(Image Credit: Author ‘Lena’ on flickr.com; the image is at this link. Used without modification under Creative Commons Licence)
Canada’s MAiD policy was sold on the basis that it would ONLY apply with the individual’s voluntary consent. However, this basis is being undermined relentlessly with a nudge here and a push there.
(Note: This is my final article on MAiD. I dearly hope that I won’t have to return to this topic. While it was imperative for me to explore all possible angles of this issue and bring my ideas to you, the experience has been emotionally draining. I sincerely thank you all for following – and contributing to – my series of articles on MAiD.)
PROXY WARS
When the National Post reported that “A guidance document produced by Canada’s providers of medically assisted death states that doctors have a professional obligation to bring up MAiD”, the first question in my mind was about the institutional standing of the body that produced the said ‘guidance document’. Unfortunately, the National Post article did not throw any light on this at all, although it did link to the document in question. The name of this body is ‘Canadian Association of MAiD Assessors and Providers’ (CAMAP). I assumed that this was an officially recognized body, with the remit to issue such a guidance note that would be binding on medical professionals.
Some days later, a Twitter friend dug up the details about this body. According to his research, CAMAP is a registered charity, and for the 2021 tax year, its only source of revenue was funding from the federal government (see this link for his tweet). This information puts the ‘guidance note’ in a very different area of the debate o MAiD. I believe that it is necessary for someone armed with the necessary arsenal of legal prerogatives & professional knowledge to dig into the nature and purpose of this organization. From my layman’s perspective, it does not appear to be an organization that can exert any sort of authority on medical professionals in Canada. If that is true, what is the idea behind issuing this ‘guidance document’?
TOURNAMENT OF SHADOWS
Is CAMAP a legitimate component of the officialdom in Canada? Or is it a pseudo-official entity seeking to exert influence on MAiD policy via the back door? It is crucial to know the answer, given the seriousness of the issue. Unfortunately, apart from the single article in National Post, there hasn’t been so much as a mention of this entity in the public sphere. It seems that the mainstream media, the punditocracy and the commentariat lack the intellectual resources – individually as well as collectively – to get to the bottom of this. The alternative possibility is that they aren’t interested in finding out.
In my previous articles on MAiD, I have emphasized how the public at large has been shut out of any debate on MAiD, such that the policy is entirely driven by a select group of medical professionals, parliamentarians and the judiciary. The resulting unease among the public is only exacerbated by sporadic revelations like the National Post article. Keeping the process of policy making out of the public eye creates an information vacuum for the people, and as Albert Einstein said, ‘Nature abhors a vacuum’. As a result, people will try to fill it by resorting to augmenting the scant information that has managed to emerge in the open with their own imagination. In turn, this creates a controversy around ‘misinformation’, thus derailing the debate completely. But in the case of CAMAP’s ‘guidance document’, it still remains unclear as to whether ‘professional obligation’ means that it is compulsory for medical professionals to bring up MAiD when their patient has not done so. To add to our problem, another bit of information dribbled out recently.
OUR NEW DEMI-GODS
On November 18, College des medecins du Quebec tweeted that “#MAiD is not a moral, political or religious issue. It is a medical one.” Pardon the repetition, but the public has been shut out of the formation of policy on MAiD; now the medical profession of Quebec is saying that even the politicians aren’t supposed to have a say in the matter. Let us bear in mind that over the past 7 years, the entire policy on MAiD has been propelled by judicial pronouncements. Does the above statement amount to saying that even the courts shouldn’t have a say in MAiD? In any normal society, such a blatant and brazen grab for power would have led to widespread outrage – but in Canada, there has been nary a ripple of criticism, which tells us what kind of a society we have become.
The questions around life, death and the end of life have been around for millennia – perhaps ever since humans first became self-aware. The claim that the act of ending a person’s life by human intervention is solely the prerogative of the person doing the intervention to decide upon is starkly at odds with the moral, philosophical and psychological struggles that human have experienced on the issue over all of human history. And when the claim is made by the organization representing the ‘intervenor community’ of a province – representing 25% of Canada’s population – it is tantamount to granting itself the semi-divine status of demi-gods. Sadly (but unsurprisingly) there has been no comment at all in the public sphere – including in the media – on this shockingly arrogant pronouncement. Even more sadly, theirs isn’t the only example; in Ontario, the organization governing physicians and surgeons has also decided to place itself in the driver’s seat.
LET GOD SORT THEM OUT
Even after seeing many shocking facts & revelations on the MAiD issue over the past 2 months, it came as a jolt to me that the College of Physicians and Surgeons of Ontario has made a draft policy to the effect that the death certificate of MAiD recipients in the province will NOT show MAiD as the cause of their death (see Page #4 at this link). Rather, the medical condition that caused them to choose MAiD will be recorded as their cause of death. Apart from the fact that this has been decided upon by CPSO without any reference to other stakeholders, this proposed policy has profound implications in terms of collection of data. To give you one example, before the MAiD regime came in, if a person suffering from, say, cancer was to commit suicide by drowning, what would the death certificate have said was the cause of their death? Was it death by drowning or death due to cancer? I am willing to bet that it would have been the former – and I see absolutely no reason why that should change under MAiD. Specifying a cause that did not bring about the person’s death is fundamentally dishonest.
