The fight for the right to die

In the early 1990s, Sue Rodriguez forced the right-to-die debate into the spotlight in Canada, and it came to a head with the Supreme Court of Canada narrowly deciding (5-4) in September 1993to disallow her plea for a physician-assisted death.

Since then the issue has been in and out of the headlines, but now it is back, thanks to theQuebec government introducing Bill 52, an act respecting end-of-life care, in June 2013.

The debate also regained prominence afterDr. Donald Low, a Toronto microbiologist who helped ease public concern during the 2003SARS crisis, made a plea for assisted suicide in a posthumous video released in September 2013.

Under Quebec's bill, a doctor who receives the repeated consent of a patient could administer medication to cause death. The patient must be a Quebec resident with a valid provincial medicare card.

If the bill becomes law, it will be the first of its kind in Canada to legalize physician-assisted suicide. The bill cleared clause-by-clause study by a committee of the National Assembly in January 2014.

In 1991, ina video statement played to members of Parliament, Rodriguez, diagnosed with amyotrophic lateral sclerosis (ALS, orLou Gehrig's disease), asked legislators to change the law banning assisted suicide.

"If I cannot give consent to my own death, whose body is this? Who owns my life?" asked the Victoria woman.

The Supreme Court of Canada ultimately ruled against Rodriguez, but her struggle galvanized the public. Rodriguez committed suicide in 1994 with the help of an anonymous doctor.

In Canada, as in most countries, assisted suicide is illegal, but there seems to be a growing movement toward changing the law.

A battle in B.C. between the provincial and federal governmentswas sparked by right-to-die activist Gloria Taylor, who suffered from amyotrophic lateral sclerosis anddied Oct. 4, 2012. That battle has now made its way to the Supreme Court of Canada, which said in January 2014 that it would hear an appeal from the B.C. Civil Liberties Association, seeking to overturn the legal ban on doctor-assisted dying.

• Assisted-suicide crusader Gloria Taylor dies in B.C.
• Read about the B.C. Court of Appeal hearing

What is the difference between assisted suicide and euthanasia?

Assisted suicide occurs when a person typically someone suffering from an incurable illness or chronic intense pain intentionally kills himself with the help of another individual.

For example, a doctor may prescribe drugs with the understanding that the patient plans to use them to overdose fatally. Or a doctor may insert an intravenous needle into the arm of a patient, who then pushes a switch to trigger a fatal injection.

Assisted suicide differs from euthanasia, in which someone other than the patient ends the patient's life as painlessly as possible.

Euthanasia may be active, such as when a doctor gives a lethal injection to a patient.

It can also be passive, in cases where a physician doesn't resuscitate a patient whose heart has stopped. Or it can happen when a doctor removes life-support equipment.

When did assisted suicide become a legal issue?

Philosophers have contemplated the concept of "a good death" since ancient times. However, individual choice over dying only surfaced in intense public debate in the 1970s.

'In April 2010, a large majority of parliamentarians voted not to change these laws, which is an expression of democratic will on this topic. It is an emotional and divisive issue for many Canadians.' Federal Justice Minister Rob Nicholson

Until then, anyone found guilty of attempted suicide in Canada and in many other countries could face jail time. The federal government decriminalized attempted suicide in 1972.

The legal right to turn down medical treatment emerged at the same time, as technological advances in medicine allowed doctors to keep patients alive longer.

A series of court cases in the 1970s won a mentally competent person theright to refuse medical intervention.

The debate over patient autonomy now centres on issues of active euthanasia and assisted suicide, as patients who live in chronic intense pain or with a degenerative or terminal illness such as multiple sclerosis, AIDS or Alzheimer's disease fight for the right to choose to die.

Why is it an issue?

People who want assisted suicide to be legalized believe that individuals should be able to control the time and circumstances of their own death. Some argue that actively causing one's own demise is no different from refusing life-saving treatment.

Opponents fear that vulnerable individuals may be coerced into assisted suicide to ease the financial burden of caring for them. They also worry that assisted suicide could ease pressure to provide better palliative care and find new cures and therapies.

Some religious opponents argue that God, not humans, should decide the time for death. And many medical professionals maintain it is never morally permissible for doctors to help kill a patient.

What is the law in Canada?

The Criminal Code of Canada outlaws suicide assistance, with penalties of up to 14 years in prison but opponents have recently challenged the law's constitutionality in court.

The Rodriguez case was the most famous. The 42-year-old B.C. woman, who suffered from amyotrophic lateral sclerosis, or Lou Gehrig's disease, asked the Supreme Court of Canada in the early 1990s to be allowed to kill herself with a doctor's help.

She argued that the ban on assisted suicide violated the Constitution by curbing her rights of personal liberty and autonomy guaranteed in the Charter of Rights and Freedoms.

The court narrowly rejected her argument in 1993, ruling 5 to 4 that society's obligation to preserve life and protect the vulnerable outweighed her rights.

However, several judges suggested Canada's laws might need to be changed to help people like Rodriguez.

