Assisted suicide, also known as “medical assistance in dying”, or MAID, has been legal in Canada since 2016 when the country’s Supreme Court ruled that “eligible adults with grievous and irremediable medical conditions” were entitled to medical assistance to end their lives.
In 2021 the permitted conditions for MAiD were expanded to this standard:
9.1.5 the person has a grievous and irremediable medical condition. These criteria are met only where the provider and assessor are of the opinion that:
(a) the person has a serious and incurable illness, disease, or disability;
(b) the person is in an advanced state of irreversible decline in capability; and
(c) the illness, disease, or disability or that state of decline causes the person enduring physical or psychological suffering that is intolerable to the person and cannot be relieved under conditions that the person considers acceptable.
(You can read the current MAID standards here.)
In the past MAID was largely restricted to people with a terminal illness, but now it includes patients with a medical condition that may not be terminal but causes physical or psychological sufffering that is intolerable. This thus includes people who want to end their lives because they’re suffering psychologically and/or physically with a medical condition and have found no relief. (“Depression”, however, does not qualify you in Canada for MAID; you must be suffering from a medical condition in a way that is intolerable. Nor can “depression” be listed on the death certificate—only the antecedent medical conditions that cause suffering.) Similar standards apply in the Netherlands; however, in that country intolerable and irremediable mental distress itself qualifies you for euthanasia. (Subramanya wrote about this in a previous Free Press article, “I’m 28. And I’m scheduled to die in May.“) The Guardian gives the Dutch standards:
Under Dutch law, to be eligible for an assisted death, a person must be experiencing “unbearable suffering with no prospect of improvement”. They must be fully informed and competent to take such a decision.
How is euthanasia performed in Canada ? The National Standards say this (these are limited to adults over 18 of sound mind, though if you have dementia you can order MAID in advance so long as you do it when you are in a period of compos mentis):
There are 2 methods of medical assistance in dying available in Canada.
Method 1: a physician or nurse practitioner directly administers a substance that causes death, such as an injection of a drug. This is sometimes called clinician-administered medical assistance in dying.
Method 2: a physician or nurse practitioner provides or prescribes a drug that the eligible person takes themselves, in order to bring about their own death. This is sometimes called self-administered medical assistance in dying.
Subramanya’s new article in The Free Press discusses the case of Kiano Vafeian, a 26-year-old Canadian who was blind and struggling with Type 1 diabetes with attendant severe neuropathy. This had made hin depressed and he asked for MAID. He eventually got it and died from one of the two methods above. His death certificate said that his MAID was prompted by blindness and severe peripheral neuropathy; depression was not listed. You can read the story, if you subscribe, by clicking on the screenshot below, or reading the free archived article here.
People are alarmed by assisted suicide, and the opponents are often religious. Regardless, the proportion of all deaths that occur by MAID in Canada is in the range of 5-7%, and are rising. Here’s a graph of the increase from the article:
And the fate of requests for MAID. Note that most are approved.
You will be familiar with the reasons for objections to euthanasia. For very religious people, it is often that people should die when God wants them to go, regardless of their suffering (I call this the “Mother Teresa objection”). More rational people see MAID as a slippery slope, especially for someone like Kiano who wasn’t terminal. The new conditions, they say, will lead people who could otherwise lead tolerable lives to be euthanized in a moment of despair. (I’ll put some of the quotes below.) But of course, doctors have to testify that the euthanized patient did meet the criteria, so presumably they would investigate whether any depression could be cured (this is what they do in the Netherlands). It’s not clear that Kiano was treated for his depression, though it’s implied, but to my mind I can understand how blindness and diabetes in a young man, with the diabetes slowly destroying his body, is sufficient to ethically permit euthanasia.
Kiano’s mother objected to his euthanasia because he seemed to have moments of enjoyment before he was put to sleep: he went to Mexico on vacation, joined a health club, and got a nice condominium in Toronto with a full-time caregiver paid for by mom. But it wasn’t enough. He requested and got MAID on December 30, 2024.
Here are some opinions of non-relatives opposed to Kiano’s MAID:
Sonu Gaind, a University of Toronto psychiatry professor, told me that the fastest-growing category in the country’s MAID statistics is not cancer, heart disease, or any specific illness. It is a catch-all labeled as “other.” MAID deaths in the “other” category nearly doubled to 4,255 in 2023 from a year earlier, adding up to 28 percent of all assisted-suicide deaths, Gaind’s research found.
When I told Gaind about Vafaeian and what he had been through, Gaind responded: “I’m not denying his suffering, but it doesn’t paint a picture of someone who is constantly suffering. That contradiction should trouble people.”
