REFLECTIONS ON A WORLDWIDE RIGHT-TO-DIE MOVEMENT
In Canada, suicide is not illegal, so why is assisting someone not following the prescribed regime illegal and subject to a draconian maximum 14 years of prison?
The prevailing, dominant discourse on end of life options as illustrated in places developing assisted dying legislation around the world is presently focused and advanced on a medicalization model which, while significant with its progressive changes opening doors for persons now having a right to determine when and how to die, nevertheless limits itself to exclusive sanction by state, medical, and/or religious authorities for persons who are sick (AKA the “sickness model”). Moreover, once a criminal law has been amended to specify who may be assisted, when, how and by whom, any deviation from it implies criminal conduct.
Meeting criteria for medical assisted dying (MAID) remains generally complex, very restricted, and involves many in the helping professions -even in those jurisdictions that have adopted a liberal view on this matter. It remains a fact that many, if not most, will likely never meet the stringent criteria for MAID, or decline to first become sick and experience intolerable suffering (a prescribed prerequisite to service even in Canada in 2024) before obtaining this intervention. Others simply choose not to have strangers, doctors, and assessors involved in this personal end-of-life decision in the first place and are therefore left to their own devices.
It is understandable that a MAID legislated regime will invariably involve a legal framework and establish eligibility criteria as a social policy, but unless we recognize the limitations with MAID and consequently broaden our approach to this question, many will therefore continue to fall between the cracks for a reliable, peaceful and informed end. Some will even remain at risk for making desperate decisions if left with no other options, no information upon which they can depend to secure their desired end. This, in turn, raises safety risks to others, including trauma facing first responders to violent suicides, not to mention shock for family and friends.
Switzerland, for example, has no legislated regime on assisted dying and will not prosecute those assisting a person to die unless it is done for personal gain (generally interpreted as financial) which is then considered a criminal act under the Swiss Penal Code. That country presently stands out as the exceptional “rights-based” jurisdiction without criteria for eligibility legislated by government and yet still permitting assisted dying within medico-legal guidelines assuring responsible practice is conducted with oversight. Germany has also recently removed its prohibition to assisted dying from its criminal code without adding a set of legislated regulations created by government. This allows organizations to provide reliable information, support, and an assisted dying service beyond what Canada and many other countries and jurisdictions can currently offer.
This broadened understanding of end-of-life options has implications for many matters when considering our last years of life. Advance Care Planning or an Advance Directive, for instance, can include options that assure a limit to medical interventions in certain situations often omitted when we only have MAID. Comprehending that there are different pathways in creating an assisted dying provision can inform those who have not yet set up such a provision in their own country.
A recognition of all end-of-life options will prompt one to explore the many alternative resources for persons eschewing MAID for personal reasons, or fearing they simply won’t meet the existing criteria. Such conversations will also serve to enhance the topic of death and dying that has too often remained a taboo subject.
Planned assisted dying will give persons the security of control based on knowledge, and possibly prolong and enrich their last months or years of life having reliable, informed alternatives available for them. This will further allow persons to explore both legal and ethical considerations regarding assisted dying, the possibility of having family and friends present so they won’t need to die alone when that decision is taken without compromising those who are present.
This “all options on the table” view regarding end-of-life decision-taking is the outlier in the current worldwide right-to-die movement, and advancing it may encounter the resistance of not only our usual detractors and opponents to assisted dying, but possibly also opposition by some groups and organizations exclusively focusing on MAID. A country or jurisdiction that created its pathway for voluntary assisted dying via a legislated medical regime may also imply that any other assisted dying procedure is therefore illegal. This may in turn create a chilling climate for inter society collaboration.
Some may fear that broadening our approach in this ‘revolutionary’ manner will only serve to impede the existing struggles facing MAID advocates. There may be concerns that groups only advancing a MAID legislated agenda will lose some of their financial support or liberal-minded friends in high places. However, the converse of such reasoning also merits consideration: Advancing voluntary dying more broadly will reinforce the very foundation and underlying premise for assisted dying as a human right, a refrain often proclaimed by groups advancing MAID but reluctant to implement that in practice by not collaborating with others in the right-to-die movement. That, in turn, posses additional barriers for much needed research on this provision around the world.
It’s a well-established dictum in community organizing that the greater strength lies in joining forces for an inclusive common front, even if parts of the whole chose to focus in different areas. We’ll do better united than divided, and increased conversation and debate will serve not only to bring this further into a public arena and improve inter-society collaboration, but will greatly enhance possibilities for end-of-life research.
© Jürgen Dankwort, 2024