MAID in Canada
nathansnelgrove.com
nathansnelgrove.com
This is the same level of argument as saying that people who vote for the other guys must have been tricked by FOX News / MSNBC / Russia / Tik Tok / transtrenders / tradwives, and if only they truly understood their actual self-interest they would agree with you on all things. It's a bad style of argumentation, albeit very popular in academia ('why do the poor keep voting wrong?').
There are legitimate reasons to oppose Canada's euthanasia program on its own terms, and it's not surprising the Canadian government has very carefully shielded MAID from any sort of public input or oversight, since it's deeply unlikely it would pass a majority vote in its current form. There is consistent public opposition to euthanasia being available to anyone but late-stage terminally-ill people (and even then, it's divisive at best). There is strong public opposition to euthanasia solely on the grounds of mental health.
More broadly, I think people are increasingly sick of the misuse of the term 'healthcare' (or 'public health') to sneak unpopular or controversial policies past the electorate, and the idea of 'death as healthcare' is probably the most extreme example of this trend. When people cannot express democratic opposition to policies they deeply oppose, don't be surprised if you get pushback and populism.
These policies are supported by a strong majority of people.
> Only 12.1% correctly answered ≥4 of 5 knowledge questions about the MAID law; only 19.2% knew terminal illness is not required and 20.2% knew treatment refusal is compatible with eligibility. 73.3% of participants expressed support for the MAID law in general, matching a nationally representative poll that used the same question. 40.4% of respondents supported MAID for mental illnesses. Support for MAID in the scenarios depicting refusal or lack of access to treatment ranged from 23.2% (lack of access in medical condition) to 32.0% (treatment refusal in medical illness)
Most Canadians express support for MAID but cannot correctly answer questions about it. When Canadians are actually told what's in MAID, they oppose it.
It's also worth noting that quite a lot of polling on this question is done by, or on behalf of, pro-euthanasia organisations; there is often a huge mismatch between the questions asked and the actual legislation proposed and passed (in a very motte-and-bailey kind of way).
Nobody ever correctly answers questions about legislation, to put it glibly. Any piece of legislation newer than 10 years and more complex than a sentence is not going to pass such a test with the general public. 19.2% knew that terminal illness is not required? I would be shocked if 19.2% could correctly answer a few basic questions about the definition of "terminal illness."
They screwed this up via multiple mechanisms, because that's what government seems to do, and now there is a pretty decent shortage of healthcare up here. This makes the incentives highly perverse because the government can't provide the world class health care it promised even if it wanted to, which leads to political pressure to bring in MAID and chop tens to hundreds of thousands of dollars of medical liability off the end of many patient's lives (which I would actually support if the underlying incentive structure was different, or if the government was at least honest about what was happening and compensating the MAID recipient's estates for forgoing treatment the government is obligated to provide but would be better for said government if they didn't). The most concerning bit here is the lack of provision of other life improving services like joint replacement, the latest experimental drugs, etc. and the likelihood that that is funneling people into a situation where MAID is the obvious best choice sooner than it otherwise would be. This is certainly happening with cancer treatments (although probably not intentionally, just incompetently) as people get detections for cancer and then find a months long wait list instead of days to weeks long wait list to see someone who can progress their treatment.
So this is an assertion that requires some evidence. The political pressure was instead from a majority of Canadians (across political lines) who want there to an an end-of-life option in situations when life becomes intolerable. People do not want to be forced by the state to stay alive and suffering via extensive medical interventions. Nor do they want to have to suffer through the alternative of slow and debilitating conditions that science is powerless to stop. This is the where MAID came from. Thinking of it in purely economic terms is already acting in bad faith.
> compensating the MAID recipient's estates for forgoing treatment
If you paid for private medical insurance, would you expect the same from them? To compensate your estate if you choose to end your life early rather that receive invasive and expensive treatment to temporarily forgo the inevitable? Even if you did expect that, insurance companies would never go for it. An even by the widest stretch they did then you're back to the same economic incentive but now with private industry. This is even worse I would say, because now people would be given a cash bonus to commit suicide (either by the government or private insurance, the same applies if people were compensated for foregone treatments). People with families in financial trouble may even consider this a way out to help loved ones. That is a crazy perverse incentive if you ask me.
On the side of offering better services, you have my whole-hearted agreement. Even something as simple as mandating an increase in the number of available seats at medical schools that corresponds with the population growth would be a start. Lots more to that list.
