Canada’s Supreme Court rules in favour of physician assisted suicideBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h764 (Published 09 February 2015) Cite this as: BMJ 2015;350:h764
Canada’s long political battle over physician assisted suicide seems to have been settled decisively by a unanimous decision of the country’s Supreme Court, which has struck down a century old law imposing up to 14 years’ imprisonment on doctors who help patients end their lives.
From the outset of proceedings in October, the nine justices had seemed sceptical of arguments put forward by the federal government’s lawyers, who said that the criminal penalty was essential to protect vulnerable people from being pressured to kill themselves. The justices’ decision was written “by the court,” rather than an individual judge, an unusual step intended to signify strong unanimity and confidence in the decision.
The court accepted the plaintiffs’ argument that the ban on assisted suicide violated the guarantee of equality in Canada’s Charter of Rights and Freedoms. Suicide and attempted suicide were decriminalised in 1972 and are therefore accessible to able bodied people who wish to end unbearable suffering. The ban on physician assistance meant that severely infirm people, physically incapable of killing themselves, did not have the same option to end their life.
But the court seemed to go further, in framing physician assisted death as part of the normal continuum of end of life care. “The law has come to recognize that, in certain circumstances, an individual’s choice about the end of her life is entitled to respect,” the court wrote.
“An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The law allows people in this situation to request palliative sedation, refuse artificial nutrition and hydration, or request the removal of life-sustaining medical equipment, but denies them the right to request a physician’s assistance in dying. This interferes with their ability to make decisions concerning their bodily integrity and medical care and thus trenches on liberty.”
The court also held that, to qualify for medical aid in dying, a patient’s illness need not be terminal and their suffering might be either physical or psychological.
The original plaintiffs in the case were two women from British Columbia, both of whom have since died. Gloria Taylor had amyotrophic lateral sclerosis but succumbed to an unexpected infection in 2012. Kathleen Carter, in chronic pain from spinal stenosis, travelled to Switzerland, where she took her life with physician assistance.1 Her adult children continued her suit.
The immediate effect of the ruling is that the section of Canada’s criminal code that prohibits physician assistance in dying has been declared invalid. But the invalidation is suspended for 12 months, giving the government time to craft new legislation. If it fails to do so (and the parliamentary schedule is tight) then physician assistance in dying will be unregulated as well as decriminalised.
While the federal government cannot appeal the court’s decision, the charter’s language contains an opt-out clause that could theoretically allow the government to override the ruling. But it would then become an issue in this autumn’s general election, with the ruling Conservative Party firmly on the wrong side of public opinion. Polling indicates that over 70% of the Canadian public favours abandoning the criminal penalty.2
Cite this as: BMJ 2015;350:h764