On September 26,
former nursing assistant Marielle Houle helped her
36-year-old playwright son, Charles Fariala, commit
suicide. Fariala had been diagnosed with multiple
sclerosis last year and was starting to exhibit
signs of the disease taking hold, including
difficultly walking. He made no secret of the fact
that he was seriously contemplating suicide.

Two days after his
death, Fariala's mother was

formally charged
with aiding a suicide, an offense that
carries a maximum sentence of 14 years in Canada
with no minimum term.

In the days
following, conversations across the nation focused
nearly exclusively around the incident. For
Canadians in particular, the issue of

assisted suicide
is a sensitive oneand one that's hardly new. A
series of related cases still reverberate strongly
in the Canadian consciousness.

Twelve years ago,

Nancy B
won a hard-fought battle to ensure her the
unprecedented right to refuse medical treatment. A
year later, in 1993,

Sue Rodriguez
went to court to fight for her right to assisted
suicide. Rodriguez, who was dying of Lou Gehrig's
disease, lost her case but committed suicide anyway
in 1994 with the help of an anonymous physician. And
a few days after Rodriguez lost her court case,

Robert Latimer
asphyxiated his 12-year-old daughter, who had been
suffering from severe cerebral palsy. According to
Latimer, he could no longer bear to see his daughter
live in perpetual pain.

Today, in addition
to the Houle-Fariala incident, there is yet another
assisted suicide case before the courts in Canada.
In Vancouver, a 74-year-old woman faces two charges
of assisting two women to commit suicide.

Clearly, there is
an issue here in desperate need of attention. The
Canadian government, with its blanket refusal to
allow and monitor assisted suicide, has forced
desperate people to take desperate measures.
Furthermore, the idea that our government can force
us to stay aliveregardless of the particulars of
our unique situationis quite frightening and
repugnant, especially when we consider how grossly
underfunded health care is for the elderly and for
palliative care units across the country.

But just because I
defend the right to assisted suicide doesn't mean I
have to like it. Given the primitiveness of today's
technologies relative to what's on the horizon, I
have to concede that in some cases it's a necessary
evil. But there is the prospect of significantly
advanced medical interventions arriving in the near
futureinterventions that may impact directly on
people living with diseases or irreparable injuries
today, and particularly those contemplating suicide.
So for healthcare practitioners in countries where
voluntary euthanasia is legal, and for those
considering its legalization, it's time to act
accordingly, including full disclosure to patients.
Failing to inform patients of all their options is
not only irresponsible, it could also mean the
difference between someone choosing to live or die.

Primitive
technologies

Some days I marvel
at the advanced level of current medical
technologies, while at others I bury my face in my
hands frustrated at its sheer medieval character.
Take the "treatment" of psychological conditions
such as clinical depression or schizophrenia, for
example, for which doctors prescribe
hyper-generalized pills in the hope that the voodoo
contained within will correct the

imbalanced
humors in the mind. We're basically just
a step removed from exorcisms.

While I exaggerate
for effect, the reality is that we're not too far
off from this. We still don't know nearly enough
about the brain to effectively treat these
conditions. Moreover, managing the suffering human
consciousness and all its characteristicsincluding
anxiety, depression, paranoia, pain, nausea and so
onis still very much in its primitive stages.

And of course, we
still live in the age of the terminal illness, where
people are forced to endure the slow and agonizing
decent into death, with each day worse than the
previous. It's in these situations that allowing a
preemptive death seems the most humane and merciful
thing to do. We don't let our pets suffer in this
way, yet we force ourselves to stay alive until the
extremely bitter end, even when the outcome is all
but assured.

Ultimately, because
pain-relief technologies are still largely
ineffective, and because of the devastating effects
of terminal illnesses, the state is in my opinion
morally obligated to allow patients the option of
ending their own lives. This is a right that the
state must properly manage instead of deflecting the
issue to an impersonal piece of criminal law.

But this doesn't
mean we can't have somebody looking out for us even
when the situation looks hopeless.

Quackery or
accountability?

Rarely does a day
go by now where some remarkable medical insight or
breakthrough doesn't appear in the press. Some of
the most profound work is being done in the fields
of

genetic
expression and

gene therapy,

stem cell
therapy,

cellular biology,

therapeutic
cloning,

pharmacology,

neurology,

cybernetics
and

neural
interfacing.

