Legalizing medical aid in dying for Canadians living with disabilities: What does this say about us?

by Dr. Ewan Goligher

On September 11, 2019, a Quebec judge overturned the law restricting euthanasia (widely referred to as ‘medical aid in dying’) to patients in whom natural death was “reasonably foreseeable.” The federal government has indicated that they will not appeal the decision and are prepared to modify the law accordingly. These developments require sober consideration for they speak volumes about the inexorable logic of euthanasia and about our attitudes towards those with disabilities. The Quebec ruling must be overturned to prevent further cascading demands on assisted dying legislation and to safeguard our most vulnerable citizens.

Euthanasia is offered as a means of escaping pointless and irremediable suffering. Yet we need not be dying in order to experience suffering that seems pointless and hopeless to us. Therefore, restricting euthanasia to those in whom natural death is reasonably foreseeable violates the intrinsic logic of euthanasia. If life is sufficiently hard and suffering sufficiently grievous, we might come to think that we are better off dead long before natural death becomes reasonably foreseeable. Such is the bleak logic of euthanasia.

Following this logic, is it possible to put any limits on euthanasia at all?

Just what kinds of suffering should be eligible for euthanasia? Surely psychological and existential suffering are just as (if not more) unbearable than physical pain. Therefore, patients with protracted severe depression and mental illness should also be eligible, as some argue.

What if I merely anticipate grievous suffering and this makes life pointless to me? What if my condition might get better but I don’t want to wait and endure to find out? How disabled do I need to be for my suffering to qualify for euthanasia? And who gets to answer these questions?

Any attempt to impose answers to these questions upon individual patients violates the commitment to personal autonomy and control that underpins the logic of euthanasia—as Dying with Dignity Canada states: “My life, my choice.”

Followed to its logical conclusion, euthanasia is really for anyone at any time under any circumstances, provided they want it. Those who accept this logic will not be satisfied until all restrictions are removed.

Lurking behind this logic are assumptions about autonomy and vulnerability.

A decision expresses your autonomy insofar as you “own” the decision: it reflects your wishes and values and is not imposed upon you in any way. This notion of autonomy assumes that all of us can rise above the forces acting upon us from without, and here we detect a grave possibility of error. Overt efforts at coercion may be easily detected and resisted, but the subtle influences of societal valuation are harder to appreciate and far more irresistible.

“No man is an island entire of itself” goes John Donne’s famous line. We are, in his words, “a piece of the continent,” part of an interdependent network of relationships that powerfully and unavoidably influence how we see ourselves and our significance in this world.

How then might general social acceptance and approval for euthanasia of persons with disabilities influence their sense of personal value? What does social approval for this act say about us and our values and attitudes toward those with disabilities?

Do we view those with disabilities as merely expendable, free to have their lives ended if they so choose without protest on our part? By comparison, would we protest if a healthy young woman sought to end her life because of persistent bullying on social media?

A society that prizes and prioritizes the most vulnerable amongst us is a safe place for all of us to flourish. Such a society makes every effort to communicate that each of us matters and prohibits anything that diminishes our individual value. The death of those with disabilities is as profound a loss for all of us as much as is the death of those without disabilities. ‘Any man’s death diminishes me / because I am involved in mankind / And therefore never send to know for whom the bell tolls / it tolls for thee.’

The Quebec Court’s decision of September 11, 2019 must be overturned. Canadians must demand it.

Dr. Ewan Goligher is an Assistant Professor of Medicine in the Interdepartmental Division of Critical Care Medicine at the University of Toronto.