Canada’s government should help Canadians live, not help kill them

 

Canada’s government should help Canadians live, not help kill them

To offer a “choice” between suffering and death which neglects the option of actual assistance in living is evil

 

By Hendrik van der Breggen

December 4, 2022

 

“Medically assisted deaths could save millions in health care spending”—so stated the headline of Canadian Broadcasting Corporation News on January 23, 2017, six months after Canada legalized Medical Assistance in Dying/ MAID (a euphemism for physicians killing patients). 

If that’s a justification of MAID (and for some it is), it’s sheer wickedness. 

First, some perspective is in order. Here is the MAID casualty list for Canada thus far: 

• 2016 – 1,018
• 2017 – 2,838
• 2018 – 4,480
• 2019 – 5,661
• 2020 – 7,603
• 2021 – 10,064
• 2022 – Number is yet to be calculated, but the trend is dark.

The above numbers are from the Canadian government document “Third annual report on Medical Assistance in Dying in Canada 2021.”

I should note that I wonder about the accuracy of this report. I suspect the numbers may be higher. Why? Because, according to the College of Physicians and Surgeons of Ontario: “When completing the death certificate physicians: a. must list the illness, disease, or disability leading to the request for MAID as the cause of death; and b. must not make any reference to MAID or the drugs administered on the death certificate.”

This erodes trust in at least some (a lot?) of Canada’s doctors.

But trust in Canada’s federal government (lead by Prime Minister Justin Trudeau) is also eroding.

Canada’s federal government supports MAID and, in recent years, has been making MAID accessible to more and more people by loosening restrictions. At first MAID was only supposed to end the suffering of the terminally ill. But now reasonably foreseeable death is no longer a requirement.

In fact, in March 2022 restrictions were broadened so people with disabilities or people struggling with pain could access MAID, even if not close to death. And in March 2023 [postponed to March 2024] the procedure will be available to the mentally ill. And now there is discussion about offering MAID to “mature minors.”

This brings me to my main point, which is hugely significant: Canada’s federal government supports the “choice” for medically-assisted suicide before ensuring Canadians actually have real options.

It turns out that the vast majority of Canadians don’t have access to good palliative care (palliative care is care that optimizes quality of life and mitigates suffering). Also, Canadian veterans (at least six so far) have been offered MAID to deal with their suffering instead of actually helping them (one veteran was offered MAID as an alternative to a wheel chair ramp/elevator). And there has been a case in which a disabled man successfully began the application process for MAID because he had trouble paying his bills and was afraid of becoming homeless.

This last case caught the attention of local news and, happily, a kind stranger set up a GoFundMe page for the disabled man and he subsequently changed his mind about accessing MAID (at least for now).

The GoFundMe case is heart-warming—and revealing. It sheds much-needed light onto Canada’s dark and dismal dismissal of life.

Surely it is an evil to offer a “choice” between suffering and death which neglects the option of actual assistance in living.

My suggested solution: Instead of justifying or encouraging suicide in terms of saving health care dollars, Canadians should demand their government cut frivolous spending—and redirect it to people who actually need it to live.

Think of the actual help that could be given to people if Canada’s government stopped squandering taxpayers’ dollars on things like the following: 

• our prime minister’s C$1.6 million family trip to India (complete with personal celebrity chef)
• our federal government’s $8.1 million temporary hockey rink in front of Ottawa’s parliament buildings (on which only relatively few skated)
• our prime minister’s $610 million waste of calling a not-needed federal election during a pandemic
• government officials flying across the ocean to climate conferences in fuel-guzzling jets
• a government official staying in a $6,000 per night hotel for five nights
• funding a boat-sized rubber duck
• etc., etc.

And maybe Canada should say yes to some pipelines that would generate huge revenues and increase tax-dollar funding (billions?) for, say, hospitals, ICUs, palliative care, hospices, mental health services, and life-enhancing help for people with disabilities.

 

Hendrik van der Breggen, PhD, is a retired philosophy professor who lives in Steinbach, Manitoba, Canada.

