The ethics of suffering in the era of assisted dying

Posted On 2017-08-09 09:28:22

Change both in its substance and pace appears to be increasing dramatically in all sectors of life- and the business of providing health care is not immune to this phenomena. A case in point is our institutional and cultural approach to the end of life. In times prior to the onset of modern medicine (before mid-20th century), death was an ever-present reality in all of life’s stages. In this era, before the creation of the germ theory of disease, no one was immune, and so its presence (death) was at best tolerated and more frequently even accepted. However, as the science of medicine advanced, death was seen as a potentially defeatable enemy, and battle metaphors abounded. However, even though the limits of our mortality could be pushed away—it inevitably needs to be faced, and when it was a series of new tensions revealed themselves: when does dying begin? Just because we can treat—should we? A dance with the devil began: is passive euthanasia tolerable over a more active engagement in futile treatment? Can we allow death to happen if we are not the primary cause of its eventuality? It would be within this milieu that the modern hospice movement alit in North America. Identifying that a dying process existed, responding to it with compassion and good medical care, and then normalizing death as an inevitable part of life formed the bedrock of a new type of medicine. Hospice became the safe haven for those whose death was inevitable, and a place where a measure of quality of one’s life meant more than its quantity (1). And yet the agency of change continues, and slowly over the past 25 years a new movement has taken hold—death as an event at the time and location of the patient’s choice. Over the course of the past 3 decades, religious, ethical, professional and legal barriers have slowly but steadily been moved aside such that now, in Canada, medical assistance in dying has been legalized since the summer of 2016, and currently in the US, six states have legalized physician-assisted suicide (2).

Adaptation to this change in process and the type of response one should have to death and dying has been tenuous and not without its challenges. This paper will attempt to identify some potential reasons why the medical assistance in dying approach and hospice and palliative care movement have been made reluctant and in some cases even hostile bedfellows over the issue of how we ought to respond to suffering.