Within a few years
people will have drugs tailored to their specific
genome, and the first true antiaging drug will hit
the market. Within a few decades doctors will be
correcting genetic deficiencies in full-grown adults
through gene therapy. They'll also be repairing and
regenerating tissue with cloning technologies and
stem cell therapies. It'll be an age where entire
organs are grown for transplant, spinal cord damage
is repaired and neurological diseases are prevented
altogether. By the mid-point of this century we will
likely succeed at

severely
retarding aging along with its attendant
diseases. And eventually, through the advent of
molecular assembling nanotechnologies and
cybernetics, we will truly enter into the era of the

cyborg.

Now, the timescales
I've described here are not extreme by any means.
There are many people alive today suffering from
various diseases and injuries who will have their
problems corrected during their lifetimes. For those
suffering from a disease that causes steady
debilitation or even death, these prospects
represent one very important thing: hope.

Hope is an
intervention unto itself

Oftentimes the
critical factor for someone contemplating suicide is
the complete absence of hope. In fact, I can think
of few things more hopeless than being told that
you've got an incurable terminal illness and little
time to live.

With so many health
breakthroughs on the radar, just the knowledge that
a potential cure exists could make the difference
between life and death. It may offer suicidal
patients all they need to make it through to the
next day. Consequently, I believe that doctors are
obligated to learn as much about pending medical
technologies as possible and to pass this
information on to their patients. Like a democratic
government accountable to its voters, doctors are
there to serve their patients.

Some strongly
object to this type of counseling. In these cases
they worry that hype has replaced sanity. One such
person is First Lady

Laura Bush,
who warns against giving patients a false sense of
hope. In fact, the president's wife believes this so
strongly

she even argues
that "preliminary" medical research with results
that are not "very close" or "around the corner"
should be banned altogether, including stem cell
research.

This type of
thinking boggles the mind. The idea that projects
should be aborted and banned altogether because
their potential benefits are not immediate or
immediately obvious is absurd. And as bioethicist

Arthur Caplan
notes, "if you are Laura Bush, you must
certainly know that your husband's policy of banning
federal funding for stem cell research is the
cruelest thing you can do to patients with incurable
diseases."

But Caplan does go
on to address an important point about hype in the
biotech sector. "This is partly true," writes
Caplan, "but every form of scientific research in
21st-century America gets overhyped. If the
president's wife wants to bemoan hype in
biomedicine, there are a lot of ad campaigns by
pharmaceutical companies that she should add to her
condemnation list."

Indeed, doctors who
counsel their patients about upcoming technologies
need to very carefully parse the hype from the
truthadmittedly not an easy task. But one point
needs to be made very clear: there is a considerable
amount of truth to the claims that novel health
technologies are set to arrive in the near future,
and people need to know this.

There are a lot of
heads in the sand these days about the power and
imminence of these technologies. Most of these
interventions are in fact going to arrive and
they are going to have a profound effect on
how the ill are treated. Someone who chooses to stay
alive and tough it out in the hopes of eventually
being cured may in fact be rewarded.

The second worst
thing that can happen to you

In addition to
responsibly informing suicidal patients, doctors
should also inform them of one very important
option:

cryonics.

While still
considered by many to be scientific quackery and
worthy of snide jokes, the time is coming for the
medical profession to acknowledge the possibility
that future science will be sophisticated enough to
revive those who undergo cryonic stasis. A quick
read of


K. Eric Drexler's

Engines of
Creation will show that we already
have a good idea of how future technologies could
assist in this regard.

While still very
fringe, the cryonics option should increasingly come
to be seen as a sensible choice. Such a shift in
public opinion will not be easy, nor will it be
quick, but we have to start somewhere. As with other
health interventions on the horizon, health
practitioners should know about cryonics and
communicate the possibilities to their patients.

While cryonics may
seem extreme to some, it would likely be a welcome
choice to sick people considering suicide. Let's not
forget that the term "voluntary euthanasia" is an
oxymoron. When someone is suffering from extreme
pain, continual loss of function and hopelessness,
there is an overwhelming compulsion to want to end
it all. Certainly, governments should give citizens
the right to choose death. But doctors should also
inform patients to give them hope. We should work
towards a day when death can be truly voluntary for
those who choose it, without disease and decrepitude
forcing their hand.