(RNS) — In just a few days, Canada’s revised — and poorly named — “Medical Assistance in Dying” bill will come into effect. It is poorly named because, at least as it was originally passed, people whose “sole underlying medical condition is a mental illness” were considered eligible for physician-assisted killing.
Such people, obviously, are very often not dying.
The Canadian government has proposed delaying the mental illness provision one year: until March 17, 2024. But the bill still allows those who have “a serious and incurable illness, disease or disability” to be killed as long as the following two criteria are met:
- Be in an advanced state of irreversible decline in capability.
- Have enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable.
Disability rights activists have rightly been up in arms over this. Even if one thinks “aid in dying” is acceptable, this is obviously not that. This is a capitulation to an ableist, consumerist throwaway culture in which those who do not get adequate care are structurally coerced to think of their lives as not worth living.
The New Atlantis has done some great reporting on what is actually going on here, and what it found is profoundly disturbing. People who otherwise want to live cannot get the support and care they need and thus feel compelled to “choose” physician-assisted killing. Sometimes that’s because health care providers have actually brought it up as an option when they, say, weren’t able to get a wheelchair ramp into their home or needed spinal surgery. This is not a real choice, but rather pressure on the poor and vulnerable to seek a physician who will help kill them in the midst of profound injustice.
The ideological support for physician-assisted killing is so strong in the halls of power in Canada’s medical fields that, well, even the organizations you think might not be in support of it have offered their support.
Consider, for instance, the fact that the Alzheimer’s Association — the organization that is supposed to value and defend the dignity and goodness of human beings with this disease — actually decided to work hand-in-glove with Compassion and Choices (formerly the Hemlock Society), an organization committed to killing more people with dementia. Only after incredible blowback from civil rights and disability rights activists did the association put out a release saying the values of Compassion and Choices “are inconsistent” with those of the Alzheimer’s Association.
Significantly, the association said, “We deeply regret our mistake, have begun the termination of the relationship, and apologize to all of the families we support who were hurt or disappointed.”
This is a step in the right direction, but it reveals something about the current structures of our medical system in the developed West. We are terribly ableist. We imagine anyone who needs help to thrive as a “burden” — both on themselves and on the culture at large — and thus the compassionate and wise thing to do (especially when it comes to just allocation of scarce resources) is to structurally encourage people with Alzheimer’s disease to end their lives.
Take, for instance, the recent recommendations published by the Canadian Parliament’s Special Joint Committee on Medical Assistance in Dying. It is bad enough they are recommending that disabled “mature minors” who deem their suffering unacceptable could request physician-assisted killing (perhaps even over the objections of their parents!), but they are explicitly clearing the field for advanced directives for those with dementia:
Recommendation 21: That the Government of Canada amend the Criminal Code to allow for advance requests following a diagnosis of a serious and incurable medical condition, disease, or disorder leading to incapacity.
Nearly 20 years ago, Nigel Biggar — a chaired professor of moral theology at Oxford — warned in his important book “Aiming to Kill” that once you open the door to physician-assisted killing it becomes very difficult to say why reason X is acceptable and why reason Y is not. Why person A who says their suffering is unbearable should be believed, while person B who offers a different story should not be believed. All that’s left to honor, says Biggar, is respecting the (so-called) choice of the individual.
What we need is a thick vision of the good, which goes well beyond mere autonomy and choice— like the one offered by Gilbert Meilaender in his wonderfully provocative First Things article from 2010 titled “I Want to Burden My Loved Ones.” In the article, Meilaender suggests that, just as our children “burdened” us when we were parents, so too should we “burden” our children in turn.
Of course, he’s playing with the word “burden” here, making it clear that he totally disagrees that infringing on someone’s autonomy is something to be avoided. On the contrary, he suggests that, in its place, we work toward a Christian vision of love. That vision turns our consumerist throwaway culture’s assumptions on their head and, yes, turns a burden into something else. Something that, while genuinely difficult at times, is nevertheless a true gift.
As my own children grow older and move on to different phases of their lives, I can now look back at the burdens of those first few years with regret that I no longer have the opportunity to be burdened by them in that way. That is, that I no longer have the gift of being able to love and care for them that way. And while my children still provide me with other gifts (sometimes ones that can seem quite burdensome!), there is a deep and profound loss of being able to love in those specific ways of childhood.
So it should be for those with dementia and other disabilities. Instead of capitulating to a consumerist throwaway culture that puts their value up for debate, we should focus on how to burden ourselves with love and care for one of the most vulnerable populations imaginable.