(Note: This article contains a transcript of Episode #9 of my podcast ‘Our Canadian Journey’, on the disturbing news about Canada’s Medical Assistance in Dying or MAiD policy. If you wish to listen to the podcast, the link is here: https://darshanmaharaja.podbean.com/e/ep-9-death-of-a-promise/ . It will open in your browser; you don’t need to download the Podbean App.
Credits for the image & music are at the end.)
Recent reports show that the policy of Medical Assistance in Dying (MAiD) has become exactly the kind of slippery slope that its opponents were warning about. Instead of offering timely healthcare, our Universal Healthcare system causes interminable wait times, and when the patient’s suffering becomes unbearable, cajoles them to accept dying via MAiD as an option.
In a nutshell, the promise of Universal Healthcare has died.
TRANSCRIPT OF THE PODCAST EPISODE
Hello everyone! Welcome back to the 9th episode of Our Canadian Journey. My apologies for the long gap after the previous episode (#8). Summer and all. Family obligations.
In today’s episode, I want to talk about a very disturbing story about Canada that came up for discussion in the media over the past few days, viz., the actual working of the policy on Medical Assistance in Dying. This term is usually acronymized as M-A-i-D, which is very pronounceable as a word, but doing so makes me uncomfortable because the pronunciation – Maid – reminds me of something else altogether. Therefore, I will be using the synonymous term ‘euthanasia’ throughout this episode.
A brief note on the intro music. I have changed it for this episode because my signature intro music has an upbeat tone, and this topic makes me anything but upbeat. Therefore, I have chosen a different musical piece as the intro for this episode. As for the reasons why I chose this one, I will tell you after you have listened to it.
So without further ado, let’s get started.
(Intro: Yoon Hasraton Ke Daagh, Prelude)
This piece is the prelude to a song from a Hindi movie that was released in 1958. The lyric – in the ghazal genre – was written by Rajendra Krishan, and the tune was composed by Madan Mohan. I find the entire lyric to be very apt for our situation on euthanasia.
When the policy on euthanasia was proposed and was being discussed, it was, naturally, very controversial and led to much heated debate. One major constituency that was in strong opposition to the very idea of providing euthanasia to humans came to the debate from a religious point of view. In their view, exercising judgement on who should live and who should die – and particularly, when they should die – is morally offensive. They also warned that the policy would soon become a slippery slope. Initially, the promise was that euthanasia would be made available to only those who were terminally ill AND had made a well-informed decision, while being in full possession of their faculties, to bring their lives to an end – and their suffering along with it. But the religious (or moral) argument against this was unyielding. This counterargument has been vindicated; from the media reports that I have seen from multiple sources, mentally ill Canadians have been urged to opt to end their lives, as have veterans suffering from PTSD. As to how it is supposed to be acceptable that a person with such severe and extreme mental health issues has full possession of their mental faculties is an enigma. Most worryingly, some patients were offered the option of euthanasia based purely on the basis that their medical treatment would cost too much. Whatever one’s views are of religion in general, one cannot help but accept that the religious argument against euthanasia had got this right.
I do not consider myself to be particularly religious, therefore, I will avoid taking the route of a religious argument here. As many of you may know, I view policy issues through two lenses: (1) the relationship between the individual and the State, and specifically, the obligations of the State to the individual, and (2) the impact of a policy on the evolution of the Canadian society. We can combine these two vantage points to say that I view policies in the context of our social contract, which is (a) always evolving, and (b) still must adhere to certain fundamental points of agreement among most members of the society; any evolution in the social contract has to remain within the bounds of an agreed framework.
In a nutshell, I view the current situation on euthanasia as the State abrogating its duty to ensure the physical well-being of each member of the Canadian society. Specifically, the policy on euthanasia is being used as an escape door by the State, following its failure to provide timely healthcare to Canadians. This escape door is used via intermediaries, so there is some ‘plausible deniability’ for the State here. This is not surprising, although it certainly causes dismay. In essence, what they are saying is, “We will happily take your tax money on the promise that we will provide you the healthcare that you need when you need it. But should you have any serious ailment, we will put you on a wait list – instead of providing the care promptly. And should your ailment make your life too difficult to bear, we will help you to die.” Reverting back to the religious argument, there is a church near my home that had a sign near its plot boundary saying, “Death is not healthcare”. I think it is possible to agree with this even from a non-religious point of view.
