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Hill Dispatches: Assisted suicide -- what are we talking about?

News coverage of the Royal Society's just-issued expert panel report focuses on the recommendation that Canada make doctor-assisted suicide legal.

The report says that "assisted suicide and voluntary euthanasia should be legally permitted for competent individuals who make a free and informed decision." And that "Canada should have a permissive yet carefully regulated and monitored system with respect to assisted death."

The experts who wrote the report say that most Canadians would support that change in the law. The Royal Society engaged a group of experts that includes doctors, medical ethicists and philosophers.

A national conversation

Experts don't make law, of course, certainly not with the current government. And, maybe, on fundamental matters of values and ethics society should not rely on experts alone.

The report recognizes that reality. It says its purpose is as much to provoke a national conversation as to suggest changes in the law.

"Canadians do not talk enough about the end of life," the report notes, "On a personal level, many of us do not plan for it, and as a nation we have failed to develop coherent policies or set sufficient standards for the end-of-life care delivered every day all across the country."

Before we can have that conversation, the report urges, we have to understand what it is we are talking about.

"Frequently people discuss these issues at cross-purposes," it says, "using the same term to describe different practices or using different terms to describe the same practice. This can lead to unnecessary and unproductive confusion and conflict."

And so, in what could be the most influential and enduringly useful aspect of the report, it attempts to provide us all with basic tools for understanding and dealing with these complex and difficult issues.

No conversation will make sense unless we can all agree as to what we are talking about. When we are dealing, literally, with life and death matters -- matters that naturally evoke profound emotional reactions -- it is important to be able to talk to each other in a clear and mutually comprehensible way. One of the many important contributions of the Royal Society expert panel report should be to help us do that.

The power of words

Here is the way the report talks about some of the key words we use to describe and understand assisted suicide:

"Assisted dying" is an umbrella term used to describe the full spectrum of
conduct defined above that contributes to the death of an individual.

"Withholding of potentially life-sustaining treatment" is the failure to start
treatment that has the potential to sustain a person's life. An example is not
providing cardiopulmonary resuscitation to a person having a cardiac arrest.

"Withdrawal of potentially life-sustaining treatment" is stopping treatment that
has the potential to sustain a person's life. An example is the removal of a
ventilator from a patient with a devastatingly severe head injury after a
motorcycle accident with no prospect of improvement.

"Advance directives" are directions given by a competent individual concerning
what and/or how and/or by whom decisions should be made in the event that the individual becomes incompetent to make health care decisions.

"Potentially life-shortening symptom relief" is suffering control medication given
in amounts that may -- but are not certain to -- shorten a person's life.

"Terminal sedation" is potentially life-shortening deep and continuous sedation
intentionally combined with the cessation of nutrition and hydration.

"Assisted suicide" is the act of intentionally killing oneself with the assistance of
another. An example is a woman with advanced ALS who gets a prescription from her physician for barbiturates and uses the drugs to kill herself.

"Voluntary euthanasia" is an act undertaken by one person to kill another person
 in accordance with the wishes of thatperson. An example is a man bedridden with many of the consequences of a massive stroke whose physician, at his request, gives him a lethal injection of barbiturates and muscle relaxants.

Facts, as well as words

Although Parliament is not likely to take up this issue in the short term, the rest of us can still carry on the conversation.

The Royal Society has made an important contribution in providing a basis for that conversation.

The question of words, of terminology, is important. But, in addition, the report contains much valuable information about the state of palliative care in Canada, about our end-of-life preparedness as a society and about the many other aspects of this issue.

Its recommendations are headline-grabbing, and deservedly so. But the report itself, in its entirety, deserves our attention as we start, again, to grapple with the deeply troubling but essential question of how we end our lives.

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