The Inevitable by Katie Engelhart

Author:Katie Engelhart [Engelhart, Katie]
Language: eng
Format: epub
Publisher: St. Martin's Publishing Group

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IN 2015, CANADA’S Supreme Court overturned the country’s ban on assisted death, ruling it unconstitutional. The Canadian Parliament was given one year to translate the new judgment into law and to define its practical borders: who would be eligible and who would not. Lawmakers could be as expansive as the court allowed or add additional criteria and safeguards, narrowing the dimensions of access. Adam read the text of the Supreme Court decision closely and was surprised by it. It said that a competent Canadian resident had the right to physician-assisted death if he had a “grievous” and “irremediable” medical condition that caused him to “endure physical or psychological suffering that is intolerable.” It said nothing about terminal illness or imminent death. There was no requirement of a physical pathology at all; psychological suffering was enough. The Canadian court seemed to care less about the cut-and-dried particularities of a prognosis—how much life span was left, what part of the body was diseased or broken—and more about the subjective experience of the patient, who alone could decide whether his suffering was unendurable. It seemed to Adam that the Canadian court had theoretically cleared the way for an assisted-dying law that included him.

Almost immediately, the Parliament and press began debating the limits of the would-be law, and in particular whether it should include people whose primary sickness was psychological. The Federal Special Joint Committee of the House and Senate on Physician-Assisted Dying heard testimony from both sides. Proponents argued that the law should be more elastic than its American equivalents in the kinds of suffering it recognized. They cited reports showing that mental suffering could, in some cases, be worse than physical pain. A large study of subjective well-being in Germany, for instance, had found that only end-stage liver disease was experienced as more severe than some mental disorders.

To the hardest-core advocates, the exclusion of mental illness was not just overly cautious but also ethically dubious, because it privileged physical over mental affliction. For years, healthcare officials had been working to destigmatize mental illness, in part by disputing the notion that mental illness was the fault of the sufferer or that it was somehow less than physical pain. Or less real. Advocacy groups had also challenged the perception that anyone with a mental illness was out of control or out of his mind, and so unable to recognize his own interests, much less act on them. They had made progress. But rejecting patients with mental disorders from an assisted-dying law would seem to communicate, “Your suffering is absolutely serious and real … unless you want to die, in which case it is not. In that case, we know what’s best for you.”

In Toronto, Dr. Justine Dembo, a young psychiatrist with pale skin and dark hair, followed the debate from Sunnybrook Hospital, which had become famous for treating disabled soldiers after World War II. Her third-floor office was small and sparse and cold and had a single window overlooking a garden built for the veterans.

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