MAiD: And Again

This week brought an impassioned argument against expanding access to MAiD, and a dispassionate analysis of where we’re at and how we got here.

I find that I learn something from every commentator, but am reinforced in my belief that individual op-eds are only one component of public-policy debates. Each writer expounds their own opinion with a view to convincing the reader, but there is no conversation: no actual debate. We would benefit from having more venues where people who hold strong viewpoints can both express their views and respond to challenges to them.

This is a complex issue and positions tend to be a muddle of many components:

  • Strongly held beliefs (some religiously based but not all) on the value of life and the right to personal autonomy
  • Political beliefs on the role of the state (at all and specifically in medical decisions) and the courts
  • Legal views on the appropriate scope of criminal law
  • Opinions about the medical possibility and what we might call the “cost practicality” of managing pain, both physical and mental
  • The trade-offs involved in spending money in one healthcare area versus another
  • Emotional reactions to experiences of intolerable pain, whether one’s own or that of a loved one

Mix in the different angles of how MAiD provisions can/might affect the elderly (with varying degrees of mental competence), the mentally ill, the disabled, those with terminal illness or incurable degenerative conditions, minors, and people who live in small or remote communities, and it’s amazing we can talk about it at all without coming to blows.

Anyway, first the analysis, then the passion. Both articles are worth reading in full if you have access to the National Post site. If not, the excerpts below will give you an idea of the range of commentary and approaches.

Why Liberal’s move to expand assisted dying laws to cases of mental illness prompts intense debate

The amendment to Bill C-7 still needs to pass a final vote to become law, but the Liberals only need one party to support it, and it appears likely they’ll get it from the Bloc Québécois.

The government’s move followed an intense, extensive and sometimes emotional debate in the Senate over whether excluding mental illnesses from medical assistance in dying (MAID) would be found unconstitutional.
Those in favour of the amendment argue a Charter ruling against the exclusion is inevitable, and the government is saving litigants the time and expense of getting it overturned in court. They also argue that waiting longer on this will only extend the suffering of those who want expanded access to MAID for themselves.
But those opposed contend that it’s wrong to assume how the Supreme Court of Canada would rule, and that the government has pre-empted its own parliamentary review on the matter. They say the government is now preparing to make a huge change to assisted dying law without putting it through the full legislative process in the House of Commons.

Raymond J. de Souza: When suicide masquerades as health care

The federal government’s reform of its medical assistance in dying (MAID) legislation, Bill C-7, will permit Canadians to request a lethal injection, even if death is not proximate or reasonably foreseeable. It’s not exactly death-on-demand for anyone who asks, but that’s what it is for anyone who has a serious medical problem, even one that can be readily treated.

The Senate amendments to the government’s bill will permit MAID to be administered in response to a request made years in the past, such as in the case of geriatric dementia. The Senate amendments also pave the way for an expansion of MAID for mentally ill people who are neither elderly nor dying.

. . .

This will lead to more pressure put on the ill and disabled, especially in light of the rising cost of treatment. Why take up a bed for weeks, when you can be in the morgue by sunset? Why provide years of daily home care supports for the disabled when a lethal injection is available right now?

That would never happen in Canada, you say? But we were told just six years ago, by no less than the Supreme Court, that exactly what we are doing now would never happen in Canada. In 2015, it was about extreme cases. In 2021, it’s about making suicide mainstream health care.

And when that kindly ICU doctor asks whether or not grandma wouldn’t want to do her bit to protect the health-care system, to free up capacity for others, what will her family say? And when an accident victim arrives, facing a lifetime of disability and diminishment, won’t hospital administrators, influenced by their triage protocols, see an opportunity to save resources for cases with better prospects?

It won’t happen tomorrow. But it will happen — sooner rather than later.

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4 Responses to MAiD: And Again

  1. Tom Watson says:

    I find “When suicide masquerades as health care” misleading.

    A personal example:
    A friend was born with only one kidney. When she was around 60 that kidney started to fail and she began dialysis. The next step was to get a dialysis machine in her home so she didn’t have to travel for treatment.

    Things gradually worsened over time and because her system wasn’t appropriately filtering toxins from her system, gangrene set in one leg. It was amputated but it was clear that gangrene was already setting in the other leg too.

    She asked me to come and see her in the hospital in London. The future she saw for herself was with both legs amputated, sitting in a wheelchair for the rest of her life, and still requiring daily dialysis. She wanted to tell me that she had talked it over with her husband and daughters, and they agreed with her decision that she would select a day the following week, disconnect the dialysis, and the ending of her life would take its course. That’s what happened.

    It’s, of course, quite a possible that she might have lived for several years had she remained on dialysis, so some might call what she did suicide. I don’t agree. Her decision was sound.


    • Isabel Gibson says:

      Tom – It sounds “sound” to me. These are incredibly difficult and varied situations. I think that’s part of why Andrew Roman argues for getting these provisions out of criminal law.

  2. Jim Taylor says:

    Obviously, you and I were on similar wavelengths this week — your column and mine both focussing on the medically assisted dying issue. We have a group called the “Golden Guys” who zoom every Monday. We spent the whole 1.5 hours on this issue. Lots of different viewpoints, including speculation on why some people choose MAiD. About the only thing we seemed to agree on (and that I think you and I agree on) is that this is not a situation where one can expect to find hard and fast rules. Compassion and understanding are key.
    Jim T

    • Isabel Gibson says:

      Jim T – <> Yes. I think a recognition that hard and fast rules are not suited to this problem might be behind Andre Roman’s view that the criminal law is too blunt an instrument here.

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