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The Canadian Supreme Court's reversal of a 21-year ban on doctor-assisted death offers a bold, new legal argument that could propel the American movement—in short: Aid-in-dying is pro-life, activists assert.
If Canadians have the constitutional “right to life, liberty and security,” they also have the right to end their lives, the court ruled unanimously Friday.
According to that decision, the “sanctity of life” also includes the “passage into death." And that argument, activists contend, turns on its head a long-standing objection cited by movement critics that assisted suicide is tantamount to euthanasia. This may have major implications on American law.
“It is a huge recognition of the enormous harm done to dying people and a huge correction of longstanding injustices,” said Barbara Coombs Lee, executive director of Compassion & Choices, the group leading the fight to legalize aid-in-dying in America.
To qualify for assisted dying in Canada, an individual must be a consenting, mentally competent adult with a “grievous and irremediable” condition that causes "endless suffering," physical or psychological, the court said.
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That ruling creates a large legal chasm between the vast majority of American states and Canada.
“People [in most states] who are terminally ill and looking forward to some sort of horrific symptoms before they die are forced to end their lives prematurely … while they can still boost themselves over the balcony or in front of the train or put a gun in in their mouths,” Coombs Lee told NBC News.
If death-with-dignity was legal across the U.S., those people might live longer, knowing they could have a “peaceful aid-in-dying option,” she said. “It prolongs lives, pure and simple.”
Only five U.S. states allow aid-in-dying: Oregon, Washington and Vermont by legislation; and Montana and New Mexico by court rulings currently being challenged. Forty states explicitly ban the practice.
“The activists who want to legalize assisted dying are closely watching Canada,” said Arthur Caplan, founding head of the Division of Bioethics at New York University Langone Medical Center and an NBC News contributor.
“The decision gives momentum and builds enthusiasm for a similar strategy here at the state level.”
Canada's Parliament has one year to draft new legislation. Until then, assisting a person still carries a prison sentence of up to 14 years.
But numerous questions remain, Caplan said, including how that law will be carried out to ensure the proper “checks and controls.”
“Even with a court opinion, they have to figure out how to help someone die on their own,” Caplan said. “We don’t want anyone bullied into choosing assisted suicide. And we have to make sure everybody understands the options.”
Public acceptance of assisted death is rising in the U.S.
In December, a HealthDay/Harris poll revealed 74 percent of Americans agree that terminally ill adults with no option of recovery should have the right to end their lives with a doctor's help; 14 percent disagreed.
But critics argue legalization leads down an ethical “slippery slope” that would sanction euthanasia of the elderly and disabled.
The medical ethics arm of National Right to Life Committee opposes “direct killing and denial of lifesaving medical treatment, food and fluids.”
Burke Balch, director of the NRLC's Powell Center for Medical Ethics, said it will be "very challenging for Canadian legislators to craft laws that provide any realistic measures of protection."
He, too, acknowledges the power of the Canadian ruling.
“I think one of the things we most fear is the influence it might have on the U.S. Supreme Court,” Balch wrote in an email to NBC News.
“With the present court, we think five justices would continue to reject an asserted constitutional right to assist suicide," he added. But the other four justices may be receptive to it.
Much, therefore, hinges on the 2016 presidential election, he said.
Others argue the Canadian ruling is so broad, those with diseases like ALS, Alzheimer’s and Parkinson’s diseases might not be able to speak for themselves to give consent.
The ALS Association takes no stand on the issue.
“We believe that the decision regarding assisted suicide is entirely a matter of individual conscience,” spokeswoman Carrie Munk wrote in an email.
So far, the most powerful voice within the cause has been that of Brittany Maynard, the 29-year-old newlywed who faced an excruciating death from brain cancer and moved to Oregon to legally end her life.
In videos that went viral, Maynard urged Americans to change laws. Since her death last November, “death with dignity” bills have been introduced in 22 states, most recently in California and New York.
Coombs of Compassion & Choices, which worked with Maynard on her campaign, said “there is no overstating” her impact.
Coombs also said there is “simply no evidence of elderly abuse or threats to people with disabilities” in states where aid-in-dying is now legal.
“It boils down to its very essence that people who oppose aid-in-dying, can’t be rationally pro-life, only pro-suffering,” she said.