Extending the suitable to die

The right to euthanasia continues to gain ground. The Spanish Parliament recently passed a law, expected to come into force in June, that will allow doctors to help adult patients die if they have a “serious and incurable” disease that causes “intolerable suffering”.

The doctor can either prescribe a lethal dose of drug that the patient can take himself – a mode known by various terms including medical assistance in dying, voluntary euthanasia, and doctor-assisted suicide – or give the patient a lethal injection known as voluntary euthanasia is known.

In February the Portuguese parliament passed a law allowing voluntary euthanasia for terminally ill patients. Portuguese President Marcelo Rebelo de Sousa referred the law to the Constitutional Court, which rejected it on the grounds that it was not precise enough. Parliament is expected to adopt a revised version which should enter into force before the end of the year.

Other countries have gone further. Since 2016, Canada has allowed medical assistance in the dying – both physician-assisted suicide and voluntary euthanasia – for patients whose natural death is “reasonably foreseeable”. The legislation was in response to a ruling by the Supreme Court of Canada that existing bans on assisted suicide and voluntary euthanasia violated Canada’s Charter of Rights and Freedoms.

Canadians supported the legislation, but eight in ten respondents found it too restrictive, according to a poll. In a case filed in Quebec in 2019, the provincial Supreme Court ruled that restricting euthanasia to patients whose natural death was foreseeable was against the Charter of Rights.

After extensive public consultations and parliamentary debates, the Canadian Parliament approved amendments in March to make patients eligible for euthanasia if they suffer from a “serious and incurable disease” defined as a “serious and incurable disease, disease or disability” ;; are in an advanced state of irreversible decline in performance; and to experience persistent physical or psychological suffering that is unbearable to them and cannot be alleviated under conditions that they consider acceptable. “

Although patients whose natural death cannot reasonably be foreseen are now entitled to euthanasia, requests from these patients must undergo additional screening, including a mandatory 90-day period during which the patient’s suitability is assessed, for example through counseling or improved palliative care this can alleviate the patient’s suffering.

The 2016 legislation required a parliamentary review of the law after five years. In addition to providing a general overview of how the law works, the review will take into account two aspects that will help shape the public debate on euthanasia. One is whether advance inquiries should be allowed (for example from someone in the early stages of dementia who is still able to enjoy life but does not want to live past the point where that capacity has been lost). The other question that the review will consider is whether assistance in dying should be available to someone whose intolerable and incurable suffering is caused by mental illness.

The problem of pre-empting requests for assistance in dying becomes more pressing as the population ages and dementia develops. Last year, the Dutch Supreme Court ruled that doctors cannot be prosecuted for euthanasia in patients who have given written consent but subsequently lost the ability to consent.

The main reason for this is so that patients in the early stages of dementia can enjoy their lives without fear of becoming Gillian Bennett, a Canadian advocate for advancement, if they don’t commit suicide while they are still in the Location are queries called “an empty shell”. Bennett took her own life because she was diagnosed with dementia and did not want to prolong a life that she could no longer enjoy, totally dependent on nurses who should have used her calling to care for patients who might benefit from it.

Canada’s 2021 legislation specifically excludes mental illness as the sole reason for assisting in dying, but the exclusion will automatically expire in two years. This gives Parliament a deadline to decide what protective measures are needed to ensure that the suffering of mentally ill people who ask for help in dying is truly incurable.

There can be little doubt that treatment for some mentally ill people does not help and that they suffer greatly. It is difficult to understand why, if suffering from an incurable but non-terminal physical illness is enough to support death, then suffering just as bad or worse from an incurable mental illness should not be enough either. In addition, for people with untreatable depression or other mental illnesses that are unresponsive to treatment, mere assessment of euthanasia can make life itself more tolerable.

Mental illness is accepted as a reason for euthanasia in Belgium and the Netherlands. A study of 100 psychiatric patients in Belgium who applied for euthanasia because of their mental illness found that 48 of the applications were accepted, but eight patients postponed or canceled the procedure “because that option gave them enough peace of mind to continue living.”

The only remaining question might be the reliability of psychiatric examinations, whether a patient’s mental illness is incurable and will persist. But in the end only the patient can judge how unbearable the suffering is and how much weight should be placed on the possibility that it will end either with further treatment or on its own.

Peter Singer is Professor of Bioethics at Princeton University and founder of the non-profit organization The Life You Can Save. His books include “Animal Liberation”, “Practical Ethics”, “Rethinking Life and Death” and “Why Vegan?” © Project Syndicate, 2021

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