He said that Canada’s assisted-suicide system “has been set up so that if the person says their suffering is intolerable, assessors will say, ‘Who am I to question that?’ ”
and
David Lepofsky, a blind lawyer and disability-rights advocate in Toronto, said that focusing on suffering rather than pain invites broad, subjective interpretations—and that the MAID process lacks any independent safeguards before death is delivered. “Blindness doesn’t cause pain,” Lepofsky said. “Millions of us live good, independent lives.”
and
Ramona Coelho, a family physician and member of Ontario’s MAID Death Review Committee, said provincial oversight reports increasingly show in general that the person’s suffering appeared to be driven less by medical decline than by loneliness, social distress, and fear of the future. “Young people relapse, and they also recover,” Coelho told me. Allowing government-sanctioned assisted suicide “during periods of acute vulnerability risks mistaking transient suffering for permanent decline.”
However, a doctor who performs MAID says this:
These are not people who seek assisted suicide “because of mental illness alone,” Wiebe insisted when we talked. “They have other things. . . . That’s what all of my experience is.”
Remember that chronic depression is a medical condition that is sometimes incurable and causes the same intolerable suffering specified by Canadian law (read the Subramanya’s previous [archived] account of a Dutch woman who requested and got euthanasia on the basis of severe and untreatable depression).
Some physicians object to MAID because their brief is to save lives (“First, do no harm”), but that is misguided. Throughout the U.S., for example, physicians often end the lives of suffering terminal patients by giving them an overdose of morphine. This is MAID, though it’s not given for depression. In 12 American states, though, including Illinois, assisted dying is legal.
The objections to Kiano’s euthanasia seem to me misguided—based on someone’s subjective opinion of the sufferer’s feelings. Gaind questions whether Kiano’s suffering really is intolerable. He doesn’t seem to understand that such people can have, or act out, moments of seeming normality. Lepofsky, also blind, avers that his own sightlessness is tolerable to him, so why isn’t it tolerable to Kaiano? (He seems to forget that Kiano is suffering from painful effects of type 1 diabetes.) And Coelho doesn’t realize that proper treatment of people seeking MAID for mental illness might not cure severe depression. In the case of 28-year-old Zoraya ter Beek in the Netherlands, the woman had tried many types of treatment and drugs for mental illness, and none of it worked. She wanted to end the pain of living, which had gone on for years, and I can fully understand that. (She died with assistance in 2024.)
It seems to me that the Canadian law doesn’t go far enough: it should consider mental illness alone sufficient grounds for euthanasia IF it is intolerable and doctors have been unable to relieve it over a substantial period of time. If doctors recognize that, who are other people to say that the mental distress is tolerable?
I think it’s time to realize that we should let some people go even if they are not medically terminally ill, for to do otherwise is to allow suffering that can’t be cured. I am not worried about a “slippery slope,” which can be avoided with proper medical supervision before euthanasia. I am more worried about people suffering their whole lives and not being allowed to have a peaceful death with dignity. The alternative is a self-inflicted end by hanging, jumping from a building, or lying down in front of a train. Is that what we want?
I will add a poll:
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The objection to MAID for mental illness, particularly depression, seems to be the concern that the person requesting MAID doesn’t really want to die—that it’s the mental illness talking. That does seem to be a risk, but if the patient is persistent enough and the doctor(s) or caregiver(s) concur that the suffering is truly irremediable, then the person should be granted his last wish.
That is the standard that the Netherlands uses, which I see as reasonable.
How does one even imagine separating the mental illness from the person, if treatment after treatment has been tried over a long period of time without success? I am not separate from my depression; it’s in my head like all my other thoughts, and it doesn’t go away for long, no matter what I do. And it’s not necessarily illogical or irrational. There can come a point where one is staying alive merely for the sake of staying alive–not even because anyone else would be impacted if one dies, because they wouldn’t be–and that’s not exactly rational.
I doubt that there are cases of severe depression that are truly untreatable. There are drugs – opioids in particular – that are known to alleviate so-called untreatable cases. The tradeoff is that the depressed person who finds relief with opioids is likely to become an addict to maintain that relief. However I would think that preferable to being dead. There is also evidence that one or two high-dose psilocybin sessions – under appropriate supervision – can resolve many cases of treatment-resistant depression. Depression is a disorder of brain chemistry and that chemistry can be altered by drugs.
Depression can also be caused by drugs. Decades ago I had a back injury and was prescribed a muscle relaxant to treat it. After a few days on that drug, I started having very negative depressive thoughts and feelings of the sort I’d never had before. I wondered if that might’ve been due to the drug, so I stopped taking it and those thoughts and feelings went away like snow melting before the sun!
Psilocybin, ecstasy.. maybe some others. I don’t know how well they might work. But I think these options would be tried before looking for another way out.
