Dr. Mark Komrad:

I would add Canada to that list of countries where terminal illness is not a requirement.

There are several considerations here in terms of why these things grow. First, in all of the living laboratories where this has occurred, in those countries that the committee has just heard about that have been at this for a while, as well as in Oregon, wherever one draws a line of eligibility based on contemporary ethical values, in addition to autonomy, fairness and justice, for example, people just on the other side of that limitation begin to make a case and ask "Why not us?". If the line is a six-month prognosis, they ask "Why not seven?" If it is a 12 month prognosis, they ask "Why not more?". If the line is assisted suicide drugs, they ask "Why not euthanasia, where doctors can start intravenous administration if we are not capable of doing it?" They will ask "Why not 17; why 18 only?" They will ask "Why only people with capacity; how about people with incapacity who have proxy consent?". There has always been, in every example, an expansion in the eligibility.

As someone who deals with suicide, both on an individual and a public health basis, the other point I would make is that there is a tremendous doubt as part of suicide prevention, not for stigma but for taboo. There is a difference and if someone wants to get into a discussion on that difference, we can do so. Removing the taboo on suicide by creating this zone of not only accepted suicide but suicide that can even have a romantic component, with stories, songs, newspaper articles, services and so forth, is very significant.

There is significant literature, which I will be glad to provide, on the trauma experienced by the families of people who have had assisted suicide and the physicians who were administering physician-assisted suicide. There is considerable literature emerging on the traumatic aspect of this. The committee should not take this as a beautiful, peaceful paean to dying.