Is assisted suicide a free choice?

Photo by engin akyurt on Unsplash

Assisted suicide is legal in Canada and I’m certain that different people will have differing opinions on the subject. It’s not an easy topic. I realize that my own point of view would probably not be easily be embraced by all; I believe that people should be able to choose. In the case of terminal illness, it felt like needless suffering. But even in the cases of severe depression—to someone who had tried every other option, the suffering might be too much. In both scenarios, I believe that humans in pain should have a choice.

Medical Assistance in Dying (MAiD) has been available for a few years for those who have a serious illness, disease of disability that’s in an irreversible advance state of decline and is deemed unbearable. The big change that’s coming on March 17, 2023 is that mental illness will now be included.

But despite the fact that I personally support people’s right to choose for themselves, what’s been troubling me lately is that this may not be entirely their choice. We’ve seen already how systems can be set up to provide “affirmative” care based on ideological capture, in order to profit, or perhaps simply as a cost-saving measure. In a country with socialized medicine, in particular, we are more likely to see medical practitioners be encouraged to recommend this procedure to someone who might be seen as a strain on the system. Likewise, if someone comes to see a practitioner who specializes in providing medical assistance in dying, the odds of that practitioner in discouraging the patient or providing them with alternative methods to explore are low. In order to prevent this, the safeguards have to be incredibly high. Seeing what we have over the past few years, I no longer fully trust our institutions to do so. (Organ donors also come to mind as potential prime targets).

Years ago, I recall watching a documentary about a young woman who went through a year-long process seeking doctor-assisted suicide in the Netherlands due to depression. In her case, she had a life-long struggle, had tried just about every medication, and as a condition she had to go through a process that involved therapy. The process takes a year—by design. The structure seemed to be a lot less prone to abuse by the state. Watching it, I was convinced that she’d go through with it. And yet, towards the very end, having had one good day, she decides not to proceed—saying that it will always be an option, but that right now she has a bit of hope ahead of her.

In conversations, I’ve brought up that when it comes to suicide, ultimately people already have that choice—they can do it on their own, but if they fail, they might leave their bodies in an even a worse state, or experience a more painful death. Why not let them have the choice to do it medically? I’ve been countered with the fact that many people actually would not proceed with taking their own lives without assistance. Maybe they are right. But how do we determine this? How do we measure these things? I suppose we could compare ‘traditional’ suicide numbers with assisted once when MAID comes into play, but that seems like a rather dangerous data collection experiment.

Rupa Subramanya’s piece, Scheduled to Die: The Rise of Canada's Assisted Suicide Program, in Bari Weiss’ Common Sense, definitely gave me some food for thought on this subject and is worth a read.

In Subramanya’s piece, the person approved for assisted suicide is young. Too young. He’s 23. He’s depressed. He’s also diabetic and blind in one eye. His death was initially scheduled for September 22. Is he a valid candidate?

His doctor seemed to think so. He didn’t push back. Sounded like the medical apparatus affirmed his choice, really. Sounds familiar?

Meanwhile, there are people like 81-year-old John Scully, who has had a 35-year struggle with severe depression, anxiety, suicidal ideation and post-traumatic stress disorder, according to CTV.

In the article, “[outspoken MAiD provider Dr. Ellen Wiebe” is quoted as saying that: "Mental illness and physical illness both can cause unbearable suffering." I happen to think she’s right, but she’s also more than a doctor, she’s an advocate. The article states that Dr. Wiebe has already provided MAiD to over 400 people with physical illnesses. Was it really the best choice for all of them? Maybe, maybe not. Did Dr. Wiebe play a role in their choice, or did they come to Dr. Wiebe because of the choice they’ve already made? What safeguards can we put in place to ensure it’s the latter?

According to the CTV story, in 2021, MAiD was amended to include non-terminal physical conditions such as chronic pain. When mental disorders will be included, Canadians will need to show “‘grievous and irremediable’ illness, suggesting their mental condition was incurable, with an advanced state of decline and intolerable suffering.” This may indeed be the case for John Scully, who at age 81 has a well-documented history, having been hospitalized seven times, had 19 treatments with electroconvulsive therapy (ECT), and is now on 30 pills-a-day to manage his chronic pain and health issue. But what about the 23-year-old from Subramanya’s story? Or the 21-year-old whose biggest worry is the financial strain on her family?

How do we ensure that John Scully has the right to make choice for his own life, yet also protect those who are most vulnerable? How do we ensure that truly every option has been exhaustively tried before resorting to this very…final solution?

Canada is apparently even considering a bill that would allow individuals to sign a waiver that would remove “final consent” for assisted suicide. Bill S-248, would “permit an individual whose death is not reasonably foreseeable to enter into a written arrangement to receive medical assistance in dying on a specified day if they lose the capacity to consent to receiving medical assistance in dying prior to that day.”

It would also “permit an individual who has been diagnosed with a serious and incurable illness, disease or disability to make a written declaration to waive the requirement for final consent when receiving medical assistance in dying.”

Bill C-7 might even allow “mature minors” to be allowed to take part in MAiD. It’s hard to know what can be defined as a “mature minor” — and it’s one thing to allow it for someone suffering terribly from a terminal illness and in pain, vs mental illness. Under new rules, if you allow one, I imagine you’d have to allow the other.

Another troubling proposal was made by Dr. Louis Roy to the House of Commons’ Special Joint Committee on Medical Assistance in Dying on behalf of the Quebec physicians’ college. He suggested that MAiD be used for infants up to age one who are born with “severe malformations and grave syndromes” and are unlikely to survive. Although this is not so likely to get approved, that it is even raised as option is alarming for several reasons (though perhaps an argument can be made in certain case when an infant is only going to live to experience acute suffering). Not only does this open the door to eugenics, but it also takes away the choice of life from a living human based on what a team of doctors think is best.

"I find that completely shocking and unacceptable. I would never support going down that road," Canada's minister of disability inclusion Carla Qualtrough told CBC.

Nonetheless, we are still heading down a road that doesn’t seem to have enough checks and balances. The financial incentives alone are troubling. An analysis from 2020, predicted that MAid would save $66 million annually in healthcare costs. It could even become a money-making industry as more people flock to Canada for ‘Euthanasia tourism.’ Again, we’ve seen this before.

Instead of putting in funds and thought into building better systems to provide mental health care and support for people living with disabilities, MAiD becomes the convenient and less expensive option on the table.

The reality is that in Canada, to see a psychiatrist, while free, is incredibly difficult. Wait lists can be years long. Most people rely on the family doctors, if they even have them, to get any kind of mental health care. They are the ones who prescribe antidepressants, and just go down the line of what’s typical. Sometimes it works. Talk therapy? Forgetaboutit. Psychologists are expensive. Unless you have good insurance. And even then, be prepared to wait. So the truth is that for most people, mental health care is abysmal.

And for people living with disabilities, that comes with its own set of issues—being offered assisted suicide so readily probably doesn’t help one feel like a first-class citizen, especially if one feels like a burden on their family or loved ones already. Many activist in that arena have spoken out about MAiD. People should never be in a position where they are making a decision to die because they cannot afford to live, or as a way to decrease strain on the healthcare system. It should be a deeply personal choice for those who have exhausted every other option—an option that should be made available to them first and foremost.

And above all, it should never be glamorized or romanticized.

That said, I still believe in people having access to choices—to end their unmanageable suffering. But, within the current system, I worry that their choice isn’t so free.

[This post was last updated on November 14, 2022]

What are your thoughts? Should MAiD be legal? What safeguards should be put in place? Or can we not trust the government to do it right? Leave a comment.

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