The Fletcher Effect

I like Stephen Fletcher. Our brief encounters, typically in airports or the occasional public event, are always friendly and cordial. It is hard not to admire him. Despite quadriplegia, he has found the strength and determination to serve his country as a Member of Parliament, at various times holding appointments as Minister of State (Democratic Reform), Minister of State (Transport); and currently, as a member of the Treasury Board Cabinet Committee. As of late, Mr. Fletcher has been focusing his formidable energy on promoting physician-hastened death. It appears many share his perspective, with public opinion and legislative reform starting to turn his way. Just last month, the Supreme Court of Canada overturned the prohibition against assisted suicide.

According to a recent IPSOS Reid poll, nearly 70 per cent of Canadians support the availability of death hastening alternatives for people living with significant disabilities that might impair their quality of life. In other words, Canadians find it inconceivable to imagine themselves confined to a body that even remotely approximates the one Mr. Fletcher now permanently resides in. While the majority of Canadians admire him, at some level I suspect they are afraid of the abject vulnerably his life proves is possible within the repertoire of human experience. This fear is so deeply seated that they imagine themselves preferring death. For anyone wondering why physician-hastened death makes disabled people feel vulnerable, wonder no more.

Human beings are not good at predicting how they will react in circumstances that have yet to unfold. While Mr. Fletcher argues that death should sometimes trump disability, studies of people who become disabled due to spinal injuries, head trauma or strokes, offer a strikingly different perspective. Just under 10 per cent of these patients become suicidal and the majority relinquish their wish to die within a year or two. In his biography, What Do You Do If You Don’t Die?, Mr. Fletcher recounts suicidal thoughts that lingered long after his catastrophic accident. He says that had doctor-assisted suicide been an option after his 1996 car accident, he would have considered signing up and checking out. Thankfully, it was not. His recovery took determination and strength, but such is the stuff that Stephen Fletcher is made of. It also took the support of family and friends, the unwavering commitment of medical professionals and it took time.

Those of us working in health care understand that life-altering illness, trauma or anticipation of death can sometimes sap will to live. In those instances, health care providers are called upon to commit time; time to manage distress, provide unwavering support and to assuage fear that patients might be abandoned to their hopelessness and despair. That is the essence of how medicine has traditionally responded to suffering. Stopping time by way of arranging the patient’s death has never been part of that response. In light of the decision by the Supreme Court, we must now contemplate Canada’s future euthanologists. What professional designation will they require? What disciplines will they be drawn from? What training will they receive? What ethical and practice guidelines will they abide by? And what judicial oversight will they submit to?

Mr. Fletcher and I, along with Professor Margaret Somerville, spoke at a recent forum on euthanasia and assisted suicide. Mr. Fletcher said he did not want to die drowning in his phlegm and in pain. I assured him, on behalf of Canada’s palliative care community that we would not let that happen. He said that he did not want to be reliant on machines to keep him alive. I told him that competent Canadians, under our current laws, are entitled to refuse or discontinue treatment, including life-sustaining measures. He described autonomy as a core Canadian value. I reminded him that autonomy has its limits, particularly when it causes others to feel more vulnerable and implicates the physician’s role in response to suffering.

Mr. Fletcher says he has received supportive letters from across the country from people who fear what dying will look like. With too few Canadians having access to palliative care, there is little wonder that people are afraid. Offering the option to have their physician end their lives feels akin to confronting homelessness by eliminating guardrails from bridges. Nonetheless Mr. Fletcher feels that safeguards, such as a ‘cooling off’ period to establish that a request to die is sincere, not coerced and sustained are possible. If so many in your circumstance change their mind, I asked him, do we now require a two-year waiting period? His response was, “maybe.”

To be fair, perhaps Mr. Fletcher has not contemplated these particular complexities. He may not have considered how asking physicians to stop time could undermine their most powerful response to suffering. His voice has become an important one in how we conceive of disability, death and dying and no doubt is one that all Canadians anxiously await to hear.

(Mr. Fletcher was provided the opportunity to respond to this editorial; he declined to do so).

By Dr. Harvey Max Chochinov

Dr. Harvey Max Chochinov holds the only Canada Research Chair in Palliative Care. He is the Director of the Manitoba Palliative Care Unit, CancerCare Manitoba, and Distinguished Professor, University of Manitoba.