The following post is part of a structured, multi-week,
simultaneously published exchange between Kim Carlson and Paul Magennis,
authors of MAiD in Canada, and Gordon Friesen,
President of the Euthanasia Prevention Coalition. These alternating messages will explore deeply divergent views
on Medical Assistance in Dying (MAiD), and no mutual endorsement is implied.
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| Gordon Friesen |
Previously
published installments have been:
Gordon Friesen, Monday, January 12, 2025. (Article Link).
Maid in Canada (MIC), January 19, 2025. (Article Link).
The
Evolution of Medicine under Legal Compulsion
By Gordon
Friesen
‘Homicide’ is the only English word which precisely indicates
the taking of human life.
Criminal
Code of Canada [i]
"* A person commits homicide when,
directly or indirectly, by any means, he causes the death of a human being.
*
Homicide is culpable or not culpable.
* No medical practitioner or nurse
practitioner commits culpable homicide if they provide a person with medical
assistance in dying"
Hence: MAID
is homicide, permitted as medical treatment.
The
revolution thus produced, in medical culture, may be crudely grasped in the
fact that one Canadian hospital is actually being sued for refusing to kill its
patients.[ii]
Nor has this
dramatic transformation come from organic demand among medical professionals.
It is the result of legal compulsion.
“Parliament
in legalizing MAiD, affirmed that, in certain cases, a desire to bring about
one’s death is rational, understandable, and can be assisted without violating
the Criminal Code.”[iii]
Confronted
with this Parliamentary proclamation, the Canadian Psychiatric Association (and
Canadian Psychiatry more widely) have been attempting to invent a professional
framework for the ethical homicide of patients exhibiting mental disorders
only.
And yet, in
spite of an obvious interest in harmonizing the practice of its members with
decreed legal doctrine (and despite giving MAID-favorable theorists full
latitude to develop their case since 2016):[iv] CPA has
been unable --over the last 10 years-- to produce a positive endorsement of
homicide for mental disorder alone.
Or as stated
on the CPA web page:
“There
are compelling legal, clinical, ethical, moral and philosophical questions that
make this issue particularly challenging. At this time, the CPA has not
taken a position on whether MAID should be available in situations where a mental
disorder is the sole underlying medical condition.” [v]
One reason
why psychiatrists might oppose medical homicide, concerns scientific
disagreement as to whether MAID and suicide are different, at all; and the
clinical difficulty of establishing such a difference even if it did exist.
(a difference, as earlier noted,[vi] which the
Canadian Association for Suicide Prevention[vii] and the
American Association of Suicidology[viii] [ix] both
deny).
The idea,
here, is not that mental illness causes uniform incapacity, but that the wish
to be poisoned, specifically, should not be received as a capable request.
A more
specific reason, for opposing medical homicide, for mental illness alone,
concerns the similar difficulty of determining whether any patient's disorder
might be considered "irremediable".
These
problems are both cited in a formal American Psychiatric Association policy
statement rejecting medical homicide for mental illness alone. Significantly,
this is a purely psychiatric policy (unlike its Canadian counterpart)
proactively established in the absence of legal coercion[x]
Homicide-friendly
professionals apparently believe that they can make capacity and
irremediability judgments which are "close enough".
For those
opposed, however, the whole scheme looks like sending out colorblind hunters,
to harvest certain species of game birds... but only the green ones.
Whether or
not our friends from Maid-in-Canada actually deny these difficulties, they do
apparently believe that a complete ban (or "categorical exclusion")
cannot be justified. I take this to mean (correct me at need) that certain
extreme cases must not be denied.
Unfortunately,
the practical operation of legal permission cannot be restricted to extreme
cases only. In a resource deficient systemic environment, rigor will inevitably
be sacrificed to normalization. Homicide work will naturally be done by doctors
favorable to that practice. And since there is no prohibition of "doctor
shopping", it is the most zealous of these who will test limits and set
standards, just as in our experience of MAID to date.
Indeed, once
the good people of Salem were told that Witches walked among them,[xi] it quickly
became possible to find a great number of these. And so also with persons for
whom homicide is imperiously proclaimed, by Parliamentarians, to be a
psychiatrically indicated treatment.
Finally:
MAID-in-Canada has dismissed, as "speculative", my assertion that
medical homicide for mental illness would lead to that of incapable patients
more generally.[xii]
One man's
"speculation", however, is another man's prudent forethought.
In reality,
the liquidation of incapable patients is a strict ethical necessity of
representing homicide as medical care. For medicine is ideally an objective
science. And (allegedly) beneficial medical remedies can not be ethically
withheld from anyone who might (allegedly) benefit from them: not for reasons
of age, of mental capacity, or of anything else.
Our immediate
interest (in capacity) lies with the mentally ill,[xiii]
children,[xiv]
infants,[xv] mature
minors,[xvi] and
demented seniors.[xvii]
Logically
inevitable expansions of medical homicide are projected for each of these
groups. These extensions may usefully be viewed as a cluster of poisonous
flowers, all growing from the same infected root. Legal acceptance of any one
will naturally facilitate acceptance of the others also.
This logical
putrefaction can only be stopped as it began: with legislative action.
No
medical homicide for mental illness. Support Bill C-218