Discussion on Assisted Suicide
AIDS Committee of Toronto - for consultation, September 24, 1997
Position Statement:
ACT values and affirms the right to informed individual choices about health care...(ACT Mission & Values Statement)
ACT believes in the fundamental right of self-determination for people with HIV/AIDS, and all people, including the right to consent to or refuse treatment, the right to die with dignity and the right to assisted suicide.
While ACT advocates for access to a choice of assisted suicide, suicide prevention and ensuring support for people to live with HIV/AIDS continue to be ACT priorities.
ACT believes there must be support for the individual and their caregiver(s) to consult, and to receive appropriate counselling before any action of assisted suicide is taken. We believe a process can be developed to protect the individual from abuse and to also protect the care-giver(s), lay and professional, from future legal action.
ACT therefore urges the federal government to amend the Criminal Code to permit assisted suicide consistent with the following principles:
- the availability of assisted suicide.
- prevention of systemic, and individual abuse.
ACT further urges the federal government to establish a process that:
- ensures voluntary decision-making by the individual.
- affirms individual autonomy and self-determination.
- affirms the rights of people with disabilities.
- has been developed with community consultation and input.
- includes repeated, informed request and consent with appropriate time intervals between requests.
and further, that the federal and provincial governments ensure:
- provision and funding of socialized health care including palliative care, home care, mental health services, health promotion and psycho-social counselling.
ACT recognizes the complexity inherent in amending the law in a manner consistent with these aims. However, ACT strongly believes that the time has come to confront these issues and work toward creative solutions. Consequently, ACT is committed to participating in advocacy to achieve these aims.
ACT further acknowledges that there is no clear consensus on when a person would have access to such a process. There is no simple dividing line but we agree on the following:
- individuals can make rational choices about wanting to end their lives.
- assistance should be available to people living with a terminal diagnosis.
- “terminal illness” should not be used in only the most restrictive definition. Individuals should be able to have sufficient control over their dying to decide against experiencing the severe forms of illness that can accompany the last weeks or months of illness.
Discussion & Background
ACT’s Position:
Section 241 of the Canadian Criminal Code prohibits the giving of assistance to commit suicide. Anyone who counsels a person to commit suicide, or aids and abets a person to commit suicide, whether a suicide ensues or not, is liable for a prison term of up to fourteen years. ACT complies with this requirement of Canadian law in the provision of its services. However, ACT is also committed to advocacy for people living with HIV/AIDS, and as part of its advocacy role, ACT believes that s. 241 of the Criminal Code should be amended. We believe this position is consistent with our Mission and Values.
ACT consistently supports self-determination and choice. We advocate for the right of people living with HIV/AIDS to be involved in decisions affecting their lives. We believe that choice and self-determination needs to include individual involvement in decisions affecting one’s death as well as one’s life. It is reasonable that the desire to have as much control as possible over one’s life would extend to one’s death.
If an individual has had sufficient support and time and reasonably comes to their decision, we believe that action taken to counsel and/or assist them should not be considered a criminal act.
ACT’s position on assisted suicide is taken in a broader context of advocacy & support for people living with HIV/AIDS:
Through the provision of adequate services and medical treatment, people with HIV/AIDS can live healthy, productive lives. With adequate support, even those who are very ill are still able to maintain a reasonable quality of life. ACT believes that all people with HIV/AIDS are entitled to have access to all the necessary resources to maintain a good quality of life. ACT recognizes that with adequate services, counselling, care and appropriate pain & symptom management, most people with AIDS will not choose assisted suicide.
ACT believes that individuals who are recently diagnosed with HIV, show signs of depression, and/or are having initial thoughts of suicide/assisted suicide, primarily need support to live, not to die. A belief in the right to choose one’s time of death does not negate all we know and practice in suicide prevention.
Many people with HIV/AIDS suffer from depression, either chronically or at varying times during their experience with the infection and illness. Newer drug treatments have given renewed hope but not everyone responds to the treatments or can tolerate them, treatment regimes are complex and can harm one’s quality of life while extending it. Repeated, chronic illness, the loss of friends, partner(s), independence and quality of life, survivor guilt and anticipated death & suffering can lead an individual to consider hastening death to some degree.
Our first response and our priority is to assist people with the underlying reasons for their expression of a desire to die. Supportive counselling, peer support, assistance with acquiring housing, adequate income and health care are all examples of responses that may allay fear and suffering and remove the desire to hasten death, perhaps completely, or for a time.
There are also situations where assisted suicide may not be a real choice. An individual may feel a subtle or not so subtle pressure to exit early; they may feel an economic or emotional burden on others. We need to also be aware that the increasing cuts in social services and health-care can only harm people’s quality of life and contribute to feelings of desperation.
We recognize that the decision to die may be based for some people, upon the lack of adequate services, and palliative care. We wholeheartedly support all efforts to ensure palliative care is available throughout Canada. However, even with palliative care, some individuals will want to choose to control the time and manner of their death. We believe people should have that choice.
Importance of Safeguards:
ACT would prefer to simply acknowledge people’s right to die and the right to be supported with assistance in their choice. To establish regulations or an official process goes against the belief in individual autonomy as expressed by some of our members. However, it is recognized that the potential for abuse in a purely open-ended policy requires safeguards that, at times, will impede upon individual autonomy. There needs to be a balance in the changes to the Criminal Code to prevent individual and systemic abuse of people who are more vulnerable to such abuse.
For example, some disabled rights groups have responded angrily to the support in the AIDS movement for the right to die. People with disabilities, physical, developmental and mental have long been subject to systemic abuse and discrimination; their lives are not seen as valuable by many in society. Disabled people are justifiably afraid of losing the choice to live with disability and illness.
The AIDS movement must recognize these justifiable fears and clearly separate ourselves from a societal norm that condones de-valuing the lives of people with disabilities. There is common ground between people living with HIV/AIDS and people with disabilities and lessons for us to learn from their longer history and struggles. Some disabled rights advocates have in fact, not opposed assisted suicide, but have identified the common ground of fighting for autonomy and would “not deny people with terminal illness the right to end their suffering.”(brief by Gay Men’s Health Crisis and others).
The dangers are, in themselves, not a reason to deny choice in dying. We cannot accept the status quo and the criminalization of assisted suicide where there is choice, where it is clearly voluntary. The dangers do demand attention to safeguards, therefore, we believe it is essential to establish a process to verify the individual’s free, informed request; a process that recognizes and takes into consideration different individual power dynamics.
We believe that a process that is no longer hidden because of fear of criminal prosecution will create an openness that can better ensure safeguards. It would be less likely for mistakes based upon good but misguided intentions or from outright abuse to happen. Problems and uncertainty about the appropriateness of the assistance will continue to happen in the current environment of secrecy where only 1 or 2 individuals, with varying experience and no one to turn to for advice, literally hold someone’s life in their hands. We support choice in dying and must therefore ensure that the choice is real and voluntary.
References:
1. Euthanasia, Assisted Suicide & AIDS, Russell D. Ogden, Perrault/Goedman Publishing (1994).
2. Brief for the Amici Curiae: Gay Men’s Health Crisis and Lambda Legal Defense and Education Fund: On Behalf of their Members with Terminal Illnesses; and Five Prominent Americans with Disabilities...to the Supreme Court of the United States (December 1996).
