How to not euthanize the homeless
Canada should start over with MAID
Arecent Research Co. poll suggests nearly 30 per cent of Canadians believe homelessness should be adequate grounds to seek medical assistance in dying (MAID). It's a “surprisingly high” number in my colleague Colby Cosh's estimation, and my sense is most Canadians agree. On social media, folks alarmed by Canada's current trajectory on euthanasia have wrapped it into a sort of rapidly-unfolding-dystopia narrative — understandably, considering how quickly and needlessly Canada has lost the plot on euthanasia.
The good news is, it's not too late for Canada to craft a defensible, compassionate and non-dystopian assisted-dying regime. We just need to go back to the drawing board.
The poll landed more or less concurrently with an “extended essay” in the Journal of Medical Ethics by University of Toronto philosophy professors Kayla Wiebe and Amy Mullin, who argue we mustn't deny MAID to those seeking it on account of “unjust social circumstances.”
That's something we've heard much about in recent months: The man applying for MAID in terror of finding himself homeless; the woman unable to find housing suitable for her multiple chemical sensitivities (an especially tricky case, since medical science doesn't recognize the condition).
“The fact that better supports are not provided in cases like these is abhorrent and the lack of options constitutes a deep injustice,” Wiebe and Mullin conclude. “(But) restricting an autonomous choice to pursue MAID due to the injustice of current non-ideal circumstances causes more harm than allowing the choice to pursue MAID, even though that choice is deeply tragic.”
It has always seemed to me that the most permissive visions of euthanasia being promoted in Canada run counter to the harm-reduction principle that many of the same people promote with respect to drug addiction. Some Canadian jurisdictions offer addicts supervised injection sites, and thus a near-zero chance of overdosing fatally. Some offer addicts a “safer supply” of drugs on the same principle: They can't get better if they don't stay alive.
Wiebe and Mullin actually argue for MAID in situations of social injustice as a harm-reduction approach. It boggles my mind. I'm convinced almost everyone is making this far more complicated than it needs to be.
The Research Co. poll suggests 73 per cent of Canadians support allowing MAID for those with “a grievous and irremediable medical condition” — Canada's original law, more or less, before it was swiftly broadened. Only 16 per cent oppose that, the poll suggests. Solid majorities in every region, age group and political affiliation are on board with helping people who are already suffering at death's door step across the threshold, on their own terms. There are some tricky lines to be drawn within that proposition, but really not that many.
Then there's everything else. There are serious medical conditions — physical and psychological — that won't kill the patient in the short term, if ever. There are conditions like electromagnetic hypersensitivity and multiple chemical sensitivity, which undeniably cause suffering even though they can't scientifically be proven to exist. There are social conditions like poverty, woefully inadequate housing, or homelessness.
Certainly with respect to the latter, I'm astonished anyone in the medical community wants anything to do with prescribing MAID. It's not to diminish the suffering that comes with the aforementioned afflictions simply to say that they aren't terminal medical conditions — or medical conditions at all — and thus shouldn't be treated with medical assistance in dying.
So what if we created two separate regimes: Medical assistance in dying and, just, assistance in dying.
This idea first came to me as very black comedy, but more and more I think it's at least a useful thought experiment: If you have a painful, untreatable and terminal illness, we'll offer you medical assistance in dying. In other cases — rules and regulations to be determined — we might send you home with a cocktail of lethal drugs, or require you to take them in front of a death registrar or other government official.
In fact, that's what “medical assistance in dying” means, other than in Canada. (Everyone else calls what we do “euthanasia,” but for some reason we didn't have the stomach for the E-word.) Oregon's and Washington's MAID regimes, for example, require patients to self-administer a fatal drug cocktail, prescribed by a doctor under strictly controlled circumstances (which do not include homelessness, needless to say). But there's no reason Ottawa couldn't allow social workers or shelter managers to hand them out as they see fit.
This would trigger the same complaints we hear about every proposal to “limit” MAID — that it infringes upon the “rights” of Charter-protected groups. But as I've argued before, medicine is almost never about “rights.” It's about diagnosing illnesses and treating them appropriately. You can't get a kidney transplant for depression, or a fentanyl prescription for an ingrown toenail, and you bloody well shouldn't get a fatal dose of barbiturates for depression. At least my modest proposal would save the medical profession the indignity of euthanizing the homeless. At least it would make some kind of grim, practical sense.
But the real solution, of course, is for Ottawa to nut up and draw the line where most Canadians want it drawn: terminal, untreatable, painful. The Research Co. poll suggests 20 per cent of us think MAID should be available to anyone for any reason. If that's surprisingly high, it's still a hell of a lot less than 80 per cent. There is wisdom in crowds.
MEDICINE IS ALMOST NEVER ABOUT `RIGHTS.'