse is also true. For the patient suffering from dementia, for example, a patient in a seemingly irreversible coma, or even a patient who has previously arranged for DNR (Do Not Resuscitate), life can and often will be prolonged against patient wishes. This is because the patient must be deemed capable at the moment the request for Assistance with Dying is made. The result at both ends of the spectrum, therefore, is that a patient may not have legal right to participate in a decision to preserve length of life. Meanwhile, resources continue to be allocated where they are not welcome, thus reducing services for others in need.

Doctors’ Duties

As per the Hippocratic Oath, medical doctors are obliged to do no harm and to protect both the quality and length of life. Determining quality of life and deciding when length (or quantity) trumps quality makes the euthanasia debate so challenging because it is comparable to apples vs. oranges in the context of cause and effect. To illustrate the absurdity here, the worth of a single Northern Spy apple is apparently held up to the number of oranges used to produce a glass of juice. The argument is nonsensical, as basic rules of logic demonstrate that false premises cannot lead to a true conclusion, and this only applies when the syllogism itself is possible. Since every case is different, the responsibility falls on the attending physicians to exercise sound judgement within the legislation of the territory in which s/he is licensed to practice.

The state of North Carolina can impose the death sentence upon convicted criminals, yet such a sentence is impossible to carry out, due to conflicting state laws. On the one hand, the only legal method of execution is lethal injection, which requires the oversight of a physician. On the other hand, physicians in North Carolina are forbidden by law from participating in the killing of a person. The miserable, basically inescapable conditions endured by prisoners indefinitely on Death Row is a real-life metaphor for euthanasia/assisted death candidates, whose own bodies are like their prisons. Populations (specifically, racial and economic groups) disproportionately represented on Death Row sadly underline the tendency toward eugenics.

Over 60? Eat your apple a day and stay far, far away.

On the topic of discrimination, ageism and silent euthanasia are rampant. Montreal’s Royal Victoria hospital (among others) trains nurses in preparation and use of death bags on elderly patients, who are given opiates to cause pulmonary failure. This latter appears as the cause on the death certificate prepared by an internally conducted autopsy; not incorrect, just incomplete. The reason is economics, as publicly funded hospitals make more by turning their beds over for other business. The line between this and racketeering is arguably invisible.

Conversely, as Human Rights Charters provide for the right to palliate a handicap, existing law plus jurisprudence determine eligibility by territory. Precedents are built on a case by case basis. Choosing euthanasia courtesy of the taxpayers versus possibly paying one’s own private treatments allows patients to live only to continue funding the same system. Politicians’ salaries and PR during election years are strong motivators for Assisted with Dying legislation. The fledgeling laws have yet to sprout much plumage. For instance, the validity of life insurance, and that of will & testament instigate fascinating questions in the face of the Charters.

Absolute rights come with a price tag. Global spearheading Switzerland will listen, take your money and grant your wish. True compassion can mean extreme and extended suffering for the patient and loved ones, as in the devastating case of Terry Schaivo, or extensive vilification as in the Tracy Latimer case. There are no answers when “playing God”.

By Carol Ann

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