The moment, one of the few great ones in the whole trial, occurred during the short oral plaidoyer of the defense, after which the court withdrew for four months to write its judgment. Servatius declared the accused innocent of charges bearing on his responsibility for "the collection of skeletons, sterilizations, killings by gas, and similar medical matters," whereupon Judge Halevi interrupted him: "Dr. Servatius, I assume you made a slip of the tongue when you said that killing by gas was a medical matter." To which Servatius replied: "It was indeed a medical matter, since it was prepared by physicians; it was a matter of killing, and killing too is a medical matter." – Hannah Arendt, Eichmann in Jerusalem, 1963 (Robert Servatius was Eichmann's defense attorney.)
BILL C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), is now Canadian law. But what kind of law is that?
Archbishop Miller speaks up.
McGill begins to back down? Let us hope not, for this is not just politics as usual: 
muhc_letter.pdf
We are witnessing a war of "ideologies" and a deadly power struggle, as this open letter to Véronique Hivon, MNA, signed by 57 physicians, reveals:
Mme Hivon:
You label as « ideology » the decision made by the McGill University Health Centre to not euthanize patients on the palliative care ward.
“The patients at the end of life are the ones who should have their rights respected and be at the centre of the organization of care”, you say. If that is what you really believe, where were you when the number of palliative care beds at the MUHC was reduced for budgetary reasons? When the specialized geriatrics unit was closed completely? Why do you not speak out when patients are transferred all over the hospital and the city for trivial reasons, as is regularly done in Quebec?
What other than ideology could make you want to force hospitals, not only to kill patients, but to kill them in the one place where they most need to be protected?
Palliative care professionals are experts in easing the pain and suffering of terminally ill patients, accompanying them to the very end of their lives, with no need to kill them in order to do so. Now they are struggling, all over Quebec, to continue providing the same peace at the end of life in a situation where death is being promoted. Yes, promoted. This law was passed against the better judgment of those who know best how to care for the dying. Now you want to eliminate even the little safe space that is left for patients and professionals. All they ask for is one place in the hospital where there is no risk of being killed.
You got what you wanted when this law passed. Now you want to crush every tiny focus of opposition to your favourite project.
That is more than ideology. It’s intolerance, pure and simple.
We support the freedom of the palliative care professionals at the MUHC (and at every hospital) to ensure there are safe spaces for patients.
Twenty years ago, Professor David Novak analyzed the underlying problem and predicted the course of events we are now following: Suicide is not a private choice should be read widely today.
C-14 not only introduces euthanasia and assisted suicide but makes medical practitioners the agents, indeed, the only explicitly authorized agents, of these procedures. It thus abolishes medicine as the ancient art of doing good, and only good, to the body. Certainly standard modern definitions of medicine, such as 'the science of diagnosing, treating, or preventing disease and other damage to the body or mind' (American Heritage Dictionary), no longer properly identify medicine where 'medical assistance in dying' refers not to palliative care but to deliberate killing. Simply put, medicine is no longer medicine if it includes, in its own purview, deliberate killing. As for 'medical practitioners and nurse practitioners' – what are they, as here categorized, if not the State's angels of death? Medicine itself is the bill's first casualty.
It is not at all clear that either the Court or Parliament has a right to define medicine, much less to redefine it as inclusive of killing. (Would education or engineering or philosophy accept such redefinition? If not, why should medicine or any other science?) At all events, intrusion of the state should be minimized, not expanded, and deference to dissent should be seen as a requirement of justice, even when it impedes the state and its purposes. – Jeffrey Collins and Douglas Farrow, "The New Hobbesians"
Language is the second casualty. Here is a layman's guide to the basic distinctions one ought to keep clear despite persistent attempts at obfuscation:
1. Palliative care: accompanying someone in the natural process of dying to aid, comfort, and relieve suffering
palliative sedation: using high drug dosages to prevent or relieve extreme suffering, even if those dosages may hasten death by reason of their side-effects, yet without intending to kill
NB: If there is an intention to kill, it is not palliative sedation but so-called terminal sedation (i.e., euthanasia).
2. Suicide: killing yourself
3. Assisted suicide: killing yourself with someone else’s help
physician-assisted suicide (PAS): killing yourself with a doctor’s help
NB: Physician-assisted dying (PAD) is a loaded term that implies, contrary to fact, a moral equivalency between accompanying someone during natural death (i.e., palliative care) and abetting a suicide or performing euthanasia. Moreover, the specification physician in either expression, PAS or PAD, is a form of special pleading, for the participation of a doctor is not necessary; a terminating technician would do nicely, leaving intact the idea of medicine as the art of curing.
