Death Wishes Writ Large and Getting Larger

Canada’s “MAiD” Policy Promotes Death for the Desolate

In 2019, Prime Minister Justin Trudeau clarified that efforts to expand assisted death in Canada would ensure that the process would not take advantage of those who are vulnerable, and he insisted that people won’t choose assisted death because they aren’t “getting the supports and cares that [they] actually need.” Considering that Canada’s Medical Assistance in Dying (“MAiD”) law includes those with “grievous and irremediable” conditions, not strictly those with terminal illnesses, and that it will soon expand to include those with solely a mental illness, it appears that every person who requests assisted death is not getting the “supports and cares” that they need. There is, realistically, no line between those who want to die for the “right” reasons, and those who want to die for the “wrong” reasons, as every person, even those with terminal illnesses, should receive “supports and cares.” ( I put “MaiD” in quotes, because it isn’t really “medical assistance in dying.” It’s killing.)

Lack of Support as a Motive for Assisted Death

Proponents of Canada’s laws insist there are sufficient safeguards in place to protect against abuse of the “vulnerable” or those who request assisted death because of poverty, loneliness, or lack of social services, and euthanasia providers insist there is no evidence to support claims that people are turning to “MAiD” for these reasons.

However, in seminars conducted by leading euthanasia providers in Canada, providers have admitted that patients are indeed citing poverty as their driving factor for requesting euthanasia. One woman requested assisted death because she could not afford the vitamins, special diet, and physiotherapy that would relieve the symptoms of her non-terminal illnesses. Other patients with chronic pain, diabetes, cardiac issues, anxiety, and depression have requested assisted death simply because they could not find housing. The provider in charge of these cases stated that these people have “no other options,” as referrals will get them “not very much, and certainly not very fast.” The provider also made no mention that these applications were being discouraged or denied. If they are not being denied, are we to assume that the provider is encouraging, if not perpetrating, exactly the abuse Trudeau and the Supreme Court of Canada assured would not occur?

Les Landry, a man with a chronic medical condition, recently lost the disability payments that provided him with needed support such as prescriptions, a specialized diet, and travel to medical appointments. He stated that he doesn’t want to die, but he feels pushed to end his life because his new pension payments don’t provide him enough to live on. His request for euthanasia was, unfortunately, given the green light by one provider already.

Another chronic illness sufferer, 41-year-old Rosina Kamis, was approved for euthanasia due to her constant pain, inability to make food, fears of losing her house and being institutionalized, and a myriad of other reasons. Kamis admitted that her suffering was actually mental, not physical, and stated, “I think if more people cared about me, I might be able to handle the suffering caused by my physical illnesses alone.” The approval of both Landry and Kamis’s euthanasia requests shows a lethal unwillingness to notice signs from those who are desperately crying for help. Kamis had major depressive disorder, and Landry, a history of suicidality.

Assessing patients for assisted death when they really need other support is frightfully common. In a study of “MAiD” assessments on 54 patients who didn’t have terminal illnesses, two-thirds had concurrent mental illness, a fifth had difficulty finding treatment for their afflictions, and over a third were simply not offered treatments.

Doctor-Shopping and Inadequate Assessments

If a physician decides a patient does not qualify for assisted death, the patient can find another doctor willing to sign off. One patient was denied assisted death because he didn’t have a serious illness and was ruled incapable of making informed decisions about his health. He was then assessed virtually by Ellen Wiebe, a prominent euthanasia provider, who found him eligible, picked him up from the airport, and euthanized him at her clinic.

Although physicians are required to have a second practitioner sign off on assisted death requests, the law allows them to ask as many physicians as they like until they find someone who agrees with them. Since providers have varying opinions on what qualifies one for assisted death, as well as what justifies cognitive ability to choose assisted death, it isn’t difficult to find a provider who will agree to kill a patient. Wiebe, for example, stated that she would consider a patient on a five-year waitlist for an effective treatment to have “irremediable suffering.”

The assessments completed by providers to determine eligibility for assisted death are a faulty tool, and they leave a lot of room for providers to decide whether requirements are satisfied. Dr. Paul Appelbaum stated, “It’s not clear from these forms how an evaluator would decide that a condition is ‘grievous and irremediable.’” He also said the questions used to screen for depression and anxiety “are not detailed enough to result in a diagnosis, and even if they did, the impact the answers to these questions are supposed to have on the final decision about authorizing ‘MAID’ is unspoken.” In other words, those suffering from, and requiring treatment for, mental health issues can’t accurately be identified on the assessment forms.

Love over Death

In a 2022 study that interviewed 20 euthanasia providers in response to concerns that it’s easier to access assisted death than necessary treatments, one provider stated, “I think we live in a society where we have structural inequities. And that really sucks…. But it doesn’t mean that we should be sheltering people from the option of having an assisted death. I think we keep seeing death, and “MAID” in particular, as the wrong outcome…” However, promoting assisted death is the wrong outcome. While it is extremely concerning that social services and other supports are increasingly harder for patients to access, death should not be provided as an alternative to support.

In order to truly love those vulnerable persons requesting assisted death, one must

understand that the desire for death does not always come from wanting to actually be dead. Instead, it often comes from a place of wanting to escape an affliction. As Dr. Susan Windley-Daoust reveals in Why You Shouldn't Kill Yourself: Five Tricks of the Heart about Assisted Suicide (2018), those who request death often change their minds when given comfort remedies, such as pain medication or antidepressants. However, the desire for death can often come from deeper psychological motives, such as craving affirmation from someone—anyone—that they still have a reason to live - that others care about them and don’t simply want to get rid of them. Wesley J. Smith writes that often, when patients feel loved (and receive pain relief), they stop asking to be killed.

Another reason vulnerable patients may request assisted death is that they feel they have

lost control over their lives and that choosing when they die will help them regain that control.

But choosing to kill oneself, to surrender to the evil that is suicide, is anything but regaining control of one’s life, especially when one surrenders to the coercion built into legalized assisted death.

The option to kill oneself opens vulnerable persons up to the suggestion that if they are not healthy like the rest of society, then they are burdens who should be dead. In this regard, it is not the suffering persons who are exerting control over their own lives, but clinicians and the wider society. Patients should never question that they are loved, wanted, and valued, and Canada must do better to recognize and uphold the dignity and worth of all human beings.

works for the children's rights organization Them Before Us. She holds a master's degree in Mental Health and Wellness with an emphasis in family dynamics and a graduate certificate in trauma-informed practice and is working towards a second masters in bioethics. She has written for various outlets on beginning and end-of-life issues, and has had articles published in The Times UK and The Scotsman through her work as a research associate for the Scottish Council on Human Bioethics.

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