COVID-19 casts stark light on assisted dying dilemmas

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Hospital bed. Image credit: Martha Dominguez de Gouveia/Unsplash

Almost five years ago, when Parliament passed the medical assistance in dying (MAID) law, the challenge seemed to be getting it through at all. The groups in favour were disappointed that its grounds were strongly limited.

Now, under pressure from a lower court decision, the government has expanded it well beyond its initial range and seems ready to go further to gain agreement from the Senate, who've become the radicals on this. The window has expanded on what's considered politically acceptable and the Tories are the only holdouts to a swift enlargement of justifications.

I'm a bit surprised by my own qualms on expansion, as I've expressed before. Now, I'd say, COVID has added further reasons for wariness.

The case against expanding MAID is argued by the Council of Canadians with Disabilities by saying it can become "a legally and socially sanctioned substitute for assistance in living." Dr. Ronald Bayne, Canada's pioneering geriatrician, railed against the refusal to spend more on elder care, till his own medically assisted death last week, at 98. For him, it was about social justice.

Till recently, this was a powerful but somewhat theoretical point. The death toll in long-term-care (LTC) homes due to COVID has concretized it. The numbers of dead in LTCs during COVID are far higher than they needed to be. How do we know? Because we lead the world in this category. In the first wave, 80 per cent of deaths from COVID here were in LTCs. Across 26 similar countries, the average was 47 per cent (Spain, 63 per cent; Belgium, 61 per cent; France, Sweden, 46 per cent; U.S., 41 per cent; Germany, Israel, 39 per cent; U.K., 36 per cent). We were easily at the top. In the second wave we dropped into the 60s, but elder-care death totals rose.

This was our special shame. On overall COVID deaths per million, we were well down the list: 50th by one count with many worse and many better. It's not true that this couldn't have been different; the homes have been studied, as it were, to death. Solutions are known: e.g., four hours per day of personal care per resident; or full-time jobs with guarantees like sick leave. They've simply not been implemented because, as Dr. Bayne often said, it costs too much.

This attitude runs deep. When Premier Brian Pallister called the Manitoba Hydro debt "the scandal of the century," he wasn't being purposely callous -- but it was acutely and you might say systemically insensitive, in light of Manitoba having the second-highest rate of LTC deaths per capita in Canada.

This kind of systemic (including financial) neglect and even abuse of the ill and aged, muddies the question of "choice" for medically assisted deaths. How free is the choice when you know the care you get is inadequate and grudgingly given? In a place like Denmark -- considered the gold standard for elder care due to provisions for staying in your home, etc. -- you can know you are "choosing" between the best life possible in your circumstances, and willingly ending it.

How free is that choice if you know you've been knowingly left in a poor situation because you're "going to die anyway" and reducing the public debt or enhancing corporate profits is a higher priority? Might the "choice" for medically assisted death even amount, sometimes, to a protest against being forced to lead an unnecessarily undignified, so-called life? An act akin to self-immolation in other societies, to protest against remediable injustices?

COVID has raised disquieting questions about how to die without customary ritual and comfort. Many have died alone with minimal company, perhaps a masked nurse or personal support worker kindly holding their hand. It's a very bare-bones version of even a MAID end-of-life. It's also raised questions of how to face death, often more alone than is "normal." Too many have been put to that test.

The dilemmas around MAID have also been more starkly illuminated. There is a fairly simple way to meet them. Ensure that the conditions in which the ill and/or aged approach the end reflect the best that's possible, or at least a better effort than we've made so far. If this means reordering social and fiscal priorities, make the most of it.

Rick Salutin writes about current affairs and politics. This column was first published in the Toronto Star.

Image credit: Martha Dominguez de Gouveia/Unsplash

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