Redefining the Practice of Medicine- Euthanasia in Quebec, Part 3: Evolution or Slippery Slope?

Abstract

Euthanasia laws frequently include guidelines and safeguards intended to prevent abuse.  Eligibility criteria are the most basic guidelines or safeguards.  In considering their stability, it is important to consider not only the elasticity of existing statutory provisions, but recommendations for expansion that might ultimately result in changes to the law.
ARELC’s requirement for legal competence can be sidestepped through the provision allowing substitute decision makers to order the starvation and dehydration of legally incompetent patients (Euthanasia Beneath the Radar- EBTR).  Beyond this, there are strong indications that the reach of the law will be expanded to include legally incompetent patients.

The Quebec Commission on Human Rights and Youth Rights has indicated that it would consider refusal of euthanasia to the legally incompetent, uninsured persons or minors, including children, to be unlawful discrimination

No agreement was reached during legislative hearings about when a patient is “at the end of life,” so this added criterion provides only an opportunity for disagreement and judicial interpretation.

A “serious and incurable illness” could conceivably include clinical depression, which could cause “unbearable psychological pain” that cannot be relieved because the patient finds the side-effects of anti-depressants intolerable.  Such a patient qualify for euthanasia, and the Quebec Ombudsman recommended that the possibilty of euthanasia for the mentally ill be seriously studied.

Expanding the law’s reach in these directions is supported by a number of powerful and influential organizations in Quebec; a number of them recommended an incremental approach to accomplish this.

For these reasons, it is reasonable to believe that ARELC’s criteria for euthanasia will be broadened by interpretation, by statutory amendments and by court rulings, so that, as time goes on, there will be more euthanasia, not less.  Depending upon one’s moral  or ethical perspective, this can be described as a slippery slope, a process of natural evolution (for better or worse) or progressive democracy in action.

It is not necessary here to determine which of these conflicting perspectives is the most accurate.  It is sufficient to observe that the expansion of the eligibility criteria for euthanasia can be safely predicted.  This is relevant to concerns about freedom of conscience because increasing the range of circumstances under which euthanasia can be provided increases the likelihood of conflicts of conscience and conscientious objection. [Full Text]

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