Decriminalizing “Medical Assistance in Dying” (MAiD) in 2016 apparently confirmed a powerful social bias in favour of personal freedom. Presented as a free choice – affecting no one else – euthanasia seemed acceptable to most Canadians.
However, this tells only part of the story, for euthanasia is not only about death by choice; it is also defined as high-priority medical care. Unfortunately, like a new organism released in an established ecosystem, the arrival of euthanasia could not fail to affect every detail of the medical environment.
First of all, it is an ethical requirement for doctors to inform patients of all available treatment options. This means informing each patient of their “right” to access euthanasia (MAiDs). The typical non-suicidal patient is thus immediately confronted with the possibility of assisted death, in the same way that one is confronted by an open elevator shaft or a missing guardrail. Suddenly a danger exists which must be consciously avoided.
Nor does the threat end there. Doctors are expected to proactively prescribe optimal treatment (to which the patient normally consents), but some doctors are very partial to euthanasia. It is thus to be expected that many patients will succumb to the suggestion of these “professionals,” even though they would never have spontaneously thought, themselves, to request assisted death.
Indeed, it is not easy to fix a clear boundary between the legitimate professional duty to convince recalcitrant patients of what is truly best for them, and the abusive application of “undue influence” in proposing death as treatment. Certainly, this is a slippery slope!
Roger Foley, for example, eloquently describes being offered euthanasia on multiple occasions during a prolonged hospital stay caused by his inability to obtain adequate care at home. Eventually, hospital staff informed Foley that he would either have to pay an exorbitant daily fee or be discharged without the care he needed to survive. Accounts of this situation were naturally greeted with outrage by the press. But there also remains a sort of perverse logic in defence of the hospital based on the medical definition of MAiD. By refusing euthanasia, Foley had effectively refused the proposition of a perfectly legitimate medical treatment, which would normally lessen the hospital’s responsibility towards him considerably.
Similarly, in the now-famous scandal of Canadian veterans being offered MAiD for PTSD, we must remember that Bill C-7 authorizes euthanasia for mental illness without any physical issues. Therefore, while many Canadians might agree that the offending caseworker behaved misguidedly, no one in authority has affirmed that veterans will not be euthanized for PTSD. Quite the contrary: in today’s legal and medical setting, it is a virtual certainty that they will be offered MAiD.
To suggest that human life should be ended according to medical criteria is an entirely different proposition from saying that people might be allowed to seek assistance in death of their own free will. As euthanasia is increasingly institutionalized, and as a younger generation of professionals becomes fully adjusted to its “medical” use, we must expect that typical patients will face an increasingly hostile clinical environment if they do not accept the recommended treatment. We are witnessing the transition of our entire health-care system to a new utilitarian model that is totally at odds with traditional assumptions of life-affirming care.
This is not what Canadians thought they were getting. And more importantly, there has been no serious debate about making such a radical change.
Happily, one glimmer of hope is to be found in the fact that health is a provincial responsibility; that just as Quebec was able to define euthanasia as medical care, so other provinces can revisit their decision. And without being able to prohibit euthanasia entirely (an exclusively federal power), each province and territory can permit or forbid euthanasia in any institution under its authority. They are free to decide whether their funds will support euthanasia, and free to regulate the behaviour of health professionals.
These are very serious concerns. Health care consumes nearly a full third of all government spending. Do Canadians wish to pay for a system that will care for us when needed? Or do we want to pay for a system designed to bury us at the lowest possible cost?
Gordon Friesen has been following the assisted death question closely since the early nineteen-nineties and is currently President of the Euthanasia Prevention Coalition.