Assisted suicide was a hot topic when I was young in Canada in the 1990s. Sue Rodriguez, a 42-year-old woman, suffered from ALS and fought for the right to die on her own terms (assisted suicide) until the end. Supreme Court This case dominated the news cycle and sparked widespread debate across predictable party lines in Canada. The Supreme Court ruled against Rodríguez stating that, “…the sanctity of life must figure in determining the principles of fundamental justice.”
I remember feeling torn about it. It was a horrible situation. The idea of suicide disgusted me, but also the ALS sentence of a slow, torturous and certain death in a year. Ultimately, it was Sue's own words that influenced me,“If I cannot consent to my own death, whose body is this? Who owns my life?Even if I find suicide repugnant, even if I myself wouldn't choose it under your circumstances, who am I to interfere in your life? What property right do I have over her body and her choice? Sue eventually found a way to die on her own terms, despite the criminalization of assisted suicide by the state with the help of NDP MP Svend Robinson, who arranged for an anonymous doctor to administer morphine and secobarbitol.
Years later, my commitment to “hold out” was cemented by exposure to libertarian thinking that “do you support assisted suicide?” is the wrong question to ask when considering government policy. The real question is: "Do you support the initiation of force (including deadly force if necessary) to prevent consenting adults from engaging in assisted suicide?" The answer to this question in my mind must be “no”, which means that the state has no right to criminalize assisted suicide. Please note that you can oppose assisted suicide (I would never condone or participate in it) and also oppose the criminalization of assisted suicide at the same time.
In 2015, another ALS victim, Gloria Taylor, along with Kay Carter, who suffered from spinal stenosis, challenged the constitutionality of the penal code's ban on assisted suicide and won.the supreme courtruled that the criminal prohibition of assisted suicide violated article 7 of the Charter (right to life, liberty and security of the person).
This was the correct decision from a libertarian perspective and the government of Canada was forced to repeal this section of the penal code. However, since health and health professionals are exclusively under the control of the state, the repeal of this section of the penal code also gave an immediate de facto mandate to dramatically increase the power of the state in providing suicide-related services. Suicide became a state program in 2016 under the acronym MAID (Medical Assistance in Dying). That part is definitely NOT libertarian.
The first red flag about MAID was raised for me in 2017 when my mother was ill. I am convinced that my mother was sick from the nocebo effect. This is the opposite of the placebo effect, where her positive beliefs about her health manifest physically in healing and improved health. The nocebo effect occurs when your negative beliefs about your health manifest in physical illness. For decades, my mother had a negative fixation on her health that resulted in actual physical suffering. For nearly a decade she was convinced something was wrong with her eyes after undergoing LASIX corrective surgery. She complained of constant pain in her eyes. She saw a battery of specialists who found nothing wrong and tried all sorts of treatments that didn't work.
Eventually, her eye pain disappeared as she began to obsess over intestinal problems. She for years was convinced that something was wrong with her gastrointestinal tract. She was in constant pain. She saw a battery of experts who couldn't find anything wrong. She has tried every homeopathic, naturopathic, and western remedy known to man. Nothing worked. Like her eye pain, the stomach ache would predictably worsen when she was experiencing personal stress or anxiety. Over time I realized that she was becoming anorexic because her stomach hurt when she ate. I encouraged her to seek help for mental health and she saw a psychiatrist once, but she preferred pastoral support and prayer.
As a last ditch effort to stop his steady decline, he visited a surgeon. Mom was convinced that surgery was the answer. The examination showed intestinal abnormalities consistent with anorexia, but the mother convinced the surgeon that it was these abnormalities that caused the pain and anorexia. The surgeon reluctantly agreed to resect a portion of her intestine, as the mother had exhausted all other treatment modalities and her anorexia was seriously deteriorating her health. The surgery only made things worse. She now had to focus on postoperative pain and her feedback loop of negative beliefs about her health was amplified.
His postoperative recovery was difficult. He had many needs that demanded a lot from his nurses, who were visibly short. As a health professional, she could see through the smiles that masked his frustration. After my mother rang the doorbell for the umpteenth time, a nurse pulled me aside and wanted to inform me that MAID services were now available and that we should seriously consider this option. I was stunned. My mother needed medical care that instilled in her the will to live and heal, that focused her mind on the positive attributes of her body and her treatment. Instead, she gave him the opposite, reinforced her hopelessness. Suicide was not an option for my devout Christian mother, but let's just say that being told that option didn't exactly lift her spirits. My mother died a short time later in hospice care. Killed by her own negative beliefs about her health, which were reinforced by our state healthcare system.