This is especially relevant because we are moving to a stage where people suffering from disability or homelessness – or even fearing it – have chosen the MAiD option. What would the death certificate say the cause of death was in such a case? ‘Inability to move about’, no matter how severely limiting, cannot be a cause of death. Moreover, we already have MAiD ‘eligibility’ for people whose death is not reasonably foreseeable. Can a medical condition that wasn’t reasonably foreseen to cause the person’s death be said – nay, certified – to have caused that person’s death? Lapsing into colloquialism, I am tempted to say that we are in cuckoo land here.
The cardinal rule in data collection is that it is best done at the ground level, rather than depending on a roundabout method. But the proposed policy of CPSO would force us to depend on a roundabout method to ascertain & verify the number of MAiD deaths in any period. If we are to make a departure from this tenet in the case of MAiD, then the proposal needs to undergo public scrutiny, NOT decided upon by the medical Politburo of Ontario. I am also curious to know if the other provinces & territories are contemplating to follow this proposal in Ontario. As we have seen in an earlier article, people who request & are approved for MAiD sometimes pass away before MAiD can be administered. Some requesters also withdraw their request after getting approved. By not registering MAiD as the cause of death, we are likely going to create a data-mess for ourselves.
THE COST-CUTTING CONTAGION
We have already seen that the idea of offering MAiD as a way to cut costs for the healthcare system has been around since at least 2017. As the economy faces significant headwinds, this idea is bound to find renewed support – and even spread to other areas beyond healthcare. The two obvious candidates in this regard are support for mental health and disability. At the very least, there will be resistance to increasing spending on the support programs for these people by the government. In this regard, I was made aware of another shocking detail recently (I beg you pardon for overusing the term ‘shocking’ and variations thereof).
Among 38 OECD countries, Canada ranks at #32 in spending for disability supports (as a percentage of GDP). Naturally, we are far below the OECD average – about 65% lower, in fact. The only countries in the OECD that are spending less than Canada on disability support are Korea, Turkey, Colombia, Costa Rica and Mexico, in descending order. Canada’s spending is 0.7% of GDP, versus the OECD average of a little over 2%. The highest spending is by Denmark, at 4.9% – meaning Canada is spending 86% less than Denmark on Disability. To be fair, a lot of factors go into determining a country’s level of spending on this priority, but to be equally fair, being 65% lower than the OECD average, and being at #32 out of 38 countries does mean that we aren’t doing nearly enough for disabled Canadians. The data that I have cited here can be seen at this link; the chart is reproduced below:
ANOTHER (ARM)TWIST
Prior to all these discoveries, on October 04, Twitterer Nadine Ness had revealed that the College of Physicians and Surgeons of Ontario had put out an advice for doctors on its FAQ page to the effect that doctors should ‘work with their patients to manage anxieties related to the (Covid) vaccine’ – so far so good – and ‘In cases of serious concern, responsible use of prescription medications and/or referral to psychotherapy are available options’. Following her post on Twitter, CPSO amended the wording, by adding the words ‘extreme fear of needles (trypanophobia)’ before ‘cases of serious concern’.
The shift in the approach to a patient’s medical decision is unmistakable here: it is no longer an unfettered right of an individual to make a medical decision that they are comfortable with, but rather, their decision is subject to second-guessing and even arm-twisting by their physician. I don’t feel comfortable using such words for physicians, whom I respect generally unless there are demonstrated reasons not to. But at the end of the day, they are people. Moreover, their ability to make a living is in the control of their regulatory body – in this case, CPSO. That is possibly the reason – or one of the reasons – why we haven’t heard about any resistance to this idea from any physician.
THE RIDDLE OF STEEL
All of the above discussion brings us to the central point of this article: the gradual but incessant push to dilute the importance of ‘informed consent’ of MAiD recipients and increase the role of coercion in their decision to avail of MAiD. Online, there is a good deal of chatter about MAiD being a backdoor to bring in eugenics (and considering the impact on the disabled & the mentally ill, there is a debate to be had here at the very least). There are also (perhaps less credible) accusations of ‘depopulation’ flying around. Leaving those contentious issues aside, I believe that there is ample room to discuss where the ongoing revision of our MAiD policy is likely to take us as far as ‘free consent’ is concerned.
Unfortunately, owing to Covid, the idea of ‘medical coercion’ has already gained wide acceptance in the Canadian society – although one still comes across the cringeworthy argument that ‘No one was forced to take the vaccine’. The key here is the meaning of the word ‘force’. It should not have to be spelled out – but is sadly necessary in today’s Canada – that ‘force’ need not be of the physical kind. There are many other ways of ‘forcing’ people to do something, and the subtler the form of force is, the more effective it becomes and the more difficult it is to counter.
