Should aid-in-dying laws be expanded?

by Nicholas Goldberg

To take advantage of California’s narrowly drawn assisted suicide law one must be terminally ill, with only six months to live, as certified by not one but two doctors.

I’ve long believed that state officials ought to consider expanding that to include Alzheimer’s patients and dementia sufferers who are not on the verge of death, and perhaps to people with other degenerative diseases or who are in chronic, intolerable, untreatable pain. They too deserve the right to make decisions about their own lives and deaths.

These days, right-to-die laws appear to be gaining ground. Film director Jean-Luc Godard brought the debate into the mainstream last week when he opted for assisted suicide in Switzerland after being diagnosed with “multiple incapacitating illnesses.” (“If I’m too ill, I don’t have any desire to be lugged around in a wheelbarrow,” he once said when asked about his views on dying.)

A recent memoir by novelist Amy Bloom about her husband’s decision to travel to Switzerland to take advantage of its right-to-die law after he was diagnosed with Alzheimer’s became a Los Angeles Times and New York Times bestseller.

French President Emmanuel Macron said last week that he was opening talks with lawmakers about legalizing assisted suicide. Scotland’s Parliament is considering a bill as well. A number of other countries already have right-to-die laws in place.

But in the midst of all this I also read a long and thorough Associated Press article about Canada, which has what’s described as “arguably the world’s most permissive euthanasia rules.” That story seemed to suggest we may be moving too far, too fast. It opened with the story of Alan Nichols, a British Columbia man with a history of depression and hearing loss who was, at his own request, euthanized. His family says the process was not nearly protective enough: Nichols was not “suffering unbearably,” which is among Canada’s requirements for euthanasia, was not taking needed medication and was not terminally ill.

“Alan was basically put to death,” said his brother.

Euthanasia is a process in which doctors use lethal drugs to end patients’ lives. In assisted suicides, patients self-administer the drugs, which are generally prescribed by a doctor. In Canada, the vast majority of “medical aid in dying” deaths are by euthanasia.

Critics of the Canadian law say that Nichols is just one of many people the rules have failed to protect. They worry about people with disabilities in particular, who can be granted the right to be euthanized even if they don’t have other medical issues and are not terminally ill. Some disabled people have even decided to end their lives because their health care expenses grew too costly, according to the article.

Three United Nations-appointed experts reported last year that the law appeared to violate the rights of the disabled and could have a “discriminatory effect” on them.

Another worry is that Canadian doctors are initiating discussions about euthanasia with patients who are not otherwise considering it. Critics fear they may be encouraging patients to end their lives.

These are very real concerns. They shouldn’t just trouble those who oppose right-to-die laws — such as the Catholic Church, which believes euthanasia and assisted suicide are ” intrinsically evil ” acts — but supporters of it as well.

I’m not an expert on the Canadian statute. But if the law is flawed and needs to be refined or reformed or tossed out and rewritten to ensure it includes appropriate protections, by all means it should be fixed. That’s how the legislative process is supposed to work.

But let’s be clear: It was always going to be complicated to find the proper balance between protecting patients and helping them die. Complicated but achievable.

It should absolutely be possible to write laws that protect elderly, sick, disabled and otherwise vulnerable people from manipulation or coercion while still providing competent adults with options for relief from intolerable suffering or irremediable illness.

Of course we shouldn’t make it easy for people to end their lives impulsively. And perhaps there need to be special safeguards for people with depression whose judgments may be skewed when they’re off their meds. Dementia sufferers should have to make their end-of-life preferences crystal clear before they become incompetent, presumably through an advanced directive.

Perhaps it makes sense to bar doctors from initiating discussions about assisted suicide and euthanasia, although I can see arguments on both sides. Perhaps patients who do not have an imminent terminal diagnosis should have to meet a higher bar for approval than those who do.

Canada appears to have fewer safeguards than other countries that allow assisted suicide or euthanasia. Whatever reasonable protections can be enacted to ensure people aren’t encouraged, steered or pressured into ending their lives should be welcomed.

But I’m still in favor of right-to-die rules that offer end-of-life options to more than just terminally ill patients. I’ve felt that way ever since I watched my grandmother waste away slowly with Alzheimer’s over many years. She had told us often that she wanted to end her life before she became unable to read, speak, feed herself or dress herself. Yet for almost a decade she lay in a nursing home bed in just that condition, and there was nothing we could do to help her despite knowing her long-standing, unwavering preference.

I feel nothing but sympathy and support for brave people like Godard, whose lawyer said, after the filmmaker ended his life: “He could not live like you and me, so he decided with a great lucidity, as he had all his life, to say, ‘Now, it’s enough.’ ”

Living like you and me isn’t the only way to live. Sick, elderly and disabled people understand that. Many of them — most, I suspect — want to live for as long as they can even with pain or a degenerative disease.

But those who do not, and who carefully and “with great lucidity” decide that life is no longer worth living, ought to be allowed to decide for themselves.

Nicholas Goldberg is an associate editor and op-ed columnist for the Los Angeles Times.