Webcast archive: How assisted suicide and euthanasia are changing how we think – Part I

This week, we’re looking at how society’s thinking has changed with the introduction of assisted suicide, as well as refusal of treatment affecting eligibility.

In this episode of Euthanasia & Disability, Amy Hasbrouck and Christian Debray discuss:

  • How assisted suicide and euthanasia are changing how we think – Part I
  • Refusing treatment, food and fluids can qualify a person for AS/E

Please note that this text is only a script and that our webcast contains additional commentary.


  • Over the past couple of months, Taylor and Amy have been thinking about doing a webcast about the ways in which the legalization of assisted suicide and euthanasia (AS/E) has changed the way we think.  Then, lo and behold! at a conference last weekend, Aubert Martin of Living with Dignity included that theme as part of his presentation.  So with Aubert’s help, let’s take a look at some of the new ways of thinking that have come from the adoption of AS/E.
  • “Assisted suicide is suicide (with assistance),” becomes “Assisted suicide isn’t suicide.”  One of the recent trends we’ve noticed from the suicide prevention community is their adopting the position of AS/E promoters, that “assisted suicide” isn’t really suicide.  Advocates of medical killing have been pushing this change in definition for 20 years.  They started with “softening” the language, using terms such as “death with dignity” and “aid in dying,” instead of assisted suicide and euthanasia.  They claim “assisted suicide” doesn’t apply because the person is already dying.  But that doesn’t take into account the many people with non-terminal disabilities who are eligible for AS/E (even where it’s only supposed to apply to people with terminal illness).
    • In other words, they claim assisted suicide is not suicide because it’s only for ill and disabled people.  The Canadian Centre for Suicide prevention has an infographic about the differences between suicide and “medical aid in dying.”  But the differences they describe either don’t exist, or they stem from the belief that it’s better to be dead than disabled.  According to the infographic:
      • Suicidal people don’t want to die, they want the pain to end / People who ask for euthanasia “want to hasten death, they want the suffering in dying to end.”
        • This does not apply to people with non-terminal disabilities
        • The reasons people ask for AS/E mostly relate to loss of autonomy and existential distress, not physical pain.
      • Suicides are “often impulsive, violent, and carried out alone” / euthanasia is “planned, peaceful, and carried out in the presence of loved ones.”
        • The only reason euthanasia is “planned and peaceful” is because it’s approved by the person’s family and society, based on the belief that it’s better to be dead than disabled.
      • Suicides “leave loved ones with devastating grief” / euthanasia is “a deliberate process including everyone involved.”
        • The reactions of loved ones are (again) based on their beliefs about the quality of life with a disability.
        • Also, comparing the emotional response of loved ones with a “deliberate process” is comparing apples to oranges.
      • Suicides “happen much more often than” AS/E / euthanasia is “relatively infrequent.”
        • This is not true in the Netherlands
        • The numbers of AS/E are increasing so fast they will probably catch up to and pass suicide figures.
    • On the other hand, the causes of suicide listed by “Mediresource” are similar to those associated with AS/E (as listed in the Belgium annual report for 2017).
      • Unbearable emotional or physical pain / same;
      • Mental illnesses: depression, anxiety, bipolar disorder, schizophrenia, psychosis / Same, plus anguish, anorexia and existential distress;
      • Loss of hope or desire to live / despair, fatigue of living;
      • Difficulties maintaining personal relationships with friends and family / solitude, fear of losing social contacts;
      • Significant losses: bereavement, termination of an important relationship, loss of employment / Same, plus grief over loss of autonomy and physical function;
      • Loss of self-esteem, negative thoughts about one’s own worth / Same;
      • Substance abuse / same;
      • Family history of suicide / viewing idealized media portrayals of AS/E.
    • And it follows that if AS/E isn’t suicide, then Suicide prevention measures aren’t applied to people who ask for AS/E.
  • Suicide is bad, assisted suicide is good.  A related change is that suicide that is not assisted by a doctor is now labeled as especially horrible or tragic.  According to this line of thinking, AS/E is the only civilized alternative to intolerable suffering (which is assumed if you have a disability) or a violent and messy suicide.
  • “Praised for the courage to live” becomes “praised for the courage to die.”  In a recent webcast we talked about another way that AS/E has changed our thinking.  It used to be that we celebrated disabled people for their “courage to go on living,” despite their disabilities.  Legalization has spawned a new disabled hero, who has the “courage” and “determination” to get a doctor to kill them.  As we mentioned a couple of weeks ago, people like Dr. Donald Low, Brittany Maynard and Gloria Taylor were praised for their advocacy in favour of assisted suicide.  Yet people like J.J. Hansen and Maggie Karner, both of whom had the same kind of brain tumour as Brittany Maynard, received hardly a mention in the press or on social media, because they struggled to live, not die.
  • Safeguards become “barriers to access.”  There are two kinds of safeguards in AS/E laws, eligibility criteria and procedural safeguards.
    • The eligibility criteria relate to who qualifies for AS/E.  These include:
      • age,
      • residency,
      • the ability to make decisions,
      • the presence of a disability or illness,
      • the seriousness of that illness,
      • whether the person’s condition has substantially worsened, and/or if the person is at the terminal stage (or death is “reasonably foreseeable”), and
      • if the person is “suffering” (as defined by the person).
    • The procedural safeguards are mandates placed on the medical practitioners to make sure that the AS/E process is carried out correctly.  All of the procedural safeguards are measured via subjective standards (“Ensure,” “be of the opinion,” “be satisfied”) rather than objective ones; no factual proof is required.  The doctor or nurse must:
      • Be of the opinion that the person meets all eligibility criteria
      • Provide a reliable means of communication for people with communication disabilities (but not impartial nor effective).
      • Ensure that the person has been informed of their health status, prognosis, and what treatments are available, (palliative care is supposed to be mentioned, though there’s no requirement that it be provided).
      • Ensure that the person is informed that they can withdraw their request at any time,
      • Ensure that the person’s choice is informed and voluntary,
      • Be satisfied that the request form is completed, signed and witnessed,
      • Ensure that a second (independent) medical professional agrees that the person meets the eligibility criteria,
      • Ensure that ten days have passed, (unless they grant an exemption),
      • Ensure that the person gives express consent just before administering the lethal injection.
    • Promoters of AS/E call these safeguards “strict,” “stringent,” and “strong.”  Opponents point out the many ways in which they are easily and routinely circumvented in places where assisted suicide is legal.
    • In line with the evolving view that AS/E should be a “right,” AS/E promoters complain that safeguards create unjust barriers to access for people who want to die.  They pretend that without AS/E, these people are condemned, by law, to continue living, and therefore, suffering.  What AS/E promoters are actually demanding is a particular kind of suicide.  And every step in the process of achieving that goal is identified as a barrier, regardless of its usefulness in protecting people and preventing abuse.
  • Next week we’ll talk about some other ways that AS/E has changed the way we think about death and dying.  If you have ideas or suggestions, please feel free to email us at info@tv-ndy.ca


