(Image Credit: dreamstime.com; the image is at this link. Used without modification under Creative Commons Licence).
The suggestion that we should offer Medical Assistance in Dying (MAiD) as a way to save money in what we euphemistically call our ‘healthcare’ system is as appalling as it was inevitable. We shouldn’t act surprised.
Many of us were shocked (myself included) when Global News reported in mid-August that a veteran suffering from PTSD was offered the option of Medical Assistance in Dying (MAiD) by a VAC service agent, ‘unprompted’. This was mere days after a previous story was reported by the Associated Press and quoted in a National Post article, about a Canadian who was suffering from degenerative brain disorder and had been offered euthanasia because his treatment was costing too much.
Our shock was due – at least in part – by the fact that in today’s fast-paced world of social media, we do not remember the conversations that we have had in the past. Luckily for me, someone did remember, and posted on Twitter this story that appeared on CBC website in January 2017, i.e., a short time after MAiD policy came into effect, titled ‘Medically assisted deaths could save millions in healthcare spending: Report’. The CBC story was based on a report published in the Canadian Medical Association Journal. It said that “Doctor-assisted death could save millions in healthcare spending across the country by between $34.7 million and $136.8 million”.
While we, the everyday Canadians, forgot about this report, the idea seems to have been circulating in the officialdom quietly, and what we saw in mid-August was the bitter outcome of that circulation. After these latest reports in the media, I devoted an episode of my podcast to the issue, titled ‘Death of a Promise’ (you can listen to it at this link; if you prefer the text format, the transcript of the episode is at this link). This was, of course, before I came across the CBC link from January 2017. Now, with the benefit of knowledge of that background, I think it is time to revisit the issue. Specifically, I wish to focus on the fact that the actual offer of MAiD in order to save money for the healthcare system wasn’t an aberration committed by a staffer at / near the bottom of the official hierarchy; rather, the direction appears to have been set at the upper reaches of the officialdom right from the word ‘Go’. I am now also better able to understand the sign outside a church near my home that said, in plain words, that ‘Death is not healthcare’. ‘Slippery slope’ wasn’t a hypothetical argument – because that slope was right in front of our eyes., and its slipperiness was in full view.
Let us now consider the chain of people who thought it was worth exploring the idea that money can be saved by offering ‘assisted death’ instead of healthcare. According to the CBC story, the author of the report was one Aaron Trachtenberg, a resident in internal medicine at the University of Calgary. It is unclear to me as to how or why an aspiring doctor should concern himself with the financial implications (at the macro level) of providing healthcare to patients, especially when the alternative being considered is death of the patient. Next, the nice folks at the Canadian Medical Association thought it fit to publish this study. Granted, at their level, the are supposed to be interested in the broader picture as relates to our healthcare system, including overall costs. However, the fact that there is a trade-off between financial costs on one hand and lives of people on the other makes me queasy about their decision to publish it. Given that MAiD became enshrined (if that’s an appropriate term here) in law only in June 2016, it is likely that the study was under way before the law became a fact of life – or of death, to be more precise.
Thirdly, the CBC article offers zero counterargument to the whole idea of saving money by (essentially) killing off people, which any self-respecting media outlet would have and should have done. Especially as Canada’s ‘national broadcaster’ largely funded by the taxpayers, the onus to do this is heavier for CBC. Unfortunately, this esteemed organization is often found lacking when it comes to offering balanced perspectives to the people that fund it. To be amply clear, in this instance the fault does not lie solely on the shoulders of the reporter who wrote the article (one Kelly Malone); the entire chain of people, editors included, who were involved with it to the point of publication are equally guilty of this crucial lapse.
DEVIL IN THE DETAILS
Let us now take a dive into the issue via the details cited in the CBC article. As I will demonstrate, the horrendous premise of the study is exacerbated by the fact that faults therein, and the solution to the ‘problem’ that they are trying to solve, are staring us in the face VIA THE DETAILS CONTAINED IN THE STORY. I find it incredible that no one involved noticed this fact. Let me illustrate this via quotes from the CBC article, with my thoughts on each:
- “… the work is theoretical and needs to be readdressed when Canada starts collecting large scale data at home”. The only way that ‘large scale data at home’ can be available is if we start offering death as an alternative to healthcare on a large scale. At that point, it would be well nigh impossible to reverse the policy – not the least because a whole host of entities would have acquired a vested financial interest in maintaining the status quo. Any consideration of the desirability of a policy is supposed to precede the implementation of that policy for this precise reason (among others). “Oops, we got it wrong – we shouldn’t be killing people to save money on their healthcare” is, needless to say, a horribly inhumane approach that should be offensive to any proud Canadian.