In December 2008, a Quebec jury acquitted Stphan Dufour on a single charge of assisted suicide. Dufour had admitted to installing in a closet a rope, chain and dog collar that his uncle, Chantal Maltais, used to kill himself in September 2006. Dufour was the first Canadian ever to stand trial by jury for assisted suicide.

In the most recent challenge to assisted suicide legislationthe Gloria Taylor case that is being backed by the B.C. Civil Liberties Association and two other plaintiffsB.C.'s Supreme Court ruled in June 2012 that the federal ban on assisted suicide contravenes Section 15 of Canada's Charter of Rights and Freedoms. Judge Lynn Smith gave Taylor an immediate exemption from the law, which she did not useTaylor died on Oct. 4, 2012, of complications from her illness.

• Assisted-suicide ban struck down by B.C. court

The B.C. courtruled at the same time that the federal government must draft new legislation within a year that conforms with Canadians' rights under the Constitution. Smith deemed the existing law unconstitutional because it unfairly deprives people with degenerative illnesses of their liberty, and because it discriminates against those with a physical disability who might need assistance to exercise their right to take their own life.

The federal governmentappealed the ruling, takingthe battle to the B.C. Court of Appeal, which held hearings in March 2013 and overturned the lower court's ruling seven months later.

The BCCLA then asked the Supreme Court of Canada to hear an appeal of that ruling, arguing criminal laws that deny seriously ill Canadians the right to choose an assisted death are unconstitutional, and the issue is of profound national importance.

What is the law in the U.S.?

TheUnited States has long outlawed assisted suicide, charging people who help others kill themselves with murder, manslaughter and other offences.

However, Vermont has signed into lawlegislation that permits doctors to assist terminally ill patients seeking to end their lives.

Terminally ill patients who want to die must get approval from two doctorsand make the request for a lethal dose of drugs three times twice verbally, once in writing in the presence of at least two witnesses over the age of 18.

Many U.S. states introduced specific laws prohibiting assisted suicide in the 1990s after Dr. Jack Kevorkian and others pushed the debate into the public spotlight.

Kevorkian, a retired Michigan pathologist, loudly advocated a person's right to die and invented an instrument dubbed the "suicide machine" that lets patients inject themselves intravenously with a lethal amount of potassium chloride.

Police charged him in the deaths of a number of people, but juries repeatedly let him off until 1999, when he was jailed for second-degree murder after helping a terminally ill patient to die.

Kevorkian was released from jail in June 2007 and said he had no regrets about conducting the assisted suicide.

Oregon was the first state with a law that specifically allows physician-assisted suicide, enacted in 1997.

Oregon's Death with Dignity Act was approved by voters in 1994, but was subsequently blocked for three years by critics who challenged its constitutionality in the U.S. Supreme Court.

Oregon won, but again came under attack by then-U.S. Attorney General John Ashcroft, who threatened to revoke the licences of doctors who assisted suicides. The law was upheld by the U.S. Supreme Court in January 2006.

The state's strict rules governing assisted suicides stipulate that the patient must have been declared terminally ill by two physicians and must have requested lethal drugs three times, including in writing.

Washington adopted a ballot measure based on the Oregon law, called Initiative 1000, during the November 2008 election.

In December 2008, a Montana judge overturned that state's law prohibiting doctor-assisted suicide in a ruling on a case involving a man with terminal cancer. The state's attorney general plans to appeal the decision.

Texas has had a law since 1999 that allows hospitals and physicians to withdraw life support from terminally ill patients.

What's the law oneuthanasia and assisted suicide around the world?

Only four countries openly and legally authorize assisted suicide: the Netherlands, Belgium, Luxembourgand Switzerland.

The Netherlands introduced specific legislation to legalize assisted suicide and active euthanasia in 2002, but the country's courts have actually permitted these actions since 1984.

The Dutch laid out narrow guidelines for doctors: The patient, who must be suffering unbearably and have no hope of improvement, must ask to die. The patient must clearly understand the condition and prognosis and a second doctor must agree with the decision to help the patient die.

Belgium legalized euthanasia and physician-assisted suicidein 2002,ifa patient requests.

Two doctors must be involved, as well as a psychologist if the patient's competency is in doubt. The doctor and patient negotiate whether death is to be by lethal injection or prescribed overdose. In February 2014, Belgium passed legislation to extend the country's law to include children under certain conditions.

Switzerland has allowed physician and non-physician assisted suicide since 1942, but prohibits euthanasia.

Three right-to-die organizations in the country help terminally ill people by providing counselling and lethal drugs. Death by injection is banned. Switzerland does not bar critically ill foreigners from seeking assisted suicide.

Luxembourgpassed a law legalizing euthanasia and assisted suicide in 2009 with conditions similar to those in the Netherlands.

In Britain, the director of public prosecutions published an assisted suicide policy in 2010. Although the policy does not decriminalize the offence, prosecutors will examine each case on its merits and decide whether there is a public interest in beginning a prosecution.

• Your view: Should medically assisted suicide be legal in Canada?