The Dignity of No

February 3, 2024

HERE'S MY TAKE

Tuesday’s announcement that the federal government will delay the expansion of euthanasia and assisted suicide for reasons of mental illness until 2027 is welcome, but it’s hardly the end of the debate.  

Most of the arguments on either side of the euthanasia debate are familiar. I’m among the approximately one in five Canadians who believe that government-sanctioned and administered ending of human life violates basic principles of human dignity. I also recognize that almost one in three Canadians are “enthusiastic supporters” of euthanasia. The majority of Canadians are somewhere in the middle, open to euthanasia being available but concerned about potential misuse and the impact on the vulnerable.

There are a few, such as one euthanasia advocate I heard interviewed this week, who seem to sincerely believe that having “the most advanced euthanasia regime in the world” is a marker of a great society and should be a matter of national pride for Canadians. That seems to be a minority position. The Toronto Star investigative piece on MAID last weekend highlighted some key concerns. Among them, many who have supported MAID legislation are concerned that the rate of Canadians seeking death by MAID has “grown at a speed that outpaces every other nation in the world.” They fear it isn’t a marker of victory, but of failure. Might it be that there are “failures in the health-care system and social safety net” that are causing that surge? The Globe and Mail editorialised on Wednesday that “A delay is not enough: Ottawa should withdraw its MAID law for the mentally ill.”

The parliamentary report released this week recommended the delay didn’t really address the fundamental issues regarding euthanasia. Its focus was the readiness of the health system to implement the expansion for mental health. It reflected the formal request of seven provinces that the federal government “indefinitely pause” the proposed expansion since health systems were not ready to “ensure a consistent and safe approach…(with) appropriate safeguards.” The Ontario Psychiatric Association reported that 80% of those who participated in its survey of psychiatrists and psychiatry residents shared that concern.

I’ve been involved in this debate for the past decade and the issues regarding the impacts of MAID on the health system, as well as the ethical issues involved, are well-rehearsed and familiar. I listened to several interviews with proponents “on the other side” of the issue this week and could recite their lines and arguments before they made them. I am sure they would say the same about the non-MAID proponents. This led me to wonder, “Does this week’s delay for three years (which means there will be a federal election before the proposed expansion takes place) simply mean a continuation of the same debate? Is making progress just a matter of speaking louder or might a different approach be in order?”

Many Canadians have not paid attention to the debate. That’s partly because most Canadians aren’t following politics closely enough to know the details of most public policy issues. However, it also involves an unpleasant topic most prefer to avoid–death. So, is there anything new or different that those who oppose euthanasia should try in the next stage of this debate to influence the public’s views on this issue?

In some way, the euthanasia debate is a case study of how to debate moral principles in our secular age. How do you make arguments that persuade those who differ when there is no common understanding of human dignity to start with?

Both sides of the debate claim the term “dignity.” Cardus produced a 20-page paper on this a few years back, trying to put into a contemporary frame the ancient argument that humans have dignity because they bear the image of God. It is who we are, not what we do, that gives us dignity. The other side of the debate, headlined by an organisation which uses the word in their name, Dying with Dignity, conflates dignity with choice and agency.

It is remarkable to observe the shifts in the public discussion on this file. Two decades ago, when courts and Parliament were turning down repeated requests for making euthanasia legal, the question was about life. “Was it right for the state to take someone’s life?” Advocates for euthanasia successfully shifted the public question to one of choice and suffering. “Should the law prevent someone from being able to end their suffering?” Once that door opened, the question morphed from the “law preventing” to the “state providing.” The answer quickly came: “It’s my right to have the state help me end my suffering if I want.” And once we have a right, questions of equality before the law enter in. If someone with an irremediable condition has that right, why should someone else who is suffering, but may not check all of the same boxes, not have the same right? Why should suffering from mental conditions be treated any different than suffering from physical conditions? In the course of the debate, the functional definition of dignity has morphed into the state’s affirmation (and assistance, when requested) of my agency.

As I was watching these issues being debated this week, I recalled an argument from a lead FBI kidnapping negotiator regarding the importance of “No” in negotiations. Usually we think of persuasion as getting the other person to say “Yes” to our proposals. But Chris Voss observes that when your opponent says “No,” doors of conversation open and you get “to see options and opportunities that you were blind to previously.” This debate, like the life and death consequences of hostage negotiations, is one in which it’s very unsatisfying just to “split the difference” in some Solomonic compromise. Those who believe dignity is agency really aren’t going to be affirmed until everyone has state-provided death on demand to avoid (or end) suffering. (Granted, some in that group would still probably insist on a few process qualifiers to make it sound less stark.) Meanwhile, those who believe dignity is at the essence of humanity and defines who we are will always find state-sanctioned taking of life as a response to suffering to be a violation of dignity. Trying to get the other side to say “Yes” to our affirmations of different premises isn’t a likely recipe for success.

