(Image Credit: Via Colorado Community College System; the image is at this link. Used without modification under Creative Commons Licence)
Associating MAiD with organ donations creates further unease among a population that is already deeply uncomfortable with the way Canada’s policy on Medical Assistance in Dying is expanding.
(Note: After writing 8 articles on the topic, I had thought that I was done writing about various aspects of MAiD – but it turns out that I was wrong. The number of surprises that our emerging policy on MAiD keeps throwing at us is indicative of how important this piece of policy is to the future well-being of our society.)
OLD IS NEW AGAIN
One peculiar feature of the current debate / controversy around Medical Assistance in Dying is that many of the points of concern had been reported on previously (perhaps even years ago) but are gaining wide – or at least wider – public attention now. For example, the aspect of MAiD that got me started writing on the issue roughly 3 months ago was a CBC report from January 2017 which had found a new life on social media. It was in keeping with this pattern that another article, this one from January 2020 in the Ottawa Citizen, resurfaced on Twitter almost exactly 3 years later, in December 2022, titled ‘Medically assisted deaths prove a growing boon to organ donation in Ontario’. The jubilant tone of this headline isn’t sitting well with many Canadians.
The number of assisted deaths in 2019 was 5,661 (which wouldn’t have been known at the time this article was published, but let’s assume that there was interim data pointing to where the number was likely to end up by the end of the year). As we now know, the number of assisted deaths in 2021 was 10,064, i.e., almost 78% higher than it was a mere two years prior, in 2019.
As a side note, perhaps it may be desirable to publish these numbers with greater frequency, given the gravity of the issue. Also, as the issue gains more traction in public discussions, the need for more recent data is paramount. Publishing data for the entire year only once, well after that year ended is bound to be perceived as a data vacuum, which could lead to a lot of raised suspicions among the public. Many of these suspicions may even be valid.
MIXING GOOD & BAD
The sub-heading of the Ottawa Citizen article is: ‘Ontario’s waiting list for organs typically hover around 1,600 without any great headway made to eliminate that number’. I am sure that if this article were to be written today, the word ‘eliminate’ would raise quite a few heckles as being dangerously inapt in the context of MAiD. This is especially in the context of the reports that have emerged in recent months about how MAiD was offered inappropriately to several individuals, including veterans.
My focus here is on the juxtaposition of a laudable idea (organ donation) with an increasingly more controversial one (MAiD). This may sound conspiratorial, but one does wonder whether the juxtaposition has the potential to buttress MAiD against any and all opposition, no matter how disputable the circumstances; the laudability of organ donation would make it easy to demonize opponents of ANY aspect of the MAiD regime as heartless – even evil – people. In this context, I think the evolution of my own thoughts on organ donation can be useful for finding the right answer – at least for myself.
While I had known about organ donations for a very long time, when I came to Canada, I was surprised by the organized structure that enabled one to agree to donating one’s organs many, many years beforehand, and for that agreement to be recorded as part of one’s personal data. The messaging around it was a novelty, too. I wasn’t sure of what I wanted to do in this matter; although I am not very religious, Hinduism treats the body as being sacred. Causing harm to one’s body, including by voluntarily losing a limb or an organ, violates this sanctity and makes the body imperfect (which would happen if one were to voluntarily part with a body part). I was under the impression that this applied even after death, up to the moment of cremation. But as I thought more about it, I discovered two exceptions.
In the first category, there are people who need to have an organ removed (or a limb amputated) in order to avoid death. Theoretically at least, there is a choice: amputation / organ removal versus death. But in the practical world, the imperative to preserve life prevails. Their bodies are no less sacred after the amputation of a limb or removal of an organ.
My second source was a part of Hindu scriptures called ‘Puranas’, wherein there is the tale of a sage called Dadhichi who donated his entire body to help fight a particularly strong demon. The devas (demi-gods) were powerless against this demon, and needed a weapon that was strong enough to defeat him. They were told that the only way they could make this weapon was by using Dadhichi’s bones. Upon being approached by them, he willingly donated his body so that the devas could make this weapon (which came to be called ‘Vajra’) and defeat the demon. This told me that parting with an organ of one’s body without an imperative personal medical need to do so was not necessarily a violation of the dictum to preserve the sacredness of the body; in fact, context could make it a noble act.
Having arrived at my answer in a reasoned manner allowed me to register as an organ donor more confidently. But in the context of today’s discussion (sick people’s need for donated organs versus MAiD), I think I need to ponder this additional aspect of organ donation; specifically, should one person’s need for a donated organ be offered as a justification to influence another person’s decision to leave this world? In simple words, are we supposed to be a modern-day version of Dadhichi?
