University of Toronto Magazine University of Toronto Magazine
Illustration of a man in a coma; a ghost above holds a sign that says
Illustration by Graham Roumieu

Ending It All

We run our lives as we wish. Why can’t we have a say in our own death?

Canadian laws and medical ethics prohibit a doctor from directly causing the death of a patient, or from helping the patient to commit suicide. But philosophy professor Wayne Sumner believes those ethical standards need rethinking and the laws need to be changed.

“If you face intolerable end-of-life suffering that can’t be dealt with any other way, and you want a doctor to administer a lethal injection, and the doctor is willing, I don’t think the state has any right to block that,” he says.

Sumner, 69, is writing a book on what he refers to as “assisted death,” which is due out from Oxford University Press next year. He says he became interested in the subject a few years ago while teaching an undergraduate bioethics course. “Probably it also has something to do with getting closer to the end and wondering how that will go,” he says.

Sumner likely isn’t the only one thinking about the ethics of assisted death. With the oldest baby boomers approaching 65, more will face their own mortality in the not-distant future. As they do, Sumner thinks they will pressure the government to change the laws. “They’ve been used to running their own lives. I think a lot of them will want some degree of control over the last days of their lives as well,” he says.

In his book, Sumner will argue for liberalizing laws governing medically assisted death. Generally, he says, it is wrong to kill someone, because it deprives that person of something of value. When the life being lived is no longer of value, but a source of extreme suffering, then helping someone end it, or ending it through euthanasia, is not unethical. Although many of the decisions would be difficult, Sumner says doctors already withhold treatment from children born with severe handicaps and from “brain dead” patients.

The current legal situation is ethically incoherent, he notes. Under some circumstances doctors are allowed to withdraw life support by turning off a respirator, for example. They can also hasten death by providing pain relief drugs, but only as long as hastening death isn’t the effect that’s intended. Sumner believes the laws should clarify when and how a doctor can assist a patient in dying.

Some argue that allowing assisted death at all leads to a slippery slope. McGill University law professor and ethicist Margaret Somerville writes that ending the prohibition against intentional killing would cause societal harm: “To legalize euthanasia would damage important societal values and symbols that uphold respect for human life.” But Sumner says that the same objection was made to legalizing abortion, and yet we continue to respect life. He points out, for instance, that the murder rate continues to drop.

“Legalizing assisted death responds to a real and immediate need on the part of those who are experiencing needless suffering at the end of life and it is simply cruel to deny them this relief on the basis of nothing more than vague speculation,” Sumner says.

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  1. 8 Responses to “ Ending It All ”

  2. John DiMarco says:

    The social implications of assisted suicide are not nearly as circumscribed and easily dismissed as this article implies. For instance, if assisted suicide becomes a valid choice, it also becomes acceptable to attempt to persuade someone to make that choice. Do we want people, at their weakest and most vulnerable, pressured towards suicide by persons who may have something to gain by the death (heirs, for example). Moreover, what will it do to the medical profession if the role of physician becomes ambivalent: sometimes saving life, sometimes bringing death? Or what do we do about medical conditions, such as depression, that directly inhibit the person's ability to make free choices, and in which a desire for suicide is a symptom of the disease itself? We should not dismiss these issues lightly.

  3. Eric Folot says:

    I am for assisted suicide but against voluntary euthanasia.

    One must distinguish between the legal, ethical and religious arguments. One cannot just say, without qualification, that there is no difference between the two: in the case of assisted suicide it is the patient himself who take his own life, whereas with euthanasia it is the physician. One must first specify on what grounds (legal, ethical or religious) one is making an argument. In the field of ethics, one can reasonably argue that there is no difference between the two. However, in the legal field, there IS a difference between euthanasia (so-called first-degree murder with a minimum sentence of life imprisonment) and assisted suicide (which is not a murder or homicide and for which the maximum sentence is 14 years of imprisonment).

    In the case of assisted suicide, the cause of death is the patient's suicide and assisted suicide is a form of complicity. But since attempted suicide was decriminalized in Canada in 1972, this complicity makes no sense because there is no main offence.