Echoes of the mother's healthcare experience were revised in 2020 when it was reported in mainstream media that, “Faced with another confinement in a nursing home, a 90-year-old man opts for medically assisted death.”The title is self-explanatory. The system impoverished the life of Nancy Russell in the last years of her life; blocking her, forbidding her connection to the family and friends of hers who made her life worth living, all in the name of preventing her untimely death. She was not allowed to live free of her, not to kill her, but her state allowed her to be killed. What Nancy really needed was state protection.
Em 2021Donna Duncan chose assisted suicidewhen, according to her daughters, her medical care and rehabilitation were curtailed by covid restrictions.
In the news lately it's the revelationthat at least 6 veterans(that we know of), including a Paralympian, have been offered MAID when they ask for help from the very system that has crushed their bodies and minds in its service. The state is sending the message that it is happy to provide death as an alternative to the misery it creates.
This message of hopelessness concerns psychiatrist John Maher, who recentlywrote an opinion piece. “I am a psychiatrist; a subspecialist who only treats severe forms of mental illness. Unbeknownst to me, a family doctor recently offered MAID to my patient while she was in the middle of treatment. My patient wants recovery and autonomy restored, not death. MAID's offer gave him the message that my offered treatment would not work and that there is an easier way out than the slow progress of recovery. He will choose MAID.
A 2019 Quebec Superior Court ruling concluded that the "naturally foreseeable death" clause in the MAID legislation was unconstitutional. This opened the door for people with disabilities and non-terminal physical illnesses to access MAID. As aside from one of the plaintiffs in the case,Jean Trunchon, stumbled upon his suicidefor months because, “Coronavirus has literally stolen my time with the ones I love. Seeing what's coming is what scares me the most."
Given this court ruling, the Canadian government concluded that denying access to MAID to the mentally ill is also likely to violate the constitution. It is set to expand MAID access to the mentally ill with Bill C-7 in March 2023.
The libertarian in me applauds the decriminalization of assisted suicide while denouncing this new state program. And this is the crux of the problem. When medical care is considered a right in the context of legalized assisted suicide, you have a negative obligation (you must not interfere with assisted suicide) mixed with a positive obligation (you must provide suicide as a service).
More than 31,000 Canadians have died by state-assisted suicide since its creation in 2016, representing 3.3% of all deaths. The moral quagmire opened up by state-assisted suicide is dystopian as hell and it's time we talked about it lest we kill some people who would otherwise choose to live if given a life-affirming system.
perverse incentives
As a healthcare professional in Canada, my incentives are created almost entirely by the state. The state views me as an object of obedience rather than a professional exercising clinical judgment in the best interest of my client. This is an inevitable consequence of state health care. We are instruments of the will and necessity of states to behave as such. The state wants to live and expand and our job is to make sure that happens by providing data to the bureaucratic elite so they can appropriately allocate finite resources and push for more resources and bureaucratic power.
I know this is my job because that's what judges me. Did I collect enough data, correctly follow ever-changing policies, ask permission to go to the bathroom, move my ambulance to the designated area, etc.? I am not judged by patient results. I do not get a raise or promotion when I receive rave reviews from my patients about their experience with me. The system doesn't give a shit about the value I provide to my patients. In fact, my job producing paperwork for the state gets in the way of providing value to my patient. I have 30-45 minutes of paperwork to deal with or face the consequences, so having to take care of the patient interferes with the paperwork that keeps me out of trouble.
Considering that I get the same thing regardless of whether I add value to the patient or not, and considering that systemic compliance is what keeps me out of trouble, and considering that the system is dehumanizing and demoralizing for health professionals, what do you think are our incentives? The paramedic who wins is the one who takes the time to be available for another call and avoids unnecessary exposure to a toxic and dehumanizing system. The ultimate victory is to stay home on paid mental health leave and avoid toxicity altogether. Staff shortages are no mystery to those of us who work in the system.
In other words; our system encourages labor minimization over value maximization.
Despite this, I want to make it clear that I work every day with extraordinary men and women who strive to provide excellent care and value patients with a positive attitude. Many of my peers have turned their backs rather than face the continued loss of their compassion, joy, and spirit by a system that seems designed to stifle the very things that inspired us to become healthcare professionals in the first place.
I empathize with the nurse who suggested MAID for my mother. I was doing my best in a system that doesn't support value maximization. It is not hard to see how a compassionate health professional might suggest hastening death as the best option in a system that does not offer predictable help and finite resources that might help a patient with a better prognosis.
