Idelson Guerrier, 31, is innocent until proven guilty. Given his symptoms of severe paranoia, it is entirely possible he will be found not legally responsible for his actions even if a court concludes he committed the killings and the assault. Justice will out.

What matters to the medicalized killing debate in this horrid circumstance is the real world, real time hole it blows in all claims that medically delivered death can be forced into our public health care system with effective safeguards. 

The incidents between June 16 and June 22 occurred in a setting where patients are locked away from the main building for the protection of themselves and others, where there is one staff member for every two patients, and where those under care are checked every 15 minutes. It is a place that should be as safe as any imaginable safeguard could make it.

Yet two murders went undetected for 11 days, and were found out only because a third victim was attacked but not killed. How could this happen? A chilling explanation in the Globe and Mail, quoting the head of the psychiatry at the hospital, says it all.

“The two deaths raised no initial suspicions because the patients were old and suffered from other serious illnesses, Dr. (Paul) Lespérance said,” wrote Globe reporter Les Perreaux

The patients were old. Old? One of them was 69 — 69! That’s four years after normal retirement age and 10 years under the normal life expectancy in Quebec. So someone who has been retired for four years suddenly dies in bed, and no one bothers to ask why? Oh, but both patients (the second was 77) suffered from serious illnesses. So two people inexplicably expire in a hospital where patients are checked every 15 minutes, where a violent criminal is present, and no one asks why? No one wonders how “serious illness” became instantaneous death?

The focus of such questions is not the competence or the attentiveness of the staff. It is what the questions themselves reveal about the prevailing institutional attitudes within our public health care system, and society in general. It is what those attitudes, in turn, say about any possibility of building so-called safeguards into medicalized killing.

Those attitudes confirm that anyone who believes in the possibility of safeguards for medical killing is delusional. Even in the existing medico-legal environment, administered death can stalk the hallway, pick a room at random, and no one’s eyebrows rise. Is it not abundantly obvious what will happen if the current prohibitions on medicalized killing are shredded?

Paint the picture. A doctor or nurse is on a ward at midnight faced with a patient who is — what was that word again? — old and suffering from — what was that phrase again? — serious illness. The option of medical killing is very much alive. But there are “safeguard” forms to be filled out, signatures to be collected, colleagues consulted, and bureaucratic busy bodies will stick their noses in. Or there is the simple, immediate slip of a needle into an arm that will bring at worst a slap on the wrist, assuming eyebrows are even raised, questions even asked.

No laws will be broken. No criminal sanctions attend. How much easier will that slip of the needle be the next time, and the time after that? Where will the vaunted safeguards be then?

This is no longer — if it ever was — some slippery slope fantasy. It is an entirely predictable course evident from the demonstrable conditions even in specialized facilities such as the Centre Hospitalier Université de Montréal’s psychiatric unit. If there is a saving grace of the terrible tragedy, it will be that it stops us in our tracks from following death-wish obsessives down the path to medicalized killing.