 

FOR ADDITIONAL THOUGHT 

• Does Canada’s Bill C-7 ignore a dark lesson from history? C-7 promotes ableism, the view that able-bodied people are superior—more worthy of life.
• Putting the pros and cons of euthanasia under the microscope: A Canadian philosopher examines the euphemism of “medical assistance in dying”

 

Physician-assisted killing

APOLOGIA

By Hendrik van der Breggen

The Carillon, March 3, 2016

Physician-assisted killing

If you think physician-assisted killing is wrong, it's time to oppose it.

Yes, the Supreme Court of Canada calls it "physician-assisted dying." But this is a euphemism, a nice way of describing what is in fact not nice (like "going to the washroom" is a nice way of saying "going to take a piss"). Physician-assisted dying suggests comfort care at the end of life, but in actuality refers to doctors directly killing patients.

Yes, it's good for objecting doctors to insist on conscience provisions, i.e., insist that if a doctor thinks physician-assisted killing is wrong, then he/she shouldn't have to do it or make referrals to others who will.

But this is not enough. Think about it. If you think killing patients is truly wrong, as, say, slavery is truly wrong, then it's not enough not to be required to own slaves or not to have to refer slave-buyers to slave sellers. We must object that slavery itself is wrong, period, and wrong for all.

Perhaps objecting doctors may only be required to provide accurate information about physician-assisted killing. If so, keep in mind that although it may not be wrong to be required to provide accurate information about slavery, it would be wrong if this information included directions about where to purchase a slave.

Manitoba's College of Physicians and Surgeons might object (as they do) that "Physicians must not impose their moral or religious beliefs about physician assisted dying on patients." But isn't the college (and Canada's Supreme Court) imposing the moral belief that life is no longer the default position and so the patient must choose to live or be killed (patients already have the choice to say no to extraordinary and burdensome treatments that merely prolong dying) and so doctors must ensure (by referral or providing accurate information/ directions) that somebody kills them?

Intellectual health warning: Somebody is having their philosophical cake and eating it too!

I am troubled. I believe we have not learned our philosophical lessons from history.

Consider the following passage from Dr. Leo Alexander (1905-1985), medical advisor to the U.S. Chief of Counsel at the Nuremberg Trials, trials in which Nazis were convicted of crimes against humanity (this passage is from Alexander's paper "Medical Science Under Dictatorship," The New England Journal of Medicine, 241:2, July 14, 1949):

"Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived."

Dr. Alexander continues: "This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in the category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the nonrehabilitatable sick."

I don't believe that there is a Nazi Party on Canada's horizon (thank goodness). But I do believe that some of the deep philosophical principles of what Pope John Paul II (1920-2005) called the Culture of Death are becoming prevalent in our society.

Surely we should instead encourage a culture of life wherein palliative care (which can manage physical pain 90-95% of the time) and social supports (for the sufferers and their care-givers) are better funded and more accessible across Canada.

"All that is necessary for evil to triumph is for good men to do nothing," is a wise saying attributed to Edmund Bourke and others.

For goodness' sake, then, we must resist the culture of death and insist that medical, social, and psychological problems require medical, social, and psychological solutions—not physician-assisted killing.

Hendrik van der Breggen, PhD, teaches philosophy at Providence University College. The views in this column do not always reflect the views of Providence.

Further reading: 

• Apologia: Physician-assisted suicide
• Wesley J. Smith, "Canada declares war on Christian doctors and nurses", First Things, March 4, 2016.
• Douglas Farrow, "Canadian Culture of Death: An open letter", First Things, March 3, 2016. (Be sure to read the PDF.)

Physician-assisted suicide

APOLOGIA

By Hendrik van der Breggen

The Carillon, February 19, 2015

Physician-assisted suicide

Canada's Supreme Court recently declared the Criminal Code prohibition against physician-assisted suicide (PAS) constitutionally invalid and has given Parliament one year to draft legislative safeguards.

