Aid in Dying in Canada

http://www.nytimes.com/2016/04/24/opinion/sunday/aid-in-dying-in-canada.html

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Canada has moved a step closer to allowing ailing people who are near death to end their lives with the help of a doctor.

A bill introduced this month would allow doctors to prescribe life-ending medication to Canadians who have an illness that causes “enduring physical or psychological suffering that is intolerable to them” and whose “natural death has become reasonably foreseeable.” Two doctors must approve each request, and the patient must wait for 15 days before it can be fulfilled.

The proposal is similar to aid-in-dying laws in Oregon, Washington and Vermont, though those require that a patient’s death be expected within six months. Such laws offer terminally ill people not just an end to suffering, but also a way to control the time and manner of their deaths.

Oregon became the first state to legalize aid in dying with a law that took effect in 1997. Since then, reviews have found no evidence of coercion or other abuses. About a third of Oregon patients who receive medication to end their lives never actually use it; some people draw reassurance simply from knowing they will be able to end their lives if they wish.

Some European countries, like Switzerland and Belgium, allow aid in dying for people who are not terminally ill. Critics of the Canadian proposal argue that Canada should also allow people who are suffering with no prospect of relief to end their lives, even if they do not have a terminal condition. The Supreme Court of Canada appeared to support that principle when it ruled last year that prohibiting medical aid in dying violated the constitutional rights “of competent adults who are suffering intolerably as a result of a grievous and irremediable medical condition.” If the bill passes without modification, it is likely to face court challenges as being too limited.

Since 2014, aid-in-dying bills have been introduced in at least 26 states and Washington, D.C. While it’s important to provide a humane option to the dying, it’s also essential that lawmakers focus on the need to provide broader access to palliative and hospice care so that terminal patients do not choose death because pain relief is unaffordable. They must ensure that doctors be trained in prescribing life-ending medication and must encourage professional groups to offer education and support for those who want to provide such aid. And they should make funding available to study the effect of these laws.

The experiences of Oregon, Vermont and Washington State show that this option, with appropriate safeguards, can offer the terminally ill a measure of dignity and control.