Blake Murdoch is a bioethicist and senior research associate at the Health Law Institute of the University of Alberta.
A recent example of the use of medical assistance in dying (MAID) is setting off alarm bells. The CBC reported that Normand Meunier, a quadriplegic man from Quebec, was hospitalized in January for a respiratory virus. Mr. Meunier was left on a stretcher in the ER for four days despite communicating his need for a special mattress. He developed a severe bedsore with exposed bone and muscle, tragically leading him to seek out medical assistance in dying. Mr. Meunier told the CBC, “I don’t want to be a burden.” On March 29, he underwent assisted dying at home. The Canadian health care system’s failure to care for Mr. Meunier contributed to his death.
Meanwhile, on the same day Mr. Meunier passed away, popular British newspaper The Times published a column in support of assisted dying written by Matthew Parris, a former Conservative member of the British Parliament. The subtitle states, “Pressure will grow on the terminally ill to hasten their own deaths – that’s not a bad thing.” Mr. Parris argues society “must shine a harsh beam on the balance between input and output,” and claims assisted dying will help Western countries compete with China by saving money.
If you aren’t yet disabled or chronically ill, imagine you are and think about how all this might make you feel. Consider, too, what it could foreshadow about your future. The language Mr. Parris uses is synonymous to early Nazi language describing “useless eaters.” Indeed, disabled people were among the first victims of the Holocaust.
MAID emerged from centre-left liberal thinking as a way of operationalizing an ideal – the preservation of personal autonomy and dignity in the face of immense and often terminal suffering. The theory behind that is ethically sound.
But theory and practice are two different things, and the rapid expansion of MAID eligibility in Canada has produced many disquieting results. A hospital’s director of ethics telling a patient it will cost him $1,500 a day to remain under hospital care in the same breath as bringing up assisted dying – something a London, Ont., degenerative brain disorder patient has alleged in a lawsuit that contains claims that haven’t been proven in court – is barely a half-step removed from the brutal world Mr. Parris envisions.
People who can’t afford to live or can’t get the care they deserve are now being structurally pressured into assisted dying. This is a perversion of personal autonomy and dignity. Those values can only be meaningfully upheld by assisted dying in a society that fulfills its obligation to provide dignified and autonomous lives to the vulnerable. Mr. Meunier’s story is proof that we do not.
The Canadian political, social and economic landscape is fraught. We face inflationary impacts including outrageous cost of living and housing crises. Chronic illness, including the brand-new disease of long COVID, has surged since the onset of the pandemic. Our health care system is persistently overwhelmed, and we have normalized libertarian attitudes toward health decisions that are antithetical to public health and care for the vulnerable. Canada’s social safety net is crumbling because we have failed thus far to meet these challenges. This is not a stable foundation on which to operate arguably the most permissive assisted dying policy in the world.
Moreover, social and economic pressures facing Western societies have contributed to the rise of authoritarian and even fascist ideas, many of which emanate from the United States, where polls consistently show a large minority of people will believe anything their favourite politician tells them. The presence of these growing ideologies threatens to further transform MAID into a hellish eugenic nightmare.
Mr. Parris’s article shows how liberal ideas and policies like MAID can be co-opted for terrible ends. But we already have a serious problem without authoritarians in charge. Disability rights groups and bioethicists have been sounding the alarm bell through every step of MAID’s expansion in Canada, as have patients sharing their disturbing stories.
So, how can we address the issue? A key criticism of MAID is the vagueness of the eligibility criteria. For example, the requirement to be enduring intolerable suffering is a contradiction in terms, because suffering must technically be tolerable in order to be endured. This nonsensical criterion opens the door to completely subjective clinical and legal judgments. And when the criteria for MAID are fundamentally subjective, socioeconomic pressures can become powerful forces in life-or-death decision-making.
By making MAID eligibility far more clearly defined and enshrining human rights laws that prevent the practice’s potential application to nearly anyone experiencing poverty, disability or vulnerability, we can preserve human dignity instead of sacrificing it at its own altar. And while we are at it, we must demand public officials provide vulnerable people with the dignified lives they deserve.