HOW ARE WE TO JUDGE AN INDIVIDUAL’S COMPETENCY TO CHOOSE DEATH? ANDREW COYNE ON THE LOGIC THAT MAY ENDANGER CHILDREN, THE MENTALLY INCOMPETENT, AND EVEN THE DEPRESSED.

Why should this right be limited to adults

Among the many questions left unanswered in the report of the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, one strikes me as inescapable. When dispatching a patient by lethal injection, would a doctor be obliged to sterilize the needle?

I think they almost certainly would. Old habits die hard, you should pardon the expression, and the unconscious need to shroud an act that at time of writing remains illegal under the Criminal Code as a routine medical procedure would make it unthinkable to do otherwise, however nonsensical it may be.

That’s the thing about normalizing suicide. It requires us to set aside all prior assumptions except the most absurd ones. It rushes past all sorts of distinctions that might once have seemed important — between killing yourself and killing someone else, for example — yet clutches wildly at others, as if they were any more likely to withstand the momentum of its logic.

Here is what I imagine most people think assisted suicide — let us call it what it is, rather than the gentler euphemisms — is about. A patient is in the last stages of an incurable disease. Death is a certainty, but not so swift as to spare the patient unbearable torment — if not now, then in future. Suicide seems the only way out.

And yet the patient is physically incapable of killing himself — or if he is not now, fears he will be in the future. To insist, nevertheless, that he must perform the act himself will seem to many people an obtuse tyranny. By allowing others to kill him at his request we are only ensuring his choice is real. We are only sparing him unspeakable pain. We are only hastening the inevitable.

That, as I say, is how most people think of the issue. It is how it is typically presented in the press. An adult, of sound mind, in unendurable physical pain, having made his wishes abundantly and repeatedly clear, agrees to his own execution.

But that is not, alas, how those most involved in the issue think about it. It was not the basis of last February’s Supreme Court decision: The Court spoke only of a “grievous and irremediable” condition, not a terminal one, and made clear this could be psychological as well as physical.

It is not the basis of Bill 52, the Quebec law which, in splendid defiance of the constitution, “legalized” assisted suicide (a court of appeal is to hear whether the province has that power this week). Here again, the patient does not have to be in physical pain, or terminally ill, or incapable of killing himself: He just has to be in “an advanced state of irreversible decline.” Moreover, the Quebec bill does not just allow doctors to kill their patients on request, but insists they must (or refer them to another who will).

And so far as these institutional responses impose any conditions on the patient’s autonomy — Bill S-255, introduced in the past Parliament, would have imposed a 14-day waiting period as well as requiring the consent of two doctors — they are out of step with the leading thinking on the issue, as the expert panel’s report highlights.

The panel defines a “grievous and irremediable” condition as a serious illness or disability “that cannot be alleviated by any means acceptable to the patient,” making the standard essentially open-ended. It dispenses with waiting periods, or the requirement that a doctor be on hand to perform the deed. And, in its most striking finding, it suggests that assisted suicide should be open to children.

That is, it will seem striking, to those who have not been paying attention. In fact, it is only logical. The notion that a change in law invoked in the name of unlimited personal freedom could at the same time be hedged with all sorts of restrictions was always contradictory, as assisted suicide’s leading advocates have been quite willing to argue. Indeed, the panel’s insistence on “competence” in place of an age restriction runs into the same difficulty.

There are, that is, two very different sorts of rights arguments at work here. There is the conditional, hedged one most people are familiar with. In this, the right comes with certain eligibility tests, rather as you must be of a certain age to drive, or vote, or drink. It is up to the patient to request access to it, and up to society to decide whether to accept his request.

But that is not how advocates see suicide. They see it, rather, as a release from suffering; not as an evil to be prevented, but as a service to be provided (indeed, the panel recommends it be done at public expense). This presents the right to die, not as a limited one, such as the right to drive, but as an unlimited one, inhering in all persons — rather like the right to life. And, it has to be said, it is by far the more coherent of the two arguments.

For if assisted suicide is a right to be released from suffering, how can that be restricted to adults? Are we to condemn children to endless torment, where we would not an adult? Likewise for the mentally incompetent: Are we really so indifferent to their pain as to allow their disability to stand in the way of its alleviation? If they are unable to consent to their own death, should they not be assisted, intellectually, in the same way as those physically unable to kill themselves are to be assisted?

This is not some dire prophecy. It is, as the panel reminds us, the logic of assisted suicide. By making it lawful to euthanize children, we would only be following where Belgium and the Netherlands have led; by applying it to the mentally ill, we would be doing no more than Switzerland has already done.

If that is where we want to go, so be it. But let us at least be clear that that is what is really at stake.