Introduction

Medical assistance in dying (MAiD) has been one of the most controversial medical issues in Canada, second only to abortion. In this post I take what has become a minority position in the mainstream media: that Canada’s existing MAiD law is a well-balanced compromise that is both prudent and humane.  Critics repeatedly demonize it with widely publicized scare tactics. This post answers four such critics: Conrad Black, Alexander Raikin, Trudo Lemmens and John Keown.

The Supreme Court of Canada, in the Carter case, unanimously struck down as unconstitutional Canada’s Criminal Code section that prohibited MAiD.  

The first paragraph of the Carter decision presents the Court’s view in 2015:

[1]                              It is a crime in Canada to assist another person in ending her own life.  As a result, people who are grievously and irremediably ill cannot seek a physician’s assistance in dying and may be condemned to a life of severe and intolerable suffering.  A person facing this prospect has two options:  she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes.  The choice is cruel.

Parliament has since amended the law to permit MAiD, subject to strict safeguards. Also, the professional regulators of physicians and nurse practitioners have developed strict protocols for accepting MAiD requests.

Who Uses MAiD?

All MAiD cases involve patients with severe and incurable illnesses.  The majority, 63%, suffer from cancer, the rest from serious illnesses like cardiovascular, respiratory, and neurological conditions. Behind the statistics, in the movie In My Own Time, some of the people who have chosen MAiD share their stories.  They show how their MAiD experience – often a compassionate gathering with family and friends – is emotionally so different from the usual suicide, an act of desperation by someone suffering and dying, or attempting, unsuccessfully, to die, all alone.    

Objections to MAiD may be Religious

Religious views may influence some critics of MAiD.  I respect everyone’s religious faith.  However, as Canada is a secular democracy, religious objections (e.g., to same sex marriage, abortion or assisted death) do not determine our laws.  Nevertheless, there is now a flood of both religious and non-religious anti-MAiD articles. The critics focus on attacking the method of death, while largely ignoring the extreme suffering that led to the patient’s decision to apply for MAiD. 

Critics use two main anti-MAiD arguments:

Numbers:  That there are already too many MAiD deaths in Canada and the number is growing rapidly; and

Slippery Slope:  Canada is on a “slippery slope” to non-consensual killing by doctors, Nazi-style “euthanasia” of the disabled, and “harvesting” of organs.

Both arguments are scare tactics.  And the critics imply that the only solution to their prediction of a terrifying future is to repeal the law permitting MAiD.

Conrad Black

Conrad Black has written

“As a Christian, I believe that life is a sacred gift and we have some obligation to retain it as long as we can and facilitate it when we can.” 

As the Pope has condemned assisted dying, euthanasia and abortion, not surprisingly, Black also condemns MAiD.  On Black’s view, Canadian constitutional law should require that you must continue to live and suffer until God decides to end it. 

Black has also written an article headlined:

“Canada’s immoral solution to spiralling health-care costs — kill the patients”. 

The subhead reads:

“The ennobling and promotion of a vast increase in the numbers of suicides in the guise of health-care reform is a secular and ecclesiastical heresy.” 

Black says that the Canadian view is

“…to evangelize the elderly and infirm on the virtues of an early passage to the hereafter, in order to free up space and personnel for patients with a greater useful life expectancy.”

Black’s colourful writing, which I usually enjoy, may sell National Post subscriptions, but on this issue he is factually incorrect.  No one is “promoting” suicide. 

No one is killing patients to save healthcare costs, and any savings would be insignificant. The major healthcare expense at the end of life is for acute care.  Most of this can be saved today by any of the three end-of-life options: palliative sedation, patients refusing further treatment, or MAiD.  If Canada could legally ban MAiD the same ill patients would still be dying of the same cancers and other serious illnesses.  They would still choose the other two options, which would still save some money as well as reduce suffering.  The only issue, therefore, is whether there would be any significant incremental saving of the “spiralling health-care costs” in allowing MAiD, in addition to the other options.  The short answer is “no”.

The Parliamentary Budget Officer estimated in 2021 that the savings though MAiD permitting a slightly earlier death would be approximately $149 million, out of the total federal and provincial health care budgets of $308 billion. That is a trivial 0.05%, or five one-hundredths of 1% of $308 billion. 

That saving, or even ten times that amount, hardly provides a powerful financial incentive for the Canadian government to kill patients to save health care costs.  In fact, our government has consistently opposed legalizing MAiD.  But for the Carter decision there would be no MAiD in Canada.

Alexander Raikin, in Cardus and The Hub

In his August 7, 2024 article From Exceptional to Routine, the Rise of Euthanasia in Canada in Cardus (the publication of an organization advocating for “natural death”) Alexander Raikin complains that MAiD in Canada is the world’s fastest-growing assisted dying program.  But that is not surprising because it’s one of the newest, with growth of older programs having plateaued decades ago. And Raikin never says what, in his opinion, would be the right rate of growth, and why that would be right.

He also describes it as the fifth leading cause of death in Canada.  But MAiD is not a cause of death, it is a method of dying, just like palliative care or refusal of treatment.  The main cause of death in both MAiD and palliative care is cancer.

The Anti-Maid Numbers Argument in Summary

Critics cite the rapid increase in Canadian MAiD cases since 2016 as proof that our legislation has created a monster, with some 4% of all deaths in 2022 (the latest available numbers) with MAiD.  What percent is right in Canada?  The critics never offer one, they merely imply that any number is too many. 