It is particularly concerning that, according to reports in the media, the funding for this death-instead-of-healthcare comes from the budget that is supposed to be used for offering palliative care for the Canadians who are in the terminal stage of their lives. Palliative care is supposed to make the final days of a person on this earth as comfortable as feasible within their physical state, but our system takes a short-cut by short-circuiting their lives altogether.
In effect, we are paying into a ‘healthcare system’ that offers us death instead of healthcare.
My fellow blogger & commentator Spencer Fernando has written an excellent article on this ‘abdication of duty’ part; you can read it at his website spencerfernando.com.
As I see it, the promise of our Universal Healthcare system is that the government takes sole responsibility to provide healthcare for all Canadians. In the bargain, private entities are not allowed to offer healthcare services to Canadians on their own; Canadians cannot contract directly with a healthcare provider – or even via the intermediary of an insurer – to bypass the government-run system.
Recently, there was a legal challenge launched against this arrangement in British Columbia. The challengers’ contention was that the law preventing people from accessing private healthcare when wait times are too long is unconstitutional, as it violates Canadians’ Charter right to life and security of the person. The High Court of British Columbia delivered a judgement in this case last month – that is, July 2022 – stating that “while long waits for treatment HAVE denied some patients their Charter rights to life and security of the person, those violations are PERMITTED under the principles of fundamental justice”. (Emphasis added)
Let us pause and consider how the esteemed judges who delivered this troubling verdict view the concept of fundamental justice here. My understanding of the word ‘justice’ is that it provides justcircumstances to the individual. What is the judges’ understanding of the word? As the CBC reported on July 15th, they said, in their judgement, that “the laws… are meant to ensure equitable provision of healthcare, and prevent the creation of a two-tier system where access to potentially life-saving treatment depends on wealth” (Emphasis added). In other words (and this is my opinion on the words that I just quoted), the learned judges believe that (a) upholding the status quo as created by the existing laws AND (b) preventing the emergence of the much-dreaded ‘two-tier system’ amount to ‘fundamental justice’. The suffering – and indeed the fate – of the individual patient is irrelevant for them – and, sadly, for too many Canadians. Irrelevant enough to condone the violation of Canadians’ Charter rights by the government.
The cruel irony here is that the truly wealthy are not prevented from accessing the needed healthcare privately – they just go to another country to get it. Even the not-so-wealthy often pool together all their resources to go abroad and get the treatment that they cannot get in a reasonable time in Canada. These two groups of patients simply go to the US or some European country, instead of being on interminable wait lists in Canada, in a system that they paid into.
Another special case is that of immigrants. I have seen many immigrants from India who, when they need treatment for a serious medical issue, simply go to India and get the treatment with no delay whatsoever. They, of course, have the advantage of having family & social connections there, which make the exercise a lot easier. I suspect that this may be the case for immigrants from other countries as well. Let us remember that these are all Third World countries where healthcare is relatively cheap, and especially so when converted into the Canadian dollar.
Therefore, it is actually the people who don’t have the needed resources to go abroad for treatment who end up being on the wait list. A system designed to prevent the wealthy from receiving treatment earlier than the poor only ends up hurting the poor – and ONLY the poor.
In the CBC story about the High Court judgement in British Columbia, the judges are quoted as saying that “… the laws … are meant to ensure the equitable provision of healthcare…”. My firm opinion is that these laws do the exact opposite; our Universal Healthcare system punishes the poor for being poor.
Let us assume that the original intentions behind setting up our Universal Healthcare system were noble. Yet, pursuing the goal embodied in that system has brought us to a place where we value human lives less than the system that was meant to serve the same humas. The system must be preserved, even if humans suffer and die in the process. I view this as an indelible stain on the character of Canada – and hence the character of the Canadian society.
In that song by Rajendra Krishan, the opening stanza describes exactly such a situation; the implied background is that pursuing his aspirations has caused stains on the poet’s character. The poet then says that:
“My aspirations caused stains on my character, and I washed these stains away with my love for those aspirations. I opened my heart to myself and cried.”
The crucial question here is this: Why do we want a universal healthcare system that shuts out private sector providers, and puts the government in exclusive control of who can access healthcare and when?
Is it to provide timely and efficient care to Canadians? Or is it to prevent a ‘two-tier system’ from coming into being?
In my opinion, the answer should be obvious – a healthcare system is supposed to be for providing competent healthcare to people in a timely manner. That was presumably the intention when we set up our Universal Healthcare system some 50-odd years ago. But along the way, we became too obsessed with the system such that we lost sight of what should have been our primary focus. So now, instead of delivering healthcare, the system delivers suffering and misery. Rajendra Krishan addresses this in the second stanza of his poem, where he says
“I had set off from home in search of happiness. Some sorrows were standing along the path, and joined me in the journey.”