So, as we prepare for the next phase of the public debate, is a different tack required? With others concerned about euthanasia, I have been ready to point out:

• the abuses of MAID and its imposition on the vulnerable
• the perverse incentives for a health system in financial crisis
• the tragedy of abuse and mistake in which euthanasia is administered without a clear affirmation of the individual’s choice
• the challenge of conscience for those who are required to administer it.

Those arguments to date haven’t carried the day. So, how do we convince Canadians to say “No” to the reduction of dignity, mistakenly thinking it is simply an expression of choice and autonomy?

It’s not as if Canadians are going to say “No” to “choice” and autonomy, nor should they. These are good things and part of dignity. But they aren’t the only things. Making choice absolute is a mistake. It also ignores the reality that your choice affects others. The autonomy of making your own choices that takes no regard for our social relationships isn’t an absolute good. When I make a choice, I do so as an individual but it has implications for my wife, son, siblings, friends, co-workers, and neighbours. It doesn’t affect everyone in the same way, of course. Neither am I suggesting that all choices should be democratised so that everyone gets a say on everything. But building a system that takes no account for the social impacts of decisions is problematic. It’s a distorted understanding of autonomy that separates choice from life. There is an illogic to the argument that the right to choose is a greater good than the right to life. When the argument for dignity is louder on the access to euthanasia than it is on access to mental health, palliative care, and social services, it's an undignified misuse of the term.

The answers we get depend on the questions we ask. We are unlikely to soon find consensus on the theological and philosophical issues involved on these questions. But I do wonder if there is merit in forcing the question as to whether it’s ideal to reduce our understanding of human dignity as only autonomous choice? Might there be a power in getting our neighbours to say “No”?

WHAT I’M READING

Humanities Grads Wanted

A Globe and Mail feature last weekend highlighted that humanities enrollment is down by 27% over the past decade. This has implications for businesses that need leaders with “competencies in collaboration, intercultural awareness, the ability to weigh evidence, and form judgements amid uncertainty–skills cultivated in humanities classrooms.” The article rightly focuses on how effective leadership teams require input from both STEM and humanities perspectives but mostly ignores what many would argue is perhaps even the major part of the story: the failure of many university humanities programs to deliver on instilling those very skills having replaced traditional curricula with a postmodern identity ideology and agenda.

Politics or Entertainment

Fr. Raymond de Souza’s National Post article comparing Donald Trump’s politicking style to WWE wrestling pulls together several timely threads. He links “sports entertainment” to “news entertainment” and mused about the extent to which Tucker Carlson’s sold-out Alberta events last week fit this profile. As political activist-turned-lobbyist Kory Tenyke reflected on the same event on this week’s Curse of Politics podcast, he compared right-wing Tucker Carlson to left-wing Jon Stewart and noted that both had figured out how to play the emotions of rage and laughs to separate news devotees from their money.

A University Reformation?

Ben Hunt’s article comparing the need for university reform to the problems facing the Roman Catholic Church in the sixteenth century is not only an insightful and thought-provoking take, but also very creatively written and a fun read. All metaphors have their limits but comparing “Diversity, Equity, and Inclusion” to indulgences does provide a fresh perspective on the current credibility challenges facing the modern university.

Cue the Ads

According to Elections Canada the Conservative Party raised a record $35 million from over 200,000 donors in 2023. That compares to $15.6 millon from 38,000 for the governing Liberals and $6.8 million from 20,000 donors for the NDP. Given that there are election expense limits in place during the formal campaign, the Conservatives will look to use their bank accounts before the campaign begins. Count on seeing a lot of paid advertising puffing Mr. Poilievre and critiquing Mr. Trudeau in the upcoming year, not to mention a real focus on defining the election issue(s).

MEANINGFUL METRICS

Not all Votes are Equal

The redrawing of Canadian federal riding boundaries takes effect on April 1, 2024. So, in the extremely unlikely event of a federal election before that date, the current 338 seats in the House of Commons would be up for grabs. From that date onward, 343 seats would be in contention. Andrew Coyne, a long-time critic of Canada’s existing first-past-the-post electoral system, crunched the numbers in a recent column, comparing the variation in seat sizes between Canada and other Western democracies. He found that PEI and territorial voters are electorally worth about three times that of the average Canadian. By contrast, BC and Alberta voters are at below-average worth Worse yet, he argued that compared to other countries, Canada is not effectively implementing the basic principles of democratic equality.

TAKE IT TO-GO

Star Bucks?

This space targets wordplay, not slapstick but since it’s All-Star Weekend in the NHL, let’s give it a shot. The Timbits crowd relies on their roll-up-the-rim but there are hockey folk who are loyal to the other coffee team as well. It’s a bit pricier but some of us still spend at Starbucks even if we don’t earn star bucks. The all-stars however have no such worry, the winner of Friday evening’s skills competition has not only bragging rights but also a cool extra million dollars in his bank account. Even if they gave the rest of us a shot, they have a latte more skill than we do. So how about finishing this with an iced capp and signing off until next Saturday morning when we will aim to be back in your inbox. Til then.