Medically assisted suicide continues to be a heavily debated topic in Canadian politics, fueled by lots of emotion and differing moral values. Some argue that Medical Assistance in Dying (MAID) is the most compassionate thing for people suffering from painful and terminal illnesses. In contrast, others say that MAID is a form of suicide but government-funded and assisted by physicians. MAID is a very nuanced issue; fair arguments are made on both sides of the debate. On the pro-MAID side, people say that it allows for a dignified death and shortens the time when an individual has to suffer severe pain. The patients should have bodily autonomy to decide if they want to continue suffering. However, on the anti-MAID side, people argue that humans should not have a say as to when they die, that it is a slippery slope, that it has a high potential for it to be abused or misused, and that marginalized people, such as the disabled, the elderly, and the chronically ill would be specifically targeted.
History of Physician-Assisted Suicide in Canada
Bill C-14 was passed in Canada in 2016, permitting medical euthanasia and physician-assisted suicide, also known as The Medical Assistance in Dying (MAID) Act. There was strict eligibility to have a physician-assisted suicide, which included:
The individual must be 18 years of age.
Have a “grievous and irremediable medical condition” that causes “enduring physical or psychological suffering that is intolerable” to them
And they must be in an “advanced state of irreversible decline,” where their natural death has to be reasonably foreseeable.
The law also required that several safeguards are put in place, for example:
A doctor or nurse practitioner had to confirm that the individual met all the eligibility criteria.
Another assessment had to be done by an independent doctor or nurse practitioner.
The request for MAID was required to be made in writing after the patient was informed their natural death was foreseeable in the near future.
The request must be signed and dated and have two independent witnesses present.
Patients were required to be told they could withdraw their request anytime.
There must be at least ten days between the written request and the day of the procedure.
The practitioner must confirm the individual’s consent immediately before assisted suicide takes place.
In 2021, the Liberal Government removed the requirement that the individual’s natural death must be in the near future from the criteria. Two safeguards were also removed, 1) there only needs to be one independent witness, and 2) the ten-day reflection period was removed. It also removed the need for consent on the day of the suicide if the person provided consent previously or if they could not give consent for medical reasons on the day of the suicide. Furthermore, neurocognitive and neurodevelopmental disorders were qualifying disorders for MAID. However, there were four new safeguards:
Minimum of 90 days’ assessment period for the individual’s eligibility which can be shortened if the patient is predicted to lose the capacity to make their own healthcare decisions
Out of the two mandatory assessments, one must be done by a practitioner who specializes in the medical condition the person is suffering, or the specialized practitioner must be consulted.
The patient must be aware of available counselling and support services and offered a consultation with access to such services.
Both the patient & the practitioners have agreed that they discussed and seriously considered alternative ways to alleviate the person’s suffering before MAID.
In the year 2021, MAID was the sixth leading cause of death in Canada, whereas 10,000 Canadians died from physician-assisted suicide. MAID is not included in the country's suicide statistics, and suicide is already a leading cause of death in Canada. In my research as a social worker, the suicide numbers are far from accurate because many suicides are counted as "accidental deaths" and "drug overdose" because those categories can be difficult to see if the death or the overdose was intentional. MAID will only add more confusion and barriers to counting the number of suicides in Canada.
The Future of MAID in Canada
This is the current state of medically assisted suicide in Canada; however, it is about to expand dramatically to include the mentally ill, “mature minors,” and poor people. Safeguards, such as the 90-day assessment period, are projected to be eliminated. Currently, Canada has the most permissive assisted suicide legislation in the world. A United Nations (UN) representative for people with disabilities, a UN expert on poverty, and a UN expert on the right of older persons warned that MAID would lead to horrendous human rights violations. It’s important to note that these comments were made before the new expansion was announced.
Criticism of MAID
Many people say that MAID has been overused. For example, The London Free Press reported a man who was admitted to hospital after having a minor stroke that affected his balance and swallowing. The man felt depressed and isolated due to the COVID-19 policies the hospital had for the outbreak on his ward. His stroke neurologist projected that he would have an almost full recovery. The patient requested MAID; none of his MAID assessors were stroke rehabilitation and recovery experts. Due to the man starting to eat less, the assessors decided that he could skip the 90-day assessment for the disabled and have MAID immediately, even though he had no terminal comorbidities. The following week he received MAID; he died alone and depressed without trying proper therapy or reaching maximal recovery.