4. Euthanasia: a euphemism for killing someone else, putatively for his benefit and ordinarily at his request
active: by doing what ought not to be done
passive: by not doing what ought to be done
NB: Refusing to prolong the process of dying by offering treatments that neither promise recovery nor relieve suffering nor permit desired mental or physical activity is not euthanasia; it is an appropriate feature of palliative care.
voluntary: killing upon request
non-voluntary: killing without request, in the absence of competence to make the request
NB: "Involuntary euthanasia" (killing contrary to known or presumed wishes) is just ordinary murder. Then again, all euthanasia, even when requested by a supposedly competent person, is, by traditional lights, morally illicit killing and as such a form of murder. Likewise, abetting a suicide is involvement in morally illicit killing; that is, complicity in someone’s self-murder. – DBF
After the destruction of medicine and the distortion of language, the next thing to note about Bill C-14 is its colonization of philosophy and theology. This appears already in its opening gambit:
Whereas the Parliament of Canada recognizes the autonomy of persons who have a grievous and irremediable medical condition that causes them enduring and intolerable suffering and who wish to seek medical assistance in dying [...]
The preamble to the bill, like Carter, asks Parliament to make a fundamental commitment to autonomy, and to autonomy as including the right to take one's own life and indeed to help in taking one's own life when one's 'autonomy' is waning. But this is not merely a legal claim or a legislative commitment; it is based on some very particular anthropological and moral claims.
For example, it assumes that such autonomy is proper to man. Which is to say, it assumes that there is no higher authority – in short, no God – to which man is accountable for the gift of life. This assumption was already made, of course, in the matter of abortion, though the establishment of abortion in Canada was as much a sin of legal omission as of legal commission. (Curiously, it was the current PM's father who saw to the sin of commission.) But what justifies this assumption, or the political adoption of this assumption?
It also assumes that one has this autonomy in dying, though one does not have it in being born or indeed in various aspects of living. One may wish one had not been brought into the world, but one cannot compel one's parents (or the medical technicians who are now getting involved in designer-babies) to act differently than they did. One may wish one's garden were greener, but one cannot compel someone else to tend it. Yet one can compel doctors or nurses to help one take one's life, or even to do it for one?
We might go on with this line of questioning, but we must not overlook the fact that this bill, just because of its legal entrenchment of such assumptions, will have a great many knock-on effects. The Parliament of Canada will recognize as a fundamental moral principle the autonomy of man, atheistically interpreted and understood. What a fine idea of neutrality that is! And what an easy idea to contain!
"There is but one truly serious philosophical problem and that is suicide," said Camus. He was mistaken on that point, though not (in our context) much mistaken, perhaps. But Canadians are not a philosophically serious people. They can deal with a trifle like suicide in a single 'whereas' positing an undefined but quite decisive 'autonomy'. – DBF
'Authority is not given you, Steward of Gondor, to order the hour of your death,' answered Gandalf. 'And only the heathen kings, under the domination of the Dark Tower, did thus, slaying themselves in pride and despair, murdering their kin to ease their own death.' – J.R.R. Tolkien, The Return of the King (The Lord of the Rings, Book V, ch. 7)
Another casualty is the Charter preamble:
In short, the C-14 preamble is the final repudiation of the Charter preamble. “The principles of fundamental justice” (§71) now operate independently of any reference whatsoever to the supremacy of God. The link between “the supremacy of God and the rule of law” is decisively severed. No Peace with Wicked Law
And, most likely, freedom of conscience and religion, the first enumerated fundamental freedom. A futile attempt was made in C-268, a private member's bill, to reinforce it, and in this motion by Arnold Viersen (Peace River–Westlock, CPC):
That, in the opinion of the House: (a) it is in the public interest to protect the freedom of conscience of a medical practitioner, nurse practitioner, pharmacist or any other health care professional who objects to take part, directly or indirectly, in the provision of medical assistance in dying; (b) everyone has freedom of conscience and religion under section 2 of the Canadian Charter of Rights and Freedoms; (c) a regime that would require a medical practitioner, nurse practitioner, pharmacist or any other health care professional to make use of effective referral of patients could infringe on the freedom of conscience of those medical practitioners, nurse practitioners, pharmacists or any other health care professional; and (d) the government should support legislation to protect the freedom of conscience of a medical practitioner, nurse practitioner, pharmacist or any other health care professional.
