The Fight to Die

[Editor's note: In the first of this two-part series on assisted suicide in B.C., originally published on the Georgia Straight in November 2010, Stephen Gardiner, Wolf Obgielo and Ken James told reporter Daniel Wood about their desire to die -- with legal help.

Today, the "slippery slope" argument against assisted suicide, and the experience of the few U.S. states and countries to legalize it, including a 30-year movement in Holland -- which, in one year, saw over 2,500 Dutch citizens choose to access help in ending their lives.]

There are, of course, many people who argue that right-to-die advocates are proposing something abhorrent. There are pro-life Christians whose opposition to euthanasia and assisted suicide is based on the same principle as their opposition to abortion: life is as sacred at the end as it is at the beginning. No person should play God.

The Campaign Life Coalition spokesman, John Hof, says assisted suicide is "inherently against life" and would lead to "social degradation." Members of Canada's Euthanasia Prevention Coalition, which has hosted Margaret Somerville, director of McGill University's Centre of Medicine, Ethics, and Law in Montreal, take comfort in her well-documented opposition to assisted suicide and euthanasia.

Somerville fears the movement that began in Holland 30 years ago will, without resistance, lead to the unacceptable -- and frighteningly secular -- idea the individual has the right to choose death.

Organizations for the disabled point to Robert Latimer's 1993 killing of his severely handicapped, 13-year-old daughter as proof no latitudes should be made for any form of mercy killing.

And the Canadian medical profession (with the exception of Quebec doctors) oppose altering prohibitions against euthanasia and assisted suicide. They claim -- as all opponents claim -- that, once approved, there's a "slippery slope" leading to an unstoppable expansion of euthanasia, where people are legally dispatched against their wishes. This is the kind of supposition that leads to fanciful American talk of health care Death Panels, and onward to vigilante Euthanasia Squads hunting anyone too slow at the crosswalk.

There is no factual evidence to support the "slippery slope" contention, but its lineage is as old as the Boogeyman.

Over 90 years ago, Christian crusaders said alcohol was the devil's drink; and its use led inevitably to "social degradation." Thus: Prohibition. Similar "slippery slope" arguments have been voiced almost every decade since then by those opposed to the expansion of civil rights and social freedoms.

The argument was used in Canada against granting voting rights to Asians citizens in the 1940s, and against explicit literary works in the '50s, and against the distribution of birth control information in the '60s, and women in the '70s, and gays in the '80s, and harm-reduction drug policies in the '90s. Calamity looms, doomsayers proclaim, if you open the door to alternatives. Decriminalize marijuana, and ipso facto: you're on the way to a nation of heroin addicts.

Where it's legal

It ain't so. Today, there are three American states: Oregon, Washington, and, just recently, Montana, where assisted suicide is sanctioned. There are three countries: Holland, Switzerland, and Belgium, where it's legal and strictly regulated. There are also a half-dozen other countries: Scandinavia, Luxemburg, Estonia, and Uruguay, where no prohibitions exist against providing aid when a terminally ill person requests help dying; death happens discreetly -- beyond legal interference.

The Swiss have recently had to look, in fact, at restricting foreign access to its Dignitas assisted-suicide program in the face of its growing international popularity. They don't want to become a "suicide tourism" destination. Since 1998, almost 1,000 terminally-ill people, including at least 10 Canadians, have left their homelands -- where assisted suicide is illegal -- to be provided with a means to end their lives.

After strict medical protocols, the person is handed a lethal barbiturate, which is consumed amid family and goodbyes. No morphine coma at the end. And no evidence of abuse within the Swiss system. The same applies to Belgium's euthanasia program.

And in the 12 years since Oregon initiated its physician-assisted-suicide program, 460 people have ingested the prescribed lethal medications. The program is heavily monitored and there's not an iota of evidence of abuse. (Washington's 2008-launched program is too new to assess, and Montana's Supreme Court only overturned that state's law against assisted suicide in May 2010.)

In Holland, the Euthanasia Law mandates that people who are in unbearable terminal pain, and can convince two doctors of the legitimacy of their wishes, can receive stringently regulated medical help. Last year, 2,636 Dutch people died through euthanasia, a 13 per cent jump over the previous year. This increase, say opponents, is proof of the "slippery slope."

Not so, say advocates. Instead, it shows the growing willingness of the pragmatic Dutch to end their lives -- without the prolonged medical interventions, family anguish, and suffering that often mark terminal illnesses elsewhere. In fact, the Dutch right-to-die advocacy group Horizon submitted a 117,000-name petition to Holland's Parliament seven months ago, requesting euthanasia options be extended to those over 70 who feel their lives are complete.

So, while the B.C. Catholic newspaper rails against "the stench of death" drifting up the I-5 from the two pro-euthanasia states to the province's south, the fact is: it's not the current right-to-die legislation, nor allegations of abuse that really worries those claiming a "slippery slope" is underfoot.

From the moralists' perspective, the situation is far, far worse. A large segment of society has come to believe (67 per cent in Canada) that having a choice about the circumstances of one's final hours is the same a having a choice about abortion, or the sex of one's marital partner, or whether having a martini or two marks the highway to Hell.

