The Problems with Canada’s MAiD Program

Some arguments to consider about Medical Assistance in Dying

           Canada’s Medical Assistance in Dying legislation was passed in 2016, initially introduced to the Canadian public as a service intended for people whose deaths were “reasonably foreseeable” or who were “suffering intolerably” from a disease. MAiD is, in essence, medically assisted suicide, and has been described as a way to help people who are physical suffering to end their lives before succumbing to natural causes. Based on that description alone, MAiD is frequently framed in the media and political discussions as something that can only be viewed as a good thing. Since suffering is not viewed by normal people as a good thing, it is frequently viewed as simplistically as a program that gives people autonomy in end-of-life decision making and prevents suffering. The language chosen often focuses on the patient’s “right to choose,” which seems deliberately selected to equate the issue with a woman’s right to opt for an abortion.

            Because of this, any opposition to the program is often seen as not being supportive of people’s choices and individual decisions. Those that critique the program are often characterized as those that are entrenching on people’s individual rights. I admit I used to understand and agree with this argument. But since working in healthcare, I have come to realize that there are actually a lot of problems with the program, and now understand that a great deal of nuance is missing from this political debate.

Photo by Sandy Millar on Unsplash

            MAiD is a federal program. Every person is allowed to support or oppose a state program without immediately coming under accusation of being an unethical or uncompassionate person, or some kind of religious weirdo. Despite this, whenever the subject of MAiD is discussed, I notice it is frequently framed this way. Though it is a new program that has only been implemented for less than ten years, debate on the subject feels as if it is discouraged, as MAiD is now seen as a “personal right” enshrined in law. The argument is thus framed as Compassionate Good Guys Who Don’t Want People to Suffer vs. Evil People Who Don’t Care About People’s Choices and Want Them to Suffer. But this is a simplistic way to approach a political debate about a program literally about life and death, and I want to explain here the problem with this framing.

I’m going to include a disclaimer here that I know there are people who do truly suffer from their diseases, who don’t have any hope for a peaceful, painless death if they do not opt for MAiD. But this is not the beginning and end of the argument, and the program still is concerning.

I work in healthcare and understand how the process works, and want to discuss some of the issues below:

I. I don’t think people understand how easy it actually is to get MAiD

Photo by Olga Kononenko on Unsplash

When you read about MAiD in the news, you would be forgiven for believing that the only people accessing and applying for it are people who are really, truly physically suffering and would only suffer more if they did not receive it. On paper after all it reads this way. If you read through the text, it also seems like there are a lot of protective barriers included that would protect vulnerable people—those who for instance are only asking for MAiD because they feel like their illness is a burden to other people, or because they feel depressed and can’t see a way forward, or because they have been pressured into it by someone else, or because they’re economically and socially disadvantaged—from accessing it.  

But in practice, these barriers are actually quite superficial, and all that really matters at the end of the day is the patient’s self-report. All they have to do is have a disease, confirm they are physically suffering, and confirm several times with several different people that they meet the eligibility, in order to be approved for MAiD. Thus we do not actually have a way of proving objectively that they are not for example being pressured into it by someone else. This means that all one really has to do is have a disease and ask for MAiD, and one will most likely be approved.

This is not a problem for everyone. But it is certainly a problem for these grey areas.

            As well, to be approved for MAiD, you must “pass” three stages—an “independent witness” and two “independent” medical assessors that must be approved by a specific institution. On paper, this seems like a lot. But in practice, it isn’t really that much.

            This is for a few reasons:

1) One’s right to access MAiD has already been made law. Thus if a person meets the eligibility criteria, assessors cannot really say no unless there is something obviously problematic about the request, because then they would be disobeying the law;

2) Assessors and witnesses are not really “independent.” They are for example employed by hospitals, and physician and nurse assessors must be approved by an organization that is not without bias. Your employer may implicitly if not explicitly require staff to serve as witnesses or assessors. Hospitals cannot fire you on this basis alone if you decline to sign off, but you would be considered as someone who is denying someone a service and isn’t doing their job;

3) There is social pressure to sign off, because culture has already framed MAiD as being equivalent to one’s right to choose;

4) Canada is experiencing a healthcare crisis with overwhelmed hospitals, meaning there is the pressure of the time crunch to sign off; and,

5) If one for example refuses to be a witness, then another witness would just be found instead. Thus no matter who is consulted, the result is likely to be the same.

