There is a continuing and intriguing debate regarding euthanasia. It has persisted in this county for some time but really came to prominence late in the twentieth century when Dr. Jack Kevorkian was engaged in assisting suicide. He was charged and tried, but conviction was elusive. He was finally convicted in Michigan after assisting in a death that was recorded for posterity. While there have been news stories since, the topic has not led headlines in America in recent decades.
There are American states that have enacted Legal Medical Aid in Dying (MAID) laws. They include California, Colorado, Hawaii, Maine, Montana, New Mexico, Oregon, Vermont, Washington, and the District of Columbia. However, 36 states prohibit the practice of euthanasia. Another 4 have laws that leave their actual position unclear. It is perhaps most accurate to say that there is some lack of consensus overall, but a reasonably clear majority and minority view.
The British Broadcasting Corporation (BBC) reports that Canada has an "assisted death programme," and has had it since 2016. It has been for the "terminally ill." There, doctors in hospitals have been participating in the ultimate harm, death, for several years. There is an interesting study of why patients said they elect this outcome. There are malignancies, organ failure, neurological diseases, and more. Intertwined with those foundational points, there is discussion of symptoms, loss of autonomy, and "fear of future suffering."
In the end, we are each terminal. Death is an eventuality for us, and the fact is that not knowing when or how is perhaps a blessing. The knowledge is hard to live with, or at least I have been told so. I have been told that knowing the name (cancer, heart disease, etc.) of your path is both terrifying and somewhat comforting. One told me it was liberating (much like a famous song lyric, that fellow "went skydiving"). I struggle with that characterization, "comforting," but having not lived it I cannot competently consider the reactions of those who have actually faced such news. How does one cope with such information? How does one face either the end or the challenges of the painful days that may precede it?
One physician is quoted by the BBC recounting her first foray into assisted death, and characterized it as "surreal," and "like stepping off a cliff." However, she says it has now "normalized." If you do something often enough? Listen to Murder by Numbers, The Police, A&M 1983, "You'll find your conscience bothers you much less." This is not in any way a suggestion that MAID and "murder" have any correlation, but the point of the song is that things become easier with repetition. That is worthy of discussion despite the song title. Might it become too easy to discount the value of life?
The BBC article notes that "in 2021 . . . . there were 10,064" assisted suicides in Canada, "accounting for 3.3% of all deaths in Canada." That is intriguing. In Great Brittain, the Guardian reports that ten percent of all suicides are related to "chronic illness." Thus, without physician assistance, there is evidence that suicide is nonetheless engaged by some portion of society.
In 2021, the Canadian program shifted from only those with "life-threatening" conditions to "include those with serious and chronic physical conditions. However, the program is changing further in 2023, and is expected to soon "include some Canadians with mental illness." There might be some that see evolution in the law, and that is perhaps valid. Others might contend that a broader population has the right under Canadian law but that individual and serial court proceedings have been required to extend that recognition to various groups.
And, with the present expansion, there are some expressing reservations and concerns. Critics have expressed fears that "the expanded law could devalue the lives of disabled people by implying that a serious disability was worse than death." They also perceive evidence that people have elected "assisted death . . . in part because they could not afford adequate housing." There are fears that some might seek it "because of poverty, lack of housing, or extreme loneliness." There is fear expressed of "making death too ready a solution."
What of the perceptions of people? In Daytona this week a septuagenarian fulfilled half of an alleged murder/suicide pact with her husband. She was arrested after allegedly killing her husband, who suffers from a terminal condition. CNN reports that the two agreed about three weeks ago to this outcome "should his health get worse." She allegedly followed through with the killing but as to the suicide she "was physically too weak to do so." She now is in custody after a police stand-off and reportedly may face capital murder charges. When someone chooses death, is there a distinction here from what some states allow? Should people have to suffer? Should the state sanction their decisions? Should physicians assist people in their deaths? Who will draw the lines? Aren't there already lines?
Some in Canada thus see this as a government issue. They feel that providing food and shelter for everyone is a government function, a socialistic provision of "fundamental human rights." These are the souls that have concluded each and all are responsible for all and each. They argue that the government is failing to provide adequately in this socialistic paradigm and that allowing assisted suicide as an alternative to poor living conditions "is unacceptable." In the process, they perhaps discount that poor living conditions are themselves a threat to health, safety, and longevity. That is a broader discussion.
There are some who are concerned with the new law because of safeguards, or the lack of them. They express reluctance to bring suicidal family members or friends to medical facilities for assistance because of the chance they will be counseled and swayed. They see the potential that some populations will be inappropriately offered the suicide alternative and perhaps make poor choices. They fear that alternatives will be poorly explained, comprehension will be challenged, and untoward outcomes may follow. There is some fear that suicide will be encouraged, and examples are noted.
The article suggests that there is a significant debate underway. And, in the end, it may turn into a broader debate about the successes and failures of socialism generally, the rights to support and sustenance, and the challenges of living with impairment in society. The article uses the word "disabled," but there is debate among the so-called experts as to the appropriateness of that word. We have debated it in workers' compensation. It is likely that when the experts decide how they feel about the word, its use will be either accepted or derided in our modern cancel culture.
How does this plan in Canada, and the challenges, intersect with workers' compensation? There are touchpoints worth noting. There are many who find themselves impaired, restricted, or disabled following a work injury. Will their challenges steer toward the same concerns expressed above? In reality, is it possible that they have already? In patients' recovery or rehabilitation, will they be supported in a belief that much remains practical and possible despite disability? Will they be shown a path to productivity, contribution, or place in society? Will they believe themselves to be adequately housed, clothed, and fed by the social safety net that is workers' compensation?
While Canada presses forward, there remain questions. As the debate regarding euthanasia continues, it is perhaps worthy of consideration and debate in the broadest contexts. Though only a handful of U.S. states currently enable assisted suicide, what might the future hold? In a community that has struggled with helping workers recover and remediate, will we have tough questions to address in years to come?
It is a curious and serious challenge that Canada faces. It may be isolated there in the context of the law, but are the challenges faced by patients so constrained by political borders? The implications for both today and tomorrow seem worthy of some pondering.
Who should live? Who should decide?
