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The importance of definitions has long been recognized by great thinkers. George Orwell’s 1984 demonstrated the ultimate impact of language on thought and culture. Newspeak went so far as to redefine words, ban words, and simplify vocabulary, all with the express purpose of controlling thought.
In discussing MAiD, and in particular, in creating legislation around MAiD, the use of language has been the driving force. But what does Medical Assistance in Dying really mean?
Medical: “Of or relating to the study or practice of medicine.”
Medicine: “The use of an agent, procedure, or regimen, such as a drug, surgery, or exercise, in an attempt to cure or mitigate a disease, condition, or injury.”
Assistance: “help, aid, support”
Dying: “about to expire, drawing to a close”
By these definitions, MAiD is meant to be a practice of medicine which provides medical treatment to help someone bring life to a close. In theory, this sounds like a reasonable definition, and possibly even a positive effort. Yet there is so much that is left undefined.
Who is the patient, the doctor? What is the diagnosis? What are the treatment options? What is the capability of the patient?
There is much to be said for how each case is different and requires a medical team to assess and determine how to support a patient. The questions and answers are not straightforward despite what legislators may think they understand about the issues.
But let’s consider the more basic definition of “Medical Assistance in Dying”:
1. How is MAiD medical? It is provided by a physician, but that does not make it medical. Physicians do many things in their lives. That does not make them all medical activities. A drug is administered, but the same is true for drug addicts on any street in any major city. It is done in the context of a hospital, but that is because it is legislated by the State to be provided by the physician, and they work at hospitals and clinics. That doesn’t make it medical. To be medical necessitates relating to the practice of medicine, which requires the use of some agent to mitigate disease in some way.
Yet MAiD does not treat anything. It kills the patient. Killing a person is the definition of homicide. The goal of medical intervention has never been to kill people. On the contrary, the demise of a patient is considered the unwanted outcome to an unsuccessful treatment. So MAiD cannot be medical since it does not treat anything, and causes the death of one person as a result of the action of another.
2. How does MAiD provide assistance? Assistance helps, aids, or supports the patient. MAiD kills the patient. Specifically, “assistance” in this context refers to the type of assistance, i.e., medical, that the patient is receiving.
The argument is that it assists by ending suffering. Yet the prerequisite context for that to be the case has so many variables, and so many people influencing the definitions of those variables, that there is no safety in proceeding with a prescription that ends in death.
Canada has palliative care, rehabilitation programs and community supports for those who need it. Investments in those programs would prevent much of the demand for MAiD requests by providing actual medical treatment which has the intention to end or reduce suffering while the patient lives on. The “end of suffering” MAiD purports to provide causes a real danger of undesirable death to vulnerable populations, while ending life to target populations rather than actually easing suffering. As such, MAiD is not assistance. It is the opposite, i.e., it is harmful because it kills.
How is MAiD related to dying? This may seem obvious but the new legislation awaiting final approval by Parliament actually expands the use of MAiD to the living. Dying is defined as ‘about to expire, drawing to a close’. The original arguments for MAiD were made to help people who were already dying avoid suffering. By definition, we are all living until we die. But we are also all dying, drawing closer to our death, even as we live. To say someone is “dying” typically refers to the fact that they are, as defined above, “about to expire, drawing to a close.” Death is imminent. So MAiD is given to speed up that process near the end of life. The proposed legislation allows for expanded timelines and definitions so that the target groups are not “dying” but wanting to die. The imminence of death no longer becomes a factor so the use of the word “dying” now refers to wanting assistance to die, rather than wanting assistance because I am dying.
So what do we actually have that we euphemistically call MAiD? It is actually Homicide Ending Life by Physicians: HELP. The very patients who we are most meant to help get HELP instead.
George Orwell, we have arrived.
MAiD, or HELP if one prefers, is now entrenched in Canadian law, and soon be expanded if Bill C-7 passes. That’s why Sean Murphy’s proposal to create a law in the Criminal Code to make it illegal to compel a person to participate in non-culpable homicide is an excellent notion. It would act as a serious protection for those in the medical community who are concerned about the State’s control over healthcare and what can in future be considered ethical approaches to supposed treatment.
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If conscience rights are to be ignored on the excuse that healthcare is provincial rather than federal, then we must proceed in another direction to ensure that healthcare workers are not pushed into either abandoning their calling or assisting with the homicide of the patients they are intending to help.
It is important to note that it cannot be assumed that because the State endorses a treatment, it must be ethical or sound. Historically, the State has made many mistakes in this regard. The most abhorrent and obvious being eugenics, which many may associate with Hitler’s Germany, but which was also practiced in North America, with our very own Alberta Eugenics Board, as one example. In its time, eugenics was considered “progressive” and on the “cutting edge” of science. The imperative is that in all cases of medical treatment, the conscience and moral compass of the doctor cannot be stipulated by the State.
The doctor must have the power to decide, based on the merits of the case, what the best course of treatment is. To be compelled to provide death as the best option goes against all natural sense of what health care implies, as well as the basic nature of the Hippocratic oath and the Declaration of Geneva, as adopted by the World Medical Association in 1948.
Language becomes the crux of the matter in this case. How can anyone argue for the necessity of the State to compel its citizens to commit homicide? As Sean Murphy notes in his recent Convivium interview, this is absurd. The more we all use the language of MAiD, the more we align ourselves with the idea that it is actually what it says it is. But it is not. It is not medical, it is not assistance, and it is not given strictly to those who are actively dying.
It is non-culpable homicide to the living and nothing more. There are real victims. The Dying with Dignity argument has been shattered as the use of MAiD is pushed more and more to the living. The goal posts keep moving. As such, MAiD is nothing but HELP in disguise. It is actually the act of killing another person, and the physician perpetrators become active agents in the homicide.
The only reasonable solution proposed at this point to protect health care workers, and eventually patients, is Sean Murphy’s call for a law that prevents the State from compelling citizens to participate in homicide.
Convivium publishes texts that do not necessarily reflect the views held by Cardus, the Convivium team, or its editors. In the spirit of discussion, dialogue, and debate, we ask readers to bear in mind that publication does not equal endorsement. Thanks for reading. Join the conversation!