Denial of Meaningful Choice

It would be safe to say that, even three years ago, no one would have dared propose medically assisted death as a standard end of life treatment in Canada.

Of course not. The roots of public support for MAID lie in its proposal as an affirmation of personal autonomy. MAID was to be an exceptional option: to allow people to choose death at the hands of willing doctors. The motivation was political, not medical. Few would have suggested that there could be objective medical indications for euthanasia. In fact, there has never been a deep and structured discussion among Canadian doctors as to whether it can be properly called medical treatment at all.

Today in Canada we find two options for the end of life: Medical Assistance in Dying, and Palliative Care. It would appear that patient choice is respected: we think not.

Firstly, the choice is presented as between two equally valid medical solutions, but it is not. Euthanasia only became “medical” to circumvent homicide laws, beginning in Quebec, where it was legalized by a provincial government having no jurisdiction to permit an act prohibited by the Criminal Code. Palliative Care, on the other hand, is the best medical practice to relieve symptoms when cure is no longer possible, and even alongside active treatment. It is the product of the science and art of medicine coming together in the 20th century as rarely before, and continues to evolve to provide exquisite symptom control along with care for the whole person. These are not two medical alternatives: one is medical, and the other is not.

Secondly, there is also a false equivalence in the presentation, similar to that in which a real estate agent might show one property that responds to the needs of the buyer, and another, perhaps at an advantageous price, that he has been trying to get rid of for months. Ninety-nine people will buy the first property for each one who chooses the “special opportunity”. There should be ninety-nine good properties on that list. But the agent puts only one in order to promote the sale of his preferred option. He wishes to produce the illusion of a rational binary choice: as is now done between palliative care and euthanasia. The latter is cheap; it eliminates people whose care is costly; and it can be planned and scheduled to optimize efficiency.

The vast majority of people will not voluntarily choose to die before the very last moment available to them. Between real health care and immediate death, they will overwhelmingly choose health care… if, of course, it is available to them. Which brings us to the third and most important problem: resource availability.

Palliative care physicians in Quebec recently pointed out that the MAID aspect of the Act respecting end of life care has been diligently applied and documented, alongside an astonishing lack of data on the implementation of the palliative care side; indeed palliative care has suffered greatly in the past two years because of Health Ministry policies. This is a serious concern. For over forty years palliative care has moved forward slowly but steadily, as the medical establishment and the public became convinced of its value. Great progress has been made. Now there is a cheap, efficient, non-medical substitute: why fund and promote palliative care?

The same question could be applied to the often-stated goal of supporting persons with disabilities who choose to remain in their home. Roger Foley of London Ontario, who has cerebellar ataxia, is currently in hospital and refusing discharge because serious gaps and errors in his state-funded home care led to emergency admissions more than once, and he does not want to return to being cared for by the same agency. He has launched a lawsuit against various government entities, claiming a right to self-directed, publicly-funded home care. That option has so far been denied, most likely because of budgetary constraints. At first glance the situation is not unusual. But thanks to legal euthanasia, it is different from all others in the past. Now there are choices.

Mr. Foley, who is not terminally ill, has been offered a choice between a) returning to his inadequate home care situation, b) paying a fee of $1800 per day to remain in hospital, or, c) “choosing” medical assistance in dying. No longer must the public system hold onto patients like this. It might once have been unthinkable to turn them out in the snow, but today we have a cheap therapeutic option with a 100% success rate: MAID.

Death is promoted as a choice and a treatment, although all admit it is a one few would choose. Once available, it is artificially favoured by administrators who no longer attempt to satisfy the needs of the majority. Before we know it, we’ll see the total suppression of any meaningful choice at all.

Euthanasia was first presented as the only alternative to unbearable suffering… now unbearable suffering may become the only alternative to euthanasia!

As citizens, patients and taxpayers, we must call for what the majority needs and chooses:  real medical care. And as medical professionals, we must never tire in our resolve to provide that care: whatever the circumstances, whatever the constraints.

Make euthanasia unimaginable.


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