Advance directives preserve choice

The assisted-dying bill (Bill C-14) was passed in Canada almost a year ago, but not without its detractors — on both sides of the issue.

Opponents of the bill were concerned that vulnerable populations, such as those with disabilities or mental-health issues, might opt for this extreme measure as a result of inadequate or non-existent health and social supports.

Proponents of assisted dying, on the other hand, felt the law didn’t go far enough because it’s limited to those whose deaths are reasonably foreseeable, thus preventing those with chronic or neurological conditions from having an autonomous choice to end intolerable suffering.

Now, lobbying efforts are underway to expand the assisteddying legislation to include advance directives.

Advance directives are legal documents that allow patients to spell out their wishes concerning end-of-life care. When medical decisions are required, the document helps to avoid confusion about one’s true desires in case of ailing health or incapacity.

Critics reject euthanasia as an option in advance directives specifically for cases involving future dementia. But the grounds for limiting patient choice are problematic for several reasons.

For starters, opposing viewpoints are often inconsistent. One of the primary claims against advance directives for assisted dying is that they don’t protect patients who can no longer make or express decisions for themselves. But patients in various states of unconsciousness are already incapable of making endof-life decisions. Yet, acting as a legal surrogate, the next of kin can request termination of a family member’s life-prolonging treatment, often without prior knowledge of the patient’s wishes.

Another common critique forwarded by detractors suggests that many doctors might find it difficult to comply with euthanasia requests because the individual who signed the advance directive may be a different person psychologically than the person they are now. Yet this is precisely why some individuals demand the right to sign advance directives.

For some, losing the ability to think rationally is an affront to personal dignity. The person may not be able to recognize their former self; they may no longer be that person. Biologically speaking, the patient is alive, but, in the case of dementia, some may believe one’s biographical life is essentially over.

Finally, critics often point out that family members may deny a proactive request for euthanasia in cases of dementia because they’re uncertain about the patient’s current state of mind or degree of suffering. Yet these same feelings of anxiety already exist in situations where family members must determine when to stop medical interventions.

In other words, whether the patient’s life ends by a negative act (withholding nutrition and hydration) or by a positive act (lethal injection), families would experience similar doubts and anxieties. The point of an advance directive is to prevent another’s moral sensibilities or angst from overriding an individual’s preference for euthanasia.

Advance directives that include euthanasia for future dementia would help make clear, and preserve the right to, a patient’s choice. It would also prohibit governments, hospital authorities or family members from imposing their own version of the good life — or good death — on the patient.