The Different Faces of MAiD

October 19, 2024

HERE'S MY TAKE

The upcoming vote in the UK Parliament on a bill to legalise euthanasia has, among other things, put Canada’s nearly decade-long practice of “assisted death” in the spotlight. Multiple UK media stories have used the Canadian experience to picture what might happen there, including a Telegraph article this week about Canadian doctors offering a woman an early death instead of the mastectomy she had entered the hospital to receive.

Euthanasia is an unsettled debate in the UK, but the debate also continues in Canada. When participating in these debates, we must keep in mind the different faces of so-called “medical assistance in dying” (or MAiD). This isn’t just a legal or rights-based issue. Neither is it merely a moral one. There are questions of vulnerability, medical trust, and the people around us.

Let me start with the big picture of where Canadians stand on MAiD. Around one in five Canadians is opposed to euthanasia in all circumstances, many because they see the human person as an image-bearer of God. Deliberately killing someone (even at their request) violates human dignity and disrespects that image. A slightly larger group – probably close to one-third of Canadians – views the matter almost entirely in terms of human autonomy. Our lives are our own, we can end them when we wish, and the state must permit and even facilitate such wishes. About half of Canadians fall somewhere between these two poles of opinion. They’re broadly supportive of euthanasia, but with caveats and concerns about its abuse.

Questions of abuse immediately raise vulnerability as one of the faces of MAiD. This week, an Associated Press report provided chilling evidence of the way vulnerability might be leading folks to agree to euthanasia. The report documented the alarm of healthcare workers “grappling with the requests from people whose pain might be alleviated by money, adequate housing, or social connections.” The news story included data from a confidential slideshow by Ontario’s chief coroner, suggesting that “more than three-quarters of people euthanized when their death wasn't imminent required disability support before they died in 2023.” What’s more, the slideshow noted that for folks who were euthanized without being terminally ill, “nearly 29% lived in the poorest parts of Ontario, compared with 20% of the province's general population living in the most deprived communities.”

I moderated a symposium a few weeks back that focused on how MAiD affects vulnerable Canadians. I noted that, without asking anyone to suspend their deeply held moral convictions on either side of the issue, there are practical and consequential dimensions of this topic that deserve careful consideration in their own right. 

Not surprisingly, then, there are now four significant cases making their way through the courts. Dying with Dignity wants the Ontario Court of Appeal to rule unconstitutional Parliament’s three-year delay of expanding euthanasia eligibility to those suffering from mental illness. In both British Columbia and Quebec, there are cases regarding how euthanasia rules apply to religious health homes and palliative care facilities. Most recently, a coalition of disability groups, spearheaded by Inclusion Canada, is urging the courts to strike down the provisions of Canada’s laws that allow euthanasia for those whose death is not reasonably foreseeable. They say that the current law “sends a devastating message that life with a disability is a fate worse than death,” and it is “time to put an end to helping people with disabilities commit suicide and start supporting them to live.” Added to all this is wide acknowledgment that vulnerable groups, like those with disabilities, have more difficulty accessing quality health care than the average Canadian.

Bringing health care into the mix raises another face of MAiD: the fraying of trust between a doctor and a patient. Prior to euthanasia’s legalisation in 2016, when we went to see a doctor, we knew that doctor only had curative or palliative tools available. But once euthanasia got into the medical bag, the relationship between patient and doctor changed. Now the patient needs to account for a possibly recommended “treatment” that may not be welcome at all. How does the very existence of this tool, even if it is never discussed, change the trust relationship? Well, Amanda Achtman tells the story of Christine, an 88-year-old who got a “Don’t euthanise me” tattoo to protect herself from this new entry into health care. Christine’s concerns aren’t theoretical.

Consider how much insurance companies stand to gain by not having to pay for treatments for now-euthanised patients. Governments also can find healthcare cost-savings in this. A Canadian Senator has already asked the Parliamentary Budget Officer to report on how much money the expansion of MAiD could save the taxpayers. Could others now have an interest or benefit in someone else’s euthanasia?

But perhaps the most fundamental face of euthanasia involves individuals. And let’s be honest. Who has not walked through an Alzheimer’s ward or accompanied a loved one through a difficult dying process without praying for the end to come quickly? It can be hard to see the dignity of some lives in certain circumstances. But to look only at those lives through the lens of an individual person overlooks their connections to others. I am not only an individual. I’m a husband, father, sibling, friend, co-worker, and neighbour. Deciding my life is no longer worthwhile and should end via euthanasia would affect the lives of all those around me as well.

Speaking on this subject over the last several years, I use five questions to help sort through these very personal challenges and to prepare for questions of life and death. Approximately 90% of us will receive some diagnosis that enables us to know roughly when we might die. About 10% of us die suddenly from accidents or fatal incidents like a heart attack. Whenever it is that we are coming to grips with an “inevitable natural death diagnosis,” it seems there are five things that should be a priority in making decisions. All of these things involve other people.

First, there is probably someone to whom we need to say, “I love you.” Second, there is someone to whom we owe an “I’m sorry,” reconciling a relationship before it’s too late. Third, we probably need to give a “thank you” to some people or to share some important things with them. Fourth, for those who are depending on us in some way, we need to make the appropriate arrangements to assure them that they will be ok after we are gone. Finally, we can tell those who love us and will miss us that “I will be ok” in dealing with the questions of what happens after we die.