But how many years must go by, and how many treatments, before you decide, well, okay, they could have MAID. If all antidepressants and theraphy have failed, would you say: Well, you need to try ecstasy and psilocybin, too!
“Factitious disorder imposed on self (FDIS), commonly called Munchausen syndrome, is a complex mental disorder in which an individual imitates symptoms of illness in order to elicit attention, sympathy, or physical care. Patients with FDIS intentionally falsify or induce signs and symptoms of illness, trauma, or abuse to assume this role. These actions are performed consciously, though the patient may be unaware of their motivations.”
Source :
https://en.wikipedia.org/wiki/Factitious_disorder_imposed_on_self
“The significance of prima materia in Hermeticism lies in its representation of the potential for both material and spiritual transformation, embodying the Hermetic principle of “as above, so below”, where the macrocosm and microcosm reflect each other in the alchemical process.”
https://en.wikipedia.org/wiki/Hermeticism
“ter Beek has a tattoo of a “tree of life” on her upper left arm, but “in reverse.”
“Where the tree of life stands for growth and new beginnings,” she texted, “my tree is the opposite. It is losing its leaves, it is dying. And once the tree died, the bird flew out of it. I don’t see it as my soul leaving, but more as myself being freed from life.
…
“I’m a little afraid of dying, because it’s the ultimate unknown,” she said. “We don’t really know what’s next—or is there nothing? That’s the scary part.”
(Article linked above)
I think the slippery slope is that government starts deciding who lives and who dies. Sick people cost too much, old are taking up valuable resources or housing, prisoners’ organs could be used to help others, or some invented category that means “we just don’t want them around.” And if depressed people want to die, why do they need help? Unless a person is physically incapacitated, shoudn’t they be able to commit suicide themselves? I think the fact that this wasn’t happening on the scale that it is now with MAiD is significant. Canada has made it easy; perhaps it shouldn’t have.
Why do they need help? Because other methods of suicide might be painful, messy, or may not succeed. Assisted dying is dignified, painless, and quick, and there is no chance of survival.
I concur with PCC(E) here. I wish something akin to MAID for chronic depression (with other complications) were available here in the US, honestly. Doing things on one’s own is daunting, and it’s often messy, particularly the most effective means. It generally would have to be done in private if one wants to avoid interference. That means someone will eventually stumble upon one’s body, or at least have to retrieve it (if you leave a message). And none of the methods are very sure. I can put an IV in myself for myself, but I don’t have access to appropriate meds. And even if I did, if it fails, which is always possible, particularly when one is in distress, then one has the possibility of brain damage, etc. It would be nice not to have to think of doing something that makes one feel like a criminal for doing it, and risking an even worse life after if one fails, but to have support and infrastructure in place for arranging matters afterward (for people like me who have no one around to do such things).
Marx in the Anthropocene: Towards the Idea of Degrowth Communism
Kohei Saito
Cambridge University Press
2023
The five-pointed star on gravestones in former Communist countries serves well here to clearly illustrate that Communism is a transcendent spiritual religion of “degrowth” – that is, incentivized death.
Why is this comment relevant to the discussion? I will put you in moderation until you explain what you are talking about.
Sorry about that –
On the spot, I’d say that when incentives are to degrow an economy, as Saito’s literature describes at length and are implemented in ESG scoring for instance, the role of the State in assisted suicide – here, the MAiD program – deserves severe scrutiny. DrBrydon seemed to point discussion in such a direction.
In particular, the limits to reducing one’s carbon footprint are not clear. How much can that weigh on the mind – specifically for the scenario ter Beek’s case describes. The thought that you yourself is responsible for destroying the Earth – how significant is that?
The thing about gravestones is a real thing that illustrates how Communism is a religion. It also deserves severe scrutiny in this case with suicide – again, with degrowth Communism as Saito named it in his book.
Seems directly relevant to me, and only recently occurred to me with ter Beek’s story – since it last came up
in a post – to at least show that Saito book and try to connect it – without going into a long comment, hopefully readers could look that up on their own, or look up videos on it.
Hopefully that is alright… sorry if something was out-of-line – I mean, suicide is a hard enough topic to even say anything. So that’s my hasty reply.
I thought that doing oneself in, rather than doctor prescribed suicide, cancels the life insurance policy so your next of kin do not get a pay-out.
In the UK, most life assurance policies have a one year suicide exemption clause, so if you commit suicide by whatever means one year and a day after taking out the policy, it will pay out.
Leaving aside the question of suffering caused by a chosen method of suicide, it is worth remembering that suicide has at least other victim – the person who finds the body. This may be a police officer if a delayed email is sent, a family member, or if an outdoors suicide is chosen, a child or children. All of these people deserve not to have to deal with the stress of such a find and some will be negatively affected long term. A major advantage of assisted suicide is a planned, controlled and painless death which does not inadvertently cause harm to others.