            Because of how easy MAiD is to access, MAiD is currently the fifth or sixth leading cause of death in Canada. There were 13,000 cases in 2022, accounting for approximately 4.1% of all deaths in the country. When this many people are requesting it and there are so many grey areas, it is understandable that we should ask why so many people are choosing this and if there are people accessing it that perhaps should not have done so.

2. The right to MAiD is being framed as being a more important priority than other human rights

Photo by Aaron Doucett on Unsplash

            Sometimes a patient may be someone suffering from one of many other social problems as well as having a disease. For example, they have a respiratory problem, but they are also low income, and can only afford to rent a room that doesn’t have enough space for their medical devices. Or they have leukemia, but they are isolated and lonely, and cannot find someone who will voluntarily serve as a medical caregiver to call for help if they have an acute issue at home. Or perhaps they have chronic kidney disease, but there are no dialysis centres in the rural area in which they live, meaning they have to choose between dying from their disease or relocating away from all of their social supports in order to get treatment three times a week.

The reason these people may ask for MAiD thus may not be purely because of the disease, but because they feel unable or unwilling to manage their disease due to social and structural problems. There is however no way of proving which one it the actual motivator. While applicants are assessed for demographics as an attempted safeguard to ensure there is not a disproportionate amount of low-income people for example opting for MAiD, one is not actually required to answer the demographic questions.

MAiD supporters often argue that problems with society—eg lack of affordable housing, lack of mental health supports, lack of wage growth to match increasing prices—are not easily solvable, and thus should not be an argument against MAiD, as a person in pain now cannot for example wait for the housing crisis to be resolved.

            But this is not actually my argument. If someone is truly in pain I do understand. But my argument is, at what point do we become a society and civilization that prioritizes one’s right to die over a right to live, because death is quicker, cheaper, and easier? Why is the government so obsessed with expanding people’s rights to access MAiD (see bullet below) when Canadians are quite split on the topic, but I do not see the government arguing for example for guaranteeing housing as a human right or food as a human right? Why is MAiD the priority?

            Consider if a person would ask for MAiD if they could afford a private nurse to help them manage their ADLs at home. If they did not have to wait so long for medical treatment, or if they were able to afford a home to store their massive medical equipment. Wealth and comfort makes it easier to manage disease.

A part of MAiD’s eligibility requires that an applicant confirm that all and every avenue has been considered before opting for MAiD. But if all of those options are shitty, because Canada has nothing better to offer, then of course that person is going to choose death. This should be the government’s focus.

            As well, as someone in social services, government applications for the living are way more arduous than MAiD applications. I understand that when one is suffering, one must move quickly. But it does feel like the government is prioritizing reactive policies for those close to death rather than preventative ones that could have helped them from getting to that point. For people who want to live, there are tons of barriers to and huge wait-times for government programs. The Life Threatening Health Need government benefit, for example, is extremely intrusive and difficult to access. It requires one to provide the government access to their financial accounts and documents before an application will be accepted, and even then it takes about a month to approve while the patient suffers.

            MAiD can get done in a day though. It’s cheap and easy for the government.

3. The criteria of suffering keeps expanding

Photo by Hailey Kean on Unsplash

            Despite many concerning issues and incidents with MAiD, the program never actually slows down or becomes more limited. Instead, it keeps quickly expanding. The criteria for “suffering” keeps getting more and more broad, in a way that is framed as “inclusive” and supportive of people with different problems, and also happens to be convenient for the state as they will have to fund less courses of care. For example, the “reasonably foreseeable death” requirement was removed in 2021, and the government is also changing rules so that they can approve advance requests. This means that a person will be able to request it months or years before their condition has even declined.

            The government also really, really wants to expand the criteria to allow those suffering from mental health issues to become eligible. The media is constantly pushing this idea to seed it in the public. They frame it as “equity,” and imply if we have any issues with this then we do not care about the suffering of people with mental health problems. I do not doubt that people with mental health issues suffer. But the program has not sorted out its issues with determining consent for even those suffering from medical conditions. It is even harder to determine consent when it comes to cognitive issues or mental health concerns, so they are thus more vulnerable and more at risk of being pushed into a death they may not actually want.

