Assisted suicide raises difficult questions
By Michael Swan, The Catholic Register
Dying is no fun and it never was. But adding doctor-assisted suicide into the mix only seems to have made things more complicated.
Do you now need a lawyer to tell your doctors you don’t want assisted suicide when your death becomes foreseeable? A Catholic lawyer and partner with the legal firm of Miller Thomson LLP says no. But medical ethicist Fr. Mark Miller recommends adding a line about rejecting the suicide option, just in case.
Over the past 20 years Miller has become very knowledgeable in advance care directives and Powers of Attorney (POA) for personal care. When he was a parish priest in Saskatchewan, the Redemptorist priest used to bring in a lawyer one Sunday a year, set up tables in the back of the church and, armed with booklets on planning for the inevitable, serve up coffee and doughnuts to get people talking about what happens when they can no longer make medical decisions.
“It’s just getting them beyond that psychological barrier. It’s almost like a superstition that if we talk about it something is going to happen,” said Miller. “People don’t like to talk about death and dying. They sort of throw up their hands, not quite sure they know where to begin.”
Lawyer Rosanne Rocchi sees the same phenomenon among her clients.
“People find this difficult to talk about. They don’t want to have this discussion with their family. If they start thinking about it, the reflection on who they are going to choose (to make medical decisions), what’s going to happen — it’s depressing,” she said. “No one wants to anticipate a dispute between and among their children.”
But bitter family fights that drag up old resentments and rivalries are exactly what does happen all too often when people don’t plan, said Miller. Still, he shies away from saying Catholics have a duty to write a Will and set up a POA for personal care.
“It sounds like we’re going to force you to do it whether you want to do it or not,” he said. “So my response would be to say there’s a responsibility to prepare for your death. It takes the pressure off everybody if your wishes are known.”
Rocchi would love to see more parishes help their parishioners get the planning process under way. Most people should consult their lawyer, but it makes things clearer and keeps the costs down if people know how things work before they see a lawyer.
“It’s a good idea for parishes, if they can, to get somebody to do an evening session perhaps with coffee and doughnuts — just an opportunity to give them the broad outlines,” said Rocchi. “That will save them on their legal fees, because they will know the right questions to ask.”
Of course, people try to avoid paying lawyers.
“There are kits that you can pick up, but inevitably they are filled in wrongly and it costs more to fix things,” Rocchi said.
There are lots of things a lawyer can’t do. A lawyer isn’t a doctor, so if you’re worried about particular medical conditions or procedures it is best to discuss them with your family doctor, said Rocchi. And lawyers, trained to compose legal documents, aren’t necessarily better than you are at expressing your basic values and attitude toward dying.
“I usually tell clients there’s only so much you can put in the actual Power of Attorney for personal care,” she said. “In your own language, in your own handwriting is preferable, set out the things you would like to happen.”
The lawyer’s job is then to ensure the document is legally enforceable.
A POA for personal care isn’t just about dying. It applies to things that can happen years before death — a stroke, dementia, psychological illness — that might make it difficult to either make decisions about medical care or to express your desires.
A critical decision has to do with who gets appointed to which role. The most frequent dispute Rocchi sees is between the person with Power of Attorney for personal care and the person in charge of the money. Often the caregiver, who doesn’t have access to the funds, is boxed in by the daughter or son with signing authority at the bank.
People should also think about just when they would rather say no to any more surgeries.
“Most people, as they get older, they think, ‘If I have to go through another general anaesthetic and a stay in hospital and be exposed to pneumonia and hospital viruses — no thanks,’ ” she said.
Make sure you have somebody who really understands what you would want in the role of deciding when it’s time to opt for palliative care, which medical procedures are too invasive or marginal or burdensome and, to the extent you have a choice, what care facility might be best.
“After years of experience in these things, my key insight is the importance of appointing a substitute decision-maker,” said Miller.
With a task force working in Ottawa to consider whether assisted suicide should be expanded to include mature minors, the mentally ill and to see whether the procedure could be triggered by an advance care directive, Miller believes Catholics now must take an extra step.
“In all the documents that I have ever prepared, there’s a very clear statement that under no circumstances is there to be euthanasia or assisted suicide,” he told The Catholic Register.
Rocchi takes a different view. The substitute decision maker, who holds the Power of Attorney for personal care, can only exercise the powers laid out in the document.
There can be no legal case for a substitute decision-maker calling for assisted suicide, she said. Nor does Rocchi believe Ottawa is about to allow advance care directives to trigger so-called medical assistance in dying.
“There’s so much elder abuse within the country, I don’t think the committee is going to recommend that. I honestly don’t,” she said.
Getting our affairs in order should be about helping your spouse, children and friends face your death without confusion or conflict, Miller said.
“I was working in Saskatchewan and somebody had one of our advance care directives, brought it to their doctor, and the doctor said, ‘This is so helpful. I wish that everybody had something like that,’ ” said Miller.
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