Going over the Falls with (MAiD) euthanasia

This reflection by Dr John Maher was republished with permission. It was also published by the Globe and Mail on March 17, 2021.

Several years ago I was on the promenade at Niagara Falls with my 3 young children. As we stood at the railing some 20 feet from the roaring cascade, with a cooling mist on our hot summer faces, a young man, maybe 18 years old, climbed over the low railing and walked out to a small rock promontory that jutted out immediately over the 150 drop onto the rocks and churning waters. The happy crowd of tourists seemed to magically come to a standstill as everyone looked at the young man and knew that a life stood in the literal balance. The young man looked down and never back. His clothing was dirty and he seemed like he was talking to himself. An existential conversation, or hearing voices, or both?

I am a father. I turned my children away from what I feared was about to happen. They, all under 9, asked, “didn’t that man know it was dangerous to get that close to the edge… it was wet and he might slip”. They were scared for him. So was I.

Dr John Maher

I am a psychiatrist. I wondered, what could I do? What should I do? He couldn’t hear anyone over the thunder of the water. I weighed trying to grab him and pull him back, but knew I could go over with him. Would I risk dying to save him? What of my children that I was shielding and held close?

The world stood still. Seven very long minutes. No one watching moved, and the dead still crowd had grown to hundreds watching from the safety of the low fence. A fence that any one of us at any moment could easily step over.

I knew the suicide numbers for Canada. Of the 100% of people who attempt suicide, 23% try again, but only 7% complete suicide. That 7% is 4000 human beings each year. I knew that most suicidal thinking is ambivalent and transient and that people can be helped. Would this young man, with a whole life ahead of him, choose help?

I am also an ethicist. Last night I watched the televised proceedings from the House of Commons as the Liberal government shut down debate on the MAID bill. As I listened to the combined pleas of the Conservatives, NDP, and Green Party (right joined with left in their common humanity) to not extend Medical Assistance in Dying to people with mental illness I thought of Niagara Falls. 

The image that came to mind was the young man on the edge of life with two groups standing to either side of him. On one side, stood a Liberal MP and a Bloc Quebecois MP saying to the young man that they respect his autonomous right to choose death, and that if he has been suffering a lot and has a mental illness, that is good enough for them, and they will get a doctor who can push him over the edge. On the other side stood a Conservative MP, an NDP MP, and a Green MP. They told the young man that he mattered, that despite what he might be feeling right now, there was hope. They said they would try to help. They would try to get him some money so he wasn’t living in poverty. They would try to get mental health care for him, even though it was hard to find and there are long wait lists. They would try to get people to stop making fun of him because of his mental illness. And in that moment they held the doctor back who was all too ready to give a hefty push in the name of autonomy.

What happened that day? He turned back from the edge. In a daze, in his own world, he climbed the railing. Strangers spontaneously hugged him. Some cried. He was genuinely surprised by the attention and seemed pulled into the sudden awareness that he was not alone. Several people walked away with him, fearing leaving him alone when he was fighting despair. I want to believe he got help and is living a good life.

He was a stranger, but his life mattered. Which side of him would you stand on? 

John Maher MD FRCPC
Psychiatrist, Canadian Mental Health Association
President, Ontario Association for ACT & FACT
Editor-in-Chief, Journal of Ethics in Mental Health