(Image Credit: Charles Foster, via Wikimedia Commons; the image is at this link. Used without modification under Creative Commons Licence)
Expanding MAiD to infants (who cannot possibly ‘request’ it) and mentally ill people solely based on input from parliamentarians, health professionals & academics is lopsided & can only take us in a dangerous direction.
(Note: This is Part-2 of my earlier article ‘… And Euthanasia For All’)
CATCH ‘EM YOUNG
The revelation that a medical doctor representing a professional body proposed to a parliamentary committee that new-born children up to the age of 12 months should be covered under our MAiD policy came as a shock to many Canadians. The understanding thus far has been that MAiD is to be offered to individuals only if they request it. Extending the policy to infants, who can not possibly request it, changes the entire paradigm of assisted suicide; the primary assessment comes from persons other than the individual being ‘suicided’. At the risk of sounding melodramatic, I can say that we are entering a dangerous territory where an arm of government – or institutions having State backing – sits in judgement over whether a person should continue to live.
One of the reasons for this shock was that generally speaking, this issue of MAiD does not get wide coverage in our media – whether the legacy type or social. It was therefore unsurprising to me to discover that an entire exercise of expanding MAiD to cover mentally ill persons had been carried out and a set of recommendations issued in that regard without much commentary in the broader society. There seems to be an unspoken agreement among the political class, media and opinion-makers to keep the unfolding exercise under wraps. Whether this suspicion is true or not, the near-total silence is concerning.
CIRCLES OF POWER
The interim report of the Special Joint Committee (SJC) on MAiD, issued in June 2022, on ‘Medical Assistance in Dying and Mental Disorder as the Sole Underlying Condition’ makes for an interesting reading – in all the bad ways possible, from where I stand. Before we jump into the details, I think some broad observations are in order.
The list of participants in the proceedings of the SJC (pages iii & iv, plus 31 & 32 of the Report) shows that they can be classified under the following headings:
- Medical professionals: 11
- Academics: 7
- Public servants: 2
- Lawyer: 1
- Indigenous knowledge keeper: 1
- Activists: 2
- Parliamentarians (MP’s and Senators): 34
- Staffers at Parliament: 2
Some of the medical professionals and academics, plus the lawyer, represented their institutions. In addition, there were 14 people attending in their individual capacity (8 medical professionals and 6 academics). Among the activists, 1 is a lawyer by education. I could not find similar details for the other activist; the website of the voluntary organization that he represented merely gave his name and photo.
ARTICLES OF FAITH
The observant reader will have noticed the glaring omission in the above list: Not a single representative of any of the religions or from the field of philosophy was invited to provide input in the deliberations for expanding MAiD to mentally ill people. It has become fashionable in recent years to pooh-pooh religion as an ideology lagging behind the times, especially Christianity (although other ‘minority’ religions in Canada do get some kid-glove treatment). But the question of life (as in the state of being alive) and whether humans have a right to end the life of another person, and under what circumstance, has mystified us since the dawn of civilization – and quite possibly earlier, when humans first became self-aware. Over countless millennia, people have tried to find answers to this pivotal question, and their answers (whether we consider those answers to be valid in the current times or not) are, for the most part, distilled in religious texts and teachings as well as philosophical works. For all the faults of religious and philosophical ideologies, this is an issue where they are capable of making uniquely valuable contributions; excluding them from the deliberations altogether (whether intentional or otherwise) is a grave error in judgement on the part of the government.
Even the Conservative Party members of SJC, in their DISSENTING report (pages 36-42 of the Report) make no reference to the ideological / philosophical arguments against providing MAiD to people who don’t necessarily have the mental capacity to make an objective decision in the matter. Instead, their objections are that (a) we need more studies to be done on the matter, (b) there hasn’t been enough consultation, including with historically marginalized groups such as the Indigenous community, (c) it is difficult to predict whether a mental disorder is irremediable, with no possibility for the person to live a good life, (d) the line between suicide prevention and suicide assistance is being blurred, with the result that there is a perverse incentive for mentally ill persons to opt for MAiD and (e) that the proposed regime for expanding MAiD lacks safeguards. In a nutshell, the CPC’s stance appears to be that with more information, consultation and safeguards, expanding MAiD is a desirable policy direction. Clearly, there is no one in our entire political class who is interested in exploring the philosophical aspects of ending a human life via human action.
Turning to the Recommendations in the Report, one gets a sense that the entire exercise is meant to drive policy to an outcome that has been decided in advance. This is likely due to the trajectory of court decisions over the past 7+ years, and because Bill C-7 carries a sunset clause for excluding cases of mental illness from the MAiD regime, set for March 2023. However, as I have written in ‘… And Euthanasia For All’, the wider discussion on MAiD at the societal level has not happened as it should have, and there appears to be no appetite in political circles to find out what the people want in the policy of MAiD.