    Judge McLachlin wrote:

    « In summary, the law draws a distinction between suicide and assisted suicide. The latter is criminal, the former is not. The effect of the distinction is to prevent people like Sue Rodriguez from exercising the autonomy over their bodies available to other people. The distinction, to borrow the language of the Law Reform Commission of Canada, "is difficult to justify on grounds of logic alone" -- Working Paper 28, Euthanasia, Aiding Suicide and Cessation of Treatment (1982), at p. 53. In short, it is arbitrary »

    In contrast, voluntary euthanasia is considered first-degree murder. The doctor kills the patient (at the patient's request) by compassion to relieve his or her pain and suffering. This is a violation of one of our most fundamental ethical and legal principles: the prohibition against killing a human being. Our democratic societies are based on the principle that no one can end a person's life. We abolished the death penalty in 1976. Even if voluntary euthanasia (at the request of the patient) may, under certain circumstances, be justified ethically, we cannot ipso facto conclude that euthanasia should be legalized or decriminalized. The legalization or decriminalization of such an act requires that we take into account the social consequences. The undeniable potential of abuse (especially for the weak and vulnerable who are unable to express their will) and the risk of erosion of the social ethos by the recognition of this practice are factors that must be taken into account. The risk of slippery slope from voluntary euthanasia (at the request of the competent patient) to non-voluntary euthanasia (without the consent of the incompetent patient) or involuntary (without regard to or against the consent of the competent patient) are real - as confirmed by the Law Reform Commission of Canada, which states:

    "There is, first of all, a real danger that the procedure developed to allow the death of those who are a burden to themselves may be gradually diverted from its original purpose and eventually used as well to eliminate those who are a burden to others or to society. There is also the constant danger that the subject's consent to euthanasia may not really be a perfectly free and voluntary act."

  4. University of Toronto Magazine says:

    Wayne Sumner's enlightened approach to euthanasia is most interesting. It is strange that in Canada suicide is not illegal − not even the attempted kind − but helping someone to perform that very same not-illegal act is. People who desperately wish to die are usually not dissuaded by even their most caring friends and relatives. The state is not our friend; nor did it give birth to us. It should not be able to say to its citizens that they must cling to life whatever the circumstances. It can insist that we not hurt other people, of course. But it shouldn’t play a role in keeping us alive if we choose, of our own free will and with a clear mind, to die.

    Ethicist Margaret Somerville worries that euthanasia implies a lack of respect for “important societal values.” On the contrary, euthanasia affirms these values by supporting the integrity of individual choice on an essential issue.

    Geoff Rytell
    BED 1975 OISE

  5. University of Toronto Magazine says:

    Thank you for publishing this story. The Right to Die movement has grown from one tiny American group, The Hemlock Society, to organizations in more than 40 countries, and an international federation that meets regularly (in Toronto three years ago). There are now laws permitting assisted suicide in at least six countries and one American state.

    So far, only Switzerland allows non-residents to come for assistance. Two excellent feature-length films have recorded the full journey from decision to final action: The Suicide Tourist and A Short Stay in Switzerland (also on DVD). Both programs are intensely honest and deeply moving, showing the support of spouse and children. There is absolutely no evidence to support the “slippery slope” argument. On the contrary, there are now fewer messy, sudden and hurtful (to relatives) suicide attempts where a doctor’s assistance is legal.

    I joined the Hemlock Society at the age of 30. My opinion was considered weird at that time. I am now 77. Each year I see more and more public discussion of the right to die, and polls show a two-thirds majority of Canadians support permissive legislation.

    John Alan Lee
    BA 1956 UC
    Professor Emeritus, U of T

  6. University of Toronto Magazine says:

    I endorse this article completely and would take it one step further. Even if we are not suffering painfully, we should have the right to chose to end our lives if we feel the quality of life is no longer acceptable. Those suffering from dementia or with a gradually debilitating disease may not wish to prolong the process of living and having to eventually let others make decisions for us. As in the movie The Barbarian Invasions, we may choose to go out on a positive note with a great party. My point is one of choice; we get to choose to use/abuse alcohol and cigarettes, so why do we let an ethicist like Margaret Somerville tell us what to do?

