My first recollection of the impact legalised euthanasia and assisted suicide would have – for that is what Medical Assistance in Dying (the innocent-sounding MAiD) is – was at a conference in Paris. An Ontarian ethicist enthusiastically explained to us how, among other preparatory measures for MAiD, all the mannequins in the resuscitation training rooms had to be reprogrammed so that new medical students and established doctors could be taught to kill as efficiently as they were to resuscitate. It may have just been me, but I found his gleeful tone as chilling as the reprogramming he was relating.
Since the enactment of legislation in June 2016 to ‘create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing’ to allow eligible Canadian adults to request doctors’ help in ending their lives, MAiD has led the way in turning slippery slopes in the practice of euthanasia into a Niagara Falls of escalations. The primary legislation restricted MAiD to those over 18 years of age with ‘illness, disease or disability or [whose] state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable’ and whose ‘natural death has become reasonably foreseeable.’. Given that it could be argued natural death is reasonably foreseeable for all of us, these criteria seem very imprecise from the start.
Totally predictably, legal challenges were immediately launched the same year in British Colombia (Lamb) and in 2017 in Quebec (Truchon) arguing that the grounds for MAiD were too restrictive. The court in Truchon ruled that the ‘reasonable foreseeability of death’ criterion was not so reasonable after all. In fact, it violated sections 7 and 15 of the Canadian Charter of Human Rights, guaranteeing (ironically) protection against deprivations of life and liberty and security of the person’s rights to equal protection and benefit under the law, respectively. In light of this ruling, the federal Minister of Justice introduced amendments to the 2016 Act, passed in March 2021 including to ‘no longer limit eligibility for medical assistance in dying to persons whose natural death is reasonably foreseeable.’
Nevertheless, the 2021 amendments also specified that mental illness alone was not a sufficient reason for granting MAiD. This obviously could not hold for long once the terminal illness criteria had been removed since mental illness arguably inflicts much greater levels of intolerable suffering than physical illness. In Canada, the patient’s assessment of intolerability alone determines eligibility. MAiD solely for mental disorder ‘is set to become legal in March 2023’. The restriction excluding mental disorders in the 2021 Bill was only a ‘sunset clause’ and is due to expire in March 2023. The Centre for Addiction and Mental Health, Canada’s largest mental health teaching hospital, already has a webpage announcing this, with a Q and A for the concerned. The questions include, ‘What happens if someone wants MAiD because they can’t get the mental health care they need?’ and ‘What happens if someone with a mental illness wants MAiD because they don’t have enough money or a decent place to live and experience intolerable suffering as a result?’ The fact that such questions have to be put online on a treatment facility site surely does not bode well for the care of those struggling with mental disorders in Canada.
Once the slippery slope has dropped as low as granting assisted dying to those with mental disorders, it is inevitable that those in mental distress, because they are poor or vulnerable, will follow in requesting to die. Reports have emerged recently of a man requesting MAiD because he is homeless. He stated, ‘I don’t want to die but I don’t want to be homeless more than I don’t want to die.’
Though most liberal democracies pride themselves on opposing the death penalty, in Canada, even those incarcerated in prison have been given MAiD. Canada’s prison ombudsman criticised the three deaths of prisoners in his 2019-2020 report and recommended a moratorium on providing MAiD in federal penitentiaries.
Campaigning to reduce the age of elegibility for MAiD from 18 to ‘at least 12 years of age and capable of making decisions with respect to their health’ has also been intense in Canada and professional journals are also advocating for it. Belgium has already introduced euthanasia for minors; it can only be a matter of time before Canada permits this also. An expert witness to the Canadian parliamentary committee taking evidence on this was reported by a UK newspaper recently as saying that ‘Sick children between the ages of 14 and 17 […] should be allowed to choose to commit suicide with medical assistance. Parents of babies who are born with severe disabilities should be allowed to kill them.’
Finally, a well-known Canadian fashion retailer is waving the flag for MAiD in a recent advertising campaign. Assisted death is portrayed as ‘a soft and comforting choice’. Yet as the trends outlined above demonstrate, this ‘choice’ can quickly become heartless and cruel. And, once legalised, impossible to control.