Protecting the Vulnerable

Hello, Suicide Prevention Hotline? I Would Like a Medically-Assisted Death

Christopher Snook
December 5, 2022
Plenty of government policies act in opposition to one another. The Bank of Canada raises interest rates to fight inflation while politicians fall over themselves handing out money that will stoke it further. But such efforts are at least no worse than economic farce. Ottawa’s current plan to expand doctor-assisted suicide to cover mental illness while simultaneously claiming to take action against rising suicide rates surely reaches the level of ethical travesty. Christopher Snook examines the moral incongruity of the Trudeau government’s willingness to sanction almost unfettered suicide-on-demand as it also rolls out a national 988 suicide prevention hotline.
Protecting the Vulnerable

Hello, Suicide Prevention Hotline? I Would Like a Medically-Assisted Death

Christopher Snook
December 5, 2022
Plenty of government policies act in opposition to one another. The Bank of Canada raises interest rates to fight inflation while politicians fall over themselves handing out money that will stoke it further. But such efforts are at least no worse than economic farce. Ottawa’s current plan to expand doctor-assisted suicide to cover mental illness while simultaneously claiming to take action against rising suicide rates surely reaches the level of ethical travesty. Christopher Snook examines the moral incongruity of the Trudeau government’s willingness to sanction almost unfettered suicide-on-demand as it also rolls out a national 988 suicide prevention hotline.
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Last year’s national crisis over unmarked graves at Indian Residential Schools across Canada offered the country one concept that everyone can hopefully agree on: “Every Child Matters.” 

Unfortunately, the federal Liberals seem unable to grasp the essential moral content of this assertion. If they could, there’d be no planned expansion of Canada’s already-expansive Medical Assistance in Dying (MAID) legislation. Yet the changes they have already implemented plus those set to take place early next year and into the future will mean that every child does not matter in Canada. Neither will every military veteran. Nor every senior. Nor anyone with a mental illness or physical disability. The ongoing changes to this country’s MAID legislation will deny Canada’s most vulnerable populations the protection that a caring and competent society owes them all. Is this the Canada we know?

A moral contradiction: All Canadians seem to agree that “Every Child Matters,” but the planned expansion of Medical Assistance in Dying (MAID) means that every child does not matter. Neither will every veteran, senior nor anyone weak or fragile. (Source of photo: Wandering views/Shutterstock)

MAID for all Seasons

Canada’s road to assisted suicide began with the 2015 Supreme Court decision in Carter v. Canada, which held that the Criminal Code’s prohibition on assisting or assenting to suicide violated the Canadian Charter of Rights and Freedoms; specifically (although not obviously) the guarantee of the right to life, liberty and the security of the person.

Bill C-14, the first federal legislation on doctor-assisted suicide, was passed in 2016 after just two months of parliamentary debate, a timeline Conservative MP Kelly Block properly called “reckless.” It allowed for physician-assisted dying under specific conditions: that the person be an adult, mentally competent and burdened with a “grievous and irremediable medical condition.” Voluntary assent and the presentation of alternatives were also required. Assisted suicide was thus presented as a final act of mercy hastening an inevitable end.

These limitations were largely lifted when subsequent MAID legislation was passed last year via Bill C-7. Such a move was widely expected; while campaigning in 2019 Prime Minister Justin Trudeau noted about the issue, “We recognize that we need to take more steps to move forward as a society.” As a result, state-approved suicide is now available to almost anyone who wants it and can prove they have a chronic health condition.

The earlier stipulation requiring that death be reasonably foreseeable is gone. Retained is the entirely subjective judgement about what constitutes “unbearable” suffering. Even more worrisome, beginning on March 17, 2023 – following a mandated two-year delay – Canadians whose only underlying medical condition is a mental illness will also be eligible for MAID. As a government website explains, “This includes conditions that are primarily within the domain of psychiatry, such as depression and personality disorders.”

The slippery slope: Conservative MP Kelly Block (top right) called passage of the original MAID bill “reckless”; the new law makes it even more accessible, including to those with only mental illness, something Prime Minister Justin Trudeau (bottom right) said was a “move forward as a society.” (Sources of photos: (top right) Facebook; (bottom right) 360b/Shutterstock)

Opposition to Canada’s initial MAID regime was widespread and diverse. Some, like Kevin Yuill, author of Assisted Suicide: The Liberal, Humanist Case against Legislation, opposed in principle the idea that the state could intervene to end the life of any citizen. Others have observed that the legislation undermines decades of advocacy for expanded palliative care accessibility. Disability rights advocates worried that what might begin as the state’s capitulation to a private person’s feeling that their own life was not worth living could easily become a cultural or political assertion that certain kinds of lives are unworthy.

