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The ongoing pandemic continues to generate great uncertainty and suffering for people in Canada and around the world. Much of the global response to COVID-19 shows that the goodwill of people to join together and overcome these challenges is altruistic and morally meaningful. However, there have been notable exceptions to this growing trend of global goodwill. In the Canadian context, for example, less light has been shone on an equally tenuous ethical problem in the form of a euthanasia program.
The expansion of the Canadian euthanasia program is occurring so extensively and with such rapidity that it will have dire consequences long after we have found viable measures to manage or resolve Covid-19. Equally as important, this growing euthanasia movement shows that many in Canada have failed to take the opportunity to re-affirm the value of human life during this crucial time when so many others throughout the world have sought to do so.
From a bioethics perspective, dignity and dependency, as constituent elements of the human condition, need to be re-appreciated in order to redress the growing moral ‘pandemic’ of euthanasia in Canada. Just as the world has responded with compassion to those suffering from Covid-19, Canadians need to compassionately challenge euthanasia as an unethical response to other kinds of suffering here at home.
Euthanasia was decriminalized in Canada in Carter versus Canada in 2015, and legislated in June 2016 as a legally permissible healthcare service for those who qualify. Under the auspices of federal safeguards, Canadian patients who qualify for euthanasia – or Medical Assistance in Dying (MAiD) as it has been called in the Canadian context – can request either self-administered or clinician-administered euthanasia from their care providers.
Physicians and, in some provinces, nurse practitioners are the care providers who can administer euthanasia in Canada. Provinces vary to some extent over which form of euthanasia patients can request. In February of 2020, new legislation was proposed to Parliament to expand Canada’s euthanasia program, which would considerably lessen the safeguards currently in place.
Although safeguards do not ethically justify euthanasia, Bill C-7 would further complicate the situation by making euthanasia more accessible than it already is to the Canadian public. Among other changes, Bill C-7 proposes to do this by eliminating the requirement that natural death be an imminent factor for those who wish to qualify for MAiD.
The euthanasia movement in Canada, as we know, has gained national momentum. Touted as a death with dignity movement by its activists, and championed as a right to die program, the moral implications of a more readily accessible euthanasia program are ethically devastating for patients, healthcare providers and Canadians at large. Bioethically, such devastations include conflating death and euthanasia with human rights; failing to appreciate the dependent quality of being human; and depreciating human dignity, which is inherent in all phases of human life.
Legislating euthanasia into the Canadian healthcare landscape is both complicated and problematic. Because Canadian healthcare is based on the principle of universal access, whenever any service becomes legally available it can generate the idea that anyone should be able to have it. However, euthanasia is still illegal, generally speaking. It is only legally permissible for those who federally qualify for it according to specific requirements and legislated safeguards.
When something such as euthanasia becomes available specifically under the auspices of “healthcare” it can be seen to be a “good,” which Canadians are entitled to access. So much so that when a service is not made widely available, social tensions start mounting and “rights-talk” emerges. Echoing across the Canadian euthanasia movement is the notion that every person has a right to die. What euthanasia advocates mean by this is a right to die as one autonomously chooses.
With choice being the lifeblood of liberal Canadian government, moral stability in Canada is eroding with the misplaced notion that autonomy is synonymous with individual access to all possible options. This fuels the idea that those who do not have access to a service provided for by the federal healthcare system are being discriminated against. It is what Bill C-7 supposedly aims to redress. It wants to grant Canadians who are ineligible for MAiD (barring the foreseeable natural death provision) their choice to be relieved of suffering by death at any stage of illness. Simply put, it operates from the belief that Canadians who think their lives are unlivable should have the right to request death, whether or not they are on a terminal trajectory.
However, there exists no right to death. Everyone is going to die; that is a certainty. Authentic human rights are those that need to be safeguarded because, among other reasons, they are not guaranteed in life but are morally necessary to safeguard so people can live well and in peace. To live the good life, moral principles that uphold such rights need to be externally protected by law.