But such is not the opinion of the House. (214–96 against the motion.) One wonders whether it will be the opinion of the Court. Certainly it is not the opinion of the new Hobbesians, who hunger to see state power wielded against those who cling to the culture of life.
Restriction to the terminally ill, can that be relied on? Apparently not. On 17 May the Alberta Court of Appeal said decidedly not. On 8 June the Senate concurred. The Senate lost its battle with the Government on this matter, but C-14, after all, is just the first stop on the line opened up by Carter. Perhaps this person, or someone like him, would be a candidate for an expanded regime? Another person, Julia Lamb, is already challenging the new bill in the courts. And then there's this case, which may prove to be an example of how it is easier for the state, though not for the patient, to invest in death rather than in palliative care.
Could this girl even be prosecuted in Canada? In any event, encouragement (perhaps a bit more subtle) to suicide will now be far more common in Canada than it used to be.
Background
Warnings from Belgium, including this open letter from 65 Belgian professors, psychologists and psychiatrists opposing euthanasia for the emotional distressed as 'the renunciation of what therapy still can and should be...' Meanwhile, in Holland a team of medical researchers has proposed that doctors be given power to effect euthanasia by organ harvesting.
Canada and California
A response to C-14 from Dr Ferrier and a declaration from the Physicians' Alliance Against Euthanasia
A bold new brief from the CCCB, a submission from the CCRL, and some sound advice from Wesley Hill
At the National Post, Andrew Coyne notes (critically) both the disappointment of some that the bill is too restrictive and the inevitability of restrictions being removed in due course.
For the logic of assisted suicide permits no other outcome. Once suicide has been accepted, as a formal matter of law, not as something we should wish at all times to prevent, but as relief from intolerable suffering; once it has been established that an individual has a right to such relief, not by his own hand but by another’s; once assisting in suicide has been transformed from a crime into a public service, there is no grounds to limit that relief, that right or that service to some sufferers and not to others.
To which it should be added (see below) that the logic of euthanasia goes even further, and is already operative in Canadian society, where we've been aborting or euthanizing unwanted and/or defective fetuses in vast numbers for a long while now.
A reflection on the history of hospitals and of medicine, based on the work of McGill's Faith Wallis.
Report from PDAM, which follows the earlier report from the External Panel on Options for a Legislative Response to Carter v. Canada.
An early response to PDAM:
Together with my brother Bishops, both Catholic and Orthodox, as well as with leaders from the Evangelical Protestant, Jewish and Muslim faith communities, and many of other faiths or of no faith, I urge you to inform your elected officials why euthanasia, assisted suicide and the above recommendations are completely unacceptable. – The Most Rev. Douglas Crosby, OMI
Cardinal Collins issues a statement and speaks on YouTube: It is neither right nor just.
The Coalition for Healthcare and Conscience proposes an alternative approach for legislators, which tries to protect conscience rights for healthcare workers while largely (too largely?) accommodating itself to Carter, or at all events to the language of "assisted death" and the notion that there can be "healthcare" that involves killing so long as there is also healthcare that does not.
From Professor Farrow: The Terminators
I recommend that Parliament not try to maintain the Quebec fiction, which by calling assisted suicide and euthanasia “medicine” erases the distinction between killing and healing, between harming and doing no harm. Let Parliament proceed to isolate both assisted suicide and euthanasia from the practice of medicine. Let it create a policy manual for terminations and a Register of Terminators.
Submission to the Federal Advisory Panel, A Wide View of 'Patient Rights' and letter to PDAM
Advice to Catholic leaders: The Canadian Culture of Death: An Open Letter
See also Letter from a Toronto Jail, La Petite Mort et la Grande Mort and The Ethical Cleansing of the Medical Profession
From the editors at the National Post: Respect the Conscience Rights of All
Andrew Coyne: The Absurd Logic of Assisted Suicide
Letter from the Catholic Bishops of Alberta
Patient rights and the rights of family members must also be respected – that is, their civil right to access medical care for themselves and their loved ones in which there is no pressure to request or to submit to assisted suicide or euthanasia, and indeed their natural right to be served by doctors and institutions that practice only medicine and are not involved in state-sponsored killing. This is essential to maintaining the relationship of trust between patients and doctors or other care-givers. A great many citizens still intend that their doctors, and the institutions to which they entrust themselves at need, be committed to the Hippocratic oath. They must not be deprived of access to such just because there are other citizens who desire assistance in committing suicide. If they are so deprived, this will have far-reaching consequences, disrupting the relationship of trust with the state as well as with the medical community.