I would expect private care to uphold whatever I agreed to when buying insurance from them. You continue to miss the point that there is no other option in Canada because the government made the other options illegal, which is what creates the liability. They can't make care in any other form illegal and also not provide care. I am also talking about the specific case where the person is terminally ill, not the way more crazy version we have rolled out letting people with no impending doom opt for suicide. Limiting this to the defensible type of MAID limits the perverse incentive you are concerned about to almost nothing.
You trust the government to do the right thing when they have continually proven they will choose the wrong thing if it is convenient or the outcome most likely under incompetent management.
No, I'm saying it reduces suffering and it also saves money and resources. It's the first part that is the most important and where the political pressure came from. You seem to missing that point. That it reduces suffering and that people want suffering reduced!
End of life care is expensive regardless of whether it is publicly or privately funded. And in either cases there will be people in situations where extending life via medical means just isn't worth it because the extra time would just be an extension of torment. If private insurance was an option, then it would be the private company that would incentivized to get people to end life early. The private/public part is irrelevant to the discussion if you only look at it through a financial lens. Both ways would have the same incentive monetarily.
> You trust the government to do the right
In this case the right thing is to allow people to choose for themselves, and that it what's happening. I don't even know what you want instead, do you want MAID eliminated?
Of course this is true. And if care isn't administered because of a choice by the person, then that's the end of the discussion. But, if its a lack of resources by the gov, then 100% these should be increased and I've already said I fully support that.
Is MAID replacing proper care? This could be a harder question to answer because what would your control group be. It would have to be one for which health care resources were available to them, AND, they also had a MAID-like option that normalized (i.e. not scandalous or considered morally 'wrong'). And then compare current uptake in Canada to see if there is a difference that could be attributed solely to a lack of health care resources being a driver, rather than just the existence of MAID as an alternative.
Euthanasia is illegal in most countries and almost always has been. Terminal sedation and intentional rising doses of narcotics would be considered ACTUAL murder in 100% of those cases where euthanasia is illegal.
If you are a physician and don't know this you should be immediately investigated.
The health care system can and should be improved, but there will always be people choosing MAID regardless. We should use a different measure for how to improve healthcare, and not falsely correlate MAID as a failure metric.
Statistics Canada. Table 13-10-0392-01 Deaths and age-specific mortality rates, by selected grouped causes https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=131003...
https://www.canada.ca/en/health-canada/services/publications...
I also had family member die recently; he was 95 years old. At 85 he said it was time to go into a home and went and did that for a few years. But at 95 he just decided he was done. He told everyone and then he just stopped eating. Within in a week he was gone.
"We should use a different measure for how to improve healthcare, and not falsely correlate MAID as a failure metric." No this is actually a perfectly legitimate question. Are people choosing to kill themselves due to a lack of available healthcare?
Is the government using assisted suicide as a mechanism to relive a overburdened medical system? Legit questions. Dont dismiss them.
I just dont know if they government should be involved with this to the point of counseling people to kill themselves. It leads to all sorts of perverse incentives.
"Perhaps the now-suspended Veterans Affairs caseworker who, in 2022, was found by the department to have “inappropriately raised” MAID with several service members had meant no harm. But according to testimony, one combat veteran was so shaken by the exchange—he had called seeking support for his ailments and was not suicidal, but was told that MAID was preferable to “blowing your brains out”—that he left the country."
That's followed by an anecdote in which a Vancouver patient in a suicidal crisis claims a hospital clinician said there were no beds available, but that MAID would be a "more peaceful" option than suicide.
No idea how widespread these cases are, not making any claims, just saying there's reporting around this.
They were immediately fired, referred to the RCMP for investigation, and a systematic review launched that found 4 incidents[1] - all by the same employee. There have been no further incidents reported since this happened. Since 2022.
> That's followed by an anecdote in which a Vancouver patient in a suicidal crisis claims a hospital clinician said there were no beds available, but that MAID would be a "more peaceful" option than suicide.
This was in 2023. It was covered a bunch at the time until it was revealed that it was a standard question asking if she had ever considered MAID before[2], since she had a history of depression and suicidal thoughts.
The Atlantic reporter you're referencing is themselves anti-MAID due to her religious convictions and wishes to remove choice from individuals. It is not an unbiased source of information. The MAID system is _routinely_ criticized from the religious base here in Canada for the last 9 years, and yet not even a hint of systematic abuse of the system has ever been found.
