Opinion – Ross Douthat: Euthanasia law in Canada mobilizes critics and advocates

Last month, I wrote a scathing column about Canada’s euthanasia system, which has expanded rapidly in recent years, with over 10,000 people ending their lives under its auspices in 2021. This week, I want to recommend two very different analyzes of the Canadian experience. .

The first comes from an article in the latest issue of The New Atlantis website. Its author, Alexander Raikin, obtained internal material from the euthanasia bureaucracy in Canada, showing that its officials privately argue what critics publicly accused from the beginning: that a significant number of people who request euthanasia seem to be driven to it by poverty. or difficulty accessing medical care, as much as physical or mental suffering, and that euthanasia providers may end up taking this for granted.

To quote one such provider, they may bemoan the “structural inequalities” that influence who requests euthanasia, but they don’t necessarily see their role in protecting people “from the option of assisted death”, or treating euthanasia as the “wrong outcome”. just because the candidate might be having other problems.

Raikin proceeds to consider two individual cases of people in such circumstances. One is Les Landry, a former truck driver from Alberta with a history of suicidal tendencies who missed disability payments when he turned 65 and applied for medical assistance in dying (MAID) because he felt, in Raikin’s words, that he “no longer has the fundamental support he needs” to live a normal life.

The other is Rosina Kamis, a chronically ill 41-year-old who was euthanized in September 2021: her official reasons were physical pain from chronic leukemia, fibromyalgia and other conditions, but in private communications she told people that her suffering was more mental than than physical, both because of isolation and pain: “I think if more people cared about me, maybe I could deal with the suffering caused by my physical illnesses on my own”.

As Raikin points out, both cases illustrate the tangle of motivations that can lead to an assisted suicide decision, and the impossibility of establishing a bureaucratic system capable of “reliably distinguishing a rational option to die from a desperate call for help”.

Which in turn suggests that the more permissive and expansive the euthanasia regime, the more often a person who is basically asking for support will be approved for a lethal injection.

If Raikin’s article is a particularly vivid critique of bureaucratic euthanasia, Richard Hanania’s subsequent essay in defense of Canada’s euthanasia regime is a remarkable progression through differing information in favor of the system.

Hanania begins by defending the Canadian system in familiar terms from the moderate and cautious case of assisted suicide, which seeks to make it legal only as an exceptional form of mercy at the end of life, clearly separate from the way society treats most forms of suffering. mental and physical.

He notes that even with the sharp increase in assisted deaths, the vast majority of people undergoing euthanasia are terminally ill, and that the share of Canadian MAID recipients under age 45 is still extremely small—with the implication that cases discussed by Raikin are still exceptions to the rule.

But Hanania goes further. First, he takes a more expansive libertarian position, criticizing any legal or medical presumption against assisting suicide, because it arrogates to the State the power to decide on “appropriate conditions” for exiting this life, rather than just letting the suicidal person take it. the decision itself.

From this perspective, one can agree with Raikin that the health bureaucracy is not competent to determine Kamis’s true motivations for suicide —or anyone else’s— and still considers that the State should let personal freedom take its course chosen.

Therefore, “the fact that the Canadian program is growing rapidly does not in itself mean that something is going wrong. It could easily indicate that people are very willing to infringe on individual liberty and force other people to suffer against their will, and Canada is more morally advanced than the rest of the world in this area”.

And then —responding, in part, to some insistence of mine on Twitter— Hanania goes even further, to a position that treats the suicide of people who may feel “a burden to their family or the rest of society” as a choice not merely acceptable, but potentially noble:

“Since when do we denounce people who consider how their actions will affect others? I don’t like to upset others, and for many parents the possibility of one day being a burden to their children scares them far more than death. I think that this is a noble sentiment, and I would gladly sacrifice myself when I’m old so that those I care about can live better, more fulfilling lives,” wrote Hanania.

“If we’re going to talk about human dignity, I can think of nothing less dignified than ending up a proud and successful life in diapers and with your brain rotting, leaving your children unhappy and preventing them from reaching their full potential. Suicide is, in many cases, a noble and heroic act and therefore should have the sanction of the State.”

What’s more, he concludes, many people agree with him on this, judging by research and pop culture depictions of assisted suicide: “The Romans had a concept of ‘patriotic suicide’ in which death was preferable to dishonor and, despite two millennia of Christian influence, we can still be inspired by the idea”.

There’s a lot to be said for Hanania’s argument, but I just want to take the last sentence and dwell on it for a moment because it ties in with the points I made in my original column. The column began by discussing the video a Canadian department store produced to celebrate assisted suicide — a watery, holistic spiritual tribute to a 30-something woman who killed herself to escape the suffering of Ehlers-Danlos syndrome.

Part of my argument was that the spiritual aspect of the video was no coincidence, that mass acceptance of euthanasia is unlikely to replace the Christian prohibition of suicide with a libertarian or secular neutrality. Instead, a society that encourages euthanasia will tend to sacralize it, resorting to pre-Christian or post-Christian narratives in which the decision to kill oneself is not only permissible, but sacred.

This point connects to one of my recurring themes—the idea that liberalism by itself, liberalism as pure procedural neutrality between competing worldviews, cannot really exist for long as the exclusive ordering principle of a society.

Rather, what we have historically called liberalism is really “liberalism-plus,” in which a constitutional order is framed by liberal principles, but then infused with some animating theology or ideology that orders lives, shapes politics, and defines terms. of cultural debates.

In Hanania’s essay, one can see a version of this within the confines of a single text. He begins with a sobering argument that seems calculated to reassure people who want to be a little permissive but also want the old Christian taboos on suicide to be upheld.

He moves from there to a more expressly libertarian perspective that sweeps away biblical religion entirely. And then it actively infuses this libertarianism with a sort of pseudo-Roman, pagan, pre-Christian argument for suicide as a positive good, a proper service to the gods of the city and the home.

These gods need not be literal; I have no doubt that Hanania would be dismissive of the festive spirituality of the Canadian euthanasia video. But this kind of therapeutic and mystical post-Christianity and its refashioned Stoicism are different versions of the same fate, two related examples of what de-Christianization produces—not just “free minds and free markets” and freedom for all, but a new theory of goodness. life, and with it a new set of conformist pressures.

This transformation is not a simple or quick inevitability; a divided society can stay between worldviews, so to speak, for quite some time. And Western society’s mix of Christian, semi-Christian, and post-Christian ideas helps explain the variation in euthanasia regimes in different developed nations—a variation that may last for some time, rather than everyone simply converging on the Canadian approach.

But the fact that ancient Christian taboos still have a preventive force should also make one a little skeptical of Hanania’s initial attempt at reassurance, her suggestion that the rise to 3% of all Canadian deaths may have been slippery until now, but we can rely on the natural human preference for life over death to prevent developed nations from doing or accepting anything far worse.

This is not reassuring because we can see in Hanania’s own logic the potential for a much larger category of lives not worth living: the degraded life, the depressed life, the painful life, the financially burdensome life. (Or chronically ill life, to cite the territory of despair I know best.)

And you can see in the current trends of our society, our “social recession”, the potential for many more lives to be lived in psychologically tenuous or seemingly disposable conditions, whether because of poor health, seemingly intractable drug addiction or card games. gambling, various forms of social isolation and lack of work, a friendless and post-familial existence.

In this environment, the Canadian proposition that the medical system may not be able to help you feel better, but it can always help you die, does not strike me as a particularly self-limiting innovation.

And if euthanasia is kept within bounds or withdraws from its advances I suspect it will be the old Christian taboos and prohibitions that will make the difference, not a libertarianism that yields so quickly and easily to pagan destinies.