    Numerous polls over the years have indicated that the majority of Canadians endorse the right to end our lives so why aren't the politicians getting the message? Are they afraid to tackle anything controversial? What can we do?

    Molly Russell
    MA 1960 Trinity

  7. University of Toronto Magazine says:

    End-of-life care and the ethics surrounding it are very complex issues, influenced by personal, cultural, religious and philosophical views. The debate, moreover, has been ongoing for many years and much has been written about it in a number of fields.

    The views expressed here by Prof. Sumner sounded somewhat simplistic, repetitive and have already been extensively discussed.

    What does he mean, "Generally it is wrong to kill someone because it deprives that person of something of value"? Value is a highly subjective concept. History offers countless examples of people who have chosen to die for an ideal or who have refused to risk their lives for something they deemed unworthy.

    And it is inaccurate to suggest that a drop in murder rates occurs when society gains a higher respect for life.

    I can only hope that these flaws relate more to the fact that Prof. Sumner is still writing his book on the subject, or to inaccuracies resulting from the difficulty in transmitting to the public matters of such complexity.

    I have always felt a great respect for Prof. Sumner's work and can only say I was sadly disappointed at the frivolous way of dealing with these end-of-life issues.

    Cristina Honorato
    U of T Clinical Fellow, 2008

  8. University of Toronto Magazine says:

    After reading this article I can’t help but wonder why it is that playing God has been added to a bucket list of sorts for this latest, aging crop of control-mongers, who, as philosophy professor Wayne Sumner believes, will want to weigh in on "the ethics of assisted death." After all, we don’t get to choose when we are born, to whom or where, for that matter, so why should we be able to choose when we die? Life is a precious and wondrous gift, as gazing into the eyes of a newborn child will reveal, and it is a gift until the very end - whenever that fateful day may be. Every breath we take, including our last, symbolizes a living soul within our bodies - regardless of one’s religious or spiritual beliefs - and I am not referring to the kind found on the bottom of an old pair of shoes.

    The danger in Sumner’s advocacy of liberalizing laws governing medically assisted deaths is that it opens the door to a Pandora’s Box of misinterpretations concerning euthanasia – thereby sending the incorrect message that it is socially acceptable to end a life. Consequently, we could very well see an increase in incidents where people will use this law to justify their own, possibly, criminal actions. Indeed, most disturbing is the consideration of who will be the one to decide that the life being lived is “no longer of value." Will it potentially be the frustrated parent of a disabled child? Will it next be the distraught spouse of a chronic drug-addict? Where will society draw the line on this “slippery slope” that author Kurt Kleiner alludes to?

    Another problem with Sumner’s view is that, even when done according to proposed new ethical standards and laws, he implies the person who is terminally ill will be able to make a cognitive, constructive, and orderly decision about ending their life. Are we not overlooking the fact that the individual would likely be subjected to many other internal and external factors? For instance, they will likely be suffering excruciating pain, be under the influence of mind-altering drugs, and experiencing emotional stress - not to mention financial pressures. And what of the psychological impact on the families left behind such decision-makers? All of this will certainly take a toll.

    Finally, are we not forgetting something here? Whatever happened to the idea of hope? Even someone with a terminal illness can still hold onto the hope of yet another precious day spent with loved ones, yet another beautiful morning sunset to enjoy, and even the ever-illusive hope of a miraculous cure that could stretch out more days like these in the future. The tragedy in all this is, that when you schedule an appointment to leave this world, you are effectively closing the door to any hope – and what kind of a life is that?

    Rosanna Ortino
    BSc 1995

  9. University of Toronto Magazine says:

    The headings for this article are “Leading Edge” and “The Big Idea." In fact, in so doing you’re suggesting the subsequent content and opinion of Prof. Sumner is a “big idea” or “leading edge” thinking. His quotes alone reveal anything but that.