Answering the big questions

Eike Kluge, a professor of bioethics at the University of Victoria, has confronted the big questions around dying and assisted suicide for decades. He has investigated the cultural and religious history of euthanasia worldwide, and acted as a consultant to dozens of terminally-ill people, including Sue Rodriguez.

It's Kluge's contention the central ethical issue for the coming decades, as millions of Boomers age, is how society deals with assisted suicide. And he's clear, he tells me, that it's the medical profession, first and foremost, that's failing those who, at life's end, desire death.

By lobbying against the establishment of legal protocols -- like those in place in Oregon and Holland -- most Canadian doctors, Kluge believes, are on the wrong side of history and ethics. Without legal assisted suicide/euthanasia guidelines (which they oppose), doctors fall back on medicalized efforts to extend life -- at great emotional cost to people seeking expedited death.

"It's not life that's being prolonged," says Kluge. "It's dying." Where once death was considered normal, and pneumonia called "the old man's friend," Kluge says that doctors today are held hostage by the Canadian Medical Protective Association (CMPA) and its lawyers who argue physicians must never be seen to be hastening dying. It could prompt lawsuits. So instead, death is delayed. Hospitals' costly intensive care units are full. And palliative care units overwhelmed.

But the almost unmentionable truth, Kluge tells me, is B.C. physicians perform assisted suicide on terminally ill people all the time. But they can't admit that. Not if they want to remain under the legal protection of the CMPA.

Kluge explains the medical charade. "You give a large enough dose of a narcotic -- like morphine -- ostensibly for pain relief. But the patient's breathing and heart stops. It's called 'the double effect.' Of course, the doctor knows the dosage is going to kill the patient! But, he can't say that. He can say: 'I didn't intend to kill. The morphine was for pain.' So it's not officially called 'euthanasia.' It's called 'terminal palliation.' It's semantics. It's finessing the system. The CMPA is happy." And Kluge laughs aloud at the duplicity.

"The fundamental ethical question is: 'Are you -- or are you not -- prepared to go to the line, and face the consequences of your actions?'" says Kluge of his belief in the morality of euthanasia.

Overturning the law

He's waiting, he tells me, for some brave B.C. doctors -- like the ones now speaking out in Quebec on this issue -- to take a stand against the medical profession's self-interested opposition to legal assisted-suicide. "You're pretending," he says of doctors, "if you say you're for choice, but do nothing. Your values are hot air unless you do something. It's when the chips are down and the stakes big, that's when you find out if your ethical." And Kluge tells me one of his uncles was hung in Nazi Germany for being part of the famous 1944 attempt to assassinate Hitler.

At a time when many doctors are silenced by their fears and professional association, and when politicians see little benefit in leading an ethical crusade, people who support legalizing euthanasia will have to look to the Supreme Court of Canada to overturn section 241b of the Criminal Code.

It's this law against assisted suicide that the Court refused to set aside for Sue Rodriguez 18 years ago, and it's this law today that well-known Vancouver constitutional and civil rights lawyer Joe J. Arvay, while watching his best friend die of ALS, told himself needed a new legal challenge.

He knows it won't be easy. The Supreme Court, he explains to me, isn't inclined to revisit issues that it has ruled on fairly recently. Precedent usually trumps a challenge. But a lot has changed.

Only one of the nine current justices was involved in the close 5-4 decision against Rodriguez in 1993. Three European countries and Oregon have amassed a mountain of evidence demonstrating the value and safety of euthanasia programs. Quebec doctors are lobbying for new legislation. And public opinion has swung heavily in favour of permitting assisted suicide.

"I get calls from individuals and organizations about re-litigating the Rodriguez issue," Arvay tells me. "But I'd argue it differently than in '93. There's a much richer evidentiary basis today. I could see a coalition of petitioners -- right-to-die organizations, terminally ill individuals, doctors in favour of physician-assisted-suicide like in Oregon, civil liberty advocates, people familiar with palliative care. It wouldn't be based on a single individual like Sue Rodriguez, but on a range of views."

And then Arvay briefly argues the case he'd present to the Supreme Court to me. I tell Arvay I hope he gets to do it.

But by then, I know, it will likely be too late for people like Ken James, Stephen Gardiner, Wolf Obgielo, and hundreds of others in Canada who will be forced, in the months and years ahead, to act surreptitiously to end their lives.

[Editor's note: Since his first appearance in this two-part article, originally published in the Georgia Straight in 2010, Russel Ogden founded the Farewell Foundation, which continues to actively challenge the criminality of assisted suicide in B.C. Its members believe they "have the right to make choices about their own bodies, their physical and psychological integrity, and their basic human dignity."

Wolf Obgielo lost his battle with cancer, at the age of 56, on March 16, 2011 at Royal Inland Hospital, with wife Carolyn by his side. Carolyn said his death was peaceful and that Wolf was comfortable at the end. A celebration of life will be held for Wolf at the end of July. You can read more about Wolf and Carolyn and their life together on her blog.

Stephen Gardiner died in early March of this year. According to his obituary, he passed away in hospice care after a year-long battle with cancer.

The Tyee was unable to contact Ken James or his family.]