Anyone spending much time around people in that kind of condition gets a better understanding of the dynamics than armchair observers I think. Once, in hospital late at night, I noticed the personnel “helping” a dying liver cancer patient over the edge by titrating his opiates up.
The best commentary on this came to me (via Pinker’s recommendation) a few years ago:
https://www.richardhanania.com/p/canadian-euthanasia-as-moral-progress
I’m all for plug pulling in MANY circumstances. Pro-lifers/pro-pain people love to pull up exceptional examples and anecdotes in their mission to inflict suffering.
D.A.
NYC
This happens every day, and it happens close to home, too. I can think of some of my own relatives, suffering and near death, who were helped with opiates to end their suffering.
Yes that has become pretty standard. Both of my parents when terminally ill were pushed over the line by morphine administered by medical professionals who knew what they were doing. But the controversy here concerns cases of depression, not terminal illness.
Opiate doses resulting in early death do not contravene medical ethics (this may vary by country) if the primary intent of the administration of the drug is the relief of pain or other suffering and if this is the patient’s wish. Even the Roman Catholic Church accepts this as a reasonabe and humane course of action.
Yet, in my very limited experience, doctors tend to be very reluctant to publicly admit that doctors do this. Why?
From what I’ve seen and heard, the decision is made between doctor and patient or doctor and the holder of a care and protection power of attorney, usually a first degree relative, in line with any wishes the patient may have previously expressed. Patient confidentially (in New Zealand) precludes discussion of specific cases even after death.
It is still a controversial subject, one the media would fix on and hound people about. Relatives are often not on board with the decision, especially if there is a Roman Catholic involved somewhere. But discretion around patient care is probably the main reason for being reluctant to talk about the issue.
If someone wished to choose adequate analgesia over prolonging life a few days, it needs to be discussed at some stage with a person’s doctor – not all doctors think it is a reasonable course of action.
I wasn’t sufficiently clear.
I have asked some EOL doctors and nurses at public events on doctor assisted dying whether such unofficial consensual ODs do occur, and whether prescribed opiate doses resulting in early death do not necessarily contravene medical ethics. None admitted even the actual existence of such a thing, usually blaming media sensationalism, with IMO about the same nervousness as a politician caught in flagrante delicto.
(Yes, the media and politics contain a lot of self-serving liars; we expect much better from medical professionals.)
Has anyone studied the contagion effect of medically assisted suicide?
Not that I know of. But if you want to make an argument that it’s contagious, you’ll have to separate those with terminal illneses with those from nonterminal conditions that are experiencing unbearable suffering. And you might want to parse that second part into even more parts. It would be a very hard thing to study.
Interesting question.
Contagion usually takes a bit of contact between parties (like teens on social media). I’m not sure people in extremis, sick, are “joining up” like that. But it is worth looking into.
D.A.
NYC
One part of me says…just let people who want to die do it, in a painless way, for whatever reason they want. 10s of thousands of people attempt suicide each year, and a portion of those botch it and end up disabled instead of dead. A safer form of suicide would prevent a lot of that. Also, we let people overeat, abuse alcohol, smoke, and in general engage in activities that could be considered a slow form of suicide.
We should continue to offer counseling to people who want to commit suicide, as this is a rather permanent decision, but I’m not sure what is to be gained by limiting it to a terminal illness. For people like myself, who don’t really want to live until 90 (unless we make some serious and quick gains on combatting senescence), I can easily see a scenario where I have so many limitations, and my world is now so small, that my body has become a prison. I don’t see why I should be deprived of a legal and safe option to exit the party.
I’m well inclined to agree. If I were king, I’d make it much easier for people who want to die–for whatever reason–be able to do so with the least restrictive guardrails/screening. Hospitals (or designated/regulated facilities) would have nicely appointed suites in which patients could check-in and be made comfortable. They could then invite their family and friends (or no one at all) to visit them, to say good-bye, to reminisce, and to witness their dignified death. All covered by insurance. Inhering to our right to life is a right to die.
Those who attempt suicide and botch it — how many of them go on to try again, or continue living in their disabled state? Are there any statistics?
The ones who are severely disabled often don’t have agency to try again, or even feed themselves. Anecdotally, thwarted suicide attempts that were really serious attempts with highly lethal methods, not just taking four Xanax and calling 911, are often one-offs, instantly regretted with no repeat attempts.