    The future of rationed health care, as is already suggested in Obama’s health plan, will inevitably need to be justified and opinions convincingly presented as to how green or environmentally conscious it will be to dispose of oneself for the greater good. Unfortunately, it will be for the greater good of government or the bottom line, or family members, all too eager to spend their money or time elsewhere. Compassion or any virtue require too much effort in our times and have no economic return. The crisis of faith and holiness is ever more obvious.

    In an era when all is for self-gratification and any suffering is shunned, it becomes harder and harder to see heroic people who conquer by an act of the will, surrendering self, offering suffering beyond their limits for something greater.

    In the story “Waging Peace," we learn that Dr. I. Abuelaish overcame the death of his wife due to leukemia and a month later lost three daughters and a niece to a bomb attack in Gaza. Dr. Abuelaish says “…life doesn’t stop with tragedies.” On the other hand the professor of philosophy, precisely the discipline historically that answered life’s questions, sees only “vaguely”.

    Philosophy can never be subject to the scientific method. Philosophy has explained the existence of God. It is not “vague”…back to the books dear professor. To see with the heart instead of the mind is a profound education. Perhaps at age 69 our esteemed professor should avoid the Netherlands or any other jurisdiction where the elderly are now avoiding hospitals or going to nearby countries for care to prevent their untimely deaths. This is not so vague.

    The choice to write a book on “assisted death” instantly bestows credibility and authority to the author or the subject The professor suggests that when a life is no longer of value, then it is not unethical to help someone end it. What will be ethical about a depressed teenager at 14 going through changes in life when the law will say he has the same right as an elderly person to legally reduce his/her suffering.

    The professor appears to appreciate utilitarianism. But when things are viewed solely on their inherent value - ask yourself whose value? God’s or man’s. God values all equally, man only the opinions of his day. The fad of today is not the value of tomorrow. Everything has a value or nothing has any true value except the relativistic opinion of the time, or the views of the majority.

    Sumner says”…the same objection was made to legalizing abortion and yet we continue to respect life.” If abortion had not diminished our value of life, no matter how small that life, we would not be having this discussion now.

    Further, to suggest that when someone no longer is of value we should help them end it all doesn’t respect life for its own sake but only for its utilitarian measure. The lives of the poor or the disabled are in fact of even more value despite the attitudes of the powerful who always see themselves as the most valuable. Governments that have exterminated their less desirables did what was relativistically acceptable to them, but were not ahead of their time? They were making choices, but wrong choices relative to all people for all time. It was not “leading edge” or a “big idea” then, nor is it now. Assisted death today is not such big idea, no matter what the fad of the day. Eating out of the dumpster for sustenance will always be wrong.

    It’s no surprise that in an era when people are only satisfied in doing whatever they desire, everything goes, all things are relative, nothing has any objective truth or value. There is no right or wrong, only what is in vogue.

    The actual only right we have is to develop a well-formed conscience. To choose right from wrong. By the very argument made that it is “cruel” to not allow assisted death, you are admitting an objective truth, a moral standard which can only exist if there were a God. In effect you are admitting there is a God. Becoming less vague yet?

    Higher education is becoming a handicap to the use of both faith and reason. Faith and reason help us appreciate what either alone cannot teach us. Acceptance, sacrifice, offering up and hope are not “vague speculation," but cataclysmic explosions of satisfying and transforming love. “Pain free” will not give meaning to a life, rather all the pain in the world with understanding can have meaning.

    The school of life is not limited to U of T or a professor’s opinions, but to the very conflicts, restrictions and roads less travelled that edify us in compassion and love, to value each other because of our limitations and humanity, rather than our perfection or strengths. Some drop out of school or go through it and fail to learn the essentials that foster hope and joy, but those that “endure patiently” have riches our era can no longer measure or value, and which will maintain them forever. An eternally “Big Idea”.

    G. Spinosa
    Picton, Ontario