Freedom to choose requires choices

Short opinion article about competence, choice, euthanasia and Québec’s bill 52

Bill 52 would, by euphemism, implication and innuendo, allow euthanasia in Québec.

It’s sponsors say the bill would provide relief for people who are enduring terrible suffering due to a terminal illness. In actuality, the bill would kill disabled people who have physical or emotional distress, even if they refuse help, whether or not they have a terminal illness.

The major “safeguard” the sponsors rely on is that the person must make a free and informed choice to be killed.

A “free and informed” choice depends on the person’s being competent to consider the risks and benefits, being free of outside influence and having a range of choices.

Where suicidal feelings are concerned, the question of a person’s competence really depends on whether society approves of the act. If a non-disabled person says she wants to commit suicide, her wish will be prima facie evidence of incompetence. She will be met with suicide prevention services and even put in a psychiatric hospital against her will to prevent her harming herself. That is because we (rightly) have a public policy to try to prevent suicides. However a person with a disability or terminal illness who wants to die will be euthanized under Bill 52. That is because most people believe having a disability is a fate worse than death.

A disabled person who wants to die is seen as making a rational choice, and is therefore deemed competent. Thus, Bill 52 includes no requirement for a psychiatric evaluation before allowing euthanasia.

Joseph Arvay is a lawyer with a disability who argued for the plaintiffs in the case of Gloria Taylor in British Columbia. He says that not allowing people to choose euthanasia is discriminatory because it assumes disabled people are incapable of choosing. But when one is not offered a viable choice, how can one choose?

The deplorable conditions facing most people with disabilities and the those at the end of life are not caused so much by their impairments as by political priorities and social policies. Every aspect of life, from the experience of physical pain to the ability to vote, is controlled by these factors. If there is not enough palliative care – services that relieve pain and improve the quality of life – many people will live with pain. If Québec continues to prioritize medicalized, institution-based care over self-directed home-based services – where people receive funds to employ their own attendants to provide personal care – then many people will live in virtual incarceration in CHSLDs, eating, bathing, dressing and using the toilet on the institution’s schedule, not their own. Or people will be left isolated, impoverished and without support in the care of family members who sacrifice careers and their health to meet their daily needs.

Because of these choices made by the government and society, to treat elders and people with disabilities as objects of medical care instead of enabling them to be truly equal members of society, the “choice” to accept euthanasia can never be free.