MAID In Canada

A rapidly growing number of Canadians are choosing to die with help from our medical system. MAID – Medical Assistance In Dying – is scheduled to become accessible to even more people next year. What will happen then, and should we be comfortable with this?

In a recent article in Christianity Today, a Canadian physician named Ewan Goligher wrote:

When the hospital staff called me to my patient’s bedside, I could see her distress was severe. She was agitated and breathless, her face etched with discomfort and frustration. “I can’t take this anymore,” she cried.

She had suffered for years with chronic illness and had been admitted to my intensive care unit with acute complications. She was debilitated and exhausted, and her grief and frustration had come to a head. “I just want to die,” she wept.

Her friend was standing next to me at the bedside, and he was clearly upset by her distress. “Just ask for MAID,” he told her, using the popular acronym for medical assistance in dying, often referred to as physician-assisted death. “Then you can end it all now.”

I was startled by his statement. Though physician-assisted death is available in Canada, where I live, I had not expected the conversation to move in that direction. Yet I saw that he was feeling desperate and helpless at the sight of her distress.

After some gentle exploration, we quickly realized that the patient didn’t really want to die; rather, she needed relief from her pain and anxiety and to understand her acute illness and what it meant for her future. She still wanted time with her loved ones. We worked to address her symptoms and concerns, and she soon felt calmer and more comfortable. Watching her rest and converse with family made it hard to believe she was the same person who only hours earlier had cried out to have her life ended.

What is more unbelievable is that the ability to have one’s life ended on short notice is an increasingly acceptable option for Canadian patients—with implications that will reverberate around the globe.

MAID was introduced in 2016 after a Supreme Court decision ended the criminal prohibition on physician-assisted suicide and euthanasia. In response, the Canadian health care system began allowing MAID for patients who were experiencing “grievous and irremediable suffering” for whom “death was reasonably foreseeable.”

This change gave me some discomfort at the time. The Christian Church has long advocated for treating life as sacred and death as something under God’s control, not ours. It is one thing to ease someone’s pain or to withdraw medical treatment to allow death to take place. Intervening to cause death is something different. It is hard for me to imagine Jesus doing this, or instructing His disciples to do this.

Jesus called people to a radical degree of service and self-sacrifice, and the early Christians cared for the poor and sick and marginalized in a way that surprised the people around them. The Christians vision I know is one that seeks to help people thrive as humans, and not one that discards people or helps them discard themselves. But like many Canadians back in 2016 I could imagine how a patient experiencing severe suffering who is near death might desire MAID and tried to empathize with the plight of people facing the prospect of enduring a terrifying degenerative disease.

For those who staunchly opposed MAID from the beginning a major concern was what might happen once the door to causing death was opened. I don’t usually put too much stock in “slippery slope” arguments that claim that action A will soon lead to event B, then C, and then the end of civilization as we know it before long. But in the case of MAID it looks to me like the slope has proven to be very slippery after all.

In 2016 about 1,000 Canadians died with physician assistance. Last year that number grew to 10,000, which is 3.3% of deaths in Canada according to official government reporting.

The biggest changes happened last year, when bill C-7 was passed and expanded eligibility for MAID by getting rid of the “death is reasonably foreseeable” criteria. Now Canadians with disabilities and illnesses that aren’t imminently life-threatening can seek to end their lives.

More changes are expected in March of 2023. Parliamentary hearings have been underway this summer and fall to hear testimony about the possibility of allowing people to receive MAID if they are mentally ill, unable to consent, or if they are “mature minors” (potentially as young as 12). One Quebec doctor advocated for infants being eligible under certain circumstances.

These changes to MAID are connected to the shifting values of Canadians. The prohibition against MAID before 2015 was grounded in beliefs about the dignity and sanctity of human life.

As Patricia Paddey writes in one of her feature articles about MAID in Faith Today magazine, MAID is troubling to many Christians because it conflicts with the Biblical perspective “that every human being is created in the image of God (Genesis 1:27), that every human life is equally full of value and worth (Malachi 2:10), that suffering can be redemptive (2 Corinthians 4:7–12, 16–18) and that God is sovereign over life (Acts 17:24–26) and death (1 Corinthians 15:20–28).”

Paddey continues, saying: “It is compassionate to want to alleviate suffering. Compassion is good. But the Christian conviction that God can redeem suffering, that there can be sparks of light in the deepest darkness, and that all human beings have an innate dignity is directly at odds with a perspective that considers suffering as only cruel, to be avoided at all costs and as something that erodes human dignity.”

But this traditional view is becoming passé. Dr. Goligher notes that an influential report by the Royal Society of Canada in 2011 declared that the new consensus among Canadians was “the value of individual autonomy or self-determination.”

That report concluded: “There is a moral right, grounded in autonomy, for competent and informed individuals who have decided after careful consideration of the relevant facts, that their continuing life is not worth living, to non-interference with requests for assistance with suicide or voluntary euthanasia.”

