In the pages of National Post, two weeks ago, a text related the results of a Research Co. poll according to which more than a quarter of the Canadian population would be in favor of the idea of “prescribing assisted suicide” for people experiencing homelessness . It also read that a similar proportion agreed to extend medical assistance in dying to people whose only ailment is being poor. The results of this survey are chilling.
Let’s be clear: prescribing assisted suicide is not so different from participating in the definitive exclusion of these people because of their social condition. However, can we consider consent to be truly “free” under such a prescription, when social inequalities in health are widening and access to housing and social and health services is becoming increasingly difficult?
The position I am about to defend here is quite unpopular. Criticizing the way in which medical assistance in dying is deployed in Quebec and Canada means exposing oneself to the reproving gaze of a majority of people who only see this measure as a form of “social progress”. However, the extension of this measure to populations other than those with a serious and irremediable health problem, such as people with a mental illness, who are disadvantaged or in a situation of homelessness, or even those who live with a handicap , deserves to be questioned.
The case of disability
My main motivation for sitting on the expert panel formed by Quebec to examine the extension of medical assistance in dying to people with disabilities was the initial use of the inappropriate term “neuromotor disability”, which attributed to physical bodies the origin of the disability.
The name formulated by the group as an alternative better reflects the contemporary understanding of disability. Rather, it speaks of “serious physical impairment leading to significant and persistent disabilities”. This formulation was retained by the parliamentarians in the bill, amended on Wednesday by the commission. If the bill is passed, it will enter into force within nine months of its adoption.
However, the mandate of the expert group was not limited to choosing an alternative term. It was also a matter of developing guidelines concerning the expansion of medical assistance in dying while avoiding harm to the people targeted by this measure. This second component was just as important, as it involves giving doctors and nurses the power to administer death to people living with disabilities.
We had a duty to take all the necessary precautions so as not to repeat history. And in order not to repeat history, it must be taught.
Many doctors and nurses are unaware that “competent professionals” like them killed 200,000 disabled people in the euthanasia program during World War II. Although extreme, this measure was seen as medical care, because according to those involved, we could not claim to take care of these people by keeping them alive. They were given death on the pretext that their life “was not worth living”. In the eyes of the medical staff, these people were not really people, because they could not carry out even the least basic activity without requiring the assistance of others.
In Germany, the euthanasia program was installed gradually, in a context of financial constraints, after the First World War, which called into question the capacity to care for these people. Such eugenic measures have also been implemented in Canada and Quebec.
Although very uncomfortable, this dark part of the story absolutely had to be found in the report of the group of experts, beyond a simple footnote.
A hasty debate
The expert group met 11 times in just over a month. The final report was tabled on May 16, in response to the speed requirements imposed by the parliamentary system. Could we imagine the same precipitation if it had been a question of creating a policy aimed at killing any other group of the population?
Three days before the filing, a dozen groups for the defense of the rights of persons with disabilities had come to share their concerns and recommendations with the group of experts during a forum also attended by parliamentarians, including the minister. As no meeting of the group of experts took place after this meeting, none of their recommendations could be incorporated into the final report.
Some asked for additional guidelines, including the systematic use of a peer expert to support applicants in these procedures.
Others called for access to a decent income, accessible housing and independent living resources to be considered as factors influencing requests for medical assistance in dying, and for the course to be adjusted if abuses. It should be remembered that people with disabilities, like those with a mental illness, are much more likely to find themselves in a precarious economic situation than the rest of the population.
Even before the law was passed, one of the forum participants said that a home care worker had suggested that he consider medical assistance in dying when possible. Suddenly, the desire to “prescribe assisted suicide” doesn’t seem so distant.
In short, all the groups reiterated the need to support what makes life worth living for a person with a disability before rushing to offer to end it.
The expansion of medical assistance in dying for people with physical disabilities opens the door to major abuses, with very few solid guidelines to prevent them. Seeing the determination with which the government is preparing to expand eligibility for other populations, there is reason to be concerned and to take the necessary time, or even to backtrack, before crossing a limit that we will regret.
* Also signed this letter:
- Dave Holmes, Full Professor, School of Nursing, Research Chair in Forensic Nursing, University of Ottawa;
- Emmanuelle Bernheim, Full Professor, Civil Law Section, University of Ottawa, Canada Research Chair in Mental Health and Access to Justice;
- Marie-Josée Drolet, Full Professor and Ethicist, Department of Occupational Therapy, University of Quebec at Trois-Rivières (UQTR)
- Pierre Pariseau-Legault, Associate Professor, Department of Nursing, University of Quebec in Outaouais (UQO)
- Dahlia Namian, Associate Professor, School of Social Work, University of Ottawa
- Georgia Vrakas, Psychologist, Associate Professor, Department of Psychoeducation and Social Work, University of Quebec at Trois-Rivières (UQTR)
- Bogdan Ovcharuk, PhD student in political science, York University
- Édith Perrault, doctoral student in law, University of Ottawa
- Anne Thibault, Lawyer and Master of Laws student, University of Ottawa
- Isabelle LeBourdais, PhD student in political science, York University
- Vika Vinik, PhD student in political science, York University
- André Prévost, Executive Director of the Confederation of Organizations of Persons with Disabilities of Quebec (COPHAN)
- Paul Lupien, President of COPHAN
- Steven Laperrière, Executive Director of the Regroupement des activists pour l’inclusion au Québec (RAPLIQ)
- Jasmin Lemieux-Lefebvre, coordinator of the Living with Dignity citizen network
- Amy Ma, from the Disability Without Poverty Movement
- Dominique Salgado, Director General of the Action Committee for People Living with Disabilities (CAPVISH)