Lee Carter, left, whose mother was a plaintiff in the landmark case, embraces her husband while speaking to journalists at the Supreme Court of Canada on Friday.Chris Wattie/Reuters

In 1991, Sue Rodriguez, a Canadian woman living in British Columbia, was diagnosed with amyotrophic lateral sclerosis, better known as Lou Gehrig's disease. Knowing the illness was terminal, and not wishing for a painful, prolonged death, Rodriguez wanted to end her life on her own terms. The Supreme Court of Canada denied her request, 5-4, in 1993. Unsurprisingly, Rodriguez managed to kill herself anyway, with an anonymous doctor helping her die the following year.*

The conversation Rodriguez started came full circle Friday, as the SCC ruled unanimously that Canadians have a right to physician-assisted suicide. The reason for the reversal is intriguing, too—if citizens have a right to life, the judges said, they have a right to end it, too. The Charter of Rights and Freedoms, Canada's constitution, grants everyone "the right to life, liberty and security of the person." That doesn’t mean, however, that people are obligated to live, the judges said; it simply means that neither the state nor other individuals can deprive them of it.**

This would create a “duty to live”, rather than a “right to life”, and would call into question the legality of any consent to the withdrawal or refusal of lifesaving or life-sustaining treatment.

In contrast to a standard decision, this one had no individual judge's name attached to it, a symbol, according to Canadian media, of how important the court deemed it to be. To qualify, an individual must be a consenting adult; must have a “grievous and irremediable” condition; and that condition must cause "endless suffering," physical or psychological.

The change won't take place immediately. The court stayed its decision for 12 months, allowing Parliament to act to regulate physician-assisted suicide; until then, aiding or abetting suicide will be illegal. For obvious reasons, it's impossible to ban individuals from killing themselves, but in the case of severely ill people unable to do so themselves, any assistance could be penalized with as much as 14 years in prison.

One reason cited in the decision was the increasing meaninglessness of geographic borders: "In the new ruling, the court found the breadth of the Charter has changed since the early 1990s. It also said the social landscape has evolved, because assisted dying is permitted in other places such as Belgium, Switzerland, and Oregon." In fact, Kathleen Carter, the mother of a plaintiff in this case, traveled to Switzerland to commit suicide.***

In the U.S., it's not just Oregon. Washington and Vermont also allow terminally ill adults to get lethal prescriptions from doctors, but the laws require any patients to be residents of those states. (A court in Montana struck down laws penalizing doctors.) Since the Canadian charter covers individuals "without discrimination based on race, national or ethnic origin," Friday's ruling would seem to allow Americans access to assisted suicide in Canada—perhaps opening up a corridor for suicide tourism—but no one is exactly sure what the ruling means for foreign nationals, according to Canadian advocates, and the answer could depend on what sort of law if any parliament passes.

"Death with dignity," as advocates call it, was in the news in the U.S. in November, when 29-year-old Brittany Maynard, terminally ill with aggressive brain cancer, chose to end her life. That case brought out intense passions, especially among social conservatives for whom "pro-life" doesn't just mean opposition to abortion laws—it also means the preservation of adult life. Overall, however, a majority of Americans seem to favor assisted suicide, though the way the question is phrased changes the level of support:


Support for Assisted Suicide

Gallup

Maynard's situation is unusual. A more typical case is perhaps that of John Rehm, the husband of NPR host Diane Rehm:

His Parkinson’s disease had become unbearable. “He just kept getting weaker,” the NPR host told NBC News. “We called in the doctor and John said to him: ‘I am ready today.’ He said ‘I can no longer use my legs, I can no longer use my arms, I can no longer feed myself.’ And knowing with Parkinson’s it is going to get worse rather than better, he said ‘I wanted to die.’” He asked the doctor for help.

The answer they got surprised and disappointed both of them. “The doctor said ‘I cannot do that legally, morally or ethically’,” Rehm said. “He said ‘I don’t disagree with your wish that you could die with the help of a physician but I cannot do it in the state of Maryland.’”

John Rehm had to deliberately die by dehydration. It took nine days.

“John said he felt betrayed,” Rehm said. He said, ‘I felt that when the time came, you would be able to help me.’”

As health care improves and prolongs life, cases like this may become more and more common. People who would have died much sooner will instead survive to suffer from slower, more painful illnesses. Despite efforts to expand hospice and palliative care, a report this week found a 12 percent jump over the last 15 years in the number of Americans who suffered pain in the last year of life.

That means there are likely to be more laws like Oregon's and more rulings like Canada's, deciding that the right to make an informed decision to end one's life is part of the right to life, liberty, and the pursuit to happiness—or however a jurisdiction phrases the most essential rights. Then again, given porous borders, the changes may be less and less relevant.


* This post originally gave an incorrect surname for Sue Rodriguez. We regret the error.

** This post originally stated that the Supreme Court of Canada agreed with a lower court's interpretation of the right to life. The court's decision has been clarified. We regret the error.

*** This post originally stated that Kathleen Carter was a plaintiff in the case. We regret the error.

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