Many also saw assisted suicide as reviving a disturbing aspect of the early 20th century North American eugenics movement, with its forced sterilization of the “feeble-minded,” or even the Nazi regime’s pursuit of “public hygiene” through the elimination of the mentally and physically disabled. Modern eugenic echoes can certainly be heard in Iceland’s cultural aversion to children with Down’s Syndrome, where pre-natal screening and selective abortions have led to the near total disappearance of such children. Then there’s the tone-deaf impact on Canada’s Indigenous population. Canada’s first MAID law took effect the same year that the native community of Attawapiskat in northern Ontario declared a state of emergency due to a suicide contagion that included 11 deaths in one night.

For many critics, assisted suicide revives memories of the Nazi regime’s horrific practice of eliminating the mentally and physically disabled. (Source of photo: Federal German Archives)

Once the upcoming changes regarding mental illness are unleashed, we can likely brace ourselves for further demands that it cover so-called “mature” minors. And if the Quebec College of Physicians has its way, it could even be widened to cover what are euphemistically called “after-birth abortions” – that is, the legalized killing of infants up to one year of age. Every child matters indeed.

Conservative ethicists including Wesley Smith, as well as the United Nations, the Journal of Ethics in Mental Health, business magazine Forbes and a host of other organizations and publications have all decried Canada’s new changes, what we might call MAID 2.0, for the further denigration of the disabled and its irrational assumption that those who are by definition least able to recognize their own best interests (that is, the mentally ill) should nonetheless be considered able to consent to their own deaths. Canada now regularly makes global headlines for having one of the world’s most permissive assisted-suicide policies. One of many is “The barbarism of Canada’s euthanasia regime,” recently published in Spectator World. It’s hardly the image most Canadians hold of their country.

Canada’s Real Suicide Epidemic

No public policy exists in a vacuum. And throughout the time since the Supreme Court invented the right to a doctor-assisted suicide and the Trudeau government eagerly implemented and expanded upon it, another crisis of far greater immediacy has also been spreading across the country.

Suicide – of the privately-arranged variety – is often described as Canada’s “hidden epidemic.” In 2019 there were over 4,000 deaths by suicides, making it the ninth most common cause of death in pre-Covid Canada. The suicide rate among Indigenous people from 2011 through 2016 was three times higher than the national average for non-indigenous Canadians – rising to a staggering nine times higher for Inuit communities in the North. The leading cause of all this self-harm is depression; in 2017, the World Health Organization ranked depression as the number-one cause of disability on the planet.

A “hidden epidemic”: In 2019, suicide was the ninth leading cause of death in Canada, and roughly three times more prevalent among Indigenous communities. Depression is the leading cause and these “deaths of despair” are on the rise, says American medical ethics expert Aaron Kheriaty (right). (Source of left image: Athabasca University)

Since Covid-19, rates of mental illness have only grown as the associated lockdowns and other forms of government-imposed isolation took their toll. According to the Canadian Mental Health Association, the rate at which Canadians had suicidal thoughts more than doubled from the start of the pandemic – rising from 2.5 percent to 6 percent. Calls to the Kids Help Line increased by 350 percent in the first few months of the pandemic. Writing in Public Discourse, American medical ethics expert Aaron Kheriaty refers to the staggering rise in mental health issues and related “deaths of despair” as “the other pandemic.”

Governments and the charitable sector have responded to this growing disaster with a host of new programs and spending. This past summer, for example, Saskatchewan announced it was offering training for 1,800 volunteer suicide prevention workers as part of its broader “Pillars of Life” provincial suicide prevention program. The Okanagan Charter, which promotes wellness on university campuses, is among the most recent of a seemingly endless stream of wellness initiatives at institutions of higher learning meant to address student mental health challenges. Private sector organizations, such as the Montreal-based Graham Boeckh Foundation, are also pouring resources into innovative mental health initiatives to bring down youth suicide rates.