Where are they now? A follow-up study of suicide attempters from the Golden Gate Bridge (1978)
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.goldengate.org/assets/1/6/suicide-deterrent-seiden-study.pdf
Main finding: “Despite the high rates vis-à-vis the general population, still about 90% [of persons apprehended by police while overtly attempting to climb the parapet of the bridge] do not die of suicide or by other violent means.” (Italics in original)
As I, a Canadian, am now at the 4.5 year mark of my “journey” with a Motor Neuron Disease (PLS – a slower progressing form of ALS), I am starting to wonder when that time will come when I will want to utilize MAID. I presently cannot walk without a walker, and numerous other physical losses continue to progress. It really is awful, but I’m not yet at the point of saying “cheque please!”
My wife and I recently had to put our beloved 18 year old cat down due to an illness, and the experience really drove home the finality of it, and also the pain of loss for those remaining. But given his level of suffering, and inevitable death just days away, it was the right thing to do.
All those people who belong to the death cult known as Christinsanity can go pound sand, for until you can demonstrate that this god of yours exists (you know, the one that has a black belt in killing), all of your claims can be and are dismissed. Your primitive superstitions gave birth to the suffering-worshipping nut-job Mother Teresa, and thank you Christopher Hitchens on revealing her stunted and impoverished view of life.
Our lives are just that – OURS. We were not asked to be born, and it is our right to end it if we so choose. The MAID system was carefully crafted to avoid abuse or misuse, and I’m glad it’s there if & when needed.
YES, many times YES. Quantity of life is nothing but a severe burden when quality has quite vanished and shows no sign of reappearing in the foreseeable future.
Well put, and I agree. Our lives are our own, no one else should have the power to decide.
However I make one exception If the person has dependent children, this decision affects them deeply in ways that are not their fault. I would set higher standards for such cases.
Well, most of us have people who love us and would be severely affected if we died. If you are worried about how they will be supported, I see your point but should you let someone suffer for a lot longer because of that–or even die?
I almost agreed with a comment above about being the owner of our own lives, so that we should be free to exit for any reason at all. Then I thought about dependent children. In that case we must weigh the rights of the parent against the rights of the child. I think it is ok to raise the bar a bit for people if they have children that depend on them, because their exit will have drastic consequences for innocent children. If such parents are truly suffering badly, maybe it is ok to end their lives, but if the problem is not so bad, I don’t think they should be helped to exit.
With medical access to death being more accessible to Canadians than access to medical care or palliative care, especially for the poor and disabled, it’s not surprising that more and more Canadians wish to apprise themselves of MAID. And if they don’t ask for it, the government will kindly offer it, for example, the veteran who asked Veterans Affairs Canada for help with his PTSD and was offered MAID, or the Paralympian (and veteran) who asked the government for help to get a stairlift and was asked if she’d considered MAID. In a survey, 35% of MAID patients said they believed themselves to be a burden. Is this a medical reason for killing people?
That is at least an order of magnitude higher than I would have guessed.
Well, remember that many of these are terminally ill, and are choosing to make a dignified and painless exit. The figure didn’t surprise. me.
Yes. We underestimate the suffering of a lot of end stage terminal illnesses. In part b/c we don’t see them unless it is with a loved one we are physically close to. We hear “disease X is terminal”, and think of sickness and then a grave. Its that in-between part which is tricky.
D.A.
NYC
Yeah, surprised me too.
According to Chat
Less than 1% in the US, where legal. Not legal in the UK
One of my complaints about Trudeau in his first term was that MAID was not that accessible. Seems like there was a workaround to the legislation.
Is there a science-based legal and medical definition of “irremediable […] psychological suffering?” Surely not, and I personally can’t fathom how we might ever devise one. Many of us have been fooled by our depression into thinking we have no hope. I, and friends and loved ones too, despise the lies that our depression has fed us, lies that led us to that false analysis of our condition.
It is necessarily subjective, and the patient’s call to make. As the best of my teachers said: “Pain is what the patient says it is”.
My answer would depend on the societal situation. On paper, it sounds like a good thing, but there are some slippery slopes, e.g. there is concern that there might be pressure felt by a person that they are being a burden on the family or the society. I would vote for better palliative care and social support first before expanding these options. Kathleen Stock has a book coming this year on this topic which I am looking forward to although I am more or less familiar with her arguments (she is critical of assisted death) and I agree with some of them.
If I were seriously ill, the cost of medical care and the burdens it would impose on those close to me would be perfectly reasonable factors to consider when deciding whether to end my life. Even if my loved ones disagreed with me, it would be my choice.
Yes, it should not be the choice of doctors, therapists, or the goernment. Suffering under the conditions specified is the criterion. The MAID regulations say nothing about children.
