Bioethicists joust over Canada’s ‘Medical Aid in Dying’

By Michael Cook 

The debate in Canada over euthanasia and assisted suicide – or, as it is called there, Medical Assistance in Dying (MAiD) – will have a huge impact upon developments elsewhere in the Anglosphere. As two of Canada’s stalwart defenders of MAiD, Jocelyn Downie and Udo Schuklenk, pointed out in a recent article in the Journal of Medical Ethics, “other countries will confront the same questions if they contemplate changing their assisted dying law”.

This makes their pushback against critics of MAiD even more interesting. (Schuklenk, by the way, is a trenchant opponent of conscientious objection over abortion and euthanasia. He has even proposed that medical schools screen out potential objectors.)

The two bioethicists home in on two weighty criticisms of Canada’s MAiD regime: “social determinants of health” and slippery slopes. “Social determinants of health” is a WHO [World Health Organization] term for the non-medical factors which influence health outcomes – which range from racism to disability and mental illness to unemployment.

They argue that it is discriminatory to deny people with mental illness and disability access to MAiD. Patient rights would be sacrificed on the altar of paternalism.

As for the slippery slope argument, they dismiss it as illusory.

The change from Carter [a 2015 decision by the Supreme Court of Canada] to C-14 [a law passed in 2016] moved Canada in a more restrictive direction. The entire scene is that Canada has not become more permissive as between the Supreme Court of Canada decision in Carter and Bill C-7. Rather, there was a period during which Canada had an unconstitutional tightening of the eligibility criteria. Canada is simply back where the Supreme Court of Canada put it through Carter.

This sets the scene for a vigorous response [https://jme.bmj.com/content/early/2021/08/26/medethics-2021-107793] in the JME from another Canadian academic, Tom Koch, of the University of British Columbia.

He says that the “social determinants of health” argument remains valid. “Inadequate control of pain and control of other symptoms was a rationale in over half of all MAID cases. This outcome reflects the limited number of palliative and rehabilitative physicians in Canada.” In his view, the availability of MAiD means that bioethicists and others no longer feel the moral urgency of clamoring for more and better palliative care.

As for the slippery slope argument, Koch simply points to the numbers.

An expanding class of persons eligible for MAID has resulted in an exponential increase in the number of reported cases. Total reported cases of MAID across Canada increased from 1,018 in 2016 to 21,589 in 2020. This is by definition the slippery slope: a relaxation of requirements resulted in an expanding class of eligible persons and an ever increasing number of medically induced deaths.

Michael Cook is editor of BioEdge where this appeared. Reposted with permission.