Unfortunately, public discourse on PAS has been skewed: it tends to look at arguments in favour of PAS, not against. But we should look at pros and cons, not just pros.

A major pro for PAS has to do with personal autonomy, i.e., the individual's choice in response to suffering. Suffering can be terrible, to be sure. And freedom is important, truly.

However, the freedom to exercise one's choice is not absolute. I do not have the freedom to swing my fist without regard for the tips of other people's noses.

So, yes, individual freedom is important, but the individual does not live in a social vacuum. In public policy debates we should think about the individual's freedom AND the consequences for the larger society.

The acceptance of PAS has (at least) four cons or concerns—i.e., four possible negative consequences for the larger society—which should also be considered.

Concern 1. With the acceptance of PAS, our society will see suicide more and more as a legitimate way of solving an individual's problems. Got a problem that makes you suffer? Don't forget you can get help to kill yourself!

(This scenario is not far-fetched. At one of the universities I attended not too long ago, I worked as a teaching assistant in an ethics course for a fellow doctoral student who told the class [a] that he had advised his roommate that suicide was an option as a solution to the roommate's problems and [b] that subsequently the roommate committed suicide. My fellow doctoral student displayed no qualms about the advice.)

Concern 2. Life will no longer be seen as society's default position and so our most vulnerable—the elderly, terminally ill, disabled—must begin to justify their lives. Surely, this is a nasty burden to place on people when they're already down.

Concern 3. If the choice or autonomy of the sufferer constitutes sufficient legal grounds for the sufferer to end his/her life, then unwanted suicide intervention or counseling against suicide may become grounds for a lawsuit against the intervener or counselor. There may very well be a chilling effect against suicide intervention and counseling.

Concern 4. With the acceptance of PAS, a non-fallacious, logical-legal slippery slope looms large.

Reasons for one action sometimes also justify other actions that are unintended to be justified by those reasons. The alleged right to end one's life because one is suffering justifies not only the situation of the terminally ill, but also the elderly, the disabled, the parent suffering the loss of a child, the person suffering chronic back pain, the depressed, etc. (Think of the experience of Belgium and Netherlands here.)

Enter: so-called safeguards—and their failure. Significantly, if we have already accepted individual autonomy as a legal justification for PAS, how can we deny anyone PAS?

Courts will do what courts do: promote consistency. But consistency requires that PAS's fundamental justifying principle—i.e., that the sufferer has the right to choose PAS to end his/her suffering—will carry more legal weight than the situational differences. The situational differences will (with the help of a good lawyer) be seen to be incidental.

In other words, legal acceptance of PAS puts gobs of logical-legal grease onto the path that leads to killing as a solution to suffering. The result: eliminating sufferers becomes equated with eliminating suffering.

In view of the pros and cons, I think it would be wise for Canadians not to embrace physician-assisted suicide. Instead, we should do a better job of providing palliative and hospice care for those with terminal illnesses—and we should do a better job of providing life-enhancing dignity for all who suffer.

We should strive for a culture of life, not slip into a culture of death.

(Hendrik van der Breggen, PhD, is associate professor of philosophy at Providence University College. The views in this column do not always reflect the views of Providence.)

Additional Apologia columns on physician-assisted suicide:

• On putting down pets and people (August 18, 2011)
• Physician-assisted suicide? (August 13, 2011)
• Physician-assisted suicide is a slippery slope (December 1, 2011)
• Are we ignoring a philosophical lesson from history? (May 31, 2012)
• Doubting euthanasia (June 12, 2014)

Doubting Euthanasia

APOLOGIA

By Hendrik van der Breggen

The Carillon, June 12, 2014

Doubting Euthanasia

Is it wise to legalize euthanasia (a.k.a. physician-assisted suicide/ doctor-assisted death)? I doubt it, for five reasons.

1. The popular argument for euthanasia hinges on a false dichotomy: euthanasia or painful death. Significantly, there's a third option: palliative care.