If 4% of all deaths were with MAiD then 96% occurred without MAiD.  Why is that so terrible?   

Professor Trudo Lemmens

In a February 9, 2024 Globe & Mail article law professor Trudo Lemmens, a frequent MAiD critic, wrote:

“….. Offering death as a solution to the suffering of Canadians with disabilities significantly deprives them of protections against suicide that others receive.

The results of our MAiD regime’s promotion of access to death as a benefit and the trivialization of death as a harm to be protected against are increasingly clear.

Increasingly clear to whom besides himself?  He offers no evidence that “access to death” for Canadians with disabilities is systematically being promoted or trivialized.  It is perhaps true that some patients with disabilities may be more inclined to use MAiD than others without disabilities, especially if waiting lists for medical treatment are too long or they have low incomes. But what is Lemmens’ proposed solution?  Ban MAiD for everyone until waiting lists are much shorter and poverty has been eliminated?  Prohibit anyone with disabilities or low incomes from having MAiD?  He offers fear, but no useful solutions. 

In his advocacy for the disabled Lemmens ignores the irony that the key plaintiff in the Carter case was Gloria Taylor, who suffered from ALS, a disabling, fatal disease. Half the people with ALS die within 14 to 18 months of diagnosis.  ALS gradually takes away the ability to move, swallow, speak and breathe.  Gloria Taylor and others suffering like her do not need Lemmens to provide them with “protections against suicide” when they will soon be dying slowly of suffocation. Lemmens’ lack of concern for their suffering is striking.

Lynne Cohen

As a fan of Lynne Cohen’s writing I was startled by the headline of her January 10, 2021 article in the C2C Journal:

“Canada’s Newest and Deadliest Human Right: Assisted Suicide for All”

In discussing “how slippery is your slope?” she says that the law is about to be widened “to include nearly everyone who might wish to end their life for almost any reason”.  That was not the proposed law in 2021 and it isn’t the law now.

She then says that

… “While euthanasia or assisted suicide policies may begin with earnest claims of the tightest procedures and restrictions they rarely stay that way.” 

Her only evidence for “rarely stay that way” is in her next sentence: in October 1933 the Nazis had  proposed a German euthanasia program not long after they took control of Germany. 

The Nazis did not really provide “euthanasia” (the word comes from two Greek words meaning good death). They simply murdered people they didn’t like, in death camps.  The universal horror today at what the Nazis did shows us that almost everyone can distinguish between a grievously ill patient’s requested euthanasia and the genocidal murder of millions.

Cohen later says that “None of this is to suggest that a country that adopts euthanasia is likely to follow the Nazis into mass murder.”  But that’s exactly what she is suggesting.  Otherwise, why would she even raise the issue of Canadian good deaths today being merely the top of the slippery slope to Germany in 1933?

Professor John Keown

Professor Keown, the author of a book against legalization of euthanasia, holds a university teaching Chair in Christian Ethics in Washington, DC.  His March 25, 2024 article published by the McDonald-Laurier Institute is titled:

“Skiing down euthanasia’s slippery slope”

Keown testified before the trial judge in the Carter case, and now complains that the judge rejected his evidence as being speculative.  He argues that he was right and the judge was wrong because she didn’t “join the dots” to the frightening future that he presented. His slippery slope argument, like Lynne Cohen’s, is a pessimistic prophesy about the future. But the judge’s duty was to adjudicate the current facts of the severely suffering plaintiffs in her court, not to join the dots produced by Keown’s crystal ball.

Continuing down his imaginary ski slope, Keown asks:

“It is surely only a matter of time until calls are made for the “benefit” of a hastened death to be conferred on people who are incapable of requesting it.…  Why deny them their rights under the Canadian Charter of Rights and Freedoms?  The enormous cost savings will lurk supportively behind the argument, like a gangster’s heavy.”

If someone is incapable of requesting MAiD the only way a physician could end their life would be by murdering an involuntary patient.  No one is going to advocate for that.  And, as I explained above, there are no “enormous cost savings”.

The Anti-MAiD Slippery Slope Arguments in Summary

Although slippery slope predictions may sometimes turn out to be right, MAiD today is being demonized with fear-mongering slippery slope arguments like those used decades ago against the then controversial decriminalization of homosexuality and same-sex marriage.

US Senator Richard Santorum warned about the US Supreme Court decriminalizing homosexuality:

“If the Supreme Court says that you [i.e., homosexual men] have the right to consensual sex within your home, then you have the right to bigamy, you have the right to polygamy, you have the right to incest, you have the right to adultery, you have the right to anything.”

Likewise, when same-sex marriage was legalized critics warned that this slippery slope would lead to laws permitting adults to marry children, or even animals. 

Conrad Black’s “kill the patient’s” article, above, also has a slippery slope argument: that Canada is already the global leader in “harvesting” organs from euthanized patients. This is obviously intended as a comparison with China’s alleged harvesting of organs, without consent, from its Uyghur minority.  Black later admits that there is no indication that permitting MAiD patients to consent to donate their organs has been abused.  So why predict “harvesting” if not to frighten? 

Finally

Let me be clear:  I’m not saying that it’s impossible to make a fair argument against the MAiD law and practice in Canada. Some have argued that the current law is wrong because it is too restrictive. However, I have yet to see a fair argument from the above critics, whose arguments amount to ‘any increase in MAiD usage is too many’ and ‘we’re on a slippery slope to involuntary killing’.

Enough fear-mongering!