I am a retired physician. I think the author is on the right track with his/her concerns. While people certainly have the right to take their own lives, I have trouble getting from there to creating a duty on doctors to do it for them....or to “make a meaningful referral” as we are obliged to do.
I had the honour to work in a peripheral sense on the original 2015 Taylor trial, argued on behalf of the BCCL by the late, great Joe Arvay. That included all of the discovery and the entire trial. Witnesses came from Belgium, the Netherlands, Washington, Oregon -- all places that have had medically assisted suicide for decades. A seminal moment for me, at least, was when Mr. Arvay got the then head of the Canadian Society of Palliative Care Physicians to admit that it is unknown whether patients placed in a palliative coma can feel pain. I suppose physicians can make assumptions based on facts, but the admission was made. Grudgingly. This is a great article. MAiD in Canada has become, like all things, an ideological football. Media articles tend to take what-if statements and make them into reality for, one must assume, inflammatory purposes.
I acknowledge the "right to die" has not been legally recognized until recently, But I have forever thought of it as equivalent to the other rights enshrined in the Charter. The medical profession obsesses about its focus....Hippocratic Oath etc....and generally takes the position that a patient can exercise the right to die only by committing suicide. Far be it from a MD to accommodate a patients fully considered choice. Yes the medical profession "see MAID as antithetical to the traditional practice of medicine" and of course it is. Until the SCC decision, the law was entirely on the side of the MDs. No death with dignity. You must live out your time, regardless of agony, regardless of losing your mind, regardless of the huge resources spent to keep a body without much live alive as long as possible.
While this is the general view imposed by Judeo-Christian beliefs and enforced by the medical profession over the centuries, I fundamentally dissent. The right to die should supersede all this
We agree on lots of things I'm sure. The influence of faith-based ethics can be worrying. It's true that medicine in general (and palliative care in particular) is disproportionately populated by religious people and sometimes needs to be checked. That's all fair. Part of the reason I wrote about the palliative profession in particular is that this claim you've made about doctors being callous about peoples' suffering holds no water. They are often the most empathetic doctors out there. There is more to the resistance than the failure to grant an intrinsic right. I'm also wary of the term "dying with dignity" because it's loaded and imprecise. It's like being pro-choice/life. What do you mean we don't allow people to die with dignity? As I wrote, palliative care teams do a lot with dignity as the sole focus, including palliative sedation (rendering them unconscious while nature takes its toll) if they do get things like terminal delirium, refractory anxiety, pain etc. With some caveats, I view the issue as such: if you think MAID should be for the terminally ill to avoid suffering, then palliative care usually handles this with grace and compassion and the difference we're talking about is months at most (usually weeks). I don't find the arguments about a need for MAiD in these circumstances all that convincing given what good palliative care looks like. So on one hand you have some delta in life span which may or may not change the dignity of a person's last moments and death. On the other is the entire ethos of medicine, and by extension the public trust that has been earned over centuries. This isnt an optimal trade off in my view.
The rubber meets the road once you leave the terminally ill and imminently dying behind and start talking about those not terminal, but with "irremediable suffering" etc. This is where right to die activists were always going, where the court's wording was primed to lead us, and where we have subsequently gone. Is this also a right? Is the euthanasia of mentally ill young adults dignified? I'm not so sure. We talk a lot about mistreatment of Indigenous children these days. There are communities in Canada with mass suicides and attempted suicides and despair the likes of which most people can barely imagine. When they come to us to end their lives, is the dignified, ethical thing to do to oblige? The slope gets even slipperier than that. Countries like the netherlands are passing/pushing bills that would see people qualify for on-demand euthanasia if they feel their lives are "complete." This is where this goes. Once you play this game it's hard to stop. It's not clear to me what the limiting principle is.
I don't think it's crazy for euthanasia to be permitted for people with disorders like ALS, etc, but I have trouble seeing how you stop the slide into ever-more permissibility. Since the cat is out of the bag in Canada, we're going to have to try, but I'm worried - for medicine and for patients.
I'm sure you know all this. Does none of it give you pause?
The author gives the perspective of the "expert". What is entirely missing is the perspective of the person who matters-the patient. Every person should have the right to make a MAID decision provided he is mentally competent to do so. The author is in the camp of elites who think they know best and can impose their views on everyone else.
Thanks for the comment. As much as I'm flattered to be considered elite, I didn't intend for this to be my perspective as an "expert" (I'm not a palliative care doc) so much as my observation that the experts in the old way of dying tend not to support the new way of dying. This is interesting, is it not? I'm going to talk about some of the reasons going forward, but one of them is that they see MAiD as antithetical to the traditional practice of medicine. As one of the commenters above pointed out, it isn't illegal to take one's own life. One could also make the argument that consenting adults should legally be able to seek help in facilitating suicide. But is it a good idea for physicians to be doing this? Should they really be obligated to do so? We have conscientious objection for now (though many want to take that away) but even still, referring someone on to another practitioner guaranteed to do the thing you object to make objection symbolic alone. It may soon be the case that it constitutes malpractice to believe that medicine is a life-focused profession. Does adopting this practice help or hurt the profession? In terms of patients, I agree autonomy is important. I'm young (ish) and not at all of the paternalistic era of medicine. But the patient's perspective matters only insofar as it is congruent with evidence-based and ethical practice. The right to die was not a right until very recently and is euthanasia is still illegal throughout most of the world. Which is to say, it's not a no-brainer. In reality it is those of us concerned about the effects of adopting MAiD into the medical profession who are having views imposed upon us. Thoughts?
Very informative and interesting, thank you.
Leslie writing. E-mail mixup at Substack.
