Assisted dying may seem to be a humanitarian measure, but in the context of rampant austerity, evidence suggests it can have very disturbing consequences, argues John Clarke

The Canadian government is delaying its plans to extend medical assistance in dying (Maid) to those who are ‘suffering solely from a mental illness’. This had been due to take effect on 17 March but it has been decided ‘that the health system is not yet ready for this expansion’and it will be delayed for three years.

A government statement cautiously acknowledges serious concerns over the impacts of the Maid initiative and declares that ‘we will continue to work with the provinces and territories, medical professionals, people with lived experiences, and other stakeholders to support the safe implementation of MAID, with appropriate safeguards in place, to affirm and protect the inherent and equal value of every person’s life.’

Criticisms of assisted dying in Canada have focused precisely on the equal value of life and the ‘safeguards’ that are being promised. These concerns are greater than under the original legislation, adopted in 2016, that was restricted to those with terminal illnesses or who faced imminent death.

Things changed significantly in 2019, when the law was struck down by the Superior Court of Quebec on the grounds that it infringed upon the constitutional rights of those with chronic and painful conditions. New legislation, adopted in 2021, considerably expanded access to Maid, with a provision to include some mental-health conditions after a two-year period of preparation. It is this additional step that has now been placed on hold.

Austerity and abandonment

Whatever you conclude about legally sanctioned assisted dying in Canada, there is no disputing that the measure has expanded in a way that is unprecedented. ‘Government figures show that 13,102 people ended their lives under Maid in 2022 – an increase of 30% on the previous year’ and that 4.1% of deaths in Canada are now being assisted by doctors.

In 2021, UN human-rights experts warned that the expansion of the legislation to include those with chronic conditions ‘would create a “two-tiered system” and push people with disabilities towards suicide.’ The great majority of those who access Maid do so on the basis of terminal conditions but, in 2022, 463 cases were assessed and accepted on the basis of chronic conditions.

The question of just how free the choice of assisted death can be, when adequate measures of support are lacking, is at the heart of the debate over Maid. Recently, Ramona Coelho, a GP based in London, Ontario, wrote an article that tackled the question of supposed free choice from the standpoint of a medical provider whose ‘practice serves predominantly low-income and marginalized patients, including refugees, those who have been in our prison system or are facing charges, and many with disabilities and mental health issues.’

Coelho notes that, when Maid was extended to those not at immediate risk of dying, ‘I was appalled to learn that my patients, who are frequently blocked from care as a result of hurdles created by our government and systems, could potentially be offered an expedient death provided by the government.’ Her article shows how the longstanding political agendas of austerity and social abandonment cast a shadow over the option of assisted dying.

The article goes on to suggest that, beyond the risk that despairing conditions may prod those with chronic conditions and disabilities into choosing Maid, undue pressure from the medical profession is a serious factor. ‘The Canadian government commissioned a University of Guelph study, published in 2021, in which the researchers noted that some persons with disabilities were encouraged to explore the MAiD option – even though they had not been contemplating doing so – because of a lack of resources that would enable them to live.’

There are also alarming indications that medical providers, who see degraded supports and services as inevitable, may feel that Maid becomes necessary in such circumstances. ‘One such provider testified at a parliamentary committee on MAiD that if someone had to wait a long time for a service that would remediate their suffering, she would still consider that waiting to be irremediable suffering and grant them MAiD in the interim. Therefore, it is not surprising that patients with unaddressed psycho-social suffering are being given MAiD by assessors like her.’

Coelho concludes her article by arguing that with ‘eligibility for MAiD continuing to broaden, we are not giving priority to serving those most in need, but instead seem intent on rapidly expanding a path to end their lives.’

The factors that can make death the preferred choice are an intensifying feature of Canadian society. The Homeless Hub notes that the ‘links between poverty, risk of homelessness and living with disabilities has been well documented.’ Social benefits have become ever more inadequate and harder to access and, in this situation, it is estimated ‘that 45% of all people experiencing homelessness are disabled or diagnosed with a mental illness.’

Dying with dignity?

In January, The Walrus published an article on Dying with Dignity, the lobbying organisation that ‘owns the conversation around assisted deaths.’ A picture emerges of an exceptionally well-funded, politically connected and highly influential initiative that is able to draw on the active support of an array of legal and medical experts.

As a general concept, the ability of someone to make an informed choice about the quality of their life and the timing of their death has much to commend it, but the problem is that Dying with Dignity insists that ‘access to assisted death for anyone with a chronic or terminal medical condition is an essential liberal right,’ while doggedly disregarding the social context in which they advance this demand.

Case after case has surfaced of people whose choice of assisted death has been driven by inadequate medical services, sub-poverty income, the unavailability of viable housing solutions or a lack of other supports. The case of Rosina Kamis is horribly typical of this now prevalent trend.

Suffering from fibromyalgia, she was unable to continue working and faced poverty and despair. Before her life was ended by a physician, in 2021, she wrote in an email that ‘I can’t believe it’s so easy for me to get MAID.’ She made clear that ‘the suffering I experience is mental suffering not physical’ and acknowledged that her isolation and inadequate healthcare and social supports were a major part of her decision. She bleakly concluded that ‘I think if more people cared about me I might be able to handle the suffering.’

Yet despite copious evidence of this kind, Dying with Dignity CEO, Helen Long, insists that as ‘far as we’re concerned, there is no evidence that MAID has been delivered inappropriately.’ It is this blinkered approach, in which social realities have been erased, that has helped to produce such dangerous and harmful results.

Even for those who are nearing the end of their lives, inadequate healthcare resources undermine free choice when it comes to assisted dying. Palliative care in Canada is underfunded and under resourced, with access to it as low 35% in some areas. Without this essential option, there can be no talk of any legitimate decision-making power in the hands of those whose lives are coming to an end.

The extension of Maid to those with chronic conditions and its possible application to those whose sole reason for opting for it is a mental-health condition, however, has taken the initiative into enormously dangerous territory. Not only does the degrading of public healthcare and the social infrastructure exert pressure on people to take the assisted dying option but, the more that ‘choice’ is taken up, the easier it will be to remove resources from the systems of support that would make it possible to go on living.

Maid is looking less and less like the enlightened social policy it was supposed to be. It is becoming a means of disposing ‘humanely’ of those who, to an ever greater degree, are denied that which would sustain their lives. The harsh lesson is that the right to death with dignity can only become distorted and dangerous in a society that refuses to support life.