Doris Barwich, M.D., President of Canadian Association of Palliative Care Physicians: "Pain is rarely the reason patients ask for hastened death—it more often comes out of a desire to control the circumstances surrounding death. Fortunately, we can assure our patients that with Palliative Care tools and resources, pain and other distressing symptoms can usually be controlled and support provided to ensure comfort and quality of life."

2. Instead of euthanasia for the (rare) difficult cases, there is palliative sedation.

Journal of the American Medical Association: "Palliative sedation is the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious (as in a deep sleep) while the disease takes its course, eventually leading to death. The sedative medication is gradually increased until the patient is comfortable and able to relax. Palliative sedation is not intended to cause death or shorten life."

If, foreseeably, palliative sedation hastens death, it needn't be judged unethical. According to ethicist Margaret Somerville, just as death isn't the intended effect of high risk surgery (needed to relieve pain), and so such surgery isn't immoral if death occurs, so too if death isn't the intended effect of high risk pain management, yet death occurs, then such pain management isn't immoral either.

There's an important moral difference between engaging in a procedure with intent to kill (euthanasia) rather than not (palliative sedation). Euthanasia takes the lower moral ground.

3. Allowing terminally ill patients to die from their illness via termination of life support by withdrawing/ withholding extraordinary, burdensome, or medically useless treatment is already a legal and ethical part of palliative care—and doesn't require euthanasia.

Ethicist Scott Rae: "Physicians need not always 'do everything' to stave off death, especially when it involves no more than simply delaying an inevitable death…. Choices about CPR, respirators, and intravenous procedures in the last weeks of life should not be viewed as choices for death."

Euthanasia isn't needed, in other words.

4. Euthanasia imposes a terrible burden on the vulnerable. If life is no longer society's default position, then the most vulnerable members of our society—the elderly, terminally ill, disabled—must justify their continued existence.

This is just plain nasty.

 

5. According to philosopher Paul Chamberlain, a logical-legal slippery slope looms large.

Consider the notion of patient autonomy and the fact that reasons for one action sometimes also justify unintended actions.

In the context of legalized euthanasia, patient autonomy becomes understood in terms of the following fundamental principle: the sufferer has the right to doctor-assisted death to end his/her suffering.

Significantly, accepting euthanasia as a legal right on the basis of this fundamental principle opens up and justifies many other situations in which persons suffer and request death. These situations include the non-terminally ill, the elderly, the disabled, persons with chronic back pain, the depressed teenager, etc.

Trust legislative safeguards for protection? Good luck. Aside from abuse (one third of Belgium's euthanasia deaths were illegal and lacked patient consent), safeguards fail because courts will do what courts do—promote consistency. Consistency demands that all of the above-mentioned persons, if suffering, and if desiring death (and if represented by a smart lawyer), can be reasonably seen to have the right to death as well.

After all, at the core of these other situations is a sufferer who requests doctor-assisted death, rendering situational differences incidental.

Legalizing euthanasia, then, puts us on a non-fallacious slippery slope that embraces death as a solution.

But medical, social, and psychological problems require medical, social, and psychological solutions—not killing.

Surely, legalizing euthanasia is not wise.

(Hendrik van der Breggen, PhD, is associate professor of philosophy at Providence University College. The views in this column do not always reflect the views of Providence.)

P.S. For further reading on euthanasia/ physician-assisted suicide, see the following APOLOGIA columns:

• Are we ignoring a philosophical lesson from history? (May 31, 2012)
• Physician-assisted suicide is a slippery slope (December 1, 2011)
• Physician-assisted suicide: Look at pros AND cons (September 29, 2011)
• On putting down pets and people (August 18, 2011)
• Physician-assisted suicide? (August 13,2011)

P.P.S. See too Dutch ethicist Theo Boer's views on the recent euthanasia experience of The Netherlands:

• Don't make our mistake (Daily Mail, July 9, 2014)

Are we ignoring a philosophical lesson from history?

APOLOGIA

By Hendrik van der Breggen

(The Carillon, May 31, 2012)

Are we ignoring a philosophical lesson from history?

