On Canada’s MAiD and the limits of the bodily autonomy argument
On Canada’s MAiD and the limits of the bodily autonomy argument
Plus: Medieval honor declarations, a Substack rec, and more
Good morning! It’s Wednesday, and here are this week’s five items for you.
1. A take I haven’t written elsewhere
On Canada’s MAiD and the limits of the bodily autonomy argument
The last few months have produced a flurry of deeply worrisome reporting and commentary on Canada’s euthanasia program, Medical Assistance in Dying (commonly called MAiD).
In 2017, the first full year in which MAiD, which is administered by provincial governments, was in operation, 2,838 people opted for assisted suicide, according to a government report. By 2021, that figure had jumped to 10,064—accounting for more than 3 percent of all deaths in Canada that year. […]
Why the dramatic increase? Over the past few years, doctors have taken an increasingly liberal view when it comes to defining “reasonably foreseeable” death. Then, last year, the government amended the original legislation, stating that one could apply for MAiD even if one’s death were not reasonably foreseeable. This second track of applicants simply had to show that they had a condition that was “intolerable to them” and could not “be relieved under conditions that they consider acceptable.”
A number of recent news articles have reported on Canadians who, driven by poverty and a lack of access to adequate health care, housing, and social services, have turned to the country’s euthanasia system. In multiple cases, veterans requesting help from Veterans Affairs Canada — at least one asked for PTSD treatment, another for a ramp for her wheelchair — were asked by case workers if they would like to apply for euthanasia.
Roger Foley, who has a degenerative brain disorder and is hospitalized in London, Ontario, was so alarmed by staffers mentioning euthanasia that he began secretly recording some of their conversations.
In one recording obtained by the AP, the hospital’s director of ethics told Foley that for him to remain in the hospital, it would cost “north of $1,500 a day.” Foley replied that mentioning fees felt like coercion and asked what plan there was for his long-term care.
“Roger, this is not my show,” the ethicist responded. “My piece of this was to talk to you, [to see] if you had an interest in assisted dying.” Foley said he had never previously mentioned euthanasia.
There are lots more quotes I could share, but this is enough to give you a sense of the scale of the program and how far it has strayed from the classic scenario of slightly speeding the imminent end of painful terminal illness. Also, something about “Roger, this is not my show”—ugh. I’ve read a fair bit on this subject, and that line sticks.
In the U.S., assisted suicide (the doctor provides lethal drugs the patient can self-administer) is legal in a handful of states, operating with safeguard schemes and on a much smaller scale than MAiD, while euthanasia proper (the doctor administers the lethal dose) is illegal in all 50 states. (Canada offers both and also has universal health care, a combination which creates obvious bad incentives, as e.g. for Roger.)
Regular readers will know I’m a libertarian, and that includes wanting people to have the right to make bad choices, including morally wrong choices through which they’ll harm themselves, so long as they aren’t abrogating others’ rights in the process. Thus my opposition to the drug war, even for the scarier drugs, though I also believe no one should use those drugs.
This issue is far more complicated, I think, and can’t be resolved with the same arguments. I usually appreciate Ross Douthat’s work at The New York Times, but I think he’s incorrect to characterize as plainly “libertarian” a critique of “any legal or medical presumption against assisting with a suicide, because it arrogates to the state the power to decide on ‘the right conditions’ for making an exit from this life, instead of just letting the suicidal person make the decision for themselves.”
For one thing, Douthat is writing in the context of Canada’s program, where the state is even more involved if it facilitates these deaths than if it prohibits them. But more broadly, an assertion of bodily autonomy for the patient can’t resolve the core debates around assisted suicide and euthanasia, which concern the doctor’s role and preventing coercion and/or murder of vulnerable people by the doctor or a third party.
We can appeal to bodily autonomy to argue against banning suicide generally (like not criminalizing suicide attempts or punishing surviving family members). I would make that case. But I also recognize its limits. Bodily autonomy says the patient has the right to ask; it has nothing to say of what the doctor can answer.
2. What I'm reading this week
“Injured parties,” a Spring 2022 piece by Alan Jacobs for Hedgehog Review. If you’ve read the cancel culture chapter in Untrustworthy, you’ll know why I find the history here so intriguing. An excerpt:
Late medieval and early modern understandings of these matters, in England and on the Continent alike, differed in important ways from our modern understandings. […]
To begin with falsehood: When an accusation against another person was revealed to be false, three actions typically ensued, at least when the system was functioning properly. These had distinct names in German—Abbitte, Widerruf, and Ehrenerklärung—though the practices themselves were more widespread. Abbitte is apology, often accompanied by a request for forgiveness; Widerruf is a formal and public retraction of the defamatory claim.
The most interesting of the three is Ehrenerklärung, literally “honor declaration,” in which the society as a whole declares to the injured party that it acknowledges the accusation as false and sees that person as a fully honorable member of society. It was widely believed that wrongly defamed persons need to be assured that they have not in fact been defamed—in other words, that their “fame” (i.e., reputation) has been fully restored.
Read the rest here.
3. A recommendation
's Substack. I disagree with deBoer on ... a lot! Faith is the biggest (he's an atheist), and we're also pretty far apart on economics (he's a Marxist). But he's a consistently thought-provoking writer and has sharp insights on the evolution of the progressive left, how our society handles mental illness, the media, and more.Some recent(ish) posts I found worthwhile:
4. Recent work
American anti-liberalism can only lead to violence | The Daily Beast
The Biden classified docs story is why people hate politics | The Daily Beast
Bit of a light list this week as I’m working on a handful of articles with longer timelines, including some book reviews
5. Miscellaneous
I was late to learn about it, but Marvin Olasky (formerly of World Magazine) very kindly included Untrustworthy in his December book recommendations:
Bonnie Kristian’s Untrustworthy (Brazos, 2022) has good advice for a time when media deceit is rampant. She shows us to rise above cancel culture, conspiracy-mongering, reliance on untrustworthy experts, and the use of personal experience to shut down conversation.
Kristian also exhibits a rare humility at a time when some writers claim to be prophets with new revelation: “Is it really likely that I … unable to read Scripture in its original languages, still inadequately informed of church history, on Twitter too much, not 100 percent certain I could steer clear of well-intended heresy if I tried to explain the interrelation of the Trinity off the top of my head?”
(I feel similarly, and if I come up with some heterodoxy I should ask what she asks: What are the odds that I “finally drew together all the thread of truth every saint before and around me failed to connect? C’mon.”)
See his other picks here.
