FR. RAYMOND DE SOUZA AND FOUR PAGES OF COMMENT.

The legislative expansion of assisted suicide, combined with four critical developments in the last year, herald a new medical ethos in Canada: the state medical apparatus will have control over the deaths of an increasing number of Canadians.

No one professes to want that result, but the underlying plates are aligning in such a way as to do just that.

The federal government’s reform of its medical assistance in dying (MAID) legislation, bill C-7, will permit Canadians to request a lethal injection, even if death is not proximate or reasonably foreseeable. It’s not exactly death on demand for anyone who asks, but that’s what it is for anyone who has a serious medical problem, even one that can be readily treated.

The Senate amendments to the government’s bill will permit MAID to be administered in response to a request made years in the past, such as in the case of geriatric dementia. The Senate amendments also pave the way for an expansion of MAID for mentally ill people who are neither elderly nor dying.

If C-7 passes, Canada will have abolished medical assistance “in dying” and replaced it with “medically assisted death,” independent of whether the patient is dying or not. Suicide — and the right to have another administer the lethal injection or fatal dose — will become a positive good, in law and in medicine.

bill C-7 is about making suicide mainstream. In 2019, assisted suicide accounted for two per cent of all deaths in Canada, a 25 per cent increase from 2018. The change in medical culture will soon drive that figure much higher. Four trends are in place for that acceleration.

First, palliative care is lacking. It is what most Canadians want — an end to burdensome therapies, sophisticated symptom treatment, pain management, comfort and care with family close by. yet most Canadians can’t get it, as palliative and home care are chronically underfunded. Lack of access to palliative care for the terminally sick, and to effective home care for the disabled, are big drivers of MAID.

Nowadays, suicide promotion is being foisted upon palliative care. Patients increasingly report being offered MAID as an option when they enter into palliative care. Some palliative care budgets — which are already stretched — are being used instead for MAID.

british Columbia recently shut down a long-standing hospice because it would not perform MAID, even though it is readily available nearby.

A second trend is the effort, which is increasing in the medical community, to make MAID an option of first resort, rather than last. That’s why the disabled community is aghast at C-7. One parliamentary witness testified that she was asked to consider MAID when she had a very treatable case of pneumonia — and she was in her 20s. Far from extreme cases in close proximity to death, the changing medical culture offers patients a lethal injection alongside other treatment options, as if being helped to die is equivalent to being helped to live.

Those two trends affect the supply side of suicide. What about the demand?

A third trend is the acceptability of triage. Canadian health care has long operated on the basis that all who are sick are treated in principle, even if they have to wait in practice. The pandemic introduced into the public discussion the principle that, in extremis, some would not be treated. That hasn’t come into effect yet, but a conceptual threshold has been crossed.

As the rapid shift from MAID to mainstream suicide has shown, what begins in extremis is normalized very quickly.

The fourth trend is the reverence for “health-care capacity,” which has reversed the usual relationship between the healthcare system and patients. before the pandemic, the patient, when sick, turned to the health-care system for healing. The coronavirus turned that upside down. People now have a moral obligation not to require treatment, in order to protect the health-care system. Tens of thousands of patients needing surgery were told to go without it this past year.

In Great britain, the principal rallying cry of the pandemic has been to “Protect the NHS.”

What happens when you put C-7’s mainstreaming of suicide together with these four trends? It’s not hard to imagine. Once suicide facilitation is offered alongside other treatments, the entire ecology of therapy changes. The question is no longer “What can we do?” but “Should we bother?” When assisted suicide is made available to the mentally ill — which the government says could become a reality in two years — it will act like an accelerant on a fire.

This will lead to more pressure put on the ill and disabled, especially in light of the rising cost of treatment. Why take up a bed for weeks, when you can be in the morgue by sunset? Why provide years of daily home care supports for the disabled when a lethal injection is available right now?

That would never happen in Canada, you say? but we were told just six years ago, by no less than the Supreme Court, that exactly what we are doing now would never happen in Canada. In 2015, it was about extreme cases. In 2021, it’s about making suicide mainstream health care.

And when that kindly ICU doctor asks whether or not grandma wouldn’t want to do her bit to protect the health-care system, to free up capacity for others, what will her family say? And when an accident victim arrives, facing a lifetime of disability and diminishment, won’t hospital administrators, influenced by their triage protocols, see an opportunity to save resources for cases with better prospects?

It won’t happen tomorrow. but it will happen — sooner rather than later.