- “In a resource-limited health system…”. This is without a doubt one of the most persistent canards in Canadian public policy. As I have shown in my article ‘Canadian Healthcare is NOT Underfunded’, with data from the World Bank, OECD, and Canadian Institute of Health Information (CIHI), this assertion is grossly uninformed at best and a flat out lie at worst. The fact is that our funding for healthcare is among the highest in the world, both on a per capita basis as well as on a percentage of GDP basis. Moreover, this spending has consistently grown disproportionately over the past five decades. Justifying ‘death-instead-of-healthcare’ on the basis of this patently false premise only serves to add duplicity atop the inhumanity.
- “It’s just the reality of working in a system of finite resources”. Broadly (or philosophically) speaking, every system in this universe is a ‘system of finite resources’, including the universe itself. But at the practical level, we know that our healthcare system is adequately resourced – perhaps even more than adequately (which may actually and ironically be one of the reasons why it is so inefficient; a large part of the ‘funding’ may in fact be meant to siphon public money into private pockets, with the safe assumption that healthcare being a scared cow in Canada, no one would dare to question the waste).
- “… we have a lack of palliative care services … (a)nd therefore people end up spending their final days in the hospital.” At the risk of overemphasizing, THIS IS WHERE YOUR SOLUTION LIES. If there is a lack of palliative care, resulting in patients remaining in hospitals (and thus occupying the bed capacity – which is meagre in Canada; see my article ‘Canada’s Healthcare Crisis’), then the proper solution is to increase the capacity of palliative care services, NOT offering death.Moreover, the final days of a dying person is precisely the time when their loved ones can travel to meet them for one last time and, if possible, to touch them and hug them. The period may be brief in the day-to-day context, but in the dimension that these patients and their loved ones are in, its importance is vastly greater that what would be inferred by looking at the clock or the calendar. THIS IS AN INTERGRAL – AND INDEED, CRUCIAL – PART OF CANADIANS’ MENTAL HEALTH, and for a healthcare system, or anyone within it, to suggest or even imply that it isn’t is shameful. Denying people the opportunity for a final interaction with their loved one before the latter passes on is cruel beyond measure.
- “Hospital-based care costs the health care system more than a comprehensive palliative care system…”. Then we are kind of dumb not to advocate for the creation of more capacity for palliative care, aren’t we? Why on earth are we looking, instead, at the alternative of offering death?
- “We are not suggesting that patients or providers consider costs when making this very personal and intimate decision to request or provide medical assistance in dying.” They may not be ‘suggesting’ it directly, but as we have learned after five and a half years since these words were spoken, that is exactly what can be expected to transpire. Whether this utterance was a fond hope or a pretense, evidence now demonstrates conclusively that cost of healthcare at the individual level HAS become a factor in MAiD. This was predictable – and predicted. Let us not act surprised.
The irony here is that in the process of Covid lockdowns and other assorted restrictions, we destroyed an untold number of lives ‘to save grandma’. But when the same grandma is in the very last stage of her life, the system goes deadbeat on her due to cost concerns. (For an early peep at the carnage that was just beginning to unfold in 2020 due to the lockdowns etc., please see my articles ‘Being Eaten Alive’ and ‘Lost Childhoods’). A lot of this damage was caused because Canadians were told to ‘protect the healthcare system’. In my view, this was exactly backwards; the healthcare system is supposed to protect us, not the other way around.
But widespread acceptance of this faulty notion has brought us to a point where the healthcare system is sought to be ‘protected’ at the cost of people’s lives. This reminds me of the tales that I have read about ancient civilizations where members of the society were routinely sacrificed at the altar of whatever god the society had accepted as the supreme deity. Today, we would not consider them to be much of a ‘civilization’ because we believe that killing off humans in that manner and for that purpose is in fact barbaric rather than civilized. Unless we get a handle on our MAiD policy, and how it is implemented, future civilizations will also judge us as being barbaric rather than civilized.