[1] https://www.veterans.gc.ca/en/about-vac/reports-policies-and... [2] https://www.theglobeandmail.com/canada/british-columbia/arti...
You introduce several forms of asking "why" as a reaction to my comment, but that's exactly what I argued for: a better metric with the actual possibility of causation.
While I think people should be free to choose, I don't know how much information hospital staff should be able to give.
Difficult.
Edit: I'm not 100% certain as to the timeline. She may have been in the hospital for 2 days.
You have to have 2 independent medical assessments at a minimum as well as written consent that is witnessed. So its not like you can just say you want to do it and then they just off you right there. She could have had all sorts of reasons for not telling anyone including her sisters. There's nothing in your anecdote that disputes she could have planned it long in advance and just not told anyone.
It seems implausible.
She lived with her sisters and while she was quite capable of many tasks, I think that long term subterfuge was beyond her. She was well into mental decline.
"You have to have 2 independent medical assessments at a minimum as well as written consent that is witnessed"
Could this not have happened at the hospital?
Yes, it could have happened at the hospital but do you think they have people sitting around waiting to do medical assessments and be witnesses just so they can push MAID onto people? At most hospitals the doctors and medical staff are extremely busy.
Which is ironically a pretty strong argument for why euthanasia shouldn't be legal
https://www.canada.ca/en/health-canada/services/publications...
In my opinion, this drives the narrative in this article, and is at the root of why there is little stigma in Canada surrounding MAID.
It's also a way for collapsing government-run healthcare to save money.
How many examples? What percentage of patients eligible for MAID receive such treatment?
What we do have is the words of people saying they do not wish to die, but are taking MAID due to necessary supports not being offered instead. What percentage would you consider too high for that?
But these are separate issues, no?
I mean, if we don't have MAID, the existing failings of our healthcare system won't just go away; they won't just magically get the support they need. Instead, they'll die anyway, probably in a painful way.
Of course, for this discussion to be worth anything, we'd need more details. What does "support not being offered" mean, precisely? ..How many people is this actually happening to? And no, we can't just believe accounts posted on social media. And even if we did, are we going to get the other side of the story?
What you do have is a handful of anecdotes, to put it in more honest terms.
What's fascinating to me is that the discussion of these anecdotes revolves around wanting to eliminate MAID rather than -- gosh, I don't know -- offering those necessary supports instead? The anecdote (in the article) about it being easier for "some people" to get MAID than to get a wheelchair makes for a great soundbite, but the people who quote it always seem more interested in eliminating MAID than in providing wheelchairs to those in need, for some odd reason.
And now here we are. Maid is a thing, and people are being encouraged to do it while not being provided the alternatives they are asking for. And the numbers for how many are totally illegible but also somehow too low for you to be concerned with.
My activism has long been more focused on getting people the care they need than opposing maid. But regardless people still don't always get the care they need and we have maid for them instead. We said it would be like this and it is like this.
Without having actual data, this is nothing more than an excuse to eliminate MAID indefinitely pending an imaginary system in which no one slips through the cracks; in the meantime, you will force countless more to suffer months or years of needless agony on the off chance that one of them might be one of your anecdotes.
> And now here we are. Maid is a thing, and people are being encouraged to do it while not being provided the alternatives they are asking for. And the numbers for how many are totally illegible but also somehow too low for you to be concerned with.
The only "numbers" I get from anyone like you are a handful of anecdotes that add up to a tiny fraction of a percent of people who elect MAID, and a vanishingly small percent of people eligible for MAID. If you genuinely mean well, I want you to understand: you are being manipulated by people who will do nothing to help those in need, and on their behalf you are campaigning to immiserate thousands upon thousands every single year.
Can't make an omellette though, right?
The only pushing I’m seeing is that by religious people onto non religious people, as usual.
One person’s account of what happened against an entity who is not allowed to discuss their side of the story is useless. And even if the whole account is accurate, it is not sufficient to stand in as proof of a nation’s protocol.
I'm not really surprised. It looks like Canada's healthcare costs are growing exponentially, and are outstripping growth in GDP. These costs are mostly driven by hospitalizations. If a government can carefully promote the message that hospitalization means suffering, suffering is hard, a life with suffering is not worth living, and that relief is quick and easy, then a route is charted to a reduction in healthcare expense. It would certainly help if the large physician organizations are on board, and the nation's major broadcasters lean into euthanasia-friendly messaging.