 Last month the federal Minister of Health issued a news release marking International Survivors of Suicide Loss Day, referring to suicide as “a significant public health issue.” It also reminded voters of Ottawa’s $21 million-five-year commitment to tackle the issue head-on. Among the initiatives is a new national three-digit suicide hotline set to go live next year. This 988 service will replace the current system that offers suicide counselling and support for anyone who calls 1-833-456-4566 across the country. “The Government of Canada continues to invest in mental health supports for Canadians,” the release stated.

Two Hands Fighting Each Other

As this simultaneous broadening of MAID alongside new public and private investments in suicide prevention reveals, Canada has apparently decided to fight the problem of self-harm on two mutually irreconcilable fronts. On the one hand, suicidal ideation is being addressed in the public and private sectors through squadrons of frontline workers trained to lead people out of despair via new hotlines, campus programs and other national, provincial and local efforts. Yet the nation is also working to actively affirm people in their despair by making suicide readily available to almost anyone who wants it.

New research by economists Sourafel Girma (top right) and David Paton (bottom right), shows strong evidence that MAID laws lead to an increase in total suicides; normalizing suicide makes prevention more difficult.

Further complicating this profound contradiction is newly-emerging evidence suggesting that jurisdictions which permit MAID experience higher rates of non-assisted suicide than those without. According to an academic paper published earlier this year in the European Economic Review by Nottingham University economists Sourafel Girma and David Paton, U.S. data offers “strong evidence that legalization of assisted suicide is associated with an increase in total suicides, especially for females and older people.” It appears that by normalizing suicide, MAID laws push those already at the edge right over it. Public and private rates of suicide thereby rise in tandem. All of which makes suicide prevention even more difficult in the presence of MAID legislation.

In a recent essay in Law & Liberty, Amanda Achtman framed the dichotomy of Canada’s competing suicide policies as one in which society is attempting to decide, “Who gets suicide prevention and who gets suicide facilitation?” Her poignant query deftly pulls back the curtain on the illusion promoted by advocates that suicide at one’s own hand and assisted dying are somehow different things.

Simply using the term MAID is an attempt to steer the public away from value-laden terms like euthanasia and assisted suicide, says John Mahar (left) of the Journal of Ethics in Mental Health; Amanda Achtman (right) says Canada’s suicide policy is one in which society decides “who gets suicide prevention and who gets suicide facilitation.”

Much of this has to do with the subtle crafting of language around the issue. John Mahar, editor-in-chief of the Journal of Ethics in Mental Health (JEMH), has ably critiqued the invention of the phrase “medical assistance in dying” as an effort to steer the public away from terms like “euthanasia” and “assisted-suicide.” As Mahar observed, “Using the term ‘MAID’…is an attempt to separate ‘suicide’ from its value-laden meaning and thousands of years of moral reflection.”

For most of history the concept of a “good death” meant submission to an event beyond our control, indicative of a larger and lifelong acceptance of the mystery of life itself. Today MAID is supposed to portray assisted suicide as a corporeal work of mercy. That we have so quickly come to think of “dignified death” as a departure over which we exercise direct control – a kind of last moment of self-mastery or a sleight-of-hand by which we do for nature what nature is well-able to do on its own – is a victory of a purely materialistic sense of self.

“Cozily and on Cat’s Feet”

With MAID 2.0 we are witnessing the rapid erosion of a fundamental principle of Canadian political culture: that it is the state’s role to safeguard the vulnerable. This includes troubling evidence that Canadians in precarious positions are being pushed towards assisted dying as a legitimate “treatment” option. Consider the well-publicized plight of Roger Foley, a homeless man in London, Ontario, who was goaded into considering assisted death as a cost-saving measure by health staff. Recent reporting by the National Post that at least five Canadian Armed Forces veterans have had MAID proposed to them by a Veterans Affairs case worker raises further grave concerns regarding misuse of the policy.

American journalist Derek Humphry (left) predicted cultural pressures would make choosing death appear to be the moral choice for the impoverished; Canadian philosopher George Grant (right) warned of a creeping totalitarian impulse to deny the right to life to those “who cannot defend themselves.” (Source of left photo: Sawade1056, licensed under CC BY-SA 4.0)

As these incidents suggest, end-of-life decisions are quickly being transformed from ethical dilemmas into cost-benefit analyses. Derek Humphry, an early advocate of assisted suicide, admitted in his 1998 book Freedom to Die (co-written with Mary Clement) that, “In the final analysis, economics, not the quest for broadened individual liberties or increased autonomy, will drive assisted suicide to the plateau of acceptable practice.” Humphry predicted that cultural pressures would make choosing death appear as the moral choice for the economically impoverished or unproductive. Gone will be the once-powerful arguments of the inherent dignity of the human person, the infinite value we ascribe to our children and the long tradition of speaking about humans as something other than spreadsheet entries.