  • The College of Physicians and Surgeons of British Columbia has decided that a woman who refused medical treatment, food and fluids was correctly deemed eligible for euthanasia.
  • Ms. S. was a 56-year-old woman with multiple sclerosis when she was deemed ineligible for AS/E in June of 2016 by Dr. Ellen Wiebe because her death was not “reasonably foreseeable.”  Following an email exchange in December, 2016 and January, 2017, Ms. S. re-applied for AS/E on March 3 of 2017, having stopped medical treatment, eating and drinking for two weeks.  At that time, Dr. Wiebe, another physician and a home-care nurse agreed that her “significant malnutrition and dehydration were inconsistent with continuing survival.”
  • The BC Coroner expressed concern that Ms. S’ decision to refuse potentially effective treatment contributed to the serious nature of her disease and the decline in her condition.
  • The College of physicians cited the section of bill C-14 that states the person must experience “physical or psychological suffering that is intolerable … and that cannot be relieved under conditions that they consider acceptable.”  It said “a patient cannot be forced to take treatment they do not consider acceptable … “
  • This is the first written approval we’ve seen for the practice of refusing treatment, starving and dehydrating oneself in order to become eligible for AS/E.  Count on this decision to be used to support other people whose death is not “reasonably foreseeable” to make themselves eligible for AS/E.