Female doctor comforting older female patient
During the past few days, organizations representing people with disabilities in Canada have spoken out vociferously against the country’s ultra-liberal laws on assisted dying – identifying them as an existential threat to those they represent.
Canada’s medical assistance in dying (MAID) laws, established in 2016, received global media scrutiny last year in the wake of several high-profile cases.
Opponents continue to express distaste and discomfort with physicians routinely and all too casually setting out options around assisted dying alongside other medical interventions, not just for the terminally Ill, but for patients with chronic conditions with the potential to yet enjoy many more fulfilling years ahead with the appropriate support.
Though last month, the Liberal government rowed back on plans to immediately extend medically assisted dying provisions to individuals living with a range of mental health conditions, it is widely accepted that this is simply a hiatus during which the appropriate protocols will be finalized before the policy is rolled out.
On January 5, an open letter jointly penned by multiple disability groups opposing MAiD in Canada was sent to Prime Minister Justin Trudeau, Justice Minister David Lametti and Leader of the Opposition Pierre Poilievre amongst other important stakeholders.
The letter was unequivocal in its opening statement:
“We, the undersigned disability and human rights organizations are writing to express our concern and opposition to the legalization of Medical Assistance in Dying (MAiD) for mental illness and to the already-legal practise of euthanizing people with disabilities who are not terminally ill.”
A perversion of accessibility
The debate around euthanasia is quite different from any other debate around accessibility – notwithstanding the profound moral complexities in which it will forever be entangled.
In most discourse on disability rights – access to goods, services and civic participation is universally heralded as a positive thing.
In these contexts, there is no such thing as “too much accessibility.” Even in situations where accessibility is inadequate, the vast majority acknowledge it to be a noble aspiration, too often compromised by financial resources and competing priorities.
In assisted dying, both ferocious opponents and advocates project themselves as the self-appointed champions of the disability community.
Proponents claim they are sparing seriously ill people from unbearable pain and suffering by promoting self-determination, stripping back centuries of outmoded and irrelevant religious precepts.
Opponents, on the other hand, say that the casual proliferation and over- liberalization of medical assistance in dying devalues the divergent but meaningful lived experience of disabled people and provides the state with an easy way of foregoing its responsibilities to its most vulnerable citizens.
Cutting across this is a discourse around the decades-long, but yet, incomplete evolution from the medical to the social model of disability.
The former expounds that disability is a matter purely centered around deficits of the affected person’s physiology.
Where these cannot be satisfactorily addressed therapeutically – it might be reasonable to consider an alternative medical means of ending pain and suffering.
The social model, on the other hand, is far more layered and nuanced and views the negative experiences of many disabled people as the product of entirely optional social constructs in addition to physical impairments.
After all, poor access to public transportation and employment, discriminatory public attitudes and media projections and a paucity of welfare benefits that force many disabled people, even those living in wealthy countries, to live on the breadline, are not inevitable results of any one illness or disease.
These are active choices, usually made by non-disabled people at all levels of society, to behave in a certain way towards people with disabilities, or simply look the other way and not consider them at all.
Consequently, the recent missive penned by Canada’s disability rights collective stated:
“We know, as do you, that the existing law is not working and has not worked, and that people with disabilities have been dying by MAiD due to their life circumstances and oppression.”
Later adding, “As a country, we cannot provide state-assisted death to people who are not terminally ill, without ensuring a legislated right to a decent life for all. The current MAiD law has chipped away at the constitutional protections of Canadians. The very existence of the current law is a threat to the lives of people with disabilities and their families.”
Running out of choices
Dr. Stefanie Green is a physician who has assisted over 300 patients to die and is the author of This Is Assisted Dying: A Doctor's Story of Empowering Patients at the End of Life. She also heads up the Canadian Association of MAID Assessors and Providers (CAMAP).
Dr. Green, in a recent interview given to The New Atlantis stated, “You cannot access MAID in this country because you can’t get housing. That is clickbait. These stories have not been reported fully,”
Yet, Alexander Raikin, the author of The New Atlantis article also cited a stash of verified CAMAP training materials in which specific guidance is given on how to weigh up and assess patient-reported poverty and economic deprivation.
In 2023, and concerning Canada’s unique pedal-to-the-metal approach to assisted dying in particular – there remain many more questions than entirely satisfactory answers.
Even though it continues to be unlawful in most parts of the world, many western societies at least acknowledge that judiciously administered and highly controlled medically assisted dying is certainly no outrage in a fair-minded egalitarian society.
However, it is surely reasonable to suggest that its laissez-faire overuse underpinned by political ideology and a lack of sufficient safeguards is a far worse outcome than an outright ban.
It is a timely reminder to disability rights campaigners that their avowed mission of assisting people with disabilities to live dignified lives as integrated members of society did not peak out in the 1990s.
As societies evolve and modernize – new threats emerge and the hazards of staying silent can be now, more than ever, a matter of life and death.
