Duty to die: the hidden assisted-death imperative

Medical experts weigh the cost factor. Photo: Vlada Karpovich

News reports from around the developed world pop up regularly about the slippery slope that is euthanasia, also known as assisted suicide, among other terms. Canada is a good example of how slippery that slope is, with people telling how they don't want to die, but they cannot get the care needed to stay alive, to lessen their suffering, even though medical palliative care is now at a very advanced level.   

 The first report is from an experienced journalist, not someone likely to be fooled by a begging case.

A report [on June 9] by Penny Daflos for CTV News Vancouver concerns a chronically ill woman in her 30’s who was approved for [the Canadian government medical assistance in dying programme known as] Maid but who has been unable to obtain the medical treatment that she needs to live. “Kat” wants to live. Daflos writes that Kat had an easier time accessing death care than accessing health care. Daflos reported:

The chronically ill woman is in her late 30s and lives in the Lower Mainland, but given the sensitivity of the subject matter has asked us to refer to her by the pseudonym of “Kat.” She has applied to Fraser Health and been granted a request for Maid – even though she wants to live.

“I thought, ‘Goodness, I feel like I’m falling through the cracks so if I’m not able to access health care am I then able to access death care?’ And that’s what led me to look into Maid and I applied last year,”

Kat has been struggling to access health care. Daflos reported:

A decade ago she received a diagnosis of Ehlers-Danlos Syndrome (EDS), a genetic disorder where the body doesn’t produce adequate collagen, essentially the glue that holds together connective tissues, skin and our internal organs, sometimes leading to complications and always resulting in significant pain.

As a result, Kat has been on opioids for years and says that’s interfered with finding a replacement for her family doctor, who moved away years ago. She’s been seeing nurse practitioners for several years, as well as a revolving door of rheumatologists, neurologists, psychiatrists and other specialist doctors, none of whom are experts in EDS.

[The regional Fraser Health Authority], who are the same health authority that defunded the Delta Hospice Society and expropriated their buildings for refusing to participate in euthanasia [update here], approved Maid for Kat but is not working to obtain the medical care that she needs. Daflos reported:

Fraser Health’s Maid documentation includes a summary noting that the “patient has an extensive medical chart” and that “there were no other treatment recommendations or interventions that were suitable to the patient’s needs or to her financial constraints.”

Daflos continued:

Kat’s disability and poverty are two of the key concerns raised by advocates warning Canada is moving too broadly and too quickly in expanding access to Maid.

Initially, applicants required a terminal illness in addition to suffering physically, but now physical suffering is the only requirement. Legislators are now hearing arguments from various groups about the next phase of the Maid program, which would allow those suffering mentally to apply for medically assisted death.

Two British Columbia families have pleaded for more scrutiny of the process and acknowledgement of wrongful deaths to protect those who are most vulnerable.

"It is imperative that these safeguards ensure vulnerable people are provided care as a first option, not death," said Alicia Duncan, whose mother’s Maid death in Abbotsford is now the subject of a rare police investigation.

Further instances are reported:

In 2019, Alan Nichols died by euthanasia in Chilliwack BC. Nichols was not dying but deeply depressed. His family begged the doctors to re-assess Alan based on the fact that Alan had been living with chronic depression, but they refused (Link).

Donna Duncan, from Abbotsford BC, died by euthanasia in October 2021. Donna was not terminally ill, but rather she was injured from a car accident in February 2020 and was living with post-concussion syndrome. Due to the COVID protocols, Donna did not receive adequate rehabilitation and her symptoms persisted until she decided to seek out death by euthanasia to escape her suffering. 

 Other such cases have been reported in the Guardian: 

After pleading unsuccessfully for affordable housing to help ease her chronic health condition, a Canadian woman ended her life in February under the country’s assisted-suicide laws. Another woman, suffering from the same condition and also living on disability payments, has nearly reached final approval to end her life.

The two high-profile cases have prompted disbelief and outrage, and shone a light on Canada’s right-to-die laws, which critics argue are being misused to punish the poor and infirm. 

The Guardian report tries to "balance" the concerns about Canada's rush to impose what are regarded by the woke as progressive policies, but supports the key concern:  

Jocelyn Downie, a professor of law at Dalhousie and expert in end-of-life policy, said there are extensive guardrails in the [Maid] system to protect Canadians.

“You have to meet rigorous eligibility criteria. And being poor and not having a home, or a home that is suitable for you, does not make you eligible,” said Downie. 

But she said that the cases do highlight societal failures [...].

“Listen to what people living with disabilities have been asking for years,” she said, pointing to investments in accessible housing and transportation.

Instead of fighting over the law, which lawmakers are unlikely to repeal given a string of supreme court cases upholding the right to physician assisted death, Downie said a greater emphasis should be on disability supports and services and mental health supports.

“The reality is, it’s a small number of people who qualify for Maid. But investments in mental health and disability resources would go so far to help so many more people live their lives.”