Jerry’s post is welcome and thoughtful, as are the comments. Ironically our national media here are not focused at all on MAID. The issue is characteristically Canadian, as are the tradeoffs and the arguments for and against. But instead of headlines and thought pieces about MAID, the CBC is obsessively convulsed by American immigration politics and its current ugly manifestation in Minnesota. It’s a weird emphasis by the national broadcaster on the internal politics of another country.
Strongly agree with Jerry. As Jeff mentioned above, many people choose to end their life by suicide, with its high risk of failure, including a person being left worse off. As well as suicide, people can choose to refuse food and drink to starve themselves to death. A peaceful process according to many who have observed it (e.g., palliative care nurses), but why force a person to such a prolonged dying when an alternative is available? Then there is the “accidental” overdose by doctors. The distinction between physical and psychological is also somewhat misleading or arbitrary. Even people dying a painful death report that they chose assisted suicide because of “suffering” and “quality of life” rather than “pain” per se. One has to have a pretty malevolent view of governments and relatives to think that they will promote MAID to save money or just get rid of all the bother. An indicator that MAID is not being abused, perhaps, is that the median age in Canada is about 78 years with over 60% 75 or older. People are hardly being shuffled off this mortal coil prematurely. One difficulty with MAID could be that it will make life expectancy a less valid indicator to compare countries. Canada could end up losing its greater life expectancy than the USA, although much of the current difference appears to reflect infant and child mortality.
I work in the legal field in a peripheral sense, and I had the honour of doing all of the discovery and then the entire trial that resulted in the current Canadian MAID legislation. Gloria Taylor’s lawyer, a fabulous fighter called Joe Arvay, sadly since deceased, got the head of the Canadian palliative care physicians to admit in discovery that they don’t know if someone in a palliative coma — the only alternative to MAID for a terminally ill patient pre-MAID — can feel pain. They suspect the patient cannot feel pain but it’s not known for certain. If that’s the case, said Joe, why do you offer that as the only medical alternative to MAID? There were many intervenors in the trial who all advocated for MAID. They had a gamut of diseases for which there was no cure and they all spoke about their desire to be able to have a dignified death at the time of their choosing. It was an emotional trial. Since the legislation passed there have been a few loosening of restrictions, but not many, setting Quebec aside, in spite of what Canadian mainstream media and others would have us believe. There is a current case before the BC Supreme Court — a Charter challenge — that challenges the exemption of religious-based publicly funded care organizations from MAID. They simply refuse to do it in any of their institutions, which necessitates moving patients, who are often in extreme pain, to a different location to be able to fulfil their wishes. Other jurisdictions have much less restrictive provisions than Canada does for receiving MAID. The issue has become, as all things seem to do, a political point. For me, I am grateful to be able to have the choice, should I have to do that, for many reasons.
If you endorse the medical killing of people who aren’t dying do you also agree that doctors should be obligated to honour this “last request” on pain of losing their licences? That’s what “the right to die” has become in Canada: the power to compel another person to kill.
Not that many doctors are willing to kill their patients. The task has been taken on by a small band of MAiD docs such as Dr. Wiebe who take referrals as their calling, which lets the rest of us off the hook. From what she says in public, Dr. Wiebe will kill chronically depressed people if that’s what they say they want. But I wonder how many others of that little band, who are OK with accelerating the deaths of patients with terminal cancer and motor neuron disease, will baulk at killing the mentally ill. If they decide not to take on that business, or maybe get out of MAiD altogether (the slope having become too morally slippery for them), it will become a “reverse turf war”. Who has to do the deed instead: the patient’s general practitioner (who in our system must do what other doctors won’t) or the psychiatrist who has been following the patient for his depression? Either one will tell the patient, “Um, you need to ask your [GP or psychiatrist] to do that.” But neither will say so to the other’s face.
It’s one thing for lay people to say they don’t care who does it as long as it gets done. But you can’t make medical graduates go into disciplines such as primary care and psychiatry where they can predict this duty to kill healthy people with years of life left will be forced on them by the state.
We’ve all heard anecdotes of doctors deliberately accelerating death by giving surreptitious overdoses of morphine. (These concern patients very near death, traditional “mercy killings”, not the mentally ill.) The controls on the use of narcotics are so tight, and so many people are watching and documenting, a doctor couldn’t get away with this today and not be charged with murder, as some have. Doctors don’t even handle narcotics personally. Nurses do. Even a miscommunication between a “difficult” doctor and a resentful nurse about the intent of an order for an unusually large dose could cause grave trouble for the doctor.
I doubt that Canadian doctors are obliged to do what their patients want. American doctors sure aren’t. No doctor ever has to obey the wishes of their patient; they can always bow out if they can’t do it. And you are using hyperbole using “killing their patients” when the patients sant to die. I am not surprised that many doctors don’t do it.
