No justification for euthanising the vulnerable

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Kevin Yuill

Kevin Yuill, author of the book - Assisted Suicide: The Liberal, Humanist Case Against Legalisation - has written an excellent article published by Spiked on May 22, 2023. Yuill responds to an article published in the Journal of Medical Ethics (JME), which has garnered a great deal of attention in the Canadian press. Yuill writes:

The article in question, written by two bioethicists at the University of Toronto – Kayla Wiebe, a PhD candidate in philosophy, and Amy Mullin, a bioethicist and professor of philosophy – tries to defend Medical Assistance in Dying (MAID), Canada’s now notorious euthanasia programme...

The article tries to respond to the widespread criticism that Canada is ‘euthanising its poor’. MAID is currently made available to anyone with a condition or disability that they believe ‘cannot be relieved under conditions that they consider acceptable’. In practice, this has led many people who are poor and helpless to seek an assisted death as a means of escaping their problems. In 2024, the eligibility criteria for MAID will be expanded further to include people who suffer from mental-health problems alone.

Yuill continues by commenting on euthanasia based on homelessness:

The case of Amir Farsoud, a disabled man who applied for MAID last year because he was about to be made homeless, sparked an international outcry and led many people to reconsider their support for assisted dying. As one popular Twitter blogger based in Scotland, where assisted-dying legislation is being considered, said recently: ‘Canada has pretty much changed my mind about assisted dying. It’s absolutely terrifying.’

Wiebe and Mullin see no problem with cases like Farsoud’s. In fact, they argue that it is ‘unacceptable’ to force people to wait for improvements in their personal circumstances before accessing MAID. They also see MAID as a form of ‘harm reduction’, as a ‘“lesser evil” between two or more less than ideal options’.

After explaining how Canada legalized euthanasia, Yuill states:

Of course, choosing MAID is not an expression of autonomy at all. Autonomy refers to an individual’s right or capacity to make free decisions for him or herself. But the final decision to grant MAID is made by doctors and the state, not by patients.

Tellingly, despite their appeals to autonomy, the authors of the JME article insist that patients should not have the right to decline medical treatment. They use an example cited by feminist scholar Catriona Mackenzie, who writes on relational autonomy. Wiebe and Mullin state:

‘Mrs H has cancer, has had part of a leg amputated, and her husband has left her due to her disability and regards her as an embarrassment. Mrs H, as described by Mackenzie, has lost all sense of self-worth, does not trust herself, and does not want any of the treatment options her medical team proposes. She wants to die. We agree with Mackenzie’s suggestion that Mrs H as so described is not fully autonomous. However, the judgement that she is not autonomous is grounded in the fact that in this particular case, we have an agent who lacks self-trust, has no self-worth and has evidently lost engaged hope.’

Using what can only be described as tortuous logic, Wiebe and Mullin have decided that those who seek death – who, almost by definition, have no self-worth and have plainly lost hope – should always be considered autonomous. This is because they are said to be making an active choice to be killed. Poor Mrs H, on the other hand, is told she lacks the ‘engaged hope’ of those demanding MAID. Therefore, the authors argue, she should not even be allowed to refuse medical treatment – a basic tenet of bodily autonomy and a well-established right in almost all areas of the world.

Yuill further unravels the inconsistent arguement by Wiebe and Mullin. 

He writes:

Ironically, the authors even condemn arguments that Canada should provide better palliative care and services for disabled and ill people rather than euthanising them: ‘This type of argument appears to us to licence paternalistically overriding the decisions of competent people whose suffering has led them to choose to die with medical assistance in order to make instrumental use of their suffering.’ Then they have the cheek to say that arguments for better service provision are ‘insensitive to the… very real suffering of people requesting MAID, and… therefore unsupportable, no matter how noble the cause’.

Yuill concludes:

What Wiebe and Mullin’s JME article unwittingly reveals is that arguments for euthanasia and assisted dying have nothing to do with autonomy. And they have even less to do with improving the lot of the suffering. If this article is any guide to the future of euthanasia in Canada, then we have a lot to worry about.

A previous article on the same topic:

• Wesley Smith - Bioethicists: Euthanasia OK for unjust social conditions (Link).