I see this 'minimize work' incentive at work all the time in healthcare. From ambulance crews that are slow to be available after a patient is delivered, to nurses who grumble or roll their eyes when we bring in another patient. I also see it in potentially more insidious ways.
In Alberta, we have the Personal Directives Act. It is a law that allows people to designate a medical decision-maker (usually a family member) in the event they are incapacitated and/or give explicit instructions (i.e., no CPR or ventilators) that healthcare professionals health must follow. This is a good thing. I want to fulfill your wishes.
However, more recently in Alberta, and in the Canadian healthcare system in general, something called Goals of Care (GOC) has become popular. These are medical orders, signed by a doctor, NOT the patient, regarding the level of care a patient should receive in the event of declining health. These GOCs should represent a robust conversation between the patient and the physician that provides for advanced collaborative planning. An interesting question to explore would be: why do we need GOC when we already have advance directives where a doctor can collaborate with a patient? However, I have found that many patients I see with GOC have no idea that these documents limit the care I provide them.
It is not difficult to understand why that would be the case that patients do not understand. The system encourages very short medical visits. Doctors are not paid for quality, they are paid for quantity in our system. Long-term care nurses, who have the same incentives as the rest of us, often provide the physician with a picture of the health of patients and the social contributors to health. Even before MAID was introduced, I was concerned about what I was seeing, what I saw as the twin systemic incentives to minimize work and short doctor visits. I believe that it is causing a reduction in the quantity and quality of life of a not inconsiderable number of vulnerable people, without their informed consent, who can benefit from more aggressive medical care. This move away from documents that represent the wishes of patients (Advance Directives) and a focus on documents that represent the wishes of physicians (Goals of Care) is also unimportant.
It is not hard to see how health professionals can, in good faith, convince themselves that hastening death is a compassionate outcome for many of their patients. Our sincere and good faith beliefs often end up aligning with our incentives. In a system that rewards minimal work, or at least doesn't reward and often punishes, delivering real value to patients, one would expect the loudest and most influential voices to be the ones serving the system. I have no doubt that many more healthcare professionals will convince many more people to accept MAID because of the perverse incentives in our system than would choose MAID in a system focused on maximizing value.
Perverse signs for health professionals
In my 30 years as a paramedic, I have seen countless people attempt suicide or express suicidal thoughts. My job is to help them because something went wrong with their thought process. They are having a mental health crisis, their thoughts are unclear, clouded with despair and a dark impulse. I even used force, involving the police, to confine these people for their own immediate safety. The default assumption is that these people want to live, or would like to live if they were in their right mind, so we intervene. It is a life-affirming assumption. And in my experience, most of these people are grateful for the intervention once the crisis is over.
I recently heard a joke from a paramedic colleague after responding to a suicide attempt: "Should we try to persuade them to get mental health support or offer cleaning services now?" It was dark EMS humor that also had a core of terrifying truth. Should life or death be our default assumption when faced with a suicidal patient? The case for intervention becomes more difficult to make in a system that tells us that we must respect the wishes of a suicidal mental illness patient.
In a system where so many of us are exhausted from being treated like compliance objects, and a system that allows and encourages "frequent fliers" to continually monopolize our time and energy, it's easy to become cynical. some people call itcompassion fatigue. In this system, it is not difficult for the weary to see some lives as absolutely desperate when taking the pills for the tenth time with an opiate overdose. It wouldn't be hard for a cynical person to see death as a relief for this patient whose life is endless suffering and who is going to die an early death in the streets anyway, a relief for health professionals and a relief for the child of 5 years. child in anaphylactic shock who we could be helping if we were not trapped in a hospital pasillo with this 'frequent traveller'.
Are you going to tell me that cynical and frazzled health professionals won't take the opportunity to whisper to their “hopeless” cases that MAID exists and explain exactly how they can submit a case for approval?
Heck, why didn't they tell us that we have a duty to present MAID as an option as part of informed consent?
Given the clear impact mental state has on physical health, what kind of effect could even suggest suicide in a vulnerable person like my mother, for example.
State Agency Standard Property
Nova Scotia recently became the first province in Canada to adopt presumptive organ donation. This means that unless you explicitly choose not to donate organs, the state owns your organs after you die. By all accounts it is aresounding successresulting in a bountiful harvest of removed organs. Given its success, why couldn't we anticipate an increase in the implementation of this European-style policy across Canada?
