The problems with Canada's MAiD policy.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

...is medical assistance in dying really a choice, or is it coercion?

Jeremy Appel, who does not oppose the concept of euthanasia, has written an article that was published by Jacobin.com on January 8 titled: The Problems with Canada's Medical Assistance in Dying Policy. Appel begins his article by stating:

Canada’s Medical Assistance in Dying program seemed like a step forward for choice and dignity. But it is beginning to look like a dystopian end run around the cost of providing social welfare that can beat back the deprivations that make life unbearable.

Appel follows that by stating:

But the legalization of MAiD has brought to the fore some disturbing moral calculations, particularly with its expansion in 2019 to include individuals whose deaths aren’t “reasonably foreseeable.” This change opened the floodgates for people with disabilities to apply to die rather than survive on meager benefits.

I’ve come to realize that euthanasia in Canada represents the cynical endgame of social provisioning within the brutal logic of late-stage capitalism — we’ll starve you of the funding you need to live a dignified life, demand you pay back pandemic aid you applied for in good faith, and if you don’t like it, well, why don’t you just kill yourself?

The problem with my previous perspective was that it held individual choices as sacrosanct. But people don’t make individual decisions in a vacuum. They’re the product of social circumstances, which are often out of their control.

Appel is acknowledging that individual choice has not worked out with the issue of euthanasia because decisions to be killed are based on social circumstances.

Appel explains that there are endless examples of people with disabilities who were offered euthanasia as an alternative to living a life of pain and exclusion. And with the impending expansion of MAiD to include people with mental illnesses, the problem is only going to get worse. He continues:

At least four veterans suffering from post-traumatic stress have been offered MAiD, including one instance where a caseworker told a veteran that MAiD is a preferable alternative to “blowing your brains out against the wall.” Mark Meincke, a veteran of the Princess Patricia’s Canadian Light Infantry who on his podcast spoke to the veteran who was offered MAiD, told the House of Commons Standing Committee on Veterans Affairs that the individual in question had never even contemplated suicide. He just wanted help dealing with his PTSD and other ailments.

“He expressed to me that things were sunshine and roses prior to this phone call, he was feeling good about life,” Meincke told the committee.

“Post phone call, he left the country, because he was devastated by that call.

He continues with the story of Christine Gauthier:

In another instance, retired corporal Christine Gauthier, who is paraplegic and competed for Canada at the 2016 Rio de Janeiro Paralympics and the Invictus Games, was offered assisted suicide, with Veterans Affairs offering to provide her with the necessary equipment.

Gauthier had been fighting for five years to have Veterans Affairs provide her with a wheelchair ramp. They wouldn’t provide the ramp, but they would give her the means to end her life.

He quotes Brennan Leffler and Marianne Dimain who were published in the Globe and Mail as stating:

“How poverty, not pain, is driving Canadians with disabilities to consider medically-assisted death,” notes the “excruciating cycle of poverty” that leads disabled people to choose assisted death, rather than live a life filled with barriers to their existence. “The numbers are grim,”

Joannie Cowie

Leffler and Dimain explain that according to Statistics Canada (2017), 25% of people with disabilities are living in poverty. Appel then quotes Joannie Cowie who lives in poverty, has multiple disabilities, and is considering death by euthanasia as stating:

“People with disabilities have been put on the backburner and nobody gives a damn about them,” she told Global. “I’ve cried a lot at night. I usually stay up a lot of the night. I pray. I pray a lot.”

Alan Nichols with his brother.

Appel further explains the problem by telling the story of Alan Nichols.

The case of Alan Nichols demonstrates how uncomfortably permissive Canada’s euthanasia framework is. Nichols, who suffered from depression, was hospitalized in June 2019 over fears he was suicidal. Upon hospitalization he asked his brother Gary to “bust him out” as soon as possible.

A month later, Nichols successfully applied for MAiD, not for depression, which is not yet legal, but for hearing loss, which occurred as a result of brain surgery when he was twelve.

His family, who filed a police report and notified health authorities, said that there was no way that he was eligible for MAiD, arguing that he had refused to take his meds and use his cochlear implants, which would have helped his hearing.

“Alan was basically put to death,” Gary Nichols said.

Sean Tagert with his son.

Sean Tagert died by euthanasia in August 2019 and left behind his 11-year-old son rather than be institutionalized. Appel writes:

While his condition required him to receive twenty-four-hour care, the government would only provide funding for sixteen hours, forcing him to pay $263.50 a day for the remaining eight hours.

He called the option of institutionalization, as opposed to fully funded care, a “death sentence.”

Roger Foley

Another story is that of Roger Foley, who has fought to live. Appel explains:

Roger Foley, who was hospitalized with a degenerative brain disorder in London, Ontario, began surreptitiously recording his conversations with hospital workers who offered him euthanasia unprompted.

In one recording, the hospital’s director of ethics told him continuing care would cost “north of $1,500 a day,” the Associated Press reported, which he correctly regarded as coercive.

Appel asks the question based on people with disabilities who are living in poverty - is medical assistance in dying really a choice, or is it coercion? Appel quotes Dr. Naheed Dosani, a palliative care physician in Toronto who told Global news:

Combined with COVID policies that have consigned disabled and immunocompromised people to a life of perpetual self-isolation, a lack of funding for people on disability assistance makes MAiD an increasingly palatable solution to ending their suffering. In this context, the cavalier way in which MAiD has been implemented in Canada serves as a form of eugenics, where only the able-bodied survive.

Appel explains that Canada has fewer safeguards than other jurisdictions. In some jurisdictions doctors must exhaust medical treatment options before approving euthanasia. In Victoria Australia only the patient can bring up the option of euthanasia.

Appel loses his appeal by completing his article with the following statements:

I still believe it’s cruel to refuse MAiD for people on the verge of death, with no prospects for recovery. But it’s even crueler to offer death as an alternative to a properly funded social support system.

We’ve let the MAiD genie out of its bottle. There’s no going back. We must ensure that our health care systems have sufficient resources to guarantee everyone, regardless of ability or mental health, a dignified existence.

The genie may be out of the bottle but as Gordon Friesen, who lives with disability, recently wrote:

Poverty high-lights the problem of euthanasia in a particularly graphic way. But poverty is not the cause of this problem (and even doing away with poverty, entirely, would in no way solve it). For as long as there is legal euthanasia based on medical criteria, there will be discriminatory eligibility, and discriminatory death.

Most importantly: The shortest road to solving the euthanasia problem is to seek legislative initiatives narrowly designed to restrict this practice, or to remove it entirely.

Unlike Appel I recognize that the horrifying Canadian stories of euthanasia for poverty, homelessness, and a lack of medical treatment are the result of legalizing euthanasia. That as Friesen also stated: euthanasia is abhorrent on its own!