Medical Decisions Facilitation Bill
Debates of the Senate (Hansard)
2nd Session, 36th Parliament,
Volume 138, Issue 9
Thursday, November 18, 1999
The Honourable Gildas L. Molgat, Speaker
Second Reading-Debate Continued
On the Order: Resuming debate for the second reading of Bill S-2, to facilitate the makingof legitimate medical decisions regarding life-sustaining treatments and thecontrolling of pain.
Hon. Douglas Roche: Honourable senators, legislation affecting the issues oflife and death demand the deepest reflection of parliamentarians. Thus, Ihave examined with great care Bill S-2, to facilitate the making oflegitimate medical decisions regarding life-sustaining treatments and thecontrolling of pain.
I have consulted leading ethicists, including the Catholic HealthAssociation of Canada and the Care-in-Dying Coalition/Canadian CoalitionAgainst Euthanasia, which comprises 30 organizations across Canada,advocating compassionate, just and respectful care for people who are dying.
Also, I bring my own experience to the consideration of this bill. In mypersonal life, I have had to make decisions and recommendations concerningthe extension of medical treatment for loved ones who were dying. I knowpersonally how agonizing the decision-making process can be for health careproviders, as well as for family members.
In addition, it is important in such a legislative debate to state one's ownpersonal convictions - that is, what one brings to the debate. I bring adeep conviction of the inherent dignity and value of the human person. Ibelieve all human beings are to be respected at every stage of life, fromconception to death.
In brief, honourable senators, I oppose euthanasia and assisted suicide asincompatible with human dignity. However, I also recognize the legal rightsof patients to refuse treatment and strongly support the need for widespreadavailability of adequate palliative care to control and relieve suffering. Sickness, suffering and dying are an inevitable part of human experience.Dying can be a time of deeper self-awareness in which people freely andconsciously affirm the meaning of their lives and not merely an inevitableprocess to which they must passively submit.
At the same time, advances in science and medical technology aredramatically improving our ability to cure illness, ease suffering andprolong life. These advances also raise ethical questions that society hasnever had to face. This is true of issues encountered in end-of-life careand particularly around life-sustaining treatment.
There are occasions when prolonging life by artificial means places onerousburdens on the dying person and his or her family. It is necessary tomaintain a balance between two important obligations: the obligation not tointentionally kill someone and the obligation not to use life-sustainingprocedures that would impose burdens out of proportion with the benefits tobe gained from the procedure.
In this light, I find both positive and negative aspects in Bill S-2. Isupport the intent of the bill, which is to clarify the distinctionssurrounding end-of-life decisions, especially the withholding andwithdrawing of treatment when appropriate and the proper use of medicationsto alleviate pain.
It is both legal and moral for a health care provider to administermedication to alleviate the physical pain of a person suffering from alife-threatening condition, even if such medication might shorten the lifeof the person, provided that it is not the intention to cause death. Sincethe Senate has been informed that some health care providers are reluctantto provide sufficient pain control medication because of a fear they may beheld criminally liable, the bill provides a positive step. The inclusion inthe bill of a clause recommending that Health Canada establish nationalguidelines for the withholding and withdrawing of treatment, further promoteand train professionals in controlling pain and palliative care, and conductresearch that monitors frequency, is a further welcome step.
Having established the need to protect health care providers who sincerelywant to alleviate the pain of their patients, we must ensure that thislegislation, if passed, does not open the door to direct, legalizedeuthanasia. That is the concern expressed by the Campaign Life Coalition,which sees this bill as a first step toward creating a demand for assistedsuicide.
Honourable senators, here is the dilemma we face as legislators. How can bewe be sure the medical treatment is intended to alleviate pain, even thoughit may shorten life? How can we be sure a patient is not coerced intoaccepting such medical treatment? Will such treatment become common in casesthat are not life threatening? Are we, in short, weakening the integrity oflife, which, as legislators, we must uphold, through our legitimate desireto ease pain?
These are questions that need a thorough airing by the Senate committee thatwould examine this bill if it passes second reading. In my view, the billshould go forward. The issue deserves our best effort to write goodlegislation for the benefit of all Canadians.
Although this bill does not amend the Criminal Code, it is my understandingthat the bill is not intended to weaken the Criminal Code's prohibition ofeuthanasia and assisted suicide. However, the bill as presently drafted doesnot give us sufficient assurance that this is the case. This issue requiresfurther probing and thought. It should be specified that the person the billis talking about in clause 2 is a person "for whom death is imminent andunavoidable." It is not good enough to leave a person undefined, as clause 2presently does. If it is the intention of the bill to ease the pain of aperson in a life-threatening condition, let the bill state this clearly. Atcommittee stage, I will propose the appropriate amendment for clause 2, withconsequential amendments to follow.
Honourable senators, it should be remembered also that there arelife-threatening situations that are not associated with imminent andunavoidable death. Many conditions are chronic and long-term, but notnecessarily life threatening. A diabetic who goes into diabetic shock facesa life-threatening condition, but death is neither imminent nor unavoidable.As well, a person who might be termed "terminal", suffering a chronic ordeteriorating condition, is not in a life-threatening situation in the waythat the bill should make clear.
For now, I want to assert the principle that a person who is suffering fromthe imminent and unavoidable threat of death is entitled to pain relief, andthe doctor or nurse who provides that relief is entitled to be free ofprosecution. However, we must not open the door to the direct practice ofeuthanasia. We must ensure that there can be no misinterpretation of thetrue intent of the bill. I call on the Senate to be diligent in this matter.
Senator Carstairs, in replying to the question I addressed to her when sheopened debate on second reading, quoted from the Catechism of the CatholicChurch as follows:
Even if death is thought imminent, the ordinary care owed to a sick personcannot be legitimately interrupted. The use of painkillers to alleviate thesufferings of the dying, even at the risk of shortening their days, can bemorally in conformity with human dignity if death is not willed as either anend or a means...
That quotation, honourable senators, is helpful, but let us remember thatthe quotation is prefaced by the statement that: Whatever its motives and means, direct euthanasia consists in putting an endto the lives of handicapped, sick, or dying persons. It is morallyunacceptable.
I am hopeful that, acting together, the Senate can write legislation thathelps maintain both the dignity and rights of a patient whose death isimminent and unavoidable and the professional standards of a health careprovider.
Honourable senators, this bill also gives us the opportunity to strengthensupport for palliative care programs in Canada. Good palliative care isaimed at relief of suffering and improving the quality of life of personswho are living with or dying from advanced illness. Let us strengthen thisgrowing need in Canada.