The Dissenting Report of the Conservatives makes multiple references to cautions offered by the various attendees that the Recommendations ignore, perhaps blithely. For example, despite several presentations from doctors and psychiatrists that the irreversibility / incurability of mental illness cannot be ascertained with confidence, Recommendation # 2 of SJC is that “MAiD assessors should establish incurability with reference to treatment attempts made up to that point, outcomes of those treatments, and severity and duration of illness, disease or disability.” Recommendation #3 contains similar words in regard to irreversibility (of mental illness). How one can find a meeting ground for these two diametrically opposed ideas is a mystery to me.
Recommendation #6 does address the issue of some people desiring death due to hardships of an economic nature, and the Recommendation does say that housing and income supports should be offered as a means to relieve suffering, ‘where appropriate’. As to whether the concerned bureaucracies will be able to do that in quick enough time to be meaningful to the individual who is suffering is anyone’s guess.
The entire tenor of the 19 Recommendations is one of how MAiD should be offered to mentally ill persons, and the regulatory regime to be administered in that regard, rather than on whether this should be done. As I mentioned earlier, this is due to the judicial history of the issue – but I believe that inputs from important constituencies (that has not been sought so far) is required before making any binding decisions on the matter.
A HOLE IN THE DYKE
The very first Recommendation in the Report calls on the federal, provincial and territorial governments ‘should facilitate the collaboration of the physician and nurse regulatory bodies in the development of Standards of Practice … for the assessment of MAiD requests…’. Throughout the remaining 18 Recommendations, one can sense that there is an attempt to build safeguards against use of MAiD where it may not be the only option available to the individual in question. HOWEVER, given the legal history of the issue, there is reason to doubt if such safeguards would pass muster in a court of law. Just as the courts across Canada have consistently held that the criminalization of the committing and aiding of suicide, as well placing restrictions on who can access assisted suicide, was in violation of Canadians’ Charter Rights, it is entirely likely that some or all of the safeguards built into the MAiD regime for mentally ill persons would be deemed to be similar violation of Canadians’ Charter Rights. If that happens (which I expect it to, in due course of time), we will have opened the door to MAiD in an unrestricted manner (I am resisting the urge to call this ‘floodgates’).
Equally importantly, there are no proposed safeguards on the part of the individual. In light of the socio-legal environment that we have been building up and continue to build further, people in dire stress may be tempted to opt for MAiD simply to ease the burden on the people around them, or if they have no one around them. To put a fine point on it, there may be external factors (and not the medical condition) that may influence the individual’s inclination for availing MAiD, and as far as I can see, there is no proposal to provide a safeguard against this possibility. And as I said earlier, even if such a safeguard is put in place, it may fall afoul of a court’s opinion in the matter.
It is monumentally pertinent here that the provisions in the Criminal Code against committing and aiding suicide were also ‘safeguards’ to prevent loss of life. We may disagree with calling them ‘safeguards’ now if we wish, but viewed through the lens of the social norms of the time, they certainly were. But the Supreme Court, in its wisdom, opined in Carter that these ‘safeguards’ amounted to violation of Canadians’ Charter Rights. It is therefore entirely likely that any ‘safeguards’ built into the MAiD regime may also be viewed by the courts as violation of Charter Right of Canadians .
Let us take a detour here. I was listening to a talk show on a prominent radio station in Ontario one day, and the topic that the host brought up for discussion with his panel was one of ‘birth tourism’. It had just been reported that the number of children born to foreign nationals who were in Canada on a visit visa had registered an 11% increase over the past year. The host took a position that this wasn’t desirable. One of the panelists, Marit Stiles, who is Ontario NDP MPP, countered him by saying that since these women weren’t covered by the provincial health plan, they paid a high amount for their hospitalization and delivery, and ‘that means more money in the system’, which made it a good thing. I was so appalled by this reply that I had to switch off the radio. Why was I appalled?
The would-be mothers who come to Canada with the sole objective of giving birth here do so in order for their child to get a right to claim Canadian citizenship. By definition, these would-be mothers are people of greater financial means. Ms. Stiles’s stance thus amounted to giving preferential treatment to the rich, in the name of bringing ‘more money in the system’. For an elected member of a supposedly socialist party, this was an astonishingly poor -anti-poor’ stance. But as I have been saying for a while, the canard that Canadian healthcare system is underfunded has wide appeal and refuses to die, so her argument, on the face of it, would (I guess) be palatable to many. Additionally, birth tourism is a backdoor to gaining Canadian citizenship, and we should be considering whether we want to close this loophole. Advocating that birth tourism is good thing because it bring ‘more money in the system’ amounts to selling Canadian citizenship – and that too, to those who can afford the high price.
