Canada

“Our goal should instead be to support people to live by ensuring access to secure housing, adequate food, economic support and adequate medical care and by increasing access to long-term care and high-quality palliative care for all who need it.”

The statistics are arresting. Between 2020 and 2021, there was a 32.4 per cent increase in the number of hastened deaths in Canada, a total of 10,064 in 2021.¹ Of those opting for assisted suicide, 86.3 per cent said the reason for requesting death was the loss of ability to engage in meaningful activities.² And access to hastened death is soon to expand even more.

The law on Medical Assistance in Dying, or MAID (a term that is sanitized and positive – who would refuse maid service?), was first passed in 2016. Initially, it limited hastened death to those whose “natural death has become reasonably foreseeable” in the wording of the legislation.

In March of 2021 the law was changed to create a second track for those who are not dying. Persons with a serious illness or disability, but who are not dying, are eligible for hastened death if they meet the other requirements. This legislation also allowed hastened death for those with mental illness as their only medical condition, with a two-year delay before it would take effect, on March 17, 2023.

In an unexpected but welcome development, the federal government has delayed the expansion for one year. This is a significant pause, but only a pause, in what has become an expanding regime of hastened death.

This announcement comes in the wake of a number of cautions from experts and professional bodies who question whether we are prepared to cross this Rubicon, particularly when the promised guidelines for determining who qualifies are yet to be finalized.

The Canadian Medical Association says that by the age of 40, half of Canadians will have had or have a mental illness. And far too many are unable to access timely treatment or care. The law requires only that patients be informed about treatment options to relieve their suffering before having their lives ended via MAID. But often waiting lists for treatment are longer than the reflection period required by the law, in some cases up to five years, and therapy can be expensive. As Canadians, we need to commit resources to care rather than offering to kill.

This pause coincides with many heart-breaking stories of people requesting assisted suicide for reasons of poverty, housing insecurity or lack of adequate support. Their reason for opting for death is not their medical condition. Rather, they are requesting death because they lack the resources they need to live. As one stated, “I don’t want to die, but I don’t want to be homeless more than I don’t want to die.” Another said “The numbers I crunch… I will not make it. Like in my case, the problem is not really the disability, it is the poverty. It’s the quality of life.”

In addition to the debate over mental illness, in February of this year, a majority of Parliament's Special Joint Committee on Medical Assistance in Dying recommended extending the eligibility to mature minors as well as allowing advanced requests for hastened death. One law professor testifying before the joint committee recommended there be no minimum age for hastened death, but that if a minimum age is necessary, that it be 12 years of age. Another witness representing the Quebec College of Physicians recommended that those age 14-17 be able to request MAID with their parents, and that parents be able to request hastened death for seriously disabled infants.

This reality is quite different from what the Supreme Court of Canada envisioned when it created exemptions to the Criminal Code prohibition on assisted suicide. In 1993, the majority of the Supreme Court upheld the prohibition in order to protect the sanctity of human life. They wrote there is a “generally held and deeply rooted belief in our society that human life is sacred or inviolable…” and that “human life is seen to have a deep intrinsic value of its own.” They were concerned that exceptions to the prohibition would undermine this commitment to life and put vulnerable persons at risk.

In 2015, the Supreme Court determined that in some circumstances individual autonomy can outweigh the societal commitment to the sanctity of human life. It determined that the purpose of the law prohibiting assisted suicide was not to protect human life but to protect vulnerable persons from being induced to commit suicide at a moment of weakness. They were confident that with appropriate safeguards and “… stringent limits that are scrupulously monitored and enforced,” vulnerable persons could be protected from abuse and error. Each person could be assessed on an individual basis to ensure that consent was informed and freely given.

However, many of the cases we are now seeing are not a matter of consent per se, but rather of persons facing a horrible choice in the absence of adequate care and resources. Offering death in the absence of meaningful care and support communicates that “we will not help you live, but we can help kill you.” The Supreme Court did not anticipate this.

In most jurisdictions where assisted suicide is legal, medical professionals are prohibited or discouraged from raising the possibility of hastened death. In Canada, there is no such restriction and bringing up MAID is considered a medical obligation by some. Recently there have also been a number of situations in which MAID was recommended to military veterans.

Behind the issue of consent is the legitimizing ideology of personal autonomy. Once individual autonomy becomes the justification for permitting assisted suicide, it will be difficult to impose any barrier to access that cannot be challenged by an appeal to autonomy. If I am an autonomous moral agent, that is, if I am sovereign, why can’t I determine the manner and timing of my death?

More broadly, what does it say about us as a country that we would make hastened death easier to access than the necessary supports for Canadians to live? Our goal should instead be to support people to live by ensuring access to secure housing, adequate food, economic support and adequate medical care and by increasing access to long-term care and high-quality palliative care for all who need it. We must communicate our commitment to caring for people, not that we are willing to kill them. We can begin by contacting our Member of Parliament.

Finally, as the primary reason that people opt for hastened death is loneliness or lack of meaningful activities rather than a desire to die, let’s demonstrate God’s love for those who are suffering. Let’s explore how we might reach out in tangible and concrete ways that are welcomed both by those suffering and those who are caring for them.

Bruce J. Clemenger is the senior ambassador and president emeritus of The Evangelical Fellowship of Canada.

This article appeared in the April/May/June 2023 issue of testimony/Enrich, a quarterly publication of The Pentecostal Assemblies of Canada. © 2023 The Pentecostal Assemblies of Canada. Photos © istockphoto.com.

1. Third Annual Report on Medical Assistance in Dying in Canada, 2021. Ottawa, Ont.: Health Canada, 2022.
2. Ibid.