More CCCB Letters and Statements
The CBC (which feels that it has been dying with indignity) has apparently taken up the cause of Dying with Dignity: institutions receiving tax dollars must be institutions that kill. This prompts the observation that there are several contests going on here at once:
First, the contest between patients or potential patients: One wants 'care' that kills, another wants care in which caring and killing are not confused. The interests of the former don't trump those of the latter; and the latter have a right to their own institutions, which protect them from that confusion.
Second, the contest between euthanasia activists and religious or conscientious objectors: The former are attacking the Charter rights of individual care-givers as well as the freedom of their institutions, though some fancy that institutions are a softer target. The outcome of Loyola would suggest otherwise, which ought to give the latter some heart; but the former will insist that the right to access terminal sedation must overcome the right to conscientious objection. They will also talk of the right of the patient not to be "abandoned" by their carers, but that is an obviously tendentious manner of speaking, since no one thinks that a doctor or nurse should simply do for a patient whatever the patient wants, or that refusal to do it, if the refusal is rational and consistent with their medical practice, constitutes abandonment.
Third, the contest between people with a modicum of good sense and those who have abandoned even that. The former recognize that tax dollars that go to institutions created and run by religious and other voluntary associations go a lot further than tax dollars that have to stand alone. The latter think that tax-funded national broadcasters, like tax-funded healthcare institutions, should take their side in the contest, of course. – DBF
Note to MPs from St Anselm, apropos of whipped votes:
No one deserts uprightness against his will. For a man can be bound against his will, because he can be bound when he is unwilling to be bound; a man can be tortured against his will, because he can be tortured when he is unwilling to be tortured; a man can be killed against his will, because he can be killed when he is unwilling to be killed. But a man cannot will against his will, because he cannot will if he is unwilling to will... As long as the will is upright it neither is subjected to nor serves what it ought not; and it is not turned aside from uprightness by any alien force unless it willingly consents to what it ought not. – De libertate arbitrii §5
Memo from Leo XIII, apropos even of free votes:
If, then, by anyone in authority, something be sanctioned out of conformity with the principles of right reason, and consequently hurtful to the commonwealth, such an enactment can have no binding force of law, as being no rule of justice, but certain to lead men away from that good which is the very end of civil society. – Libertas §10
Underlined by John Paul II:
Abortion and euthanasia are thus crimes which no human law can claim to legitimize. There is no obligation in conscience to obey such laws; instead there is a grave and clear obligation to oppose them by conscientious objection... In the case of an intrinsically unjust law ... it is never licit to obey it, or to ”take part in a propaganda campaign in favour of such a law, or vote for it.” – Evangelium vitae §73 (see §§ 64-74)
In the euthanasia debate one can hardly overlook the relevance of abortion, and not only as regards the question of referral. (Which isn’t really a question: it is obviously illogical to refer for abortion and not for euthanasia.) Insofar as our society thinks it morally acceptable to kill babies in the womb, it is certain to think that it is acceptable to kill the terminally ill, for it has already decided (i) that human life is disposable and (ii) that eliminating suffering or even inconvenience is a legitimate reason for its disposal. Such a society, note well, is equally certain to go beyond the notion that any suffering person may be killed if they wish to be killed, a form of violence that does not even rise to the level of abortion. It will come eventually to think that it is fine to kill those whom it determines are lacking any real justification for living, perhaps even those whose lives it deems inconvenient, whether or not they are willing. For that is the logic of abortion, a logic already well entrenched in high places. – DBF
Quebec's Bill 52
The PDAM dissenting minority held up the Quebec model as a viable alternative. But the Quebec model is hardly that, despite the claims made for it. Geoffrey Kelley, MNA, was among those who argued that "the principle goal of the proposed legislation is to improve access to palliative care." What this really meant, however, is that what used to be called suicide and murder would now be deemed forms of healthcare, and as such have access even to palliative care institutions, competing with and corrupting the latter. That is one reason why the pioneers and practitioners of palliative care such as Balfour Mount opposed it, as did many others (see e.g. mcgill_professors_and_researchers_against_euthanasia and the statement of the Quebec bishops). Mr Kelley and friends also claimed that, as amended, the legislation accommodates conscientious objection, which is only partly true. It still requires referral, which conscientious objectors regard as culpable complicity.