This belief in autonomy above all sounds very empowering. Why shouldn’t we all have the choice of life or death, and even receive help in ending our lives if we no longer want to live them?

But it’s not hard to imagine some disturbing outcomes of this way of thinking, especially if MAID is expanded to include anyone who is facing any kind of suffering they find intolerable. It’s not hard to imagine because disturbing outcomes are already occurring.

As Dr. Goligher writes (backed by various reports) “some patients with disabilities or mental illness reported that assisted death was proposed to them without their instigation. Patients have sought and obtained euthanasia because they were unable to access affordable housing. There are even reports that patients have received physician-assisted death based on misdiagnosis, discovered at autopsy.”

Let me put that in language that’s even more plain. Disabled people have been approached by workers in our medical system about assisted death without them requesting information about it. People unable to find or afford suitable housing have requested MAID and been euthanized because they lost hope at finding a place to live. And Canadians may have been given wrong diagnosis about their illnesses and then been allowed to die through MAID before the error was discovered.

And what happens next if we expand eligibility to include mental illness and minors? One 19-year-old witness before the parliamentary committee investigating MAID testified that she would have died years before during a season of depression and despair if she had been given the option to end her life. But she survived that experience and was grateful to have her life ahead of her. How many people will die in a dark period of their lives who were in redeemable and recoverable situations if MAID is expanded?

Patricia Paddey writes “William Robert Nielsen, a surgeon who wrote last year in the Canadian Journal of Bioethics that quite a few of his patients have "benefitted" from MAID, predicted, ‘MAID will lose the status as a last-ditch intervention for uncontrollable pain in imminently dying patients. Sick people will begin to see themselves as easily erasable and as excess human specimens. The conviction that it is a wonderful and divine thing to exist will be hollowed out by notions of a life that strives for societal convenience.’"

Dr. Margaret Cottle writes that this prediction is already coming true. "It’s just become so routine. The standard of care used to be when someone said, ‘I wish I were dead,’ our team worked hard to try to understand what lay behind that request, and then to do our best to address those issues. Now, many health care workers are not taking the time to explore the request in any depth. They simply respond, ‘Okay. We’ll call the MAID team.’"

Resources are also an issue here, one with serious ethical hazards. We already have examples of people solving a non-medical problem through MAID when they couldn’t access housing. What will people with challenging mental health issues do when they are offered the choice of being put on five-year waiting list for specialized therapy or start a 90-day waiting period for MAID? We are facing the troubling possibility of MAID being used to relieve our medical system and social services of the burden of caring for certain people.

Advocates for the disabled and seniors’ groups are especially concerned about this. What will people do when they feel like burdens and know that accessing the supports or accommodations they need to live and function in society will be extremely difficult? Will we become a country willing to subtly (or not or subtly) encourage our most expensive and “undesirable” citizens to end their lives rather than rising to the challenge of providing the supports and opportunities they need?

Or, put another way, will we offer more and more people the false promise of “dying with dignity” because we aren’t willing to help them live with dignity?

The Evangelical Fellowship of Canada’s statement captures this concern, saying “It should not be easier to obtain MAID than it is to obtain good quality palliative care, mental health care, or other needed medical or social supports. MAID must not serve as Canada’s response to poverty or lack of essential supports.”

There are other reasons for concern. One is the effectiveness of safeguards. Can an expanded MAID regime prevent doctors who are comfortable with MAID from providing it to people with too little assessment? There’s reason to believe the current safeguards are already insufficient.

Dr. John Scott (quoted by Paddey) writes: "I encounter a lot of patients who are not competent [to make the decision for MAID], but who are receiving euthanasia. That’s upsetting.”

He says it doesn’t matter if the physician in charge of a patient’s care thinks the patient is incompetent. If the two assessors assigned by the institution – typically physicians "keenly supportive of MAID" – have declared the patient competent, the patient will be put to death.

As one other doctor testifying before the parliamentary committee studying MAID noted, there is no objective standard or reliable way to determine how likely many disabled or mentally ill patients are to recover with proper treatment. Will some patients be referred to MAID if they are seen by certain doctors, but would have been referred to treatment if they happened to be assigned to different physicians?

And that leads to a final area of concern, which is the effect on medical workers who chose their profession in order to bring help and healing and don’t see MAID as compatible with those values.

Dr. Goligher has thoughts on this as he reflects on how the medical establishment in Canada has been changing:

the “culture of death” (a term I initially resisted as needlessly provocative) has taken hold in insidious and surprising ways. Assisted death is no longer seen as a desperate option of last resort but rather as one “therapeutic option” among many, a reasonable and effective means of definitively resolving suffering offered not only to the dying but also to those whose lives are not regarded as worth living. The logic of assisted death has proven inexorable: If death is therapy that addresses psychological wounds of suffering and the feeling that life is pointless, then who shouldn’t be considered eligible?