Part of my job as a philosophy professor is to teach a course on ethics once a year, so I regularly examine various ethics books that may be helpful to my students, and I pay attention to discussions of issues relating to life and death.

In fact, I've been thinking about and attending to topics relating to ethics for years—going back even into my childhood. I remember nervously giving a speech on Adolf Hitler to a grade 8 class when I was in grade 6, and I remember part of my preparation involved looking at William L. Shirer's book The Rise and Fall of the Third Reich: A History of Nazi Germany. (My parents had an extensive home library. They also survived the Nazi occupation of The Netherlands.)

Over the years I have noticed a trend in Canada, a trend towards an acceptance of the philosophical view that there is such a thing as human life not worthy to be lived.

If the reader hasn't noticed this, then I urge him/her to think of the growing acceptance in the medical profession of death as a solution to various problems. Think of the prevalence of abortion; think of the recent slippage into the acceptance of what some thinkers call "post-birth abortion"; think of the present movement to promote the legalization of physician-assisted suicide for the elderly and terminally ill.

Think, too, of the growing acceptance of the ethic of utilitarianism, the ethic that what is right is what maximizes the utility or happiness/pleasure for the greatest number. Significantly, the utilitarian ethic tends not to be connected with the more traditional view (in the West) that human life per se is sacred or has objective (intrinsic) moral worth.

Couple this growing acceptance of utilitarianism with the present generation's penchant for popular movies that positively portray so-called mercy killing.

Think of the Academy Award winning Million Dollar Baby, in which Clint Eastwood is an old boxing coach who kills his young female boxing student, played by Hillary Swank, because she has become quadriplegic. Or think of the Emmy Award winning You Don't Know Jack, which treats euthanasia proponent Jack Kevorkian (1928-2011, a.k.a. "Dr. Death"), played by Al Pacino, as if he—Kevorkian—were a saint.

Keep in mind that in these films the emotion-laden pros of euthanasia are emphasized without a sustained careful examination of the cons. Keep in mind too that a characteristic of propaganda is that it usually doesn't present pros AND cons, or if it presents any cons, it presents them weakly.

I don't mean to sound alarmist, but I am troubled. I suspect that we have not learned our philosophical lessons from history.

Consider the following passage from Dr. Leo Alexander (1905-1985), medical advisor to the U.S. Chief of Counsel at the Nuremberg Trials, trials in which representative Nazis were convicted of crimes against humanity (this passage is from Dr. Alexander's paper "Medical Science Under Dictatorship," which appeared in New England Journal of Medicine, July 14, 1949):

 "Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived."

Dr. Alexander continues: "This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in the category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the nonrehabilitatable sick."

Dr. Alexander also points out that the German people were encouraged in this "subtle shift" by movies depicting euthanasia in a positive light. Alexander writes: "Lay opinion was not neglected in this [pro-euthanasia] campaign. Adults were propagandized by motion pictures, one of which, entitled 'I Accuse,' deals entirely with euthanasia. This [1941] film depicts the life history of a woman suffering from multiple sclerosis; in it her husband, a doctor, finally kills her to the accompaniment of soft piano music rendered by a sympathetic colleague in an adjoining room."

Significantly, in the 2010 film You Don't Know Jack, when Dr. Jack Kevorkian assists with the suicides of some of his patients (at least 130 assisted killings in total), there usually is a sympathetic colleague in the room, and throughout the movie we are treated to beautiful musical accompaniments by the likes of Johann Sebastian Bach.

I don't believe that there is a Nazi Party on Canada's horizon (thank goodness). But I do believe that some of the deep philosophical principles of what Pope John Paul II (1920-2005) called the culture of death are becoming prevalent in our society.

We should remind ourselves and our children that medical, social, and psychological problems require medical, social, and psychological solutions—not killing.

P.S. For further related reading, please check Apologia archives on abortion and physician-assisted suicide.

(Hendrik van der Breggen, Ph.D., is assistant professor of philosophy at Providence University College. The views in this column do not always reflect the views of Providence.)