And again, in Canada it is extremely expensive and difficult to access good mental health supports, so not “all avenues” have been offered before introducing MAiD as an option. Private counselling is a luxury, so low-income people in particular have limited resources to try and treat mental health conditions before they opt for MAiD.

Yet our government and media are closer to demanding MAiD for those with mental health issues than for facilitating ways for other mental health services to become accessible for all Canadians. Again it seems like it is just easier, faster, and cheaper for those in power, and framed as an equity issue as a rhetorical tool so that criticism is discouraged.

            And on that note…

4. Is MAiD a bottom-up grassroots idea, or a top-down idea cheap and convenient for the state?

Photo by Nick Linnen on Unsplash

            Canada’s federal website says that 300,000 people including the public and experts were consulted before passing MAiD legislation. But I have a few questions about this. For one thing, polls and clinical research trials can be pretty easily manipulated by researchers to obtain the result they want. There can be sampling biases for example, or problems with question wording (do you believe suffering is better than dying?), or survey mode problems (was the poll conducted over the phone when certain demographics never answer the phone?) and so forth. And even if there were no issues with the study, 300 000 people is still less than 1% of the Canadian population.

            I do not remember this issue being debated much prior to the law being passed. It feels like it was passed, and THEN we were invited to debate, after it was already enshrined into law and the media began representing it as equivalent to “pro-choice.”

            So why am I so suspicious about this?

            Well, aside from all the reasons above, the genocide in Palestine has taught me that sometimes an idea in your head is not really your opinion, but an opinion brainwashed into you by manipulation of the state and media. So I must ask: how much debate did the people of Canada actually have amongst themselves before this law was passed? Did we ask for it, or was it passed first, framed as a human right encoded into our legislation, and then presented to us for debate, while we can no longer argue that it is a right and people have already been pressured into signing off on it?

            I also find it suspicious that when a person asks for MAiD, they are asked if there are any young children in their lives that might be affected by the death. The government claims this is because they want to ensure no young children are left behind when one dies, and to help them cope with the death. But you can also argue that this brochure that is being handed out for parents is actually kind of indoctrination. Children who are educated about MAiD in kindergarten might not have actually supported this policy as adults, as they might have had issues with any of the above things I have mentioned. However, they are told at a young age: “well, if Grandpa doesn’t get MAiD, he will suffer. Do you want grandpa to suffer?” One of the bullets on the brochure invites parents to clarify [with your child] what it might look like if the person’s body died from the illness. This seems like scaring a kid into supporting a government program by manipulating their love and compassion.

           Again I am not saying that MAiD is never appropriate, but that this program is moving too quickly despite its many problems, and there is also no reason why the oversight for medically-assisted suicide should be taken from the medical practitioner and given to the state. One should also note that when one opts for MAiD, the federal government has mandated that their deaths be marked as “natural” on their death certificates, despite it being unnatural.

This program the government and media supports is conveniently cheaper, faster, and quicker than putting the work in to help prevent people from getting to this stage of suffering. Plus, based on what is happening in Palestine, Sudan, the Congo, and the Ukraine, I am not convinced that the Canadian government actually cares about people’s choices and comfort or about saving human lives, and so I take issue with the prioritization of death over life.

Conclusion

            When someone expresses a critique with MAiD, do not assume it is because they are a heartless person. I do not assume conversely that someone who is pro-MAiD is necessarily just wanting to kill everyone (though I do accuse the government of prioritizing profit over human lives). I believe that the majority of normal people arguing about this subject on either side are genuinely compassionate and are just trying to support the policy that would lead to the least amount of suffering and injustice. But the subject is not as simple as being “pro-MAiD = anti suffering” and “anti-MAiD = pro suffering.” At the very least, this policy should be limited rather than expanded before all these problems are addressed.

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Some articles and writers I’ve been reading on Substack:

• Wearing the poppy is a November ritual to glorify needless wars & forget the waste of life by JM Smith

• Israel has all but ended medical evacuations from Gaza by Amba Guerguerian

• The FBI Knocked on My Door by Ken Klippenstein

• How Zionists Invented Terrorism by Kit Klarenberg

• Did British police raid me for this? by Asa Winstanley

• How A False Flag Massacre Led To The Proxy War In Ukraine by the Dissident