Ideas - How philosophy plays a vital role in Canada's biggest ethical debates

Episode Date: July 11, 2024

Arthur Schafer taught ethics to medical students in 1972. His 50-year career put the philosopher at the heart of major ethical debates like MAID. Schafer discusses the role of philosophers in addressing the increasingly complex ethical dilemmas confronting individuals and society as a whole. *This episode originally aired on May 16, 2024.

Hey there, I'm David Common. If you're like me, there are things you love about living in the GTA and things that drive you absolutely crazy. Every day on This Is Toronto, we connect you to what matters most about life in the GTA, the news you gotta know, and the conversations your friends will be talking about. Whether you listen on a run through your neighbourhood, or while sitting in the parking lot that is the 401, check out This Is Toronto, wherever you get your podcasts. This is a CBC Podcast. Ideal end-of-life legislation would respect the wishes of individuals to die according to their own values.

Dr. Arthur Schaefer has thought a lot about life and death. Your values may not be the same as mine. The way you live your life will likely be quite different from the way I live my life, You live your life, will likely be quite different from the way I live my life, and I will want the way I die to reflect the values by which I lived, as you will. The values by which we all live and die have changed greatly over the span of Arthur Schaeffer's long career as an ethicist. I think there's been a cultural revolution, and I think we have progressively, as a society, moved towards greater respect for individuals.

Arthur Schaeffer, at nearly 82, has helped shape policy, local and national, on many of the thorniest ethical questions of our time. And he isn't done yet. the thorniest ethical questions of our time, and he isn't done yet. It's a very exciting time to be alive, but it's also potentially a fearful and threatening time. All of us as citizens, as individual human beings, and as philosophy professors have, I think, an obligation to be involved, to work for a kinder, gentler society. Welcome to Ideas. I'm Nala Ayyad. At a time when expertise is increasingly doubted and even attacked, when opinion is often privileged over knowledge, we at Ideas are launching an occasional series in which we highlight the careers and thinking

of some of the most eminent and enduring scholars of our time. And we start with my conversation with the University of Manitoba philosophy professor, leading bioethicist and author, Arthur Schaeffer. You've had a career that has spanned 50 years and have tackled some of the toughest questions of our time in bioethics and other areas. When you look back to your childhood and your first days as a kid, how did those shape the way you think about

the biggest philosophical questions of our time? I think I spent a lot of time as a kid worrying about the Second World War, the Holocaust, the Cold War, the threat of nuclear annihilation. So it was difficult to grow up in the 50s and then as a teenager in the late 50s and 60s without being aware of some pretty big ethical issues, some of which were existential. If we didn't get the right answer, the survival of humankind might be at stake. Yeah. So in what way do you think that shaped the way you thought about these big philosophical questions? Well, when I was a student, I loved philosophy as an undergraduate, and I was particularly interested in ethics. But ethics in the 1960s, in the English-speaking

world at least, was very theoretical. The idea that ethics was something you could apply to real-world problems somehow wasn't current then. So I studied moral theory, studied something we called meta-ethics, the meaning of ethical terms, how you could justify moral arguments. But applied ethics, which was really what I was interested in, didn't seem to be part of philosophy either when I was an undergraduate at the University of Manitoba or when I went to a graduate school in England. So what is it that drew you to applied ethics to begin with then? Well, partly it was accidental, as so many things in life turn out to be accidental. As a graduate

student, I studied philosophy of law and theories about crime and praise and blame and moral responsibility. And when I returned to Canada in 1970 to teach philosophy at the University of Manitoba, I was teaching philosophy of law, I was teaching political philosophy, and out of the blue, the Faculty of Medicine contacted me, and they were looking for someone to teach a course to undergraduate medical students in biomedical ethics. Well, I was intrigued. I jumped at the chance. And in 1972, I began teaching ethics to medical students. Listeners might be interested to know that in 1972, the University of Manitoba medical faculty was the only one in English-speaking Canada that taught ethics to medical students. There were medical ethics courses in hospitals and universities in Quebec, but they were teaching Catholic bioethics.

So it was appeals to Catholic doctrine and to St. Thomas Aquinas and the church and its position. But secular bioethics, which is now so pervasive that I think you'd be hard pressed to find even one hospital in Canada that doesn't employ someone with the title hospital ethicist or clinical ethicist, simply didn't exist. So this was an exciting opportunity. And in 1972, I began to teach ethics to medical students. And I have to say, Nala, that for at least the first few years, and perhaps beyond then, a philosopher in a medical school, a philosopher in a hospital was viewed as an interloper. Like, what's this guy doing in our hospital? The doctors were skeptical. My medical faculty, scientific colleagues and medical colleagues were skeptical.

What about the students? Well, the students were, they may have been skeptical, but they were very enthusiastic, and we were talking about issues that they were seeing every day on the ward. So it was easier to be accepted by the students then, at least initially, than by my medical faculty colleagues. Are you able to make a broad statement about what happened to the process of resolving ethical questions when it went from the religious realm to a secular one? Our medical school consists of students of every religion and none. There are Christians and there are atheists and Jews and Muslims. And if we're going to reason about how

doctors ought to relate to their patients or who should be given priority for organ transplants, any of the issues, we have to be able to deliberate together. So if I appeal to a religious authority, my priest, minister, rabbi, that may be persuasive to my fellow Christians or Jews or Muslims, but it's not going to appeal to everyone. And so the transition from religious medical ethics to secular medical ethics was really the transition from language and reasons and deliberation that could in a multicultural, multi-ethnic, pluralistic, religiously, society could appeal to everyone. And that was our challenge. Some of my students were deeply religious and wanted to invoke the Bible or what their minister

had preached in church. And I had to say to them, you know, this is very important to you as a person. But when we're talking about what the law should be or what our obligations are as physicians, we have to be able to justify ourselves in a way that could appeal to any reasonable person. So secular bioethics was really born in the late 60s, early 70s. And just by chance, I happened to start teaching medical ethics at that time. It was the birth of a new discipline, really. And over that period, I mean, you're now still, you know, working directly with the Center for Professional Applied Ethics that you founded in 1986. So things have changed dramatically.