There was another example of MAID being misused this past February. A woman with a chronic health condition was denied affordable housing that would help ease the stress in her life and her medical condition. She died of suicide through Canada’s MAID program. Another woman with a chronic illness was granted access to MAID because she relied on disability payments and still lived in poverty. Both of these conditions were not terminal, and they were given access to MAID because of their disability and financial status. Currently, inadequate housing is not a criterion for MAID.
Many critics rightly argue that instead of giving MAID to poor, disabled, and chronically ill people, there should be more effort to improve the quality of their lives and invest in potential treatments or therapeutics. Many reports that people choose MAID because they feel like a burden on their loved ones, they feel depressed over their medical condition, or sometimes feel like the only way to escape their pain is to die. At the same time, some cite the state of the Canadian healthcare system and how it has failed them. When people opt for MAID, they often reference a lack of access to care, long waiting lists for treatment, and poor quality of care. These are all issues that can be addressed. There are many chronic and terminal conditions; however, that doesn’t mean that there isn’t much work to be done to improve the quality of life for the suffering individuals. The Trudeau Liberal Government stated that MAID could save $136.8 million in federal healthcare costs. This poses the question: is MAID being expanded to save money and to cover up the failed state of Canadian healthcare? Is the government putting a dollar sign on the lives of the sick and the poor? Is this the beginning of a genocide of the chronically ill, the mentally ill, the poor, or the disabled?
As a pro-life social worker, I am against MAID for many reasons. The first is that I believe that the purpose of life isn’t to avoid suffering and that God ultimately decides when our time on Earth is finished. I want to note that when I reference MAID I am not referring to someone who is on their deathbed and is given a treatment that can reduce pain, but will also shorten their last moments. Another reason is that I think this is a slippery slope into a potential genocide of dependent people or the “undesirables.” I hold this view because the government is calculating how much money MAID will save them in healthcare spending and using that to decide whether or not to expand MAID. If this isn’t a sign of an utterly failed healthcare system, I don’t know what is. The phrasing of the mainstream media, for example, CBC, suggests that saving money is more important than saving lives. Although consent is still required, the question remains: are the disabled, the mentally ill, and children capable of giving consent?
Children aren’t capable of consenting to sex because they aren’t able to think thoroughly of the consequences. Still, we expect them to be able to grasp the consequences of suicide. Suicidal thoughts are prevalent among teenagers; however, most grow out of them. A common symptom of mental illness is suicidality. Many people who are chronically ill are depressed and are also suicidal sometimes because of their symptoms. When someone is suicidal, first responders have the right to involuntarily take that person to the hospital, where they are forced to stay in the mental health ward under the Mental Health Act in Ontario. Other provinces have similar laws. This act suggests that the suicidal person is not in their right mind and cannot make medical decisions. So, why are they allowed to consent to physician-assisted suicide? What about someone who is mentally disabled? Are they the ones who will give consent, or will their caretakers be giving consent? What happens when the caretaker’s motives are not in the best interest of the person they care for? Finally, what message does this give the people targeted by MAID? In the future, will MAID be required of people with a certain level of need? Are we telling people who are ill and poor that it is their duty to die to save the healthcare system? Will this impact who is eligible for treatment and services? Will practitioners begin to recommend or even pressure MAID to individuals seeking care and treatment? Will this disincentivize the creation of new treatments and services? These are reasonable questions that need to be answered if they haven't already. It's also really concerning that after years of lockdowns, economic devastation, and the backlog on our medical system, MAID is being expanded. From an outside perspective, it appears that the government is attempting to clean up the mess from their destructive policies during the pandemic.
Again, this is a slippery slope. This creates a two-class society: the desirables and the undesirables. The government is slowly starting to kill the undesirables and seeing this as a way to save money. Everyone, especially pro-life, should be outraged at the expansion of MAID and, in general, the legalization of physician-assisted suicide.