Bill 52 immediately generated a constitutional challenge, but the deepest issues here cannot be settled by courts. Our view of euthanasia is our view of who and what we are. When the bill was passed on 5 June 2014, a strong majority of the National Assembly endorsed the thesis of Véronique Hivon, MNA, that "Dying with dignity means dying with the least amount of suffering." What this morally absurd thesis does to the very concept of "dignity" few seem to have pondered. Or for that matter what it does to the concept of sacrificial suffering and death – ironically this was the eve of the 70th anniversary of D-Day. Nor should it be forgotten that it was with similar falsehoods that the Nazis embarked on the road on which we have now embarked:
Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the nonrehabilitable sick. – The New England Journal of Medicine, 14 July 1949: Major Leo Alexander Medical Science Under Dictatorship.pdf
The early experience in European jurisdictions that have found their way back to this path does not give much reason to think that the destination is a different one. Very much to the contrary. – DBF
If people are only considered to be economic entities whose value is measured by the quality and/or quantity of their productivity, then what conceivable justification is there for maintaining, at great expense and difficulty, mentally and physically handicapped people and elderly? … [G]overnments will find it impossible to resist the temptation ... to deliver themselves from this burden of looking after the sick and the handicapped by the simple expedient of killing them off. Now this, in fact, is what the Nazis did ... not always through slaughter camps, but by a perfectly coherent decree with perfectly clear conditions. In fact, delay in creating public pressure for euthanasia has been due to the fact that it was one of the war crimes cited at Nuremberg. So for the Guinness Book of Records you can submit this: That it takes just about 30 years in our humane society to transform a war crime into an act of compassion. That is exactly what happened. – Malcolm Muggeridge, speaking at a symposium on Humanae Vitae, University of San Francisco, 1978 (Religious Life, May-June, 1996, p. 9)
Carter v. Canada
The Supreme Court of Canada, apparently, does not find the Dutch experience sobering, or the German or the Swiss or the Belgian, etc. In Carter v. Canada it unanimously declared a constitutional entitlement to "physician assisted death." It even managed to turn the Charter "right to life, liberty and security of the person" into a right to kill oneself and to be helped to do so. Denial of help to do so it determined to be unjust, because "it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable." For the Court, "dignity and autonomy" are an hendiadys, a single idea; and fear of losing the power of autonomy over the timing and manner of one's death is sufficient justification for claiming an infringement of one's dignity of the kind and degree of seriousness that the Charter is there to prevent. The Court wasted no time at all considering the experience of jurisdictions that have already taken this path. It expended no effort to justify its own understanding of dignity, or in pondering its implications. It did not try to say why it thinks that taking one's life, prematurely or otherwise, is an action that deserves positive legal sanction or protection, though of course it was decided some time ago that it did not after all deserve punitive legal sanction. The Court did not try to say why a person should be deemed to have control over the timing and manner of his or her death, or why fear of losing control should be actionable, or why it should be actionable only in the case of those competent adult persons who have "a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." (What is a "medical" condition anyway, and why must it be medical? How is "intolerable" to be measured - will we need a sincerity test? And why must one be an adult?) It did not try to say whether adopting all these rather arbitrary conditions and unexamined assumptions, with their enormous anthropological, theological, sociological, political and professional implications, was a justifiable thing for the Court to do on behalf of Canadian society. It did not pause to consider - though it was asked to consider - whether the move it was making would create conflicts between the new right to assisted suicide/voluntary euthanasia and the fundamental freedoms of religion and conscience to which doctors and nurses and health-care professionals and lawyers and notaries are (like the rest of us) entitled. It did not face the pressing question of how the purveyors of death would be regulated, or how the State's own conflicts of interest, including those generated by the management of health-care costs through the elimination of expensive patients, would be monitored. The Court, it seems, is oblivious to the fact that, whereas rights and freedoms that belong to a coherent moral universe will not produce intractable conflict, however often they may require careful reconciliation in practice, rights that are thus constructed willy-nilly in a chaotic moral multiverse are sure to generate such conflict. In fairness to the Court, it did spend rather a lot of time wrestling with knotty questions as to how the bills for Carter should be paid. But have the bills even begun to come in? And have we the capital, the moral capital, to deal with the ones that will matter most? – DBF (18 Feb. 2015)
Watch the Religion and Conscience in Court panel on Carter (18 Nov. 2015)
I predict that history will see each society’s decision about euthanasia as its turning-point values decision of the 21st century. – Margaret Somerville
Disclaimer: The perspectives that find expression on this page are those of the author(s) in question or of the site editor. They are not intended to be representative of McGill University or of any unit within the university.