It's not hard to see how a well-meaning healthcare professional might approach you in your debilitated condition and hint that MAID might be an excellent alternative for you, given the need for your organs down the hall. It is a triple victory; you get relief from your misery, a little boy gets a heart, and the nurse gets a lighter workload.
If I can get hold of his most valuable organs, maybe I shouldn't be the one to encourage him to die or give him a lethal injection. Perhaps your healthcare should be delivered by someone who is your biggest advocate and wants to contribute nothing more than life-affirming value to you.
Impoverishing organization that provides death
Former Libertarian presidential candidate Harry Brown said: “The government is good at one thing. He knows how to break your legs and then give you a crutch and say, 'Look, if it wasn't for the government, you wouldn't be able to walk. Harry must be rolling in his grave right now. It is one thing to break your legs and provide the support of crutches, quite another to break your legs and offer a lethal injection as relief.
Above I highlighted 3 deaths caused by the unholy alliance of the covid regime and MAID. Additionally, we know of several veterans whose minds and/or bodies were shattered by their service to the state who were offered assisted suicide. It is much easier for the state to administer a lethal injection than it is to build the wheelchair ramp that would make life easier. These are the cases we know of.
It goes without saying that if I am holding you captive in your own home, isolating you from friends and family, stealing your joy and hope through threats of force, I may not be the most qualified person to provide suicide services. If I break your body, mind, and spirit in your service to myself and my friends in the military-industrial complex, I probably shouldn't be the one to offer you a lethal injection.
options ban
In what one bioethicist, Trudo Lemmons, described as a “…dystopian display of romanticizing death as relief…”,Jennyfer Hatch was shown front and centerin a commercial that defends the beauty of assisted suicide. The commercial was produced by La Maison Simons, a 180-year-old Quebec fashion retailer. Earlier in the year, Jennyfer told CTV News: “I feel like I'm falling through the cracks, so if I can't access healthcare, can I access healthcare to die? And that was what led me to seek medical assistance in dying (MAID) and I applied last year.”
Suicide is usually only considered when someone has no options. Health care is largely off-limits in Canada outside of a narrow set of state-owned or controlled options.
In 2018, I spent a year as a project manager trying to launch a local community paramedic program. This is a program to fill the gaps and provide health options in our community for people who have urgent care issues and are not mobile enough, often elderly, to go to their primary care physician or walk-in clinic. Typically, these clients have no choice but to call an ambulance and go to the ER, leaving ambulances out of commission for hours as they wait in a crowded ER to provide care. Community paramedics provide emergency care in the client's home; performance of diagnostic tests, physical examinations, blood extraction, prescription facilitation, coordination with primary care physicians, etc. It had broad support from our politicians and city residents, but was ultimately removed by Alberta Health Services (AHS), the sole health provider/controller for our provinces.
When the pandemic hit and most local seniors were afraid to leave their homes and get the medical care they needed, it would take a week to start providing in-home community paramedic services. I have two daughters who were contract paramedics at the time (basically there is one employer and they weren't hiring) and a wife who is a registered nurse. But this type of service is prohibited in Canada outside of the government system. I am a healthcare professional who had the means and motivation to provide much-needed healthcare in my community and substantially close some of the gaps. There are 3 million healthcare professionals in Canada and all of them are prohibited from providing care outside the narrow confines of the state. Imagine how many gaps they could fill, how many options they could offer.
I can't really blame AHS for denying permission for a program to run locally like this. They would have to provide funds that were undoubtedly needed elsewhere, remember that individuals and municipalities are prohibited from directly providing/funding healthcare, although in this case they would be happy to do so. They would not have direct control of the program. No one would be comfortable financing a company they don't control when they need the money elsewhere. I really can't blame the provincial politicians who created the legislation that gave AHS a monopoly on health services, they were given a clear mandate from a public that demanded universal health care without tiering. Ultimately, public attitudes about health would have to change before I could aspire to provide this service.
Psychiatrist Gabor Mate has reported resounding success in treating opiate and cocaine addicts withayahuasca before Health Canadaturn off the. Canadians do not have the right to try experimental treatments when they have a terminal prognosis. Hope is banned in Canada, leaving suicide the only option left for many people.
It goes without saying that if I use force to deny you access to treatments or therapies that give you hope for a better tomorrow, I probably shouldn't be the one promoting lethal injection.
Incentive to save money
In 2017, the Canadian Medical Associationpublished research resultsthat assisted suicide could reduce health care costs in Canada by $34.7 million to $136.8 million. According to the author of the report, “In a health system with limited resources, every time we launch a major intervention, there has to be a certain amount of planning and preparation, and cost has to be part of that discussion. It's just the reality of working in a system of finite resources."