Coming back to MAiD, the argument that it could save our healthcare system money has been around for many years (for my thoughts on this in detail, please listen to my podcast episode ‘Death Of a Promise’). I wish to be unambiguous here: If we don’t reject COMPREHENSIVELY the idea that we could save money if people choose to die rather than avail healthcare, that idea WILL grow and pull ever more people into its dragnet. As we enter a period of financial hardship (which we are doing now), demands for austerity in the public sector will grow. The ‘financial argument’ may get pushed in relation to MAiD rather more strenuously than it has already been. Moreover, as we know from recent cases, some Canadians have been offered the option of MAiD by their case workers ‘unprompted’. We also know that in the Covid era, the idea of ‘greater good’ has found significantly greater impetus and acceptance. This could put additional pressure – on people who are already mentally ill – to choose death ‘for the greater good’ because ‘our healthcare system is underfunded’.
If you think that is bad enough, hang on – I have a scarier thought to share with you. Before I bring that up, however, I must emphasize that I am possibly going out on a limb here. In any event, I desperately hope to be proved wrong on this – but cannot ignore the possibility, however remote it may be.
In the wake of legalization of same-sex marriages in Canada, there were several reports of same-sex couples from the US coming to Canada to get married because their marriage wasn’t possible in their country. I remember it being celebrated as ‘marriage tourism’. In another context, what isn’t reported in Canadian media is that because sex-selective abortions are illegal in India (they passed a law back in 1994 prohibiting medical professionals from disclosing the sex of the unborn baby), many people from India go to other countries to find out the sex of their foetus and, if it happens to be a girl, abort it. Do some of them come to Canada? I don’t know – and likely nobody knows, apart from the people who may be directly involved. We don’t know because saying anything that shows abortion in a negative light is taboo in Canada. Mainstream media won’t do it, and any individual who dares to do so will get tons of blowback. Of course, the term ‘abortion tourism’ isn’t widely used, if at all. But a logical question arises – can this happen in relation to MAiD?
In the era of easy international travel, it is human nature that when people are barred from doing something in their country, they seek out destinations where that something is available legally, to the extent that doing that something in a distant place is feasible. In dispassionate economic terms, demand will find a source of supply. Will Canada attract people who wish to end their lives but cannot do so legally and painlessly (in contrast with the excruciating final experience of dangling from the end of a rope or bleeding out from slit wrists) in their countries? The ‘financial argument’ is likely to play a role in this discussion (if we get around to having a discussion at all) given the perennially perpetuated falsehood that Canada’s healthcare system is underfunded. Everyone is entitled to their opinion, but my view is that I don’t want Canada to become a country where people come to die.
PLENTY OF BLAME TO GO AROUND
If it seems like I am putting all the blame for the expansion of MAiD, and all the negatives outcomes that are likely to ensue, on to the political class, let me point out that the religious leadership and the philosophical community, along with all the other important social constituencies, are silent on the issue. As responsible citizens with specialized insights on the meaning of life, it is their duty to speak up – nay, raise a ruckus – over the headlong rush into expanding policy on this grave matter. Barring a handful of online commentators, I haven’t come across any signs that any degree of opposition is being mounted to the expansion of MAiD. Have they thrown in the towel? Are their energies exhausted after the previous failed attempt to block the original introduction of MAiD? Will we sleep-walk into a policy dictated from the sanitized confines of wood-panelled conference rooms (or their Zoom equivalent) where participants are disconnected from the general populace? This discussion needs to happen in the bazaar of ideas, not in the sophisticated environs of Parliament Hill.
I have deliberately chosen to use the word ‘bazaar’ above – they are messy places where people are exposed to the elements of weather, the merchandize is often scattered, and there is much haggling over the price of things as well as confrontations over the sellers having short-weighed their wares. This is in stark contrast with a supermarket where the indoor premises are temperature-controlled, everything is neatly arranged and labeled with a price. A point of crucial difference between a bazaar and a supermarket is that in the latter, there is no bargaining. Your choice as a customer is limited to paying that price or not buying the item. If enough people don’t buy, the supermarket has to either reduce its price or go out of business. Will we, as Canadians, exercise at least that limited amount of choice in the supermarket of ideas on MAiD by rejecting the ‘wares’ that are on offer?
THE NEW MOLOCH
Counter to the hypnotic attraction of the question of life and the ceaseless efforts to understand it, there was also a concomitant trend, across civilizations and time, of justifying – indeed, REQUIRING – the sacrifice of human lives, usually on grounds of ‘greater good’. Across the globe, human societies conjured up deities to which this ‘sacrifice’ was offered. One commonly known name of such a deity is Moloch. Whatever we may think of the practice now, those people thought that by taking the lives of individuals, they were creating a benefit for their societies.
The difference between those ‘sacrifices’ and MAiD is that in the former, the fittest individuals in the society were chosen to be killed in pursuit of an ideological goal, whereas in MAiD, it is the vulnerable and suffering people, bereft of all hope, who can avail it. But the underlying assumption of both the practices is common, viz., that this taking of lives will make for a better, purer and more noble society. It is unlikely, in the current social environment, to create a statue of the deity for whose appeasement the human lives are being offered up, but this new Moloch will well and truly reside in our hearts just as the old one resided in the hearts of people of yore.
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