Canada boasts one of the world’s highest assisted-death rates, supposedly enabling the terminally ill to die with dignity. However, this suicide program increasingly resembles a dystopian replacement for care services, exchanging social welfare for euthanasia.

A patient decides on euthanasia on February 1, 2024. (Simon Wohlfahrt / AFP via Getty Images)

For want of a mattress, a man is dead. That’s the story, in sum, of a quadriplegic man who chose to end his life in January through medically assisted death. Normand Meunier’s story, as reported by the CBC, began with a visit to a Quebec hospital due to a respiratory virus. Meunier subsequently developed a painful bedsore after being left without access to a mattress to accommodate his needs. Thereafter, he applied to Canada’s Medical Assistance in Dying (MAiD) program.

As Rachel Watts writes in her report, Meunier spent ninety-five hours on a stretcher in the emergency room — just hours short of four days. The bedsore he developed “eventually worsened to the point where bone and muscle were exposed and visible — making his recovery and prognosis bleak.” The man who “didn’t want to be a burden” chose to die at home. An internal investigation into the matter is underway.

Disability and other advocates have been warning us for years that MAiD puts people at risk. They warned that the risk of people choosing death — because it’s easier than fighting to survive in a system that impoverishes people, and disproportionately does so to those who are disabled — is real. Underinvestment in medical care will push people up to and beyond the brink, which means some will choose to die instead of “burden” their loved ones or society at large. They were right.

MAiD as the Failed Social Welfare State

Canada now has one of the highest assisted-death rates in the world. As the Guardian reported in February, 4.1 percent of deaths in the country were physician-assisted — and the number is growing, up 30 percent between 2021 and 2022. In a survey of just over 13,100 people who opted for MAiD, a significant majority — 96.5 percent — chose to end their lives in the face of terminal illness or imminent death, Leyland Cecco, author of the report, noted. But 463 chose it in the face of “a chronic condition.”

A libertarian ethos partially underwrote the fact that not many people blinked when MAiD was initially rolled out. Taking a more expansive view of rights, many of those not swayed by rote libertarianism were convinced that concerns over bodily autonomy and compassion were reason enough to adopt MAiD. However, in the absence of a robust welfare state, and in the face of structural poverty and discrimination, particularly toward disabled people, there is no world in which the MAiD program can be understood to be “progressive.”

Indeed, last year, Jeremy Appel argued that MAiD was “beginning to look like a dystopian end run around the cost of providing social welfare.” Initially supportive, he changed his mind on MAiD as he considered that the decisions people make are not strictly speaking individual but are instead collectively shaped and sometimes “the product of social circumstances, which are outside of their control.” When we don’t care for one another, what do we end up with?

“I’ve come to realize,” wrote Appel, “that euthanasia in Canada represents the cynical endgame of social provisioning with the brutal logic of late-stage capitalism — we’ll starve you of the funding you need to live a dignified life [. . .] and if you don’t like it, why don’t you just kill yourself?”

Bracketing the question of whether the program should even exist at all, permitting those suffering from mental illness to access a suicide program — which the government was prepared to allow before rescheduling the controversial expansion of the law until 2027 — is the stuff of nightmarish science fiction. We can instead focus on the absurd and disturbing reality that our underfunded and subpar administration of care in Canada has led some up to, and through, the door of assisted death. As things stand, more will follow. It’s grotesque.

In Canada’s most populous province, Ontario, a recipient of disability support receives about $1,300 a month — a pittance they’re meant to stretch to cover food, shelter, and other basic needs. Ontario Works — the province’s welfare program — pays a current maximum of $733 a month. Meanwhile, rental costs for a one bedroom apartment routinely push toward an average of $2,000 a month in many cities. In April, in Toronto, a one bedroom apartment averaged almost $2,500 a month.

Euthanized by the State

In a 2023 paper in the Canadian Medical Association Journal entitled “What Drives Requests for MAiD?” James Downar and Susan MacDonald argue that

[d]espite fears that availability of MAiD for people with terminal illness would lead to requests for MAiD driven by socioeconomic deprivation or poor service availability (e.g., palliative care), available evidence consistently indicates that MAiD is most commonly received by people of high socioeconomic status and lower support needs, and those with high involvement of palliative care.

By their own admission, the data on this matter is imperfect. But even if it were, the fact that “most” patients who choose MAiD are better off socioeconomically is beside the point. Some are not — and those “some” are important. That includes a man living with Amyotrophic Lateral Sclerosis  who, in 2019, chose medically assisted death because he couldn’t find adequate medical care that would also allow him to be with his son. It also includes a man whose application listed only “hearing loss,” and whose brother says he was “basically put to death.” This story came a year after experts raised the concern that the country’s MAiD regime was in violation of the Universal Declaration of Human Rights.

In 2022, Global News said the quiet part out loud: poverty is driving disabled Canadians to consider MAiD. Those “some” who are driven to assisted death because of poverty or an inability to access adequate care deserve to live with dignity and with the resources they need to live as they wish. They should never, ever feel the pressure to choose to die because our social welfare institutions are starved and our health care system has been vandalized through years of austerity and poor management.

Given the way our institutions and economic and political elite create and perpetuate poverty in Canada, particularly among disabled people, we should be particularly sensitive to the implications of the country’s MaiD regime for those who are often ignored when warning about the dangers of the law.

The fact that we collectively have the wealth, means, and resources to address endemic poverty and provide adequate care to all but choose not to while any number of poor and disabled people are euthanized by the state is profane.

For Whom the Bell Doesn’t Toll

In a February piece for the Globe and Mail, University of Toronto law professor Trudo Lemmens wrote, “The results of our MAiD regime’s promotion of access to death as a benefit, and the trivialization of death as a harm to be protected against, are increasingly clear.” In critiquing MAiD’s second track, which allows physician-assisted death for those who do not face “a reasonably foreseeable death,” Lemmens points out that within two years of its adoption, “‘track two’ MAiD providers had ended already the lives of close to seven hundred disabled people, most of whom likely had years of life left.”

In raising concerns about expanding MAiD to cover mental illness, Lemmens added that “there are growing concerns that inadequate social and mental health care, and a failure to provide housing supports, push people to request MAiD,” noting that “[a]dding mental illness as a basis for MAiD will only increase the number of people exposed to higher risks of premature death.”

In 2021, Gabrielle Peters warned in Maclean’s that extending MAiD to cover those who weren’t facing an immediately foreseeable death was “dangerous, unsettling and deeply flawed.” She traced the various ways in which a broader MAiD law could lead to people choosing to die in the face of austerity, adding an intersectional lens that is often missing from our discussions and debates over the issue.

She warned that we were failing to consider “how poverty and racism intersect with disability to create greater risk of harm, more institutional bias and barriers, additional layers of othering and dehumanization, and fewer resources for addressing any of these.” And now here we are. We should have listened more carefully.

While MAiD may be defensible as a means for individuals to exercise personal choice in how they live and how they die when facing illness and pain, it is plainly indefensible when state-induced austerity and mismanagement leads to people choosing to end their lives that have been made unnecessarily miserable. In short, we are killing people for being poor and disabled, which is horrifying.

It thus falls to proponents of MAiD to show how such deaths can be avoided, just as it falls to policymakers to build or rebuild institutions that ensure no one ever opts to end their life for lack of resources or support, which we could provide in abundance if we choose to.

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