Assisted Dying is Suicide, Part II
More evidence of the moral fiction
Some proponents of assisted dying argue that assisted dying and suicide are different. Most opponents of assisted dying argue they’re the same. I support assisted dying—even its legal expansion—but I think it’s a mistake to distinguish it from suicide.
I argued in a previous article for the neutralization of ‘suicide’. I’m not inventing a new point, but rather arguing for the traditional definition: Suicide means deliberately killing oneself. In Canada, this can be done legally and ethically with the help of a healthcare provider. It can also be done legally and ethically without help. Some suicides are tragedies that we should try to prevent; others are considered, informed choices.
The alternative approach—holding that assisted dying isn’t suicide—makes a value judgment about medical versus non-medical forms, with the latter reserved for tragic, irrational, or regrettable cases. But it’s not so simple.
The Courts Say That Assisted Dying is Suicide
My argument isn’t reinvention. It’s the approach the Canadian courts have taken. In Carter, the Supreme Court of Canada struck down the section of the Criminal Code that made assisted dying illegal. That section is about suicide:
241(1) Everyone is guilty of an indictable offence and liable to imprisonment for a term of not more than 14 years who, whether suicide ensues or not,
(a) counsels a person to die by suicide or abets a person in dying by suicide; or
(b) aids a person to die by suicide.
Prior to Carter, suicide itself wasn’t against the law, but assisting someone in a suicide was illegal no matter what. Justice Smith, the British Columbia Supreme Court judge who heard Carter before it went to the Supreme Court, describes the reason for the general prohibition on assisted dying as follows:
[1190] I conclude that the objective of the legislation is, by imposing criminal sanctions on persons who assist others with suicide, to protect vulnerable persons from being induced to commit suicide at a time of weakness.
She then struck down that legislation for being too broad. The use of ‘time of weakness’ was taken up in the Supreme Court of Canada in Carter.
[86] The object of the law, as discussed, is to protect vulnerable persons from being induced to commit suicide at a moment of weakness. Canada conceded at trial that the law catches people outside this class: “It is recognised that not every person who wishes to commit suicide is vulnerable, and that there may be people with disabilities who have a considered, rational and persistent wish to end their own lives” (trial reasons, at para. 1136).
This is the distinction I endorse. One type of suicide is the ‘moment of weakness’ type; the other is the ‘considered, rational, and persistent’ type. We should prevent the first and allow the second, but they’re both suicide.
Some People Who Have an Assisted Death Consider Non-Medical Suicide
The type of suicide we want to prevent is spontaneous and ill-considered. But not all non-medical suicide takes this form. We know this because some people who access assisted dying consider non-medical suicide.
One witness quoted in Carter (SCC) puts it starkly:
I was going to blow my head off. I have a gun and I seriously considered doing it. I decided that I could not do that to my family. It would be horrible to put them through something like that. […] I want a better choice than that.
Others reported similar plans:
A number of the witnesses made clear that they—or their loved ones—had considered or in fact committed suicide earlier than they would have chosen to die if physician-assisted death had been available to them.
Jean Truchon and Nicole Gladu, the two plaintiffs in Truchon, the decision that led to the removal of the reasonably foreseeable natural death condition, both considered suicide. According to the Québec Superior Court decision, Truchon “began to think about dying in the manner and at the time of his own choosing. Over time, this idea began to take up more and more space in his thoughts. He devised several scenarios to bring his days to an end, taking into consideration the restrictions imposed by his disability.” If Truchon had chosen one of these options instead of MAiD, it would have been suicide, and it would have been considered, rational, and persistent.
In Truchon, Justice Christine Baudouin notes that banning MAiD might lead some people to choose non-medical suicide instead:
[248] In this sense, the impugned requirements of a reasonably foreseeable natural death and being at the end of life do not protect vulnerable persons more than persons who are ineligible for medical assistance in dying, given the other safeguards in the legislation, whereas they do prevent certain persons, such as Ms. Gladu and Mr. Truchon, from choosing this path to put an end to their suffering. That could lead some towards suicide or even greater suffering. [My emphasis added.]
If some people who access MAiD might have chosen non-medical suicide instead, then the distinction gets fuzzier. Given what non-medical suicide involves, MAiD might be preferable, but that doesn’t mean that every non-medical suicide is due to a moment of weakness. Some are, but not all.