Chris Selley: The Liberals’ plan for MAID sounds good — if they aren’t bluffing

The federal Liberals on Monday solved two long-festering problems with Canada’s euthanasia regime, they’ve solved them broadly speaking in the right direction — one of the two, certainly — and they will now take your questions and dodge your flying shoes.

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In fact, I suspect this is one of those nice situations where the right thing to do morally also happens to be, on balance, the most palatable option politically. The minor miracle is that after punting for years, they’ve finally donned the big-boy pants, made a decision, and owned it.

The announcement in a nutshell is that the government will be preparing a bill that says “no” indefinitely to medically assisted death solely for a mental illness (which was originally supposed to take effect in 2023) and “yes” immediately to “advance directives” that will let people with degenerating conditions plan for MAID should they eventually lose the capacity to do so. Those deserve full and partial credit, respectively.

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An Angus Reid Institute poll released in June found a whopping 77 per cent of Canadians supported our original euthanasia regime (MAID for people severely suffering and with foreseeable death), with big majorities in every province.

That support dropped all the way down to 43 per cent when a mental illness is the sole underlying condition, which isn’t far from the 39 per cent who oppose it. But the opposition from mental-health advocates who actually work in the field is (demonstrably, given the result) much more passionate than the faculty club support for it.

If Canada’s mental-health care systems were capable of reasonably guaranteeing swift professional treatment — hours to wait, not weeks; inpatient beds at the ready; housing available in various different environments — then we could at least start talking about whether there’s even such a thing as mental illness that might qualify for euthanasia.

Since we can’t, which is a disgrace, we actually have a compelling moral obligation not to euthanize someone who is mentally ill. You cannot mitigate moral disgrace — refusing to furnish halfway adequate care, while prohibiting private insurance no less — with pentobarbital.

Then there are the advance directives. You’re diagnosed with Alzheimer’s or ALS, say, and you want to set conditions under which they’ll put you out of your presumed misery.

Several have suggested these be separate bills, the mental illness and advanced-directive issues being quite different and raising different moral questions. That’s probably a good idea, but there’s also a lot of crossover between the two issues — all the euthanasia issues, really. By definition, you have no idea when you’re going to feel when your Alzheimer’s advances to the point your sound still-sound mind considers intolerable. A few Alzheimer’s patients unwittingly turn into part-time or full-time jerks. A tiny few can turn violent. I can imagine many people believing they wouldn’t want to live if they don’t recognize their children and grandchildren, never mind being a threat to others.

But those are concerns for family and friends, and for those who have to make these men and women as comfortable as possible. Euthanasia is supposed to be about the person. You don’t have to be religious to think life is sacred.

“Caveat emptor,” one might say: Think, consult, ruminate and ponder long and hard before you decide when you’re sure you want to die, in circumstances where you cannot at the last minute reconsider. But some of these things are unknowable.

What happens if a dementia patient says “no” on the day of departure, if he otherwise meets his pre-chosen criteria including (presumably) not knowing what he really wants? Does that “no” carry the day, and if so for how long, or should it be considered the product of a terminally compromised mind? This is far more morally complex on every level than a do-not-resuscitate order. This is the act of ending someone’s life. This is never going to be black and white. Right now, it’s 500 shades of grey.

The original regime, the one with 77 per cent support nationwide, is supportable morally. (Most people are moral creatures, if not infallibly so.) People with incurable, painful, terminal afflictions like the worst cancers aren’t immune, certainly, to familial pressures with respect to “being a burden.” But with proper safeguards in place that we can trust (that’s a whole other column), I’m reasonably comfortable letting people make their own choice … although I still struggle to see why any of this should be the state’s business.

One important caveat comes from B.C. Lower Mainland Conservative MP Tamara Jansen, who authored a private member’s bill banning euthanasia solely for mental illness. (It went down to defeat in the House of Commons on Wednesday.) “We have no idea what (Justice Minister Sean Fraser’s) bill’s going to say. He’s telling us all sorts of things, (but) he hasn’t even seen the bill himself,” she said.

Indeed, this is one of those issues where you can imagine the Liberal comms geniuses wanting to get super cute. The eventual legislation will have to be combed for lice: loopholes, exemptions, avenues to possible abuse, Quebec-specific measures, all of that. For now, the Liberals actually seem prepared to bite the bullet — a victory in itself.

National Post
cselley@postmedia.com

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