Be aware of the underlying attitude and assumption that the big brains in charge of central planning must allocate resources throughout society. The idea of costs and benefits being weighed by an individual is completely foreign to these people. Such an idea would undermine their position and status, and therefore would never occur to them.
Imagine if this report was written by a private health insurance company. There would certainly be concern that the organization contracted to provide life-affirming care is looking into how much a suicide program could save on their outcomes. There would be justifiable concern that this organization might encourage customers to simply die to save some money. Well, what if you had no choice but to sign up with that insurance company?
This leads to: "Roger Foley (a veteran) suffers from brain degenerationdisorder and claimed that he was offered euthanasia so regularly that he began secretly recording hospital staff. In a recording obtained by the AP, a hospital ethicist tells Foley that his treatment is costing the hospital "more than $1,500 a day" and asks if he has "an interest in assisted dying."
It's darkly ironic when someone with the title of "ethicist" subversively suggests to a client that we'd all be better off if he went ahead and died. But this should come as no surprise to anyone who understands how bona fide beliefs align with the personal incentives imposed by a centralized state health bureaucracy. I'm sure the ethicist saw his suggestion as a "win-win" where Mr. Foley could ease his miserable life and also feel good about saving some money for the system.
Of course, cost and benefit are always a consideration when an individual contemplates any purchase, medical treatment, or suicide. If you remove the individual's ability to do a cost-benefit analysis of a service and you are the monopoly provider of that service, surely that places a duty on you NOT to influence their life and death health decisions based on how much you it will cost.
forced complicity
One of the key features emphasized by advocates of MAID legislation is that no healthcare professional is required to provide MAID services against their own conscience. However, there is a requirement that physicians refer patients to a physician who is susceptible to MAID, which understandably leaves many physicians reticent as it engages them as collaborators in facilitating death. Also, "Doctors across the country reportthat some MAID providers refuse to embrace “most responsible physician” transfer of care, implicating them in a practice they are philosophically opposed to. Some institutions, perhaps not enough MAID providers, even expect MRP conscientious objectors to do the initial MAID screening.”
Taxpayers are forced to fund assisted suicide even if, as individuals, they find it morally reprehensible.
Conclution
It should be clear by now that state-managed suicide has nothing to do with autonomy. It is the lack of autonomy that makes suicide the only option for many.
Sue Rodríguez's question is still valid: "Who owns my life?" The state did not relinquish ownership of her life. He owns her work. In some provinces she has her organs. She presents the choices she can make about her health care. He owns what you can put in your body. If you are a health professional, he is the owner of the services you provide.
I don't have a clear answer to questions about state-assisted suicide, just many deep-seated concerns. Since the State monopolizes health, since the State impoverishes lives while eliminating hopeful options, shouldn't it at least alleviate death? If the state breaks your legs, shouldn't it at least provide you with a crutch? Can be. Since there are legitimately desperate cases like Sue Rodriguez's, and since people should be free to get assistance in dying, and since it's illegal to provide these services out of state, then perhaps the state should provide these services. I do not claim to have any certainty about how a state program should be executed. I leave the claims of certainty in managing other people's lives to liberals, conservatives, and Sith Lords.
My hope in writing this is to get readers to consider how their own belief in a single, universal health care system creates the political demand for the moral quagmire we find ourselves in now. My hope is to get readers to imagine a system with 3 million healthcare professionals, all focused on maximizing value. A system that provided almost endless hope-inspiring options, including the unconventional, the innovative, and the experimental. A system in which individuals are not atomized and isolated in their communities as dependent on a state that controls all their behavior, but rather a life-affirming system in which individuals thrive the more they connect and add value to the people of their community. A system in which assisted dying would not be prohibited, but would instead be provided by people who take personal responsibility and risk personal ruin even for the perception that they are violating one of the many previously articulated ethics that the state violates as something natural. A system where assisted suicide would be much less common because hope would be so much more abundant.
A little hope goes a long way. It was hopelessness that led Amir Farsoud to apply and be approved forMAID instead of facing homelessness. It was individual Canadians who voluntarily came together and financed a home for Amir that gave him hope and prevented a disastrous and unnecessary state assassination.
As you struggle to extricate yourself from the deeply ingrained “all in state, nothing out of state” Canadian healthcare idea, perhaps you can look for opportunities to bring a little life-affirming hope to the hopeless.