For example, the right to life is a right by virtue of the fact that all human life is dependent, at one time or another, on others protecting this right, and this is particularly the case at the beginning and end phases of life. Dependency means we need to rely on others for support. And since, as our COVID-19 era reminds us daily, all humans are dependent in various ways, this dependency does not diminish who we are. Rather, it is a common feature of our humanity and one which enhances who we are in relation to one another-especially if we show each other the respect we deserve by virtue of our human dignity.
Human dignity is an inherent feature of the human experience and one which receives special attention in the tradition of ethics and its sub-field, bioethics. In bioethics, human dignity emerged as a philosophical concept within the Aristotelian virtue ethics approach. It was further developed in the Thomistic theological tradition as inalienable and that which should be upheld, respected and honoured because existence is a gift, irrespective of the difficulties and suffering it inevitably involves.
In fact, suffering is one of the most important and inescapable aspects of being human. This does not mean that suffering is a good thing, in and of itself. Rather, it means that the suffering human condition is layered with metaphysical and transcendent meaning. In his lengthy contributions to the problem of suffering, in both existential and bioethical contexts, Pope John Paul II outlined a theology of suffering that is especially timely today and in the Canadian context. In Salvifici Doloris, he writes:
Suffering is present in the world in order to release love, in order to give birth to works of love towards neighbour, in order to transform the whole of civilization into a ‘civilization of love’… at one and the same time Christ has taught (humanity) to do good by his suffering and to do good to those who suffer. In this double aspect He has completely revealed the meaning of suffering.
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The way we view suffering drastically affects the way we treat each other. Accepting that suffering has meaning can prompt us to pay attention to those who are suffering in an effort to aid them. Appreciating suffering maintains respect for human dignity, mediated by compassion for the suffering that humans endure. Compassion involves being empathetic to those who justly need it. It is just because we all suffer and justice, in society, refers to what we are owed, but also to what we owe others.
As David Albert Jones points out, those who are sick and suffering are in need of compassion owing to the losses they may experience that diminish some of the things that they can do; however, their sufferings can never diminish who they are. Rather, we can become more humane if we rise to the challenge of finding virtue in the hard places of our lived experiences. And compassion is the virtue that mediates our suffering and elevates our dignity and dependency. Through a compassionate approach to suffering, we offer others the opportunity to care for us and in return, we can receive that virtuous offering. In this way we can each partake of an ethical human experience of bearing up the weight of each other’s pain and suffering.
In contrast, and in the guise of a program to end human rights violations that make Canadians suffer unnecessarily, the euthanasia movement discounts the dignity that remains in those who suffer. Further, it aims to rid Canadians of their responsibility, born out of justice, to give other Canadians the compassionate care they deserve and which we owe each other by virtue of being human. Instead, the euthanasia movement in Canada is becoming eerily reminiscent of an Orwellian world in which, “all lives are equal but some are more worth living than others,” in which human dignity, virtue and ethics are supplanted by utilitarian values.
While death consists of a loss and may involve a prelude of suffering, which can be substantially relieved by ethically proportionate pain control and holistic care measures, all the Canadian euthanasia movement affirms is that Canada is quickly losing a sense of the significance of suffering as part of the human experience. Those who are suffering warrant more care and attention, not less. They justly deserve more scientific research for cures, treatments and pain control protocols, not less. And they are justly entitled to exceptional palliative care, in which all healthcare professionals in Canada need to be trained. Most of all, Canadian culture needs to regain a sense of the meaning of dying and death as life-affirming phases of living and life. Such phases may not be of our choosing but will happen as part of the suffering human experience nonetheless.
A solution to the Canadian euthanasia problem exists. Instead of affirming that those who are suffering have lost their human dignity, it’s time for Canadians to be united in hope. For hope can bring forth good and concrete, moral action. It reminds us that regardless of world events, despite how bleak things may look, and in the midst of the unethical problems in our Canadian and global contexts, one thing rings true: no-one’s life means less than anyone else’s.
We don’t need euthanasia to cut us off from authentically helping each other. But we all need a helping hand to make it through our suffering realities. We can start by re-affirming that dying and death are meaningful, dignified phases of living in order “to give birth to works of love of neighbour.”