America’s northern neighbor has embraced a culture of death.
America’s northern neighbor has embraced a culture of death.
A merica’s culture war over the question of when human life begins has been joined by those who want to reshape how human life ends.
The debate over legalizing physician-assisted suicide began in Oregon nearly thirty years ago. The scheme, in which doctors prescribe lethal drugs and guidance for patients who want to end their lives, was sold to the public as “death with dignity” and carefully restricted to individuals 18 and older who had an incurable and irreversible terminal illness and were not expected to live beyond six months. This novel approach to end-of-life care ran contrary to laws in all 50 states that made it a crime to assist a fellow human being in committing suicide. For physicians, it undermined the age-old Hippocratic Oath provision: “Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.”
Early advocates for this radical change in the doctor-patient relationship assured the Oregon public that sufficient safeguards were in place to prevent abuse and that the lethal medicine would be self-administered. Their legislative proposals included supposed guardrails to ensure informed consent and required psychiatric evaluations for applicants who seemed depressed. Every assisted-death seeker also had to receive referral information on hospice, comfort care, and pain-control alternatives.
With these assurances in place, the 1997 Oregon voter referendum passed 51–49 percent, and America’s experiment with assisted suicide began. Because of a U.S. Supreme Court decision that same year that found no constitutional right to assisted suicide, the battle to expand physician-assisted death moved to other state legislatures. Those in favor of the liberalization of the laws argued that their goal was to relieve suffering and honor the right of individuals to have death on their own terms. These proponents contended that hastening death wasn’t the same as killing and that compassion, not cost-cutting, was their sole motivation.
The infamous Hemlock Society, at the time the leading voice for assisted suicide and euthanasia, rebranded itself and later merged with another like-minded organization to become “Compassion and Choices.” It polished its appeal by removing unpleasant words such as “suicide” and “euthanasia” from its messaging while continuing its nationwide campaign to provide citizens “the full range of end-of-life care options.” This change in identity and tactics bore fruit. Nine other states and the District of Columbia decriminalized assisted suicide and followed Oregon’s statutory framework for assisted death. Legislative efforts in 2022 to introduce this practice or expand its use failed in Vermont, Washington, Hawaii, Delaware, Virginia, Massachusetts, Arizona, Indiana, Kentucky, Rhode Island, and Connecticut.
But in Canada, it is full speed ahead. Thanks to Prime Minister Justin Trudeau, modernity’s Doctor of Death, the slippery slope foreseen by opponents is now being stumbled down in broad daylight. Immediately after his first federal election in 2015, Trudeau’s Liberal Party pushed through Parliament the Medical Assistance in Dying Act (MAID). An applicant seeking to die under MAID had to demonstrate that his or her death was “reasonably foreseeable” and that an incurable, grievous, and irremediable medical condition existed that was in “an advanced state of irreversible decline.” Individuals with mental-health conditions or non-terminal disabilities were excluded from eligibility.
But Trudeau had bigger plans. Less than five years later, his administration has expanded the law to make Canada arguably the assisted-death capital of the world. Gone is the “reasonably foreseeable” death requirement, thus clearing the path of eligibility for disabled individuals who otherwise might have a lifetime to live. Gone, too, is the ten-day waiting requirement and the obligation to provide information on palliative-care options to all applicants. Likewise, physicians are no longer the only health professionals authorized to sign off on an application for an expedited death; nurse practitioners can now perform that function. As for the two independent witnesses who previously had to confirm that the applicant had given informed consent and actually signed the form, only one is necessary now. Unlike in other countries where euthanasia is lawful, Canada does not even require an independent review of the applicant’s request for death to make sure coercion was not involved.
Unsatisfied with simply offering final exits to the non-dying disabled, Trudeau has also offered MAID eligibility to those suffering from mental illness. In March of next year, individuals in Canada who, by definition, cannot give informed consent because of mental illness will be able to request euthanasia or physician-assisted suicide. One is left to wonder what some Canadians might do if they saw a man poised to jump from the ledge of the 20th floor of a building.
Today, the young prime minister’s pioneering in government-sanctioned deaths of the sick, disabled, and mentally ill includes making MAID available to “mature minors.” Currently, this measure is under parliamentary review which — if history is a guide — means that such an expansion in eligibility for youth in Canada is all but inevitable.
That said, reports of abuse in Canada’s assisted-death system — including coercion of vulnerable sick people by hospital attendants — have made many reconsider Trudeau’s pro-death campaign. Additionally, a recent government report brought unwanted media attention when it pointed out that MAID could save Canada $66 million while ignoring the fact that the program incentivizes the government to deny critical care and in-home services to those in need.
Where will this social experiment lead? It is no longer a dystopian fantasy to envision that an artificial-intelligence algorithm, instead of a medical professional, could come to determine MAID eligibility. It is not beyond the realm of possibility that push-button technology will allow for self-administered death by nitrogen gas. Such changes would cut the physician completely out of the unsavory business of intentionally ending life. In the Netherlands, the first European country to legalize euthanasia, such a death chamber is already under advanced development and about to be tested on its first human subject.
The good news is, there is still time in America to find an alternative to a reprise of the pro-choice, pro-life shouting match over abortion. Better pain management; earlier access to hospice and palliative care; improved community mental health services; expanded health care options for the poor; a renewed emphasis on self-determination through advance directives so that health systems respect and honor patient choices without abetting suicide; and a concentrated outreach by faith-based organizations to the lonely, disabled, and depressed, can help policy-makers avoid the “pain or poison” dynamic that characterizes the current public-policy standoff.
In the end, it will always be easier to kill people than care for them. Indeed, unless steps are taken soon, the “right to die” will be a right that the poor and disabled will get.