One of the headlines in last Thursday’s New York Times read: “Justin Trudeau Seeks to Legalize Assisted Suicide in Canada.” The headline and article caught my immediate attention.
On initial reading, the article makes it appear as if the new, young, daring — and brash — Prime Minister of Canada is trying to push the limits of what constitutes “dying with dignity” or what constitutes a “good death” under difficult circumstances. It seems as if he’s trying to allow people to make certain choices for themselves concerning end-of-life decisions.
Trudeau is young; he’s handsome. He has been known to make bold statements. He represents that generation of 40-somethings and 50-somethings who are used to getting things when they want, how they want, on their own terms. Face it, our generation is a very individual-centric community where our own needs often come first. Why should death be any different?
So many NYTimes readers may not have realized that Thursday’s article was misleading. It was written as if it is Trudeau himself who is seeking to overturn the ruling in the Canadian Charter of Rights and Freedoms (part of the Canadian Constitution) that deems Physician Assisted Death by Suicide unconstitutional. The NYTimes neglects to mention that Trudeau is only fulfilling a mandate of the Canadian Supreme Court (Carter v Canada) from last February 2015.
In February of 2015, the Supreme Court of Canada struck down the federal prohibition on physician assisted suicide, arguing that the old law violates the Canadian Charter of Rights and Freedoms. In this rule, the Supreme Court:
- gave decision makers until February 2016 (later extended to June 2016) to prepare for the decriminilization of physician assisted death by suicide;
- established guidelines for determining who can access physician assisted death by suicide and how it can be safely administered;
- highlighted that it be used only for ‘grievous and irremediable medical conditions with enduring suffering.’
Trudeau had no choice. The Supreme Court ruling required that guidelines be established within a certain time-frame. The New York Times did not have all of its facts. The article only referenced the Supreme Court ruling briefly at the end.
Why am I so interested in this discussion? I no longer live in Canada (although I am a dual American-Canadian citizen). The topic of “whose life is it anyway?” and the issues surrounding the topic of physician assisted suicide are part of a debate that is now taking place all around the globe. As of October 2015, euthanasia (withdrawing life support) is technically legal in the Netherlands, Belgium, Ireland, Colombia and Luxembourg. (Although it is practiced in various forms in many other places). Assisted suicide is legal in Switzerland, Germany, Japan, Albania and in the US states of Washington, Oregon, Vermont, New Mexico, Montana and California. A distinction must be made: withdrawing life support is not the same legally as PAD (physician-assisted death-by-suicide). Someone on life support can request that life-support be removed. A person with cancer can stop chemotherapy or radiation. PAD necessitates a physician to do something physically to hasten death, to literally end someone’s life.
The topic of “a good death” first gained traction in the 1970s, when I was in high school. What took place in my hometown left a lasting impression on me that would affect my approach to bio-medical ethics as I pursued my professional goals. I grew up in Succasunna, New Jersey and went to Roxbury High School. It was a sleepy farm town about an hour and twenty minutes from New York City. The most exciting thing that ever happened was that sometimes, the cows and horses would escape from their farms. You’d wake up in the morning to find they had wandered down the road and were grazing in your front yard!
And then suddenly one day, we became front-page national headline news. On April 14, 1975, a young woman who graduated from my high school, Karen Ann Quinlan, attended a party and mixed sedatives and alcohol. She slipped into a coma from which she never emerged. It took five months for her physicians to proclaim that she was in a “persistent vegetative state.”
Her parents did not want her to suffer nor to endure any more physical hardship to her embattled body. They firmly believed that she would never return to a state of consciousness. So they requested that her physicians disconnect her from the life-support machines that kept her alive. When the physicians refused, her parents took the case to court. The “Karen Ann Quinlan Case” became the first “right to die” case in US legal history.
Eventually, the court ruled that “no compelling interest of the state could compel Karen to endure the unendurable” and allowed the life support to be removed. Ironically, Karen lived for 10 more years in a “persistent vegetative state” after she was weaned from the respirator. The remainder of her years were spent in a nursing home in New Jersey.
“The Karen Ann Quinlan Case” is now an important part of every bio-medical ethics book, religious and secular. It has become the historical benchmark for discussions on euthansia and physician-assisted suicide (PAD) world-wide.
This incident in my own backyard sparked my interest in medicine and bio-medical ethics. It compelled me to explore the intersection of Jewish law and bio-medical ethics, to study the intricacies and nuances of the issues — and to figure out how my Jewish values inform medical decisions we confront. It spurred me to pursue pastoral care and chaplaincy work throughout my rabbinate.
I feel compelled to delve into the questions concerning the definitions of “life” and “death.” Who decides those definitions and makes those determinations? Who has the right to make decisions when it comes to our own bodies?
Ethicists fall along a huge spectrum. Depending on how one defines “who gives life,” that will determine the answer of “who determines what constitutes death,” and the ability to make decisions regarding death. For now, we will focus on the religious perspective.
From a classic, traditional religious perspective, all life comes from God. Our bodies are gifts from God. God requires that we, and by extension our physicians, are required to do all that we can care for our bodies and to preserve and prolong our lives. Therefore, by extension, only God has the ability to determine when it is our time to die. We are not allowed to do anything to hasten our death.
The Torah strongly states that God will “require a reckoning” for those who “spill the blood” of humans. For example, we see in the story of Noah:
Whoever sheds the blood of man, by man shall his blood be shed, For in the Eternal’s image, did God make him. (Genesis 9:6)
And the commandment to “not murder” is a priority as the Torah reiterates the 10 Commandments twice: (Ex 20:13 and Deut 5:17), as well as states this injunction against murder in numerous other places.
Taken at the most basic level, this means that we are not permitted to harm ourselves or others in any way physically (including committing suicide). Physician-assisted suicide would be akin to murder, from a Jewish perspective.
(For a lengthy and more complete discussion of the Jewish view on Suicide and Assisted Suicide, please refer to: “Assisted Suicide,” by Rabbi Elliot N. Dorff, in YD 345.1997a, Jewish Committee on Law and Standards).
So what happens when the Supreme Court in the country in which you live issues the following ruling:
The prohibition on (i.e., AGAINST) physician-assisted dying infringes the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice. The object of the prohibition is not, broadly, to preserve life whatever the circumstances, but more specifically to protect vulnerable persons from being induced to commit suicide at a time of weakness. Since a total ban on assisted suicide clearly helps achieve this object, individuals’ rights are not deprived arbitrarily. However, the prohibition catches people outside the class of protected persons. It follows that the limitation on their rights is in at least some cases not connected to the objective and that the prohibition is thus overbroad. It is unnecessary to decide whether the prohibition also violates the principle against gross disproportionality. (From Supreme Court Ruling, Carter v Canada)
This Supreme Court Ruling seems to be in direct contradiction to the traditional Jewish view on PAD!
(For the rest of this article, please click here: Rabbi Sharon L. Sobel writes on the Times of Israel about Physician Assisted Suicide.
I am honored to have received the request from the TOI Editor to write this article).