Canadian philosopher George Grant warned half a century ago of this growing commodification of human life in the modern era. He foretold that an implicit totalitarian impulse would creep across North America “cozily and on cat’s feet,” systematically denying the right to life of “all those who cannot defend themselves. It will come in the name of the cost-benefit analysis of human life.”

All this accumulating evidence suggests that the liberalization of assisted suicide signals the return of eugenics through the backdoor. The bureaucratic machine of contemporary culture demands the continual extinction of those who muck up the gears. Though, in a remarkable work of modern magic, this implicit urge to do away with the disabled, the elderly and the psychologically suffering is now presented as a compassionate sentiment that facilitates a victory for self-determination and autonomy.

The real evidence of MAID shows that euthanasia is no such thing. Rather, its core motivation appears to be a kind of loneliness. Canada’s 2021 MAID report notes that 10,064 Canadians chose assisted suicide last year – an increase of one-third from the year previous. Of these, 86 percent said they did so because they’d lost the ability to engage in meaningful activity. But as Swedish ethics researcher Fabian Stahle observed in the JEMH in 2017, “A wish to die most often is an expression of depression that can be treated with far better methods than a lethal prescription.” As Canadians with mental illness are allowed access to MAID in the new year, Stahle’s advice will grow increasingly significant.

More than 10,000 Canadians chose assisted suicide in 2021 – a one-third increase from the previous year; its core motivation appears to be a kind of loneliness. (Source of graph: Third Annual Report on Medical Assistance in Dying in Canada 2021)

Further, Canada’s most recent MAID statistics are notable both for their dramatic increase and the startling lack of interest in Canadian society to discuss their implications. But if 4,000 annual private suicides are sufficient to spark widespread action from all levels of government, what should we think about another 10,064 suicides facilitated by government?

You Want it Darker?

Canadians should have the right to expect their governments will to go to extreme efforts to protect the weak and voiceless. With MAID 2.0 Canada appears on the verge of losing its capacity to claim to be a political culture worthy of respect, emulation or longevity. We no longer affirm the inherent goodness of existence or our obligation to carry other’s burdens. Such compassion has been replaced with a validation of individual desires to die. Surely such a change marks the end of a just nation-state. Grave tragedies await. How long will it be before a mentally-ill teenager has their suicidal wishes confirmed and carried out by the state over their parents’ objections? We are creating a national moral crisis under the guise of medical bureaucratic proceduralism.

Abandoning compassion and the urge to protect the weak creates a moral crisis; just wait until a mentally-ill teenager has their suicidal wishes carried out by the state over their parents’ objections. (Source of photo: Shutterstock)

Shortly before his death, Leonard Cohen released one of the most haunting songs of his long career, the Grammy Award-winning “You Want it Darker.” Singing ostensibly to God, Cohen asks, “You want it darker/We kill the flame.” It was, one might argue, Cohen’s assessment of a lifetime that begin within shouting distance of the Auschwitz gas chambers, followed by the Cold War, the Korean War, the Vietnam War, two Gulf Wars and a lifetime of other anguishes and laments.

To think seriously about our current situation – and to take seriously the argument that Every Child Matters – Canadians need to confront their aversion to difficult conversations and their passivity in the face of radical cultural contradictions. We lament the rise in privately-provided suicide as a grim epidemic that must be stopped, while some of us laud the publicly-delivered variety as a moral victory. We live during a cultural moment more sensitive than ever to the historical marginalization of women’s voices yet at the same time regard as impolitic any suggestion that a citizen might reasonably ask if their tax dollars are supporting gender-selective abortion overseas. Our nation happily invests in accommodations for the physically and mentally challenged while also speedily following Iceland, where the disabled are terminated in the womb. Canada loudly affirms its solidarity with Indigenous peoples while passing legislation that will leave communities with the highest rates of suicide in the hands of a not-so-benevolent, suicide-enabling government.

If, as Cohen sang, things are darker now, it is no accident: we kill the flame.

Christopher Snook is a lecturer in the Faculty of Arts and Social Sciences at Dalhousie University in his hometown of Halifax, Nova Scotia. A widely published poet, he is the author of the 2018 collection, Tantramar Vespers.

Source of main image: Shutterstock.

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