Terminal Tenderness in Canada’s Healthcare System
Canadians kill with kindness.
We have all heard the stereotype: Canadians are the nicest people in the world. They are unfailingly polite, they are patient, they are kind, and they are always there for others. Canada has a Charter of Rights and Freedoms and strict laws against hate speech. They care so much about the health of others that they have universal, single-payer health care for all Canadians. No one is ever turned away, because they could never bring themselves to deny healthcare to others—that is, until these tender-hearted Canadians decide that some people are becoming a burden to their family and society. Then, these compassionate Canadians turn to the most radical system of euthanasia in the world.
Promising to provide a painless death to all who request it following the Supreme Court decision in Carter v. Canada, Canadians have had access to state-sponsored euthanasia since 2015. Claiming that laws prohibiting assistance in dying “interfere with liberty by constraining the ability of individuals to make decisions concerning their bodily integrity and medical care,” the Canadian Court also held that “the laws deprive some people of life by forcing them to take their own lives prematurely for fear that they would be incapable of doing so when they reached a point where their suffering was intolerable.” By 2016, the compassionate Canadians decided to expand that right through Bill C-14 allowing Medical Assistance in Dying (MAID) for eligible adults. Today, even Canada’s nurse practitioners are allowed to administer medications that cause a patient’s death.
Ever the rational actors, Canada has established an elaborate bureaucracy to administer the state-sponsored euthanasia program. The country has so routinized the protocols of death that in 2021, more than 10,000 people ended their lives via taxpayer-funded euthanasia, representing 3 percent of all Canadian deaths in 2021. And there are plans for expansion; by 2023, it is likely that “mature minors” will be allowed (or encouraged) to end their lives the same way. In a position statement published by the Canadian Pediatric Society, pediatricians gave a cursory nod to the need for palliative care, then went all in on “aid in dying” for their young patients. They recommend that:
•Governments at every level develop policies and procedures to safeguard young people from possible risks, harms or abuses of Medical Assistance in Dying (MAID) given their unique vulnerabilities
•Procedures for assessing a minor’s personal capacity to make health decisions rest with the patient’s clinical team and parents, in consultation with other designated experts.
The Canadian Pediatric Society claims that Canada’s mature minor doctrine “recognizes that a patient’s comprehension of the nature and consequences of a treatment has determinants beyond age, and that children’s wishes should be granted degrees of deference that reflect their evolving maturity. The doctrine provides an opportunity for physicians to determine a child’s capacity for consent, using similar considerations as for an adult.” The mature minor doctrine is acknowledged under common law in much of Canada.
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If the Court expands the right to taxpayer-funded aid-in-dying to minors, we can expect the same abuses of the law that have already occurred among adults. In a comprehensive study of the Canadian euthanasia laws, Maria Cheng published an article in the Associated Press revealing that the kind and compassionate Canadian healthcare professionals may not be quite as kind and compassionate as we thought. Documenting incidents of healthcare providers pressuring people to die, Cheng published the story of Roger Foley, a Canadian with a degenerative brain disorder who said that although he never previously mentioned euthanasia, healthcare professionals pressured him to consider it. In fact, so alarmed by staffers mentioning euthanasia to him, he began secretly recording some of their conversations. In excerpts from one recording published by Cheng in the AP article, the hospital’s director of ethics told Foley that “for him to remain in the hospital, it would cost north of $1,500 a day.” Foley replied that mentioning fees felt like coercion, and asked what plan there was for his long-term care. “Roger this is not my show," the ethicist responded. "My piece of this was to talk to you to see if you had an interest in assisted dying." Foley said he had never previously mentioned euthanasia. The hospital says there is no prohibition on staff raising the issue.
Cheng documented several instances of healthcare providers pressuring patients to end their lives—or the lives of their loved ones. There was a case of Candice Lewis, a 25-year old woman who has cerebral palsy and spina bifida who was brought to an emergency room in Newfoundland. “During her hospital stay," Cheng reported, "a doctor told Lewis’s mother that she was a candidate for euthanasia and that if her mother chose not to pursue it, it would be selfish.”
Catholic novelist Flannery O’Connor is known for her chilling statement that “In the absence of faith, we govern by tenderness. And tenderness leads to the gas chamber.” She was trying to make the point that tenderness or sentimentality and politeness can never restrain the darker forces in human nature. There are dark forces operating in Canada. And even though a major study by Canadian linguists comparing more than 40 million tweets by Canadians and Americans found that tweets by Canadians tweets are much “nicer” and more positive than those of the Americans, being “nice” can never hide those dark forces. The linguists concluded that the linguistic behavior of nations mirrors national character stereotypes of rude Americans and compassionate Canadians. If that stereotype of the polite Canadian holds, Canadians can be assured that when a Canadian physician, nurse, or ethicist demands you consider aid-in-dying, they will do so in the most polite way possible.