In his latest post to DWD Canada's blog, Dr. David Amies recalls a seminal British play that, like Sue Rodriguez in the early 1990s, posed the most important question Canadians must keep in mind as we consider new rules for assisted dying.
In 1971, Brian Clark, a British playwright, wrote a play for television, later adapted as a successful stage play and a movie, concerning Ken Harrison, a fictional sculptor, rendered quadriplegic following an accident. In Whose Life Is It Anyway?, Harrison has been confined to a hospital bed since the accident and had grown increasingly frustrated by his inability to practise his profession, look after himself or make love and so decides to sue the hospital for permission to leave and so end his life.
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An informal court hearing is arranged by his bedside at which evidence about his state of mind is discussed. The judge is keen to discover whether or not he is clinically and pathologically depressed. A consultant psychiatrist avers that he is not. The judge asks if there are any definitive tests that enable him to make such a decision. The psychiatrist reveals that there are not and that he relies mainly on his long professional experience in order to come to his conclusion. When the judge asks Ken if he is depressed, the latter replies, rather tellingly, that he would be insane not to be depressed under the circumstances!
The judge asks him why it is a reasonable choice to decide to die. The reply is beautifully expressed and well worth quoting at length:
The best part of my life, I suppose, was my work. The most valuable asset that I had for that was my imagination. It’s just a shame that it was not paralysed along with my body. Because my imagination — which was my most precious possession, has become my enemy. And it tortures me with thoughts of what might have been and what might be to come. I can feel my mind slowly breaking up. For example, women. I loved what they were, the look of them, the smell of them… Now I dread it when they come into the room because I loathe the way they make me feel. You know, I am filled with absolute outrage that you, who have no connection with me, whatsoever, have the right to condemn me to a life of torment because you can’t see the pain. There’s no blood and there’s no screaming so you can’t see it. But if you saw a mutilated animal on the side of the road, you’d shoot it. Well, I’m only asking that you show me the same mercy that you’d show an animal. But I’m not asking you to commit an act of violence, just take me somewhere and leave me. And if you don’t, then come back here in five years and see what a piece of work you did today.
The judge then leaves the room to have a quiet think. On his return he points out that the law on the matter is fairly clear. We must remember that this play was written 43 years ago. At that time, thoughts on assisted dying had not really evolved. I shall not reveal what his verdict was. It is worthwhile to find the play on YouTube and discover for yourself.
The Canadian context
Fast forward to 2015 in Canada and we find that our Supreme Court is inclined to mercy for people in intolerable medical situations whereas our government is unhappy at the court’s apparent activism and is dragging its feet. Many in the medical profession are similarly disturbed by the possibility that physician assisted dying will become a reality when the next six months or so have passed. The Conservative government has set up a panel to ask citizens what they feel about new law on the matter. On the face of it, that seems like a good idea. But, and it is a big but, two of the three panel members are on record as being completely averse to legalising physician assisted dying (PAD). They were witnesses at the Supreme Court hearing in February and experienced a judicial rejection of their point of view by a nine to zero verdict. In fairness, let it be known that the two are experts in the field of palliative care and emphasize how much help can be obtained through their skills. No one denies that but palliative care does not and cannot provide the complete answer. Moreover, there are some persons who might like to reject palliative care and who wish to be done with their plight and end their lives.
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Good palliative care is not widely available across Canada. It is a relatively new discipline and it is only in the past five to ten years that medical students have received any instruction in it. Active medical practitioners are known to be squeamish about discussing end-of-life issues with their patients. They have been trained to see illness as something that has to be fought. Implicit in that is the view that death represents a failure of technology, forgetting, of course, that all must die sooner or later. The Canadian Medical Association (CMA) is worried that today’s practitioners have received no training around PAD or euthanasia. They have even raised the matter of what such a procedure will be called and what billing code should be applied to it. Good heavens!
Dr. David Amies.
Such matters are worthy of address. However, in my view they are little more than road bumps on the path to law that will allow an adult, mentally competent person to ask for and receive professional help when and if that person decides that enough suffering is enough. Brian Clark’s play puts the question starkly, ‘Whose life is it anyway?’ A mature society should be able to put in place sensible measures that will allow sick people to escape from lives they deem no longer worth living. Obviously, certain safeguards will be required and such provisions ought not to be too difficult to organize. What are not required are conditions so onerous that they can only be described as a lawyer’s picnic. The last things that a truly desperate patient will need are administrative provisions that are almost impossible to navigate.
It's all about personal choice
I truly hope that all levels of government and the medical profession will come to see that physician assisted dying is a measure that mature and compassionate societies should institute. Those that choose not to avail themselves of it, for reasons of personal ethics or faith, need not do so. Physicians, who choose not to be part of the process, must not be obliged to assist the person wishing to end his or her life. What is required is a legal means that allows a distressed, very sick or gravely disabled person to ring down the curtain if and when they so desire. All should reflect upon Ken Harrison’s outrage that those, who have no real connection with him, have the right to condemn him to a life of torment, simply because they cannot feel the pain, experience the anguish or see the blood.
Whose Life Is It Anyway? gives us a pointed example of life imitating art and, although written so long ago, provides a significant distillation of an important issue in today’s Canada.
Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.