________________ CM . . . . Volume XXII Number 39. . . .June 10, 2016


Life or Death: A Matter of Choice? (Understanding Canadian Law).

Daniel J. Baum.
Toronto, ON: Dundurn, 2015.
238 pp., trade pbk., pdf & epub, $14.99 (pbk.), $14.95 (pdf), $9.99 (epub).
ISBN 978-1-4597-2378-8 (pbk.), ISBN 978-1-4597-3058-8 (pdf), ISBN 978-1-4597-3059-5 (epub).

Subject Headings:
Patients-Legal status, laws, etc.-Canada.
Medical care-Law and legislation-Canada.
Euthanasia-Law and legislation-Canada.
Right to die-Law and legislation-Canada.

Grades 12 and up / Ages 17 and up.

Review by Joanne Peters.

** /4


Our bodies are ours to control, free from state interference. This principle seems enshrined in our Constitution through the Charter of Rights and Freedoms, and in the common law through which many of the Charter principles were nurtured. Section 7 of the Charter provides: “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.”

But, how absolute is this belief? Consider these questions:

1. Do parents have the final decision in determining the medical care of their children – even if that choice may mean death?
2. May children override the choices of their parents as to medical care? For example, if a teenager is pregnant and wants an abortion, may her choice override that of her parents?
3. What role, if any, does the state (or the courts) have in reviewing individual medical choices?
4. Are there laws against suicide or assisted suicide? (p. 11)


Few things make us, (and our families), feel more vulnerable than the diagnosis of and prospect of living with chronic or critical illness. Life becomes an endless round of medical appointments, searches for support and/or respite services, and worries about the future. Suddenly, our health, something which we have taken for granted, becomes the focus of our existence: disability, uncomfortable treatments, terrible pain, or fundamental life-style changes wear on our emotions, as well as our bodies. Despite many medical advances, some conditions remain incurable, the progress of some diseases still brings intractable pain, and the decision as to treatment options, if any, can make for very difficult choices. In some extreme cases, death appears to be a preferable alternative to a life of intolerable emotional and physical suffering, increased debilitation, and a profoundly diminished quality of life.

     Life or Death: A Matter of Choice, the fourth volume in the “Understanding Canadian Law” series, authored by Daniel J. Baum, reviews the many legal dilemmas faced by patients dealing with health treatment decisions. Whether made in consultation with medical providers, or in emergency situations, when the treatment offered is not the patient’s preferred choice (or their family’s choice), health care providers find themselves between a rock and hard place. Whose interests should be served: those of the public health care system, which aims to do no harm to the patient and does its best to assist and ameliorate pain and suffering, or those of the individual, who has a Charter right to “life, liberty, and security of person”, and who can object to the treatment on ethical, religious, or emotional grounds?

     As with the previous three volumes in the series, the book begins with an acknowledgement of the role of the Supreme Court of Canada’s work, as well as the role of the media has in disseminating the Court’s decisions. Health is a very personal issue, and in the “Introduction”, Baum stresses that a patient’s choice to undergo or to refuse treatment is “deeply personal”, often rooted in religious or deeply-held personal beliefs. (p. 11) If the patient is a child or an adolescent, what right does his or her parents have to make health-care choices on his or her behalf? And, as in previous volumes, the book’s “Introduction” is followed by “Who Are the Judges?”, a description of the selection process for appointment to the Supreme Court, as well as a brief discussion of the potential roles for personal bias and emotion entering into a judge’s decision, as based on facts presented.

     The five chapters which follow the “Introduction” focus on well-known cases in which an individual’s right to allow or refuse medical treatment are often life or death decisions. These include the right of a 14-year-old to refuse a life-saving blood transfusion on the basis of devoutly-held religious beliefs as a Jehovah’s Witness (A. C. vs. Manitoba); the right of a mentally-ill person, deemed NCR (not criminally responsible) for his crimes, to refuse medication to treat his mental illness; the defence of “mercy killing” for a parent’s decision to kill his daughter rather than subject her to further medical procedures (the Robert Latimer case); the culpability of committing suicide in order to end the suffering of a life afflicted with ALS (the Sue Rodriguez case); and in the final chapter, “End of Life”, the highly contentious issue of the Supreme Court’s 2015 decision to strike down the ban on assisted dying, but suspending for one year, the implementation of that ruling. At the time of this review’s being written (May 27, 2016), Parliament is working on legislation to deal with the issue; in December of 2015, the province of Quebec enacted legislation to allow doctors to aid patients in dying, and the Supreme Court allowed Canadians to apply for assisted death in the interim of the suspended ruling, but it also allowed Quebec’s law to remain in effect.

     As in each chapter of previous volumes in the “Understanding Canadian Law” series, Baum offers details of legal cases along with a series of questions about the particular cases under discussion, provides the reader with the opportunity to consider and rule upon a hypothetical case (“You Be the Judge”), poses “Challenge Questions” which further explore that chapter’s central issue, and ends each chapter with a listing of “References and Further Reading” drawn from current media such as The Globe & Mail, as well as academic and law journals, position papers and monographs. The legal cases provided as the focus for discussion in each of the chapters (notably, the Latimer and Sue Rodriguez cases) are landmark judgements, but the extensive and exhaustive discussion of the decisions rendered by the Supreme Court justices drain these cases of their emotional intensity and make it hard for the reader to have a sense of the volatility they engendered at the time of ruling.

     Issues of life and death are emotionally intense, and anyone who has faced them, either as a patient or with a family member, might find the legalities described in this book to be distant from their own experience. The final paragraph of the book’s “Acknowledgements” chapter ends with the comment that “the state, and eventually the courts, became involved in the “problem” only after it had been disclosed to them”. (p. 12) True as it may be, describing it as “the problem” distances the lived reality of life and death as experienced by those who wrestle with very difficult healthcare decisions. As with previous volumes in the “Understanding Canadian Law Series”, Life or Death: A Matter of Choice? is more suitable for students in post-secondary courses in sociology, criminology, and similar areas of study than it is for high school students. If considering acquisition of this resource for a high school library, as support material for senior high Canadian Law courses, consult with teachers who might use it as a teaching or supplemental resource, have them examine the book’s contents carefully, and then make a collaborative decision.

Recommended with Reservations.

Joanne Peters, a retired teacher-librarian, lives in Winnipeg, MB.

To comment on this title or this review, send mail to cm@umanitoba.ca.

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