The Canadian courts and British Parliament are only two of the institutions currently wrestling with euthanasia. It is easy, wherever we fall on the issue, to think of it as a legal or rights issue – and one that is out of our hands no less. But the issue has other faces that we should not forget, especially the faces of our vulnerable neighbours, patients who’ve lost trust in authorities, and loved ones dealing with challenging questions.

WHAT I’M READING

Misc. Punditry

I don’t want to make politics the headline feature of Insights every week, in part because our leadership and witness are required in the public square of which politics is only a part. Engaging with and working through the other institutions and spheres of society is important and deserves more attention than it usually gets. Not always focusing on politics is my small contribution to correcting this imbalance.

That said, readers do reach out and ask for my take on things, especially when I don’t mention current news headlines. So, here are a few quick takes on some of the political news of the week.

Foreign Interference Fireworks

Cynics suggest that Prime Minister Trudeau used his news conferences alleging serious Indian government interference and his testimony to the Hogue Commission to “change the channel” from his internal political challenges. It’s hard to conclude it’s not partisan when the prime minister mentioned only the official opposition party by name, even though his evidence is that all parties, including his own, are implicated. The accusation also changes the story from the headline that the government neglected to take action on information it was given and sat on warrants for 54 days before signing them.

Liberal Coup?

The day-to-day soap opera reporting of an unknown number of Liberal MPs signing a letter/ pledge/ document/ “vehicle to secure a commitment” for Prime Minister Trudeau to resign has significant potential consequences, but so far seems somewhat ham-fisted. John Ivison’s sage reminder that the “first rule of regicide is if you come for the king, you best not miss” seems not fully appreciated by the Liberal backbenchers involved. This “coup” is being very tepidly put forward and the prime minister’s office seems to be actively working to identify and isolate his opponents. At the time of writing, it seems things are heading towards a confrontation at next Wednesday’s caucus meeting.

Provincial Campaigns

New Brunswickers head to the polls on Monday, October 21st, and observers are noting very different campaign strategies as Blaine Higgs’ Progressive Conservatives fight off Susan Holt’s Liberals in a race many see as “too close to call.” Meanwhile, there has been a record-breaking advance poll turnout in advance of today’s B.C. election which will determine whether incumbent NDP Premier David Eby will survive the challenge from Conservative John Rustad. For the relevance for those not living in New Brunswick or BC, see my next point.

Secession Crisis on the Horizon

Those old enough to recall the Meech Lake Accord being scuttled by the provincial governments of Manitoba and Newfoundland know that at times of national unity and constitutional debates, any provincial election can have consequences for all Canadians. Gerald Butts, former principal secretary to Prime Minister Justin Trudeau, caused some waves with his Walrus essay suggesting that a Quebec secession referendum could be likely in the next three-to-five years. Whether his prediction is accurate or not, given that Canadian constitutional change involves provincial governments (in most cases, seven out of ten provinces representing at least 50% of the population must agree to any change), every provincial election these days has potential national implications.

The Scale of Vision

Many analysts are overlooking the risk of presuming the results of the next federal election are certain. Sam Routley, who is part of the current Cardus NextGEN cohort, doesn’t go that far. Playing the odds as he sees them now, he helpfully frames a potential Poilievre government in the historical context of Conservative majorities. Routley asks whether “at the cost of electoral longevity” and “considerable risk of public backlash” Poilievre will choose to pursue a legacy of “decisive impact” that has “the potential to really change the map.”

Judicial Powers

I made Chief Justice of Canada Richard Wagner’s comments about the relevance of legal history the focus of Insights a few weeks back. This column by Stéphane Sérafin and Kerry Sun raises similar concerns but uses slightly different arguments and examples. On as foundational an issue as this, it’s an argument worth repeating.

MEANINGFUL METRICS

Flexing Muscles

Visual Capitalist created an interesting index combining GDP, trade, education, and military strength to “rank the world’s superpowers.” It’s admittedly an arbitrary measure and raises as many questions as it answers, but the graphic did provoke a few observations to contemplate. There was no surprise seeing the U.S. and China in the top two spots with a significant drop to the next tier of countries. The graph is backed by an extensive report which includes detailed data for the 24 countries studied. Canada ends up in a similarly ranked group that includes Singapore and Australia just above with Turkey and Switzerland just below.

TAKE IT TO-GO

Turtle Smuggling

The New York Times reported on a woman who pleaded guilty to attempting to smuggle 29 turtles from Vermont into Canada. She hadn’t come out of her shell long enough to provide the reporter with any quotes, but presumably she was intending to take these eastern box turtles to Hong Kong where they are reportedly worth upwards of $1,000 each. So much for life in the slow lane.

Regular readers will not be shell-shocked to see me smuggling a quirky news story into this newsletter primarily for the purpose of puns. An Insights edition without wordplay would be a turtle disaster. The fact that our smuggler attempted to use a kayak to accomplish her objectives is something that totally floats my boat, although once she got caught, she seems to have given into pier pressure by pleading guilty. I was surprised that her punishment could be 10 years in prison and a fine of up to $250,000. I suppose this is a way for the law to have tortoise well that smuggling doesn’t pay. 

Until next week.