I will yield to temptation here and recite this stanza in the original Urdu:
Ghar se chale the hum to Khushi ki talaash mein
Gham raah mein khade the wo-hi saath ho liye
The irony here is that it is common in Canada to look down upon the American healthcare system as a heartless one where patients who lack the financial means to pay for their treatment are left to die. This is of course, not true. At best, it is an exaggeration, and at worst, a lie. But in our supposedly compassionate system, we achieve the same result – if this can be called a result – where we don’t just let them die, but, as it now emerges, we actually encourage them to die. The only ‘satisfaction’ that we give them is that they were able to be on a wait list without incurring a personal financial cost for doing so – that is, if we ignore the taxes that they paid into the system up to that point.
Sadly, this is standard fare in all totalitarian systems, where the system is more important than anything else – be it the individual and their health & welfare, or principles or even basic humanity. We value individuals when they are healthy – and ONLY when they are healthy (because then they pay taxes). When they need to be looked after in terms of their health, we put them on a wait list. We prevent them from accessing healthcare privately out of a morbid fear of a ‘two-tier system’. And when the lack of attention to their healthcare needs causes their physical and/or mental state to deteriorate beyond a point, we counsel them to die. They are not worth anything to the ‘system’ anymore. Rajendra Krishan has addressed this point in the third stanza:
“Although it is withered, this heart is still a flower. Now, at your pleasure, you may weigh it with the thorns”.
Murjha chuka hai phir bhi ye dil phool hi to hai
Ab aapki Khushi se kaanton mein toliye
The question is whether enough Canadians will speak up against the horrendous condition that the whole euthanasia policy is revealed to be in. Frankly, I am not very hopeful – for two reasons.
Firstly, for far too many Canadians, their opinion on a matter of policy (or the prevailing situation under the administration of a policy, that is, on the ground) depends on their political affiliation. Since the policy on euthanasia was brought in by a Liberal government, these Canadians will reflexively defend the sad state of affairs that has been reported in various media outlets in the past few days. Additionally, the fact that euthanasia is opposed by the religious groups steels their resolve to defend the grotesqueness of offering someone the counsel to die as a way of saving costs to the system of treating these patients. Objectively speaking, the demographic that is aligned with the whole idea of euthanasia is in the majority, so the government is unlikely to come under pressure to reform the policy and put in place iron-clad safeguards to see to it that euthanasia does not become an alternative to healthcare.
Secondly, Canadians are generally a docile lot (this is my opinion) and therefore are unlikely to rise up against something even when they see a great wrong being committed. This may be due to a variety of reasons – their lives are busy, or they think it is futile to agitate because no change will result etc. As we saw during and after the truckers’ convoy in February, those who participated in the protests were made targets of ridicule, and outright victimization by the government. This factor would also reduce the appetite among the general public to stand up and be noticed. The constituency that is vocal about the egregious wrongs being committed under the euthanasia policy will probably run out of steam and stop talking about it; it is just one more disappointment for them in Canada.
The net result of this is that the problem will likely grow more serious, and at some point, will acquire enough magnitude such that it cannot be ignored. At that point, everyone will be asking everyone else why they didn’t speak up about this ‘crisis’ early enough. In the last stanza of the poem, Rajendra Krishan talks about this stage:
“When I pursed my lips, everyone asked, Why are you so quiet? Please say something”
Just as I changed the intro music for this episode, I have chosen a different outro as well. It is the aforesaid last stanza, sung by the legendary vocalist Lata Mangeshkar to the soulful tune composed by Madan Mohan. I hope you find the tune appropriate for the subject of today’s episode. I will see you the next time.
Our Canadian Journey
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Image Credit: ‘Vintage Car on a Field’. Original image from Carol M. Highsmith’s America, Library of Congress collection, from rawpixel.com; the image is at this link. I have cropped the image to fit the space here. Used without any other modification under Creative Commons Licence.
- Intro & Outro: Excerpts from a song in the Hindi movie ‘Adalat’, lyrics by Rajendra Krishan, composed by Madan Mohan. Link: https://www.youtube.com/watch?v=JP2vWqb0TMA&ab_channel=LataMangeshkar-Topic . Used under Fair Use Policy; I do not own any rights to this music.