So no I don’t think doctors should be obliged to “kill their patients.”
Nobody is making medical graduates go into fields where they are forced to kill people. I think you know that.
The euthanasia provisions in the Canadian Criminal Code are contained as exemptions in the law of murder, which is about killing people, whether they want to die or not. It is what it is.
The policy of the Ontario College of Physicians and Surgeons is distributed over several web pages but I think this captures it:
https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Human-Rights-in-the-Provision-of-Health-Services
When push comes to shove, if there is no one willing to take the referral for mental illness cases, the doctor will have to do it himself if physically able, unless the patient is willing to meet the doctor halfway and accept care to relieve distress within the doctor’s ethical limits. No special expertise is necessary to do euthanasia, and if the patient complains that it wasn’t provided, the doctor will be disciplined.
My point about specialty fields was that graduates will avoid them where they will be faced with these dilemmas for purely mental illness precisely because no one can make them choose them.
I’ll leave this.
It seems to be a very slippery slope given that this happened in Canada. She didn’t want maid but her husband had care burnout so she died.
https://x.com/OtherHalfOrg/status/2014279302251000108?s=20
I can see it being very open to abuses. Legislation can never be perfect when each case must be assessed individually with care and compassion.
I am conflicted on this matter.
As a psychiatric nurse I encountered some patients with “anhedonia” who also suffered from what one can call a complete dearth of “cathexis” (originally a Freudian idea coined in today’s form by Freudian biographer Alfred Jones to be understood as “connection”) with living. I have often wondered why it is so frequently stated that there is a “cure” possible for all patients who are suicidal, depressed, or “anhedonic” be it therapy, medication, electroconvulsive therapy(ECT) or some combination of these treatment modalities. If one truly understands the idea of variation as a precursor to natural selection, then one can begin to understand how certain minds through developmental processes and genetics or just genetics are destined to have what one might call an anhedonia that is characterized by a complete lack of cathexis with life and actually will often describe themselves with a “clinical” awareness as being not so much depressed but as “just going through the motions of life.” I have seen these patients who will sometimes not present as “depressed” or with a low measure of “suicidality” simply hang themselves with bedsheets on a psychiatric unit or walk off the roof of a building after being refractive to all depression “cures.”
It has been speculated that there are perhaps as many as 10,000 genes that contribute in some manner to brain(mind) emotional development and brain(mind) architecture. If that is found to be true, how will we deny the tremendous variation or mutation that is possible with 10,000 genes, therefore with this level of variation that will produce a seemingly almost tranquil mind that simply has no connection with living?
Fascinating insight.
Thanks.
What Dr MacMillan said…
Edifying. Thanks
Yes, very good. I had no idea!
It’s an old dilemma:
from Robert Wilkins, Death: A History of Man’s Obsessions and Fears, p. 220
Good point about senility. If I get a diagnosis of early dementia, I’m seriously considering punching out. Once it takes hold, I will have already died…a doddering and demented version of me is not me. Talk about lack of dignity!
Two of my neighbours have recently chosen MAID to deal with the ravages of dementia, Alzheimer’s in particular. But if you do that then you do have to get the timing right, as in you have to be sane enough to say “Yes” when the MAID doctor asks whether you want the needle.
For some reason, that scares the hell out of me.
We can hardly get the issues here right without taking seriously the inadequacy of much palliative care and end-of-life care. It is not kindness to offer help in dying to those who are not being offered good palliative care.
Assisted dying should be available to any adult who wants it – no medical/psychological evaluation required.
Even if the person has dependent children? I think the government has a legitimate interest in raising the bar for assisted suicide of a parent with dependent children
Lou, I hope the host doesn’t object to my replying since you’ve asked this twice. The short answer is No, external parties never have a gatekeeping role in the decision beyond what the Criminal Code permits.
I’m going to restrict my reply to cover the person with purely a mental illness (or who has just lost interest in life) who is nonetheless able to work gainfully and support his children. I think that’s what you mean and Russell Moran would include. I do see your point. (People with debilitating or terminal diseases are as a rule no longer able to support dependent children when they seek MAiD.) Actually though, mentally ill or anhedonic people who want to die are usually socially isolated. They generally aren’t relationship or parenting material and are often estranged from any family. At the risk of sounding dismissive, these poor souls are unlikely to have dependent children where your concerns would come up. They are often themselves financially dependent on others. Many have no one who might care what happens to them at all. Since MAiD for pure mental illness isn’t legal in Canada yet, we know this patient population only from foreign anecdotes and some suspicious cases in Canada.
I’m glad you brought up the communitarian implications of allowing people to die before their time. There can be externalities but there doesn’t seem to be any plan to fold them into the process.