See here, in particular the first figure: https://www.cihi.ca/en/national-health-expenditure-trends-20...
And here (slightly dated, but still valid): https://www.fraserinstitute.org/studies/sustainability-of-he...
> I live in Canada and have not seen any such messaging that you have said.
Here's a not-particularly-subtle example: https://www.cbc.ca/news/canada/new-brunswick/maid-medical-as...
If you search the CBC, they have articles both for and against MAID. I think its kind of silly to say that all positive news articles about MAID is government propaganda as there is likely to be a non-zero amount of positive experiences with it. Should the government not allow the press to make any comments on MAID to avoid biasing anyone for, or against it? For example, here is a negative video the CBC posted about MAID: https://www.cbc.ca/player/play/video/9.6521196
I have a hard time believe things are going down like, "You have cancer. We can treat it and you'd be fine, but you know what you should do instead? Kill yourself"
On the other hand, I do believe (and want) doctors to be like, "You have cancer. We can treat it and you might get a few more months with very poor quality of life. You may wish to consider these other options"
The author cites 5% as the “number too high” but as someone who’s had a family member who’s been through the MAiD system, Track 2 is pretty difficult to get so I would t be surprised if most of that 5% is Track 1, but we wouldn’t know from this article.
[1] https://www.canada.ca/en/health-canada/services/publications...
Limiting euthanasia to people with imminently terminal conditions is how you keep people in pain. The very best palliative care can still accompany suffering beyond anything a well and able person can begin to perceive.
Mental healthcare and social care and all these perpetually under-funded margins do need to be improved. MAID is not the preventative healthcare that we all need throughout our lives, but we need to be honest about the balance. Is it worse to end life prematurely for the "wrong" reasons, or to make someone suffer for the "right" reasons? This is dirty ethics. Get out the way and let people decide for themselves.
Let alone a wheelchair ramp, apparently, even if you're a veteran:
https://www.cbc.ca/news/politics/christine-gauthier-assisted...
> A paraplegic former member of the Canadian military shocked MPs on Thursday by testifying that the Department of Veterans Affairs offered her, in writing, the opportunity for a medically assisted death — and even offered to provide the equipment.
> Retired corporal Christine Gauthier, who competed for Canada at the 2016 Rio de Janeiro Paralympics and the Invictus Games that same year, spoke before the House of Commons veterans committee and agreed to provide a copy of the letter.
> "With respect to me, I have a letter in my file, because I had to face that as well," said Gauthier, referring to the debate about veterans being offered the option of medical assistance in dying (MAID).
> "I have a letter saying that if you're so desperate, madam, we can offer you MAID, medical assistance in dying," said Gauthier who first injured her back in a training accident in 1989.
> Testifying in French, she said she has been fighting for a home wheelchair ramp for five years and expressed her concerns about the assisted dying offer in a recent letter to Prime Minister Justin Trudeau.
Thinking this is akin to eugenics is silly and not doing anyone any good.
Apologies for sounding like a broken record here, but do you have anything other than anecdotes to support the claim that younger disabled people are generally against MAID?
Or maybe you meant religious vs. secular people?
https://thecjn.ca/opinion/how-jewish-nursing-homes-approach-...
In general, even the religious in Canada aren't very religious, so those who actively identify as it are likely to be _very_ religious. I have not a clue what religion any of our close friends are.
Canada becomes about 10% more agnostic/atheist every 10 years, which is a fun pattern[2].
[1] https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/pr... [2] https://en.wikipedia.org/wiki/Irreligion_in_Canada
Nope. I meant Christian vs. Non-Christian. Granted, I haven't discussed MAID with any muslims before.
only 5%?
I also remember that poor woman in Canada who died after being refused a kidney transplant because she wouldn't take the covid vaccine.
Canada has got a lot of problems.
Forcing others to contribute to funding and carrying it out through taxes is not.
It should only be offered when patients ask for it. Some sick people are already depressed and feel like a burden we shouldn't put ideas in their heads.
How else is it supposed to work?
> Some sick people are already depressed and feel like a burden we shouldn't put ideas in their heads.
You sound like you think there isn't an entire system of checks and balances around this but, of course, there is.
Like literally any other good or service.
On abortion -- that matters to a lot of people, and it's an outrage that they are forcibly taxed to pay for something they see as murder.
Just kill yourself the old fashioned way?