Colby Cosh: There's no point to gatekeeping MAiD if doctors never say 'no'
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On Sunday the New York Times Magazine published a feature about Canada's legal regime for assisted suicide, wrapping large volumes of reporting on law, ethics and medicine around the individual story of Paula Ritchie, an Ontario woman who sought and received 'MAiD' after an unhappy life full of pain and misery.
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Katie Engelhart's story plays pretty fair with an explosive social issue that is of increasing global concern. She knows the NYT 's world audience is aware of Canada's avant-garde experiment with the facilitation of medical suicide for patients who don't have terminal illnesses, and she doesn't stack the deck either way.
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She's not under any fanciful illusions about the quality of Canadian medicine or Canadian welfare, specifically describing how mere administrative mistakes can lead to intolerable suffering for which the Canadian state now provides a fatal exit. She acknowledges that there was nothing demonstrably wrong with Ritchie apart from mental illness and ill-specified 'functional disorders'; there is some accounting of times she refused potentially helpful treatments out of sheer despair.
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At the end of the story, as Ritchie is put to death like a sick pet with friends and family around her, one can't help thinking she might be better off — and one can't help wondering whether we are playing with fire. That very uncertainty is the whole problem with MAiD, of course. Because it is an experiment, we're left trying to extrapolate the second-order social effects of a legal regime over which nobody has complete political control. (MAiD is, to say the least, not the only social problem of this nature.)
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Canadian law doesn't yet theoretically allow for MAiD for mental illness alone without some accompanying physical diagnosis. But a diagnosis is a label, and there is a myriad of labels available for those 'functional disorders' and chronic-pain syndromes whether or not there is any observable biological signature. If you want desperately to die with a doctor's help, as Ritchie did, you can probably find one who has an extreme ideological commitment to total patient autonomy, as Ritchie did, and get him to sign off, as Ritchie did.
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I don't know of any case where a doctor gave MAiD to anybody who didn't have a clear, emphatically expressed desire to die. And, as Engelhart points out, there is not yet any apparent epidemic of 'Track 2' assisted suicides not involving terminal or irresolvable physical illness. But her story hints uneasily that Canada may simply be turning euthanasia into just another medical specialty, or indeed turning some doctors into vending machines for lethal poisons. They're being asked, in Track 2 cases, to approve and facilitate suicide, or to refuse to do so, after assessing a patient's purely subjective suffering. One uneasy physician interviewee asks: 'If you want to allow people to end their lives when they want to, then put suicide kits in hardware stores, right?'
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