Professor Margaret Battin:

I am happy to be here. There are two kinds of question that we need to consider. Since I know Dr. Komrad already, I think we will be disagreeing about various issues. The first kind of question is the matter of basic principles. What are the basic moral principles – my field is philosophy, hence my concern with this – that speak for or against medical aid in dying? There are two basic principles that should be honoured in any context.

The first of these is autonomy, where that is possible, and the second is the avoidance or relief of suffering. One should not make someone suffer, fail to relieve their suffering when that is possible or consign them to suffering when one could reasonably do otherwise.

The other kind of basic question that arises is about practical concerns. These are often concerns about the possibilities of abuse, the slippery slope, what the data show, what sorts of conclusions can be made, if there are abuses, if the safeguards are adequate, or if there are safeguards at all. I believe we will be hearing more about these issues from Dr. Komrad. Of course, we can discuss that.

I should point out that the original discussions about medical-aided dying, when it was still being called “physician-assisted suicide”, came from entities such as the American Medical Association, AMA, the British Medical Association, BMA, the Canadian Medical Association, CMA, and many others. They all expressed concerns and they based their opposition on the idea of the slippery slope. This is the fear that vulnerable groups would be encouraged, manoeuvred or somehow forced into ending their lives. The data we collected from Oregon and the Netherlands showed that this was in fact not true for ten groups of people in so-called vulnerable categories. In fact, just the opposite was the case. Who is getting medical aid and dying? These are quite affluent, well-educated, socially secure, non-disabled, non-minority people who are not in vulnerable categories, in all the usual senses. Therefore, that basis of objection has been largely overturned. It does not mean there are not any problems of equity, but it is people of privilege who have been getting this service, rather than the other way around.

The tensions here will be about prescriptions to patients. These are ongoing. The interest of the committee is regarding what is going on in the US. Prescriptions are made, patients receive them, take them home and use them when they want. This is compared with standard-of-practice developments, such as those that have been put forward by the new American Clinicians Academy on Medical Aid in Dying. It is a highly developed although quite medicalised set of considerations for practice.

Then there are problems with the requirements in the various statutes in the ten states in the US, as well as the District of Columbia, where this is legal. Does it have to be oral? Can it be gastrointestinal? What about self-administration? What about residency requirements and many other such things? That is just a small overview of what is at play here, although I think the central issues are regarding the positive aspects of medical aid and dying. Why should we regard this as honouring the basic principles of the position that I have just mentioned, such as autonomy, relief of suffering and, perhaps, other basic principles?