I really don’t know what the bar should be for people who are merely mentally ill and have dependent children. Those children may very well be living a horrific life as a consequence, and maybe in those cases MAID is justified. I only want to argue that for the good of the children, and for the good of the society that will have to take care of those children if the parent is gone, MAID should not be freely dished out.
I’m checking out of the discussion now. I don’t have much more to say about it.
Not obligating a reply, Lou, just some advice. If your state legislature introduces a bill to permit euthanasia, you should raise your concerns with your representative and try to get something like that written into the law. Testify at legislative committee hearings. The legislature can pass any law it wishes, subject only to the Constitution. The advocates for euthanasia on demand (which I am not one) won’t give you the time of day but your opinion is as good as anyone else’s in getting a law to say what you think it should say.
Once the law is passed, nothing anyone says can obligate it to be interpreted and enforced in any way other than how it was written.
If your state doesn’t want to allow euthanasia at all, then you have nothing to worry about it being dished out freely. That could be one reason for opposing any such bill from the get-go, the concern that there wouldn’t be sufficient safeguards. A bit odd that the public seems to trust doctors always to make the right decisions — it’s entirely up to us to interpret the patient’s consent as lawful and valid — after the cock-up we’ve done with opiates, gender treatment, and DEI in medical schools where the state has had to step in and lay down the law to protect vulnerable patients from us.
The slope is slippery. The criteria for MAiD in Canada have been progressively relaxed since the original Supreme Court decision that found a right of doctors to accelerate the deaths of consenting adults in unremitting distress from terminal illnesses. In 2027 the petitioner won’t even have to be sick in the popular understanding of the term and doctors will have to comply. If that’s not a slippery slope, I don’t know what is. I guess if the slip is toward what you wanted anyway, it’s not slippery.
Best wishes.
One reason for some people in Canada committing suicide is the restrictions put on the use of narcotics. The people who actually need them in many cases can’t get them because of the restricted access to them caused by druggies.
BTW, in Vancouver we have a drug users union, Vandu, and they protested to some kind of human rights tribunal over the use of the word ‘druggie’ on a local radio show. If you want dignity, earn it.
“The illness, disease, or disability or that state of decline causes the person enduring physical or psychological suffering that is intolerable to the person and cannot be relieved under conditions that the person considers acceptable.”
Yes, the person who suffers should decide whether, and when, they want to die (painlessly). Suffering (of humans and animals) is the worth thing on Earth, and an irrefutable argument against the existence of a benevolent God. Why do we treat our pets humanely, but not humans?
I am torn upon this issue. I agree that any adult in their right mind should be able to choose death, whilst we have something of a duty to dissuade those that do so when depressed.
What the Canadian experience illustrates is that it is no long just something up to the individual. It is becoming part of government planning. Bean-counters have had a taste of the savings to be made, and those savings are being factored into expenditure planning. How easy it would be to nudge the numbers up just a little to make the budget easier in the next fiscal year! Just loosen the requirements a little. It is also becoming a cultural norm. We all know someone who has chosen MAID. We have family members who are pre-approved. It is becoming part of the conversation when it comes down to elder care and what to do with Dad. This was all predictable, and begins to add some pressure to those who might be eligible. No on wants to be a burden, and now you don’t have to be…
There are other concerns that some will declare paranoid. We have had the suggestion that MAID should be available for ‘targeted organ donations.’ As in, “Mom, you know I need another kidney, right? Wouldn’t it be great if…?” The one thing I find truly alarming is when MAID will make its debut onto a medical treatment algorithm. Pretty much all of medical care is recipe-driven, using expert consensus algorithms. Factor in the expense of public health care and the strained system and one day we will see an algorithm that has MAID as the recommended first-line treatment choice for a certain condition. “You have Richter’s Transformation of your leukemia. The recommended treatment, and the only one available in our health care system is MAID.” Since private health care is illegal in Canada, one would have little choice.
You may agree that ‘paranoid’ is an apt description, but ask yourself whether you really expect a cash-strapped government to do anything else? At least in Canada we discovered that after legalisation for decent reasons. The current debate in the UK House of Lords on the Leadbetter Bill has actually gone there in advance, Actual quote from Lord Falconer denying an amendment to ensure poverty is not a reason for choosing death. “Do financial considerations apply? They might well apply because there is only a limited amount of money to go around, so they might contribute.” He actually presented this as giving poor people the freedom of choice to choose assisted dying. If financial pressures are excluded as reasons to die, it would limit assisted dying to the rich! And after all, who are we trying to get rid of?
Despite my desire to see people who are terminally ill have the option, the risk that this all becomes public policy is too great, so I have changed my mind to being against MAID. And I say that as someone who would have qualified for it, twice, in the last few years.