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PHL281H1 Lecture Notes - Involuntary Euthanasia, Sue Rodriguez, Palliative Sedation

Course Code
Donald Ainslie

of 4
Limits to Informed Consent: Physician Assisted Suicide
NOVEMBER 21, 2011
-Eu (well) + Thanatos (death) - is a sloppy word, its the same word used as euphony .. Etc -
its a bad word bc it gets used in some many different ways
- there is a distinction btw:
-Active vs. Passive (Let someone die by not giving them a treatment) euthanasia
- Killing vs. Letting Die
-Voluntary vs. Involuntary
- V = whtere the killing or letting die is at the patients request or able to make that re-
quest, or if its involuntary
- All 4 cut across one another
Passive Involuntary Euthanasia
“Pulling the plug”
- you have the plug pulled of all keeping you alive
- Invol bc you cant make the decision and passive but removing something that will make u die.
Used to be thought to conflict with principle of nonmaleficence - (4 principles of medi-
cal ethics) - it used it not be acceptable eon the part of hp bc it would harm the patients causing
them to die
Now recognized to be legitimate in SOME circumstances. I.e. You only need temporary
support of something knowing may recover and someone pulls the plug - if it were something
that was put forwards in a past direction Ie wrote a will that if ever on a ventilator dont want to
live, you can put in directions as when you are no lonher competent using your own CD
Can also be illegitimate - if a nurse decides, letting die bc
“Futility” - in HC ethics, HP would want to treat professional no matter what, had to go to
court to not have the treatment done, there was a reaction when the CD came out, but with rlg
commitments and bioethics of everday life, keep you alive not matter what, but for a doctor they
would say thats Futile, in an attempt to say they know best and and whats best is to not give the
treatment which is Futile.
Passive Voluntary Euthanasia
- passive not being killed directly but you are refusing treatment and vol that you are a compe-
tent decision maker = LEGIT
Refusing life-sustaining treatment
Can be legitimate
Can it be illegitimate when chosen by an autonomous person? Hard to say that it would be
Active Involuntary Euthanasia
Active= a killing i.e. An injection & invol = not asking that it be done to your
Some cases are clearly wrong: murder
- some cases where its a human thing to do, i.e. Putting a animal to sleep we think its the human
thing to do to inject them with something that cases ther death BUT we dont think that for human
beings, if someone cant make a decision i.e. Final stages of a disease or an old age, and it may be
justified? Is the sufficient to say that we shoul dmake human animals stay alive until their last
Compare treatment of pets
Terminal sedation: someone who is dying is giving drugs and be sedated and no longer giv-
en food or drink and thus they die - its considered justified, depending on who makes the deci-
sion and the facts of the case, but if you are competent to make that decision you are knowledge-
able enough to make the decision and a doc cant do anything againt their will, but who makes the
decision to put under sedation and not feed you etc
**Active Voluntary Euthanasia
Act - killing Vol - free choice = Physician-assisted suicide (a suicide, not eu-
thanasia, bc its done by the person in ?) - main person doing it is the patient.
Intense controversy in past 20 years
Kevorkian - doc who hooked ppl up to the mechines to help you die
Netherlands - holand has it
Current “Select Committee on Dying with Dignity” in Quebec;
Sue Rodriguez (was the focus of intense debate that lead to the supreme court)
Diagnosed with ALS (“Lou Gehrig’s Disease”) in 1991 at age 40;
Requested to the courts that law against assisted suicide be struck down
Lost in BC Court of Appeal and SCC • Killed herself illegally, with physician assistance, in
s. 241 of the Criminal Code
Everyone who (a) counsels a person to commit suicide, or (b) aids or abets a person to commit
suicide, whether suicide ensues or not, is guilty of an indictable offense and liable to imprison-
NB: Attempted suicide decriminalized in 1972
The Rodriguez Case
5-4 decision to sustain s. 241
Sopinka (with La Forest, Gonthier, Iacobucci, and Major)
CJ Lamer dissenting, with separate dissents by McLachlin (with L’Heureux- Dubé) and
McLachlin (she is not done when she does section 7 analysis and also has to
look at s.1)
Appeals to Morgentaler, using s.7*** (short answer) to argue that s.241 violates Char-
“security of the person” limited
Such limits do not comport with PFJ
Arbitrarily “scapegoats” those who have disabilities and who can’t commit suicide on their
own; the restrictions on what she can do woth her body are not set up in a way that conform
with the restrictions of fundamental justice; there are was in which it may be a good things,
but she is being asked to bear the burdent that other ppl may corerse others into killing
those, the law is escape goating those, so that some ppl wont corerse others into killing
themselves in an inappropriate way. What he is saying that the limits end up leaving her
bear the blame of others potential missbehavior. And so there is section 7 is violated
Makes them bear the burden of the fact that others might coerce the disabled to commit sui-
by prohibiting it sect 241 B, she cant control whats happening to her body but this talks
about the security of the person, she is disabled and not able to determine what happens to
her body and she is therefore not able to help you
Sopinka (writes for the majority)
Accepts that s.7’s “security of the person” is limited (limits to s.15 are also possible)
He admits that 7 is violated; the security of the person is limited and The limitations comports
with the security of the person bc he takes the sancity of life to be a principle of fundamental jus-
tice bc it supports the sancity of life. -
Holds that the limits comport with PFJ
“sanctity of life” as a PFJ -
Appeals to R. Dworkin! suicide may be a way to resp the sanctity of life
He shows how SofL can be shown in a non rlg manner but this is the worst decision to
have ever been made
“the active participation by one individual in the death of another is intrinsically morally
and legally wrong” ; one of his core positions that stands behind his rjecions to the chal-
lenge of 241 b, - is that true quote?
Intent matters in the criminal law
s.1 Analysis
Section 1 says that it is acceptable for Parliament to pass laws that violate Charter rights, so long
as doing so “can be demonstrably justified in a free and democratic society”
Oakes Test
The violation of the right must: 1. Serve a sufficiently important end 2. In such a way that
there is proportionality between
the legislative ends and the means thereto, i.e.:
a. There is a rational and non-arbitrary connection between the legislated means and its ends;
b. The means impair the right as minimally as is possible;
c. The effects of the right’s limitation by the legislation are proportional to the legislation’s end.
Sopinka’s s.1 Analysis
Legitimate government aim: protecting human life
Rational connection is clear