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Choosing death in a society that doesn’t support life

Clarke: In the age of austerity, medical assistance in dying is being transformed into a destructive agent of social abandonment

Canadian PoliticsEconomic CrisisHuman Rights

If assisted dying is extended and thoroughly normalized, writes John Clarke, the right to choose may be transmogrified into an ugly way to reduce costs and dispose of those who have been abandoned. Photo by Matthew Perkins/Flickr.

The introduction and expansion of medical assistance in dying (MAID) in Canada has been surrounded by substantial debate at every stage. In my view, a serious discussion of the issues involved must acknowledge that the impact of any public policy cannot be evaluated outside the social context in which the policy is applied. In the case of MAID, the right of people to make decisions about the timing and circumstances of their deaths, based on their own evaluation of the quality of their lives, is a very important consideration but it doesn’t settle the matter. If, as a result of government-imposed austerity, vital supports and services for disabled people are lacking, this, combined with the pressure of social abandonment and the weight of deeply entrenched prejudices against people living with disabilities, then the choice of assisted dying is unlikely to be freely made. Rather, it is imposed on people by a society that fails to support life.

I want to look at where MAID has taken us so far but also to consider where it might lead. There have been deeply troubling developments in the implementation of the program to date and the most alarming trends are discernible. If assisted dying is extended and thoroughly normalized, in the context of a deeply degraded social infrastructure, the right to choose may be transmogrified into an ugly way to reduce costs and dispose of those who have been abandoned.

Expanding MAID

When MAID became legal in 2016, it required an amendment of the Criminal Code that exempts doctors and nurse practitioners involved in administering MAID from being criminally charged. Initially, the intention of the policy was to give Canadians who were “suffering intolerably during the dying process,” the option of a medically assisted death.

Yet even a program concerned solely with the terminally ill runs up against the limits of available health care resources. A Global News advertising feature of the Canadian Cancer Society published last July under the headline “Critically ill Canadians lack access to quality palliative care” included an interview with Charlene Rocke, whose husband died of cancer in 2022. In it, she complained that, “he had the right to die in dignity and not alone and the exact opposite happened.” He never did obtain access to palliative care and died in a hospital emergency room “in the most undignified manner in pain, alone and afraid.”

The article decries Canada’s “patchwork system of palliative care” which leaves many terminally ill people lacking access to vital support to sustain their quality of life. Those who live in remote or rural communities have even less access. Moreover, social and racial inequality figures in the availability of palliative care. Already in 2018, the Canadian Institute for Health Information found that only six percent of long-term care residents and 22 percent of residents with fewer than six months to live officially received palliative care in their last year of life.

The choice of medically assisted death risks becoming the default option for some people if effective specialized services are unavailable in the final phase of their lives. What is worse, this terrible choice is now being made by some people who are not terminally ill for lack of sustaining resources.

In 2019, Québec’s Superior Court ruled it unconstitutional to limit MAID to those with “reasonable foreseeability of natural death.” Based on this, the federal government decided to extend eligibility for MAID to people seeking to relieve intolerable suffering, who may not be nearing natural death.

In a Government of Canada news release in February of this year that explained how access to MAID had been thus expanded, it was also noted that “the Government of Canada recognizes that mental illness can cause the same level of suffering as that of physical illnesses.”

The intention had been to include those “suffering with mental health diagnoses” by March of this year but after wide consultation with other levels of government as well as with medical professionals and other stakeholders, the federal government decided that the health system was not yet ready for this expansion. This postponement remains in effect, but it is worth considering the impacts of the post-2019 extension of MAID, even without the inclusion of mental health diagnoses.

Sarah Jama, now an independent member of the Ontario Legislature, was a co-founder of the Disability Justice Network of Ontario. In 2021, during a CBC panel discussion, as reported by Nora Loreto in The Maple, she pointed out that disabled people have been given short shrift when it comes to government supports and that with the extension of MAID, “it looks as though the government is rushing legislation to allow people the right to die without also supporting the right to live.” Jama’s observation cuts to the heart of the matter and there is ample evidence that her concerns were well founded. Case after case has surfaced showing how people are resorting to MAID in circumstances dominated by the degradation of public services.

Feeling pressured to die

For example, in 2022, the case of Amir Farsoud came to light. Afflicted with “never-ending agony” from a back injury sustained years earlier, he was unable to sleep and suffered from anxiety and depression at the time of his death. Reliant on sub-poverty social assistance income, he lived in a rooming house that was up for sale and was consequently facing the prospect of homelessness.

In an interview with City News, Farsoud stressed that poverty was central to his decision to seek MAID. He stressed that it wasn’t his first choice and commented, “I don’t want to die but I don’t want to be homeless more than I don’t want to die.” He would clearly not have contemplated MAID had he been assured an adequate income and secure housing.

Normand Meunier became quadriplegic after a spinal cord injury in 2022. As the CBC reported, he was hospitalized for treatment of a respiratory illness in April of this year but, before being admitted to intensive care, he was left lying on a stretcher in the emergency room for four days. This led to his developing a major pressure sore on his buttocks that deteriorated “to the point where bone and muscle were exposed and visible—making his recovery and prognosis bleak.”

The day before his medically assisted death, Meunier told Radio-Canada, “I don’t want to be a burden. At any rate, the medical opinions say I won’t be a burden for long; as the old folks say, it’s better to kick the can.” In the same CBC article, Trudo Lemmens, the Scholl Chair in Health Law and Policy at the University of Toronto, commented on the case to the effect that “medical assistance in dying is more easily available and on a more regular basis than some of the most basic care.”

Ramona Coelho practices family medicine in London, Ontario and mainly serves low-income patients. In an article for the conservative Macdonald-Laurier Institute, she wrote that when MAID was expanded she 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.”

Coelho notes that of the 13,000 MAID deaths that took place in 2022, 463 of those who accessed MAID were not dying. She points out that ambiguity in what defines a “reasonably foreseeable natural death” means that many of those who were fast tracked for MAID “may have had many decades of life left to live and the potential to recover with time and care.”

Coelho makes clear that a lack of resources is driving people to choose assisted death and that attitudes among medical professionals are furthering this process. She offers the chilling example of one medical provider who “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.”

The proposition that assisted death has been introduced in a social context dominated by the systematic undermining of systems of social provision needs no supporting evidence. The lack of affordable housing, the inadequacy of social benefits, the weakening of public health care and a general decline in the standards of public services are all well established.

Under these circumstances, the extension of MAID to those not facing a “reasonably foreseeable natural death” has already produced situations where the choice of death would not have been made but for poverty and a lack of support. The danger is that this will intensify as MAID is expanded and normalized.

The resort to assisted dying and the degrading of social provision may become a vicious cycle in which the impact of austerity measures increases the pressure to prematurely terminate lives, while the availability of assisted dying facilitates the further removal of vital supports. To the extent that medical providers see MAID as a necessary means of coping with a weakened public health care system, considerably more people with the potential to live for many more years may be pressured into choosing assisted dying.

The concept of dying with dignity has a great deal of validity but it can’t be removed from societal reality. In the age of austerity, MAID is being transformed into a destructive agent of social abandonment and those who “allow people the right to die without also supporting the right to live” must be challenged.

John Clarke is a writer and retired organizer for the Ontario Coalition Against Poverty (OCAP). Follow his tweets at @JohnOCAP and blog at johnclarkeblog.com.

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