Summary:
In The Atlantic article “How Canada’s Assisted-Suicide Law Went Wrong,” David Brooks explores the ramifications of extreme liberalism on healthcare and individuals by examining Canada’s MAID law. Liberalism celebrates freedom of choice, but this freedom can turn detrimental and contribute to societal breakdown when taken to the extreme. In 2016, Canada’s medical assisted in dying (MAID) law legalized physician-assisted death. The original qualifications for assisted dying were well-defined and reasonable, but in recent years, the qualifications have relaxed and the range of qualified people has increased and expanded. In autonomy-based liberalism, where individual autonomy rules above all, people become isolated and prone to suicide. Instead of autonomy-based liberalism, our society’s perspective should move towards gift-based liberalism in which each person is a receiver of gifts, and has the responsibility to recognize those gifts, use them to benefit the community, and pass them along to future generations. With gifts-based liberalism, people will find deeper purpose and meaning in life. Policymakers should value the good of the people over the will of the people.
Connections to Medical Philosophy:
Brooks’ article touches on several of the philosophical concepts described in Jacob Stegenga’s “Care and Cure” book, including what it means to be healthy (Chapter 1), the definition of disease (Chapter 2), and the definition of death and ethics of killing (Chapter 3).
According to chapter 1, the positive health view holds that being healthy involves something beyond mere freedom from disease; a patient’s overall well-being must be taken into account, which includes having meaningful relationships, achieving life goals, and being satisfied with life. A person may look physically healthy on the outside, but could be overall unhealthy if the person struggles with life circumstances or mental health. Physicians and policymakers need to be aware of the positive health view to help prevent situations like in Canada, where people see assisted suicide as an escape from misery and release of suffering. The Atlantic article revealed that some people cite poverty or housing uncertainty as the main reason for seeking assisted suicide. The positive health view would argue that people who struggle with poverty or housing uncertainty are unhealthy because they are not satisfied with their life, nor achieving their life goals. Patients who are not medically future but seek assisted suicide as a release from distressing life circumstances are looking for purpose in life.
In chapter 2, the definition of disease that relates the most to assisted suicide is normativism, which contends that diseases are disvalued states, and a person with that condition is harmed by it. Normativism holds that disease is directly related to values. Therefore, from the normativism perspective, being disabled is a disvalued state, and people with disabilities are less than people without disabilities. When MAID was created, administrators conformed to the idea that some lives are less valuable than others, in which people with disabilities have less fulfilling and worse lives than people without disabilities. However, people who find value and purpose in their lives can feel happy and fulfilled, despite their disabilities. In The Atlantic article, historian Wilfred McClay’s mother remarked that if she ever was left unable to read, write, or speak, then her life should not be prolonged because there would be no point in living. A couple years later, his mother suffered a near-fatal stroke, and she was unable to speak. Contrary to her statement a few years earlier, his mother found meaning in life: she became a warmer, more affectionate, and more generous person who communicated through gestures, facial expressions, and loved her grandchildren. Spending time with her family brought her joy in life, and her life was not any less full. Based on the normativism definition of disease, McClay’s mother was not diseased because she did not feel harmed by it and she found meaning in being a loving mother and grandmother.
Moving onto the topic of death in chapter 3, the concept of personhood applies to the ethics of assisted suicide. Personhood is a status in which a person has moral properties and cognitive capacities, like the capacity of consciousness. Personhood differs from biological death, which is the cessation of functioning of the physical body. From the personhood perspective, death is the loss of a soul and losing the capacity of consciousness. A person in a permanent vegetative state is alive as a biological organism, but dead in the sense of personhood with loss of consciousness and moral properties. In Canada’s MAID law, the requirement that natural death must be “reasonably foreseeable” was lifted in 2021. In the article, Brooks names patients who were granted access to assisted suicide even though death was not reasonably foreseeable, including 61-year-old Alan who had hearing loss and history of seizures, 37-year-old Tyler who was physically healthy but suffered from PTSD and schizoaffective disorder, and 23-year-old Kiano who had diabetes and lost vision in one eye. All three of these patients retained their personhood, but decided for themselves that life was not worth living anymore. When applying the personhood perspective to assisted suicide, administering lethal doses to these three cases would not be ethical because there was no death of personhood.
Applications:
Featured in a multi-platform, thought-provoking magazine, “How Canada’s Assisted-Suicide Law Went Wrong” is an opinion piece that harshly criticizes the implications of Canada’s MAID law. After reading this article, the average reader would be outraged by the liberalism and looseness of Canada’s MAID law and want to advocate for stricter qualifications and support groups to help people find meaning for life. However, there is a disconnect between the popular production of medical knowledge in the media, and how medical knowledge is discovered and produced in research. Although well-written, this article was opinion-based and did not thoroughly examine each qualification in the MAID law, choosing to focus more on how people who did not fit the original criteria were being granted access to assisted suicide. The article also did not explore whether people who cited poverty and housing uncertainty as reasons to seek assisted suicide actually got their request granted.
News media can exaggerate and omit parts that do not tell the readers the entire story. When people consume medical knowledge from news media instead of research journals, they might emerge with a perspective that is not completely accurate. To navigate an atmosphere in which patients are consuming medical information through the news, public health advocates and healthcare workers should be responsible for communicating both sides of medical issues and should be well-versed in how medical information is portrayed in the media compared to in research. When patients come to practitioners with misinformation about medications or treatment plans, practitioners should respond in a thoughtful and respectful way that clears up any misconceptions that the patient has.
References
Brooks, D. (2023, May 19). Canada legalized assisted suicide-and exposed the limits of liberalism. The Atlantic. https://www.theatlantic.com/magazine/archive/2023/06/canada-legalized-medical-assisted-suicide-euthanasia-death-maid/673790/