Why Vulnerability Matters
The Vulnerable Persons Standard defines a series of safeguards and requirements which can help to ensure that Canadians requesting assistance from physicians to end their life can do so without jeopardizing the lives of vulnerable persons who may be subject to coercion and abuse.
To be vulnerable is to have diminished defences, making us more prone to harm. Many Canadians are fortunate to have defences that we can take for granted: food and secure shelter; adequate income, education and healthcare; family and friends; laws and policies that protect us and promote our interests. Regrettably, however, this is not the case for every Canadian.
Research demonstrates that these kinds of defences – often referred to as the social determinants of health – are highly significant in affecting our health and well-being. People with less access to these defences are more vulnerable to illness, to suffering, and to reduced life expectancy.
Vulnerability can compromise autonomy in ways that are often difficult to detect. Vulnerable persons who request physician-assisted dying may be motivated by a range of factors unrelated to their medical condition or prognosis. Canadians living with severe disabilities, mental illness and dementia, as well as seniors living in long term care are among those who may be more vulnerable to stigma, abuse, coercion, isolation and depression. Consequently, they may be more inclined to suicidal ideation, intent and behaviour.
Additional factors can include:
Psychosocial factors and mental health issues causing distorted insight and judgment. These may include depression, hopelessness, loneliness, fear, grief, shame; coercion by others; and the psychodynamics of the physician-patient relationship.
Lack of access to disability-related supports that can improve a person’s resilience and ability to live with greater dignity, comfort and self-determination.
Insufficient or inaccessible palliative care options which can alleviate pain and suffering and improve well-being of patients and their loved ones.
Poverty and unemployment which can cause significant mental anguish, social stigma and a sense of hopelessness.
On-going physical, mental or emotional violence.
The likelihood or experience of abuse and fraud, especially affecting elders and people with disabilities.
As a society, we have both moral and legal obligations to address the needs of vulnerable persons. Access to physician-assisted dying cannot be allowed to diminish or undermine these important obligations as many of these factors can be addressed with adequate and appropriate care.
The Supreme Court of Canada recognized this reality. While it found that the absolute ban on assisted suicide breached a suffering person’s right to autonomy in some cases, it also found that an exception to the ban could make some people vulnerable to abuse and error. Therefore, access to physician-assisted death must be balanced by our moral and constitutional duties to protect vulnerable persons who have unmet needs.
The Vulnerable Persons Standard is rooted in the Supreme Court of Canada’s conclusion that a “properly administered regulatory regime is capable of protecting the vulnerable from abuse and error.”