The main theme in the movie ‘Conan, The Barbarian’ involves exactly this idea: the riddle of steel. Towards the end of the movie, the main protagonist, Conan, realizes that while steel is strong, being able to get others to do you bidding simply by possessing control over their minds is an even stronger force. The way I see it, our MAiD policy takes a leaf out of the story of that movie – whether the people shaping the MAiD policy are doing so deliberately or otherwise is irrelevant, because what concerns us is the end result. The default behaviour in politics, coupled with the policy structure that is being put in place now, is sure to bring about an outcome where, at best, patients will feel under pressure to choose MAiD owing to external considerations, and at worst, consent will have been replaced by coercion altogether.
LET’S BREAK OUT A CONSPIRACY THEORY
I had finished writing this article, but was unable to get around to uploading it for a few days. This was a cause for concern, but at the back of my mind, I had a feeling that there was something that I had been unable to pinpoint in the article. Therefore, the delay was a welcome relief. Then it struck me this morning: If we string the above points (and other facts that I have included in earlier articles in this series) in a certain sequence, it is likely that Canadians may end up losing their right to STAY ALIVE. I admit that this appears to be a far-fetched scenario, and I desperately hope that I am simply letting my imagination run wild here. However, in the interest of completeness, I am forced to offer it for your consideration, with the hope that someone will offer a solid counterargument as to why my line of reasoning is wrong here (for the record, ‘Doctors would never do this’ or ‘It can’t happen in Canada’ won’t count as effective rebuttals; worse things have happened in otherwise sane & civilized societies). Here is that sequence:
- According to CPSO, refusing to take the Covid vaccine, including a booster dose (which may be the 10th or 20th or {insert your preferred number here} dose) is a sign of potential mental illness.
- According to the law, mental illness is one of the conditions for which MAiD can be made available to an individual.
- Also according to the law, an individual’s natural death need not be reasonably foreseeable in order to be eligible for MAiD.
- According to College des medecins du Quebec, MAiD is solely a medical issue.
- According to CAMAP, it is a medical professional’s ‘professional obligation’ (= compulsory for them) to bring up MAiD when the patient hasn’t, if they think it should be considered.
- Therefore, if a person refuses to take Covid vaccine, their ‘mental illness’ makes them a potential case for MAiD, which the doctor is under ‘professional obligation’ to offer.
- Applying CPSO’s FAQ advice regarding Covid vaccine to MAiD, if the patient refuses the doctor’s suggestion of MAiD, it means that they are likely suffering from mental illness (this is the second time now).
- Repeated ‘symptoms’ of mental illness (by refusing Covid vaccine and MAiD) indicate that the ‘mental illness’ is impossible to recover from.
- Going back to the stance of College des medecins du Quebec, there are no considerations beyond ‘medical’ ones in deciding on a MAiD case.
- The death certificate of the individual will NOT say ‘MAiD’ as the cause of death. My reasonable guess here is that it would say ‘Mental illness’.
- End Result: An otherwise healthy individual, whose natural death is not reasonably foreseeable and who refuses the Covid vaccine, will end up ‘MAiD-ed’ (but the official record won’t show that).
Let me re-emphasize that I am extremely wary of this conclusion. I am putting out this line of reasoning so that someone can refute it with a fact-based counterargument, to ease my own feelings if nothing else. But until such time as that happens, this scenario is going to weigh on my mind, heavily. Given how the courts are continually over-interpreting the Charter right to ‘life and security of the person’ – to the total exclusion of all the other considerations – coupled with the medical profession’s incessant push to usurp the authority that should rightly belong to other stakeholders in the Canadian society, I believe that we have a prima facie case to be worried.
MASTERFUL NEGLECT
Moving past the above conspiracy theory, all it would take to bring things to a boil would be to neglect the administration of policies relating to supporting the disabled and the mentally ill; we already know that healthcare is collapsing and held together by duct tape. Worsening outcomes would themselves lead many people to choose MAiD to end their suffering. In addition, the proclivity to hand out hard drugs to the addicted, without sufficient thought & energy being given to their recovery and rehabilitation, is also bound to bring many of them to the brink where they believe that their only way out is death.
The media will play a major role in this matter (of course), but it remains to be seen what direction they take. So far, they have studiously avoided analyzing the policy from a broader perspective; their reporting has remained confined to stories of individual cases. If they – or enough of them – take to presenting the MAiD option as a truly compassionate policy that all Canadians should be proud of, they may be able to strengthen support for it in the general populace. The other constituencies, such as advocates for supporting the disabled etc., have already been shut out of the process, and lack a public platform in any case. The time may not be too far when the number of MAiD deaths in Canada would rival that of capital punishment in countries that we deem less evolved than us – at least on a per capita basis.
After the humiliation of the First Afghan War in 1843, the British Indian Government adopted a policy known as ‘masterful neglect’ in relation to Afghanistan. It worked splendidly – or so it seemed, until another Afghan war broke out in 1878. The British suffered another humiliation (although it was on a less grand scale, and there were some saving graces). It remains to be seen if, in Canada, a similar approach of ‘masterful neglect’ towards healthcare, social / disability supports and mental health supports would lead to a comparable upheaval.
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