Medical Assistance in Dying

and the problems therein

When my cancer came back, I met with my surgeon, expecting him to outline a plan to cut the tumor out of my throat, a perilous procedure. I felt brave, but the universe laughed, ‘You imagined you were ready for the worst?’ Here is the gist of our conversation:

Surgeon, “I’ll review your options. First, there is palliative care.”

Me, silently, What? Palliative care is medical care intended to comfort the patient or improve her quality of life but not to cure her. Why are we talking about this first?

Surgeon, “Second, there is medical assistance in dying.” This awkward phrase is a euphemism for a doctor or nurse practitioner helping you commit suicide. In the US, proponents call it ‘physician-assisted death.’ In Canada, we call it ‘medical assistance in dying,’ or MAID.

Me, “That’s not an option for religious reasons.”

Surgeon, “I understand. I mentioned these options first because we do not have much to offer regarding treatment.”

He added that I had “months, not years” to live. It’s 18 months later, and my death is not imminent. So that prediction was wrong. But I still have cancer, it’s still incurable, and still growing.

In 2015 the Supreme Court of Canada ruled that the Canadian Charter of Rights gave the right to MAID to competent adults with grievous and irremediable -- but not necessarily terminal -- medical conditions. In 2023, persons whose only medical problem is a mental health condition will gain the right to MAID. 

However, my life isn’t something I can dispose of as I see fit. My duties to and love for my wife and children take precedence over my suffering. Love and duty extend to an expanding circle of beings, other humans, animals, trees, and the natural world that sustains us. Rick Warren’s mantra gets it right, “It’s not about you.” Moses speaks for God:

I have set before you life and death, blessing and cursing; therefore choose life (Deuteronomy 30:19). 

I choose life, so I’m not choosing MAID. Whatever my circumstances, there will be something I can do to serve. Can I live up to this? Who knows?

But you may see otherwise, and if you want MAID, why should my commitments bind you? The Court was motivated by a concern for individual autonomy and that, everything else being equal, is a good thing. Moreover, read the bioethical or Christian ethical literature on assisted suicide. Real-life generates cases that confound attempts to draw absolute lines. Some people experience intractable, excruciating pain. If they say they are better off dead, who am I to deny it? Every tradition finds a way to rationalize the actions of doctors who help them die. 

I am just explaining my choice, not relitigating the Court’s decision. 

However, given that we have opened the door to MAID, we must ensure that the new law doesn’t create further victims. I am a psychologist, and suicide prevention has been part of my professional work. I fear the consequences of these changes in the law. Some people will choose MAID because they do not have access to good medical care. No one should feel they have to choose suicide because they cannot get palliative or mental health care. 

In theory, Canada’s universal health care system makes treatment available to all. In practice, for mental health care, this isn’t the case. Provincial health insurance plans do not cover most care delivered by non-physicians. Likewise, the plans do not cover outpatient medications for most patients, which are critical in psychiatric care. In many - most? - jurisdictions, you must wait months to get care from a mental health specialist. 

The situation may be even worse for palliative care. Careful analyses of data from Alberta and Ontario by the Canadian Institute of Health Information have shown that fewer than one in five Canadians receive palliative care at the end of life. 

We must make it possible for every dying person who needs it to get mental health and palliative care. Sadly, you can’t change the health care system by flipping a switch or turning a knob. It is slow, demanding, and costly work. That may be why we have yet to prioritize this in any province. But if we do not fix this, patients will choose MAID because they cannot access good medical care.