I am a retired physician. I think the author is on the right track with his/her concerns. While people certainly have the right to take their own lives, I have trouble getting from there to creating a duty on doctors to do it for them....or to “make a meaningful referral” as we are obliged to do.
Trudeau and the Liberals have taken this way too far.
He has messed up Canada terribly.
I had the honour to work in a peripheral sense on the original 2015 Taylor trial, argued on behalf of the BCCL by the late, great Joe Arvay. That included all of the discovery and the entire trial. Witnesses came from Belgium, the Netherlands, Washington, Oregon -- all places that have had medically assisted suicide for decades. A seminal moment for me, at least, was when Mr. Arvay got the then head of the Canadian Society of Palliative Care Physicians to admit that it is unknown whether patients placed in a palliative coma can feel pain. I suppose physicians can make assumptions based on facts, but the admission was made. Grudgingly. This is a great article. MAiD in Canada has become, like all things, an ideological football. Media articles tend to take what-if statements and make them into reality for, one must assume, inflammatory purposes.
Thanks for this excellent post.
This "Legally/State" Offing people is spreading faster than the scamdemic did.
One has to assume just another string to the bow. Of Population Reduction!
I acknowledge the "right to die" has not been legally recognized until recently, But I have forever thought of it as equivalent to the other rights enshrined in the Charter. The medical profession obsesses about its focus....Hippocratic Oath etc....and generally takes the position that a patient can exercise the right to die only by committing suicide. Far be it from a MD to accommodate a patients fully considered choice. Yes the medical profession "see MAID as antithetical to the traditional practice of medicine" and of course it is. Until the SCC decision, the law was entirely on the side of the MDs. No death with dignity. You must live out your time, regardless of agony, regardless of losing your mind, regardless of the huge resources spent to keep a body without much live alive as long as possible.
While this is the general view imposed by Judeo-Christian beliefs and enforced by the medical profession over the centuries, I fundamentally dissent. The right to die should supersede all this
We agree on lots of things I'm sure. The influence of faith-based ethics can be worrying. It's true that medicine in general (and palliative care in particular) is disproportionately populated by religious people and sometimes needs to be checked. That's all fair. Part of the reason I wrote about the palliative profession in particular is that this claim you've made about doctors being callous about peoples' suffering holds no water. They are often the most empathetic doctors out there. There is more to the resistance than the failure to grant an intrinsic right. I'm also wary of the term "dying with dignity" because it's loaded and imprecise. It's like being pro-choice/life. What do you mean we don't allow people to die with dignity? As I wrote, palliative care teams do a lot with dignity as the sole focus, including palliative sedation (rendering them unconscious while nature takes its toll) if they do get things like terminal delirium, refractory anxiety, pain etc. With some caveats, I view the issue as such: if you think MAID should be for the terminally ill to avoid suffering, then palliative care usually handles this with grace and compassion and the difference we're talking about is months at most (usually weeks). I don't find the arguments about a need for MAiD in these circumstances all that convincing given what good palliative care looks like. So on one hand you have some delta in life span which may or may not change the dignity of a person's last moments and death. On the other is the entire ethos of medicine, and by extension the public trust that has been earned over centuries. This isnt an optimal trade off in my view.
The rubber meets the road once you leave the terminally ill and imminently dying behind and start talking about those not terminal, but with "irremediable suffering" etc. This is where right to die activists were always going, where the court's wording was primed to lead us, and where we have subsequently gone. Is this also a right? Is the euthanasia of mentally ill young adults dignified? I'm not so sure. We talk a lot about mistreatment of Indigenous children these days. There are communities in Canada with mass suicides and attempted suicides and despair the likes of which most people can barely imagine. When they come to us to end their lives, is the dignified, ethical thing to do to oblige? The slope gets even slipperier than that. Countries like the netherlands are passing/pushing bills that would see people qualify for on-demand euthanasia if they feel their lives are "complete." This is where this goes. Once you play this game it's hard to stop. It's not clear to me what the limiting principle is.
I don't think it's crazy for euthanasia to be permitted for people with disorders like ALS, etc, but I have trouble seeing how you stop the slide into ever-more permissibility. Since the cat is out of the bag in Canada, we're going to have to try, but I'm worried - for medicine and for patients.
I'm sure you know all this. Does none of it give you pause?
The author gives the perspective of the "expert". What is entirely missing is the perspective of the person who matters-the patient. Every person should have the right to make a MAID decision provided he is mentally competent to do so. The author is in the camp of elites who think they know best and can impose their views on everyone else.
Thanks for the comment. As much as I'm flattered to be considered elite, I didn't intend for this to be my perspective as an "expert" (I'm not a palliative care doc) so much as my observation that the experts in the old way of dying tend not to support the new way of dying. This is interesting, is it not? I'm going to talk about some of the reasons going forward, but one of them is that they see MAiD as antithetical to the traditional practice of medicine. As one of the commenters above pointed out, it isn't illegal to take one's own life. One could also make the argument that consenting adults should legally be able to seek help in facilitating suicide. But is it a good idea for physicians to be doing this? Should they really be obligated to do so? We have conscientious objection for now (though many want to take that away) but even still, referring someone on to another practitioner guaranteed to do the thing you object to make objection symbolic alone. It may soon be the case that it constitutes malpractice to believe that medicine is a life-focused profession. Does adopting this practice help or hurt the profession? In terms of patients, I agree autonomy is important. I'm young (ish) and not at all of the paternalistic era of medicine. But the patient's perspective matters only insofar as it is congruent with evidence-based and ethical practice. The right to die was not a right until very recently and is euthanasia is still illegal throughout most of the world. Which is to say, it's not a no-brainer. In reality it is those of us concerned about the effects of adopting MAiD into the medical profession who are having views imposed upon us. Thoughts?