For an issue that has to do with death, medical assistance in dying (MAiD) is rife with a passion that characterizes life.

MAiD is just one name for Bill C-14, the legislation that passed in June 2016, following the previous year’s decriminalization of assisted-death in Canada. The process is also commonly known as physician-assisted suicide, and ‘dying with dignity’ to its proponents or ‘euthanasia’ to some critics.

The frictional nomenclature around the law is testament to the existential binary that lies at the heart of it: ‘What does it mean to live a good life, and then die a good death?’

The Supreme Court of Canada in Ottawa, the highest court of Canada and final appeals court for the nation. (Photo by detsang)

In the case of Carter v Canada, the Supreme Court decided that in death, as in life, the means to make autonomous choices is a fundamental right. They concluded that the federal law which made aiding in voluntary death in medical settings a criminal act violated the Canadian Charter of Rights and Freedoms. Under this old law, the “grievously and irremediably ill” would be forced into a “cruel” choice: attempting suicide alone, or suffering through until a natural death.

This landmark case began when a couple who had flown their mother, Kay Carter, to Switzerland to receive legalized assisted-death, decided to take the restrictive Criminal Code to court. Their claim that they broke the law to give Carter her due rights was rejected because it relied on the deceased Carter’s testimony; they returned with an added member, a woman with ALS also wanting to legalize assisted-death, and won.

The Criminal Code was amended to decriminalize assisting with death in medical settings. Canadians with terminal illnesses or debilitating diseases now had the legal right to die as they choose, with dignity. That was in February 2015.

In June 2016, Bill C-14 was passed in the House of Commons to provide a legal and practical framework for how assisted dying would occur. Under it, Canadian patients seeking assisted-death must undergo a rigorous eligibility process. Applicants are first screened by a team of healthcare professionals to determine if they meet the following criteria:

  1. Are 18 years of age or older
  2. Have a serious and incurable illness, disease, or disability;
  3. Be in an advanced state of irreversible decline in capability;
  4. Endure physical and psychological suffering that is intolerable to them; and
  5. Their natural death has become reasonably foreseeable.

If applicable, the patient then meets with two separate physicians to confirm, again, whether the patient is mentally capable of making the decision; whether their condition causes grievous and irremediable harm; and whether their request is made voluntarily.

If ready, the patient undergoes ‘intervention’: death via intravenous drugs. The substance is either directly administered by a practitioner themselves, ‘active euthanasia’, or provided to the patient to self-administer, ‘passive euthanasia’. If, at some point in the assessment, the patient is deemed ineligible, the process is halted and the patient referred to appropriate medical services.

Bill C-14 is intentionally more restrictive about who is eligible for assisted death than the Carter decision, and with good reason. The right to die takes for granted that the individual is firmly committed to death in as safe and controlled a manner as possible, but ethical concerns arise from such assumptions.

Barring the terminally or grievously debilitated ill, how do we evaluate whether a life is ready to end? How do we differentiate between those with suicidal ideation and those seeking assisted-death (as the former cuts a life short, and the latter brings it to a presumably dignified close)? How should vulnerable populations – the historically marginalized or medically mistreated, the elderly, the dependent – be protected against being pressured into choosing assisted death?

Opponents of the MAiD argue that those seeking a dignified death may be pressured into their choice, whether consciously or subconsciously, by family members, friends, or society, as a whole.

Feeling unwanted and perhaps burdensome onto their relatives, the bill’s critics fear that terminally-ill patients will choose euthanasia not as an end to their pain and suffering, but as an end to their family’s troubles. Indeed, there does seem to be some support for this reasoning.

“How do we differentiate between those with suicidal ideation and those seeking assisted-death?”

Oregon, where a Death with Dignity Act was passed in 1994, estimates that in 2014 about 40 per cent of those choosing euthanasia were concerned with burdening family, friends or caregivers. However, over 90 per cent were worried over losing autonomy, which the bill attempts to protect. Moreover, these are simply end of life concerns, not necessarily reasons patients chose MAiD.

Opponents further argue that bills, such as Bill C-14, create a slippery slope; other less seriously ill patients may soon be able to also obtain a physician-assisted death. This argument, however, is based on the assumption that other less controlled instances of euthanasia are morally wrong.

Many proponents of MAiD would disagree, wanting physician-assisted suicide available for a wider range of cases. In fact, Dying With Dignity Canada argues that Bill C-14 doesn’t do enough, failing “whole groups of Canadians who have been cruelly barred from accessing their right to a peaceful death.”

Like any other medical issue, assisted-death is not solely in the domain of medicine. It is resource-driven and thereby subject to the perceptions of the media and the public, and the influences of politics and economics. Individuals should have the right and the capability to choose how they die, as much as one hopes they had the same when choosing how to live.

When dying, we are plagued by the negatives that have thus far only visited us in life: anger, hopelessness, apathy, pain, fear. There is no medical treatment that can alleviate such agonizing suffering, but that suffering need not be all-encompassing.

“Like any other medical issue, assisted-death is not solely in the domain of medicine.”

To be afraid of death is the human condition — but somewhere along the way, we became scared of even talking about death and our fear of it, at the cost of real lives. In their final days, people return to fundamental desires: some comfort, real companionship, acknowledging the truth of their situation. These are reachable goals that can add meaning to life.

Assisted death should remain an option for those in unending misery, but we hope, that as a society, the focus will remain on the well-being of people, even until the very end.

By Aishah Cader and Hagr Saad

Please note that opinions expressed are the author’s own. They do not necessarily reflect the views and values of The Blank Page.