Twelve months ago, before the COVID-19 pandemic overwhelmed our lives and pushed almost every other issue to the margins of public attention, we sounded a warning that Canada seemed to be sliding toward what amounts to a system of death on demand.
We worried that the right to medical assistance in dying, or MAID, was at risk of being stretched far beyond its original conception: to ease the pain of suffering people in the final stage of life, of allowing them a so-called “death with dignity.”
Today, that possibility is no longer a risk but a reality. The latest version of the federal government’s overhaul of the MAID system, encompassed in legislation called Bill C-7, is on its way to becoming law after a long series of delays and back-and-forths between the House of Commons and the Senate.
As it stands now, Bill C-7 would greatly expand the right to MAID in ways that many doctors, ethicists and even experts from the United Nations find deeply problematic. By eliminating the requirement that a patient’s death be “reasonably foreseeable,” they say the bill will undermine the rights of disabled people and make it more likely they will accept assisted suicide rather than be provided with proper treatment and supports.
The bill even opens the door to extending the right to assisted suicide to people whose only underlying medical condition, their sole reason for seeking death, is suffering due to a mental illness. The potential for abuse is both obvious and frightening.
All this is a far cry from what most people accepted as a valid, indeed compassionate, reason for legalizing assisted suicide back in 2016. And none of it has been as fully aired as it would be — and should be — if the pandemic wasn’t dominating almost every public moment.
Nor is any of this necessary. The federal government is bringing in these changes as a response to a Quebec Superior Court ruling in 2019, in which the judge decided that the law’s provision that death must be “reasonably foreseeable” is unconstitutional.
The government could have, indeed should have, appealed that flawed decision. Instead, it promised to bring the law into line with this one lower-court ruling, launched lengthy consultations on the whole issue of MAID, and eventually came up with a series of proposed changes laid out in Bill C-7. The Commons adopted them, then the Senate weighed in with amendments, and this week the government said it would accept some of those proposals.
One is that the right to MAID would be extended to people who are suffering solely from an underlying mental illness, though that wouldn’t take effect for two years. This is a complete about-face for the government, since its first version of C-7 explicitly excluded mental illness as grounds for demanding the right to an assisted death.
You don’t have to ponder this too long to see the potential for tragic outcomes. No doubt some people suffer in a “grievous” (the law’s language) way from mental illness, but surely those very conditions put an enormous question mark over their capacity to make final, irreversible decisions.
Advocates for the change say it’s discriminatory not to include mental illness, and argue that the law must respect the autonomy of the individual, the right of everyone to decide their own fate regardless of the type of medical condition they are suffering from.
That sounds lofty, but as many psychiatrists and advocates point out, how much true autonomy does a person have if society doesn’t offer them proper support to live their lives as fully as possible, if they are marginalized, unable to earn a living or access treatment, and feel they are a burden to others? Won’t they feel pressure to take advantage of an expanded MAID system just to escape all that? Is that really what we want — to set up a system where more and more people feel disposable, and in fact become disposable?
All that may apply to people with chronic conditions or disabilities as well, which is why hundreds of organizations advocating for them have come out against C-7. Added to that is a team of UN experts who concluded that the bill violates the UN Convention on the Rights of Persons with Disabilities, which Canada has ratified. “Disability should never be a ground or justification to end someone’s life directly or indirectly,” they wrote. “Such legislative provisions would institutionalize and legally authorize ableism.”
Medically assisted dying is no longer rare. Between 2016 and 2019, according to the most recent official figures, 13,946 Canadians exited life that way. If the trends continued last year and into the first weeks of 2021, the total would be over 20,000 by now, close to the number of people who have died of COVID-19 so far.
It’s important that we get this right. Better to put up with more delay than to rush through a flawed bill that hasn’t had the full public debate it deserves. The government should think again.