It is noteworthy here that so far, the reasons for requesting MAiD have remained confined to the patient’s nature of suffering (see this part of the 2021 report on MAiD). Injecting someone else’s suffering in the equation – albeit not officially but as a persuasive external factor – alters the situation materially, in my view. This external factor would influence different patients’ thinking differently. To the extent that they are already organ donors, the overall situation would remain the same. However, if they are not, or if someone’s need for an organ is very urgent such that their life hangs in the balance, there is conflict between the donor patient’s decision, un-influenced by any external factor, on one hand and the other patient’s prospect of remaining alive on the other.
At this point, would it be proper, or indeed ethical, for a medical professional attending to the donor patient to weave in this aspect in their discussion about MAiD? Two pertinent facts stand out in this regard: (a) unlike all the other jurisdictions where medically assisted dying is legal, the law in Canada does not prohibit medical professionals from initiating a discussion about MAiD with their patients, and (b) the organization (of uncertain official standing) of assessors and providers of MAiD says, in a ‘guidance paper’, that it is the professional obligation of medical professionals to initiate such a discussion. As I have detailed in previous articles on the subject, this amounts to the medical profession taking over the reins of control over an individual’s decision, or even (if one wants to put this more harshly) usurping the individual’s authority. By extension, therefore, it is possible to see a situation where it becomes even more of a ‘professional obligation’ for medical professionals to remind a patient that someone else’s life is hanging in balance, awaiting their decision to opt for MAiD.
By any ordinary logic, this would qualify as coercion – of a subtle kind, but coercion nonetheless – but I think we can agree that we crossed over from the territory of ordinary logic a while ago in the matter of assisted dying. The farther we go beyond that boundary, the darker the prospect appears to be; there is another cultural memory of mine that makes me think that is more than being merely possible, and therefore something that we should be on guard against.
CAUSES & CONSEQUENCES
There is an excellent but little-known Indian movie called ‘Parinati’ (meaning ‘inevitable consequence’) which is so obscure that there is hardly any information available about it on the internet. The most detailed (if you can use that word here) information about its story is available on this link. Its story involves a potter and his wife, who were so honest that they were hand-picked by the local rich man as caretakers of an inn that he had built in an otherwise uninhabited stretch of land for travellers to rest. One day, an elderly traveller dies at the inn – and the caretaker couple discover that he had been carrying many valuables. They are tempted and take the valuables after disposing off the body. They knew that no one was going to know about this. Now they start wanting lonely travellers to die at their inn.
As time passes, the couple fall into a habit of killing off lone travellers at the inn if they looked like they had money or other valuables like gold etc. In the end, the obviously rich and unaccompanied traveller that they murder turns out to be their own son and lone child.
The story is a telling commentary on how anyone’s mind can be corrupted by circumstances. It does not portray the murdering couple as evil ab initio. They are just human, and thus susceptible to human failings. Thinking about this movie reminds me of the title of a novel by an acclaimed American author, William Somerset Maugham: Of Human Bondage.
PONDERING THE INEVITABLE
All this brings us to a question that, although uncomfortable, must be answered: Would there be a point where the medical professionals start discharging their ‘professional obligation’ of bringing up MAiD to their patients owing to factors that have nothing to do with the well-being of not only the organ-donor patient but also the receiving one as well? I think we should be able to ask this question without it being interpreted as casting aspersions on the entire class of people who fall under the description ‘medical professionals’. Just like the couple in the movie Parinati, they are also human, and susceptible to human failings. While it is considered impolite to suggest that they would do anything that was not in the best interest of their patients, there are ample examples in history to warn us about assuming that people can be beyond human weaknesses.
I must hasten to add here that the idea that ‘MAiD saves costs in the healthcare system’ has already been around for over 5 years. That is one example of an extraneous factor right there; the cost-saving argument has zero to do with the well-being of the ailing patient. How far would the attention to money matters be extended? We have already seen that disabled people – including ordinary civilians and veterans – have been offered MAiD where the proper recourse would have been to spend money on alleviating their difficulties in life. That is another type of ‘cost-saving’ (although an indirect one) in the MAiD scenario. Let me take it to the next step: can someone start a ‘consulting’ firm that helps people, for monetary consideration, find the organ that they or their family member is in need of by accessing data of people who are in the pipeline for MAiD? And finally, can this sourcing of organs happen as a result of a political directive? This may sound offensive to many (most?) Canadians, but let us remember that a well-designed system is one that can withstand the most extreme pressure. The issue of MAiD, because it literally involves a life-and-death matter, requires us to put in place a system that is capable of setting the highest standard in withstanding all such pressures.
Unfortunately, as we have seen over the course of the 8 articles that I have written on MAiD prior to this one, there is no appetite in either the political or the judicial circles for a well-designed system; the courts are busy over-interpreting the Charter right to life and security of the person, and the political class lacks the gall to swim upstream, choosing rather to bring the laws in compliance with court verdicts as hurriedly as possible. I think this worsening situation is now left to the people to redress. Will they rise to the challenge? Only time will tell – but ‘people’ are composed of individuals, and as an individual, it is up to you to decide to take on this challenge. It is, in my humble opinion, the defining challenge of our times.
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