CLF Attends Ontario's Consultation on "Physician-Assisted Dying"

John Sikkema, CLF Associate Counsel

Last night, I participated in the government of Ontario’s public consultation on physician-assisted dying in London on behalf of CLF.

The consultation, which took the form of a “town hall” meeting, began with a “context setting” presentation by a representative from the Ministry of Health. “As we talk about the kind of death we want,” the presenter said, attempting paradox, “we can think about the kind of life we want to live.”

The presenter briefly reviewed the Carter decision and the Provincial-Territorial Advisory Group’s Report on the issue. He mentioned a few of the Report’s 43 recommendations, including that “physician assisted dying” (“PAD”) be publicly funded, include the choice of assisted suicide or euthanasia, and have no mandatory waiting period. After recapping what the Ontario government has been doing—online surveys, town halls, receiving letters, and internal legal and policy research—the presenter from the Ministry of Health turned over the podium to Ipsos Reid. The research firm conducted a live polling and discussion session on the following questions:

1) Would you consider receiving PAD?

2) Who should carry out the act that causes death—the physician, the patient, either, or other?

3) Where or in what facilities should PAD take place?

4) How should the request should be made—in writing, orally, or both?

5) Would you lose trust in your physician if he or she participated in PAD or refused to participate in PAD, or would it have no effect on your trust in your doctor?

There were roughly 165 live votes on every question. In between each question, attendees discussed, for about 15 minutes, both the main polling questions and related questions. The room was divided into five groups, each with its own moderator.

One available voting option for every question was to respond that PAD is wrong under all circumstances. There were questions from the audience as to why this was an option at all, given that the Supreme Court had created a “right” to PAD. The moderator explained that they did not have that response available at their first town hall, and many attendees insisted that it should be a possible response. One person from the audience pointed out that Parliament could still make PAD illegal and expressed disagreement with the Carter decision.

To the first question, 51 responded that PAD was wrong under all circumstances, while around 80 said that they would be either very likely or somewhat likely to consider it (the remainder being spread between “not likely”, “unsure”, and “prefer not to answer”). When the same question was asked at the end of the evening, 60 people responded that PAD was wrong under all circumstances, though the distribution overall was similar. One audience member encouraged the researchers to not discount the slight shift towards opposing PAD, saying he has never put as much thought into an online survey as he has put into the survey conducted in the course of this evening of discussion with fellow citizens.

For each question in between, the number of people selecting the “PAD is wrong” response varied, as other response options seemed more germane to the question, while conveying a similar sentiment. For example, on the question about losing trust in your physician, 31 people responded that they would lose trust in their physician if he or she participated in PAD, 10 responded they would lose trust if their physician would not participate, 73 responded that it made no difference, and 30 responded that PAD is wrong under all circumstances.

On the question of who should perform the act that causes death, only 5 people voted that the patient should do it, whereas 15 selected “physician”, and 73 selected “either” (around 45 selected the “PAD is wrong” response). Following that question, I explained that, while physician participation in either assisted suicide or euthanasia signals medical approval of the decision to end one’s life, statistics show that where the choice is available, more people choose euthanasia, which may result in more “physician-assisted dying” overall than not making the latter an option. Euthanasia enables a person to be passive while a physician kills them. This is perhaps why the trial judge in Carter said that Ms. Taylor must take the lethal drug herself, unless she was completely physically incapable of doing so. Judging by the reaction to what I said, it seemed many people had not fully understood the significance of the question.

Toward the close of the evening, a young doctor told the audience she had voted “PAD is wrong” for every question, explaining that she went into medicine to care for people, not to kill them. Another attendee said he had lung disease and that it causes him great pain, but applauded the young doctor and said there should be more like her. Others told stories of people they knew who had suffered terribly and only wanted relief. Others told stories of elder abuse and warned about the risks of undue influence. Others told stories of people who wanted to die, but whose minds were changed when people came alongside them to care for them. The level of thoughtful engagement on the issues was encouraging.