It was clear this moral evolution has placed immense pressure on doctors who refuse to participate in assisted death. The pressure on medical professionals is not so much to perform the act of ending the life as it is to knowingly refer a patient to someone who will. But a referral is no light thing; we are culpable if we knowingly send our patients to a doctor who will treat them in a manner deemed unethical.

A number of Canadian doctors have partnered with colleagues around the world to advocate for freedom of conscience in the practice of medicine, but the pressures are immense… Once death is deemed a form of health care, health care “providers” will be expected to offer it.”

I hadn’t been paying proper attention. Now I’m very troubled by what we’ve already allowed to happen and by the implications of what might come next.

Dr. Sonu Giand gave an excellent summation to the parliamentary committee studying MAID: “It’s a myth that expanded MAID is just about autonomy. The planned expansion and sunset clause may increase privileged autonomy for some to die with dignity, but it will do so by sacrificing other marginalized Canadians to premature deaths for escaping painful lives that society failed to allow them to live with dignity. That’s not my Canada, and it should not be yours.”

This is not the redemptive love Christians believe in, or even the spirit of the Hippocratic oath doctors used to have to affirm. It is creating a disposable class of people in our society that we can eliminate if they become too inconvenient. That is an affront to our creator God, and, I hope, to a lot of good and ethical Canadians who may not be aware of what is going on and what might soon be coming.

So, what can we do?

There are three things I can suggest, one political, one practical, and one spiritual.

Politically, you can contact your MP and other Federal elected officials and voice your concerns. MAID began through a court decision but it is being allowed to expand through legislation. The Evangelical Fellowship of Canada has a document that provides some additional facts about MAID expansion and a template for sending a letter or advise for calling the offices of elected officials. It can be found here: https://www.evangelicalfellowship.ca/Resources/Documents/MAID-Expansion-Action-Kit-2022

Practically, there are things we can do as an individual and as part of the Church. We can exemplify a culture of life and seek to give help and hope to people facing isolation, illness, disabilities, or who simply can’t make ends meet. Physically and spiritually the Church is a gift to the world that should be in the business of helping people see that their lives are worth living and helping them live those lives well. Researching the sad reality of MAID reinforces the importance of those things that I know many in our congregation already do – the phone calls, drives, meals, notes of encouragement, support of our benevolent fund, Beacon House, Freedom Kitchen, and more. Whatever ways we can support each other and serve the least of these are meaningful. It’s what Jesus asks of us. And, though I hadn’t been thinking of it in these terms before, it might be the difference between life and death for certain people experiencing seasons of darkness.

Spiritually, we can pray for our elected officials who will be making decisions about the future of MAID in Canada, and for the doctors, administrators, and other medical workers in our health care system. Pray for courage for those willing to stand for vulnerable people being put at risk by MAID. Pray for eyes to be opened among those who fail to see the problem with opening the door to MAID wider and wider.

And finally, we can believe, live out, and proclaim the Gospel. God is good. Jesus has saved us. Christians should be people who are regularly filled with joy as they live out their new spiritual lives that Jesus has given, and who are able to trust Jesus whatever may come. We have a source of hope that can bless this world if we are able to live faithfully and serve lovingly.

Sources and Resources

The Evangelical Fellowship of Canada (EFC) documents cases of Canadians choosing to die because they lack the supports needed to make their lives livable in this article: https://www.evangelicalfellowship.ca/Communications/Articles/June-2022/Review-of-Medical-Assistance-in-Dying-Part-3-MAID-

The EFC also has a list of all their resources on MAID here and their submission to the government of Canada in opposition to expanding MAID here.

Articles in Faith Today magazine by Patricia Paddey that I referenced repeatedly can be read in full here:

https://www.faithtoday.ca/Magazines/2022-May-Jun/Navigating-Medical-Assistance-in-Dying

https://www.faithtoday.ca/Magazines/2022-Jul-Aug/How-MAID-is-transforming-Canadian-end-of-life-care

CTV News' report on the woman suffering from chemical sensitivities who opted for MAID because she couldn't find housing can be found here: https://www.ctvnews.ca/health/woman-with-chemical-sensitivities-chose-medically-assisted-death-after-failed-bid-to-get-better-housing-1.5860579

Lastly, the Christianity Today article by Ewan Goligher is only available to subscribers normally, but through this link it should be accessible in full to anybody. (I’m not entirely sure how CT’s “unlock for a friend” link works, but if you really want to be able to read this and it isn’t working you can contact me and I’ll email you a PDF.) https://www.christianitytoday.com/ct/2022/november/canada-euthanized-10000-people-in-2021-maid-assisted-suicid.html?share=8BpR9SCZnfBt6xmDzUOWSridMgaQSJyk