In late April, the British Spectator ran an analysis of the euthanasia programme with the headline: Why is Canada euthanising the poor? The writer* points out that of the organisations advocating for the disabled almost none supported the series of Maid legislation, with the latest law extending the programme to the mentally ill. 

In fact, cost savings in health expenses have featured in official figures, according to the Spectator:

Despite the Canadian government’s insistence that assisted suicide is all about individual autonomy, it has also kept an eye on its fiscal advantages. Even before Bill C-7 entered into force, the country’s Parliamentary Budget Officer published a report about the cost savings it would create: whereas the old Maid regime saved $86.9 million per year – a ‘net cost reduction’, in the sterile words of the report – Bill C-7 would create additional net savings of $62 million per year. Healthcare, particular for those suffering from chronic conditions, is expensive; but assisted suicide only costs the taxpayer $2,327 per ‘case’. And, of course, those who have to rely wholly on government-provided Medicare pose a far greater burden on the exchequer than those who have savings or private insurance.

In 2016, Canada passed a law allowing assisted suicide only for those who suffer from a terminal illness whose natural death was ‘reasonably foreseeable’. The Spectator reports:

It only took five years for the proverbial slope to come into view, when the Canadian parliament enacted Bill C-7, a sweeping euthanasia law which repealed the ‘reasonably foreseeable’ requirement – and the requirement that the condition should be ‘terminal’. Now, as long as someone is suffering from an illness or disability which ‘cannot be relieved under conditions that you consider acceptable’, they can take advantage of what is now known euphemistically as ‘medical assistance in dying’ for free.

Soon enough, Canadians from across the country discovered that although they would otherwise prefer to live, they were too poor to improve their conditions to a degree which was acceptable.

Not coincidentally, Canada has some of the lowest social care spending of any industrialised country, palliative care is only accessible to a minority, and waiting times in the public healthcare sector can be unbearable, to the point where the same Supreme Court which legalised euthanasia declared those waiting times to be a violation of the right to life back in 2005.

Many in the healthcare sector came to the same conclusion. Even before Bill C-7 was enacted, reports of abuse were rife. A man with a neurodegenerative disease testified to Parliament that nurses and a medical ethicist at a hospital tried to coerce him into killing himself by threatening to bankrupt him with extra costs or by kicking him out of the hospital, and by withholding water from him for 20 days. Virtually every disability rights group in the country opposed the new law. To no effect: for once, the government found it convenient to ignore these otherwise impeccably progressive groups.

Since then, things have only gotten worse. A woman in Ontario was forced into euthanasia because her housing benefits did not allow her to get better housing which didn’t aggravate her crippling allergies. Another disabled woman applied to die because she ‘simply cannot afford to keep on living’. Another sought euthanasia because Covid-related debt left her unable to pay for the treatment which kept her chronic pain bearable – under the present government, disabled Canadians got $600 in additional financial assistance during Covid; university students got $5,000.

When the family of a 35-year-old disabled man who resorted to euthanasia arrived at the care home where he lived, they encountered ‘urine on the floor… spots where there was feces on the floor… spots where your feet were just sticking. Like, if you stood at his bedside and when you went to walk away, your foot was literally stuck.’ According to the Canadian government, the assisted suicide law is about ‘prioritis[ing] the individual autonomy of Canadians’; one may wonder how much autonomy a disabled man lying in his own filth had in weighing death over life.

Canada’s lavishly subsidised media, with some honourable exceptions, has expressed remarkably little curiosity about the open social murder of citizens in one of the world’s wealthiest countries. Perhaps, like many doctors, journalists are afraid of being accused of being ‘unprogressive’ for questioning the new culture of death, a fatal accusation in polite circles. Canada’s public broadcaster, which in 2020 reassured Canadians that there was ‘no link between poverty, choosing medically assisted death’, has had little to say about any of the subsequent developments.

Next year, the floodgates will open even further when those suffering from mental illness – another disproportionately poor group – become eligible for assisted suicide, although enthusiastic doctors and nurses have already pre-empted the law. There is already talk of allowing ‘mature minors’ access to euthanasia too – just think of the lifetime savings.

The articles quoted here, first, make a clear case in refuting those who would hazard to state that slippery slopes are always a fallacy.

Secondly, we see principles opposed to each other, those that support death over life, that do not recognise the nobility of the human person despite poor health or a high level of disability, compared to principles that give rise to a generous community response in meeting the needs of fellow members of society, that encapsulate a vision of the human person as a noble entity in all instances. 

This is the choice members of society must make personally, and in teaching their children how to truly show respect to others, even when the elites in society manage to impose their agenda on a society that has lost its way.

💢 *The Spectator article is written by Yuan Yi Zhu, who is a senior research fellow at Policy Exchange’s Judicial Power Project and a researcher based at Nuffield College, Oxford.

💢 See also Journey to death should go all the way

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