Canadian Medical Assistance in Dying and the Hegemony of Privilege

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This article refers to:

Slowing the Slide Down the Slippery Slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US

When Death Becomes Therapy: Canada’s Troubling Normalization of Health Care Provider Ending of Life

The Quest for Humane Termination of Intractable Suffering May Be an Uphill Struggle, Not a Downhill Slide on a Slippery Slope

A Slippery Argument: Ableism in the Debate on Medical Assistance in Dying

Comparisons Only Yield Valid Mutual Learnings If Based on Accurate Descriptions of the Comparators

ACKNOWLEDGEMENTS

I thank Raymond De Vries for his comments on an earlier draft.

DISCLAIMER

The opinions expressed in this article are the author’s and do not represent the view of the NIH, DHHS, or the US government.

Notes

1 The same practice goes by different names in different places. The term ‘euthanasia’ is used in the Netherlands and Belgium, but not in Canada. I will refer to the practice in Canada as ‘psychiatric MAID.’

2 Gardner is quoting JJ Thomson (1999). Thomson does not elaborate, but the point is clear enough.

3 As one Canadian academic recently said to me, “I don’t understand what they are afraid of,” referring to the reluctance of their colleagues to speak in public the concerns they express in private. This mismatch between public policy and private concerns does not seem ideal.

4 One would be hard put to find another controversial issue that draws common concern from as diverse viewpoints as The New Atlantis, Jacobin, the UN Human Rights Commission, The Atlantic, and The Nation, National Review, among others. It seems to me the only reasonable explanation for this is that what is happening in Canada violates deeply held common morality that cuts across even a wide range of ideologies.

5 Another example she could have mentioned is that the current law has been interpreted by some influential sources as already permitting the use of voluntary stopping of eating and drinking as a path to MAID in persons whose death is not reasonably foreseeable (to bypass the waiting period required for MAID when death is not reasonably foreseeable; this would of course apply to even psychiatric MAID) (http://eol.law.dal.ca/?page_id=2475).

6 Especially in regard to legal analysis, readers may wish to read Downie’s commentary in juxtaposition to Lemmens’ analysis as well as the several legal analyses contained in the recent anthology by Kotalik and Shannon.

7 The idea that there are only very few documented cases is also an inadequate response for several reasons. The primary one is the inadequate monitoring system in Canada (Kotalik 2020). The kind of monitoring that the Dutch provide would allow better monitoring, since the narrative reports tend to describe the reasons and circumstances of the request. Another reason of course is that the normative issues still remain.

8 The accompanying “The Advice to the Professions” document creates an appearance of requiring clinical judgment with the following: “An assessor or provider cannot form an opinion about MAID eligibility in the absence of evidence required to form that opinion, i.e., that there are no reasonable treatments remaining…” That certainly seems promising, but that sentence is immediately preceded by “…a capable person cannot refuse all or most interventions and automatically render themselves incurable for the purposes of accessing MAID.”[my emphasis] That seems a pretty low bar, especially since the treatments, even standard of care options, do not even need to be considered unless they are “available” (Section 3b).

9 These are minimal common ground scenarios. For broader arguments against various assistance in dying laws of broader scope, see: Nicolini, Gastmans, and Kim (2019, 7), Kim (2021, 2023b, 38,).

Additional information

Funding

This work was supported by the NIH Intramural Research Program, CL010539.