Not only there there a shift between the religious realm to the secular realm, but also even the values, I would venture to say, that we measure against have changed. Yeah, that's true. What is it that changed that allowed us to get here? In the 60s and in 1970, when I began teaching philosophy, there were no courses in bioethics, but there were no courses in environmental ethics or business ethics or sports ethics or sexual ethics. Never mind computer ethics and ethics of artificial intelligence, if you look at the curricula for philosophy departments and indeed universities across Canada, across America,

and in Britain and Europe, our curricula are littered today with courses in applied ethics. So something happened. The dry-as- as dust, very theoretical speculation that paraded under the label ethics got translated or applied to a whole variety of different domains, medicine and business and nursing and environment, and sex. And I think it's been a very exciting transition. Students used to complain that philosophy, at least in the English-speaking world, was irrelevant to real-life issues. They looked to European philosophers as having profound things to say about the meaning of life and the purpose of life. Well, I don't think anyone could legitimately make that complaint today because philosophers who do ethics are now

engaged in a whole variety of ways with serious and real problems confronting both individuals as individuals and individuals as part of a community, as part of society. Can you think of the first time that, of the first ethical dilemma that kind of, as a professional, that really furrowed your brow, that really kind of made you think? I mentioned a moment ago that my scientific and medical colleagues were a little bit skeptical, at least initially, and maybe more than just initially, about having a philosopher hanging around the joint. And they decided that if they were going to let me loose on their medical students, that I should have some experience on the hospital wards. And I have such a vivid memory of my first rounds that I did with two colleagues. One was an oncologist and one was a respirologist.

And our very first patient, he was a man, I suppose in his 50s, who had metastatic lung cancer. And they reported to him that the chemotherapy they'd given had resulted in his primary tumor had shrunk. And they found that an encouraging result. And they asked him how he was feeling. And I watched and I listened. And then the two doctors and I went out into the hall, out of range of hearing from the patient, and they discussed his case. So being a naive outsider, I said, well, it sounds as if these powerful oncology drugs are working.

So he's got a good life expectancy. No, they said that the tumor had metastasized. The fact that the primary tumor had shrunk won't actually mean that he has very long to live. When they said that he didn't have long to live, I asked my medical colleagues, well, does he know he's dying? Have you told him that he's dying? And they hemmed and hawed a bit. And one of them said to me, well, no, we haven't told him he's dying, but we did tell him

that he should think about selling his pig farm, that he might not be able to resume his career. And I remember thinking to myself that maybe he understood that as a prognosis that he didn't have long to live, but maybe he didn't. And I remember thinking, well, wasn't he entitled to know what his prognosis is? Arthur never learned whether the doctors followed his advice and told the pig farmer of his impending fate. But the farmer's story lives on. These encounters with patients on the ward provided a lot of material to discuss with students, and they were the pegs on which we could hang discussions about physician paternalism,

where the doctor titrates information to the patient, as you would a drug, with the doctor knowing best and deciding what's best for the patient, and the value of patient autonomy, where the patient gets to be fully informed and then make her or his own decision. I'm grateful to my colleagues that they encouraged me, indeed insisted that I accompany them on hospital wards. And later, I myself became a hospital consultant in the neonatal intensive care unit. And gosh, there were life and death challenging decisions to be made about withholding life support, withdrawing life support, accommodating the wishes of parents, challenging decisions of

parents that seemed unreasonable. And the actual practical experience of being with physicians and dealing with cases was really helpful to me and I think translated into better classes with the medical students. I can imagine those are real life examples that you were able to use and they were provided to you by the institution. I'm curious just in that case, I mean, it's a vast difference of living in a society where the doctor knows best and the society we live in now where autonomy is such an important value and so coveted by both patients, and I think most doctors would agree, how many ethical decisions and dilemmas intersperse those two different ways of thinking? Well, if you talk to your parents, or perhaps your grandparents,

your parents or perhaps your grandparents, you'll find them sometimes using phrases such as doctor knows best or doctor's orders. I mean, there was a time a few generations ago when big burly coal miners or steel workers would passively and meekly follow a prescription or a treatment plan because it was doctor's orders. I don't know whether anyone uses that phrase anymore or whether we still assume that doctors know best, but I think in the last half century, what I've seen is a steady move away from doctor knows best, fancy label physician paternalism, towards the feeling that patient should at least be participating, that they need to be informed. And okay, if you're a patient and you don't want to participate, you don't want the information, you can set the limits. But I think the default assumption now is that patients do want to know and that families want to know. Even children are consulted, even people who may not be cognitively as sharp as

once they were. To the extent that patients can participate, they're encouraged to participate. I think that's been a major transition in medical care, but probably in all aspects of society. A move away from paternalism towards patient rights, children's rights, women's rights. The value for each individual of being able at least to participate in and perhaps to make the fundamental decisions that are going to affect one's own life. Right from the start, Arthur Schaeffer's interest in applied ethics brought him into debates and court challenges on real-life conundrums. He's helped strike down municipal laws banning panhandling and federal laws that prevented prisoners from voting, a challenge that went all the way to the Supreme Court of Canada.

But for the past two decades, his work has focused on the ethics of research. In the early 70s, I was invited by a colleague in addictions research at CAMH, the Center for Addictions and Mental Health in Toronto, to write a book chapter on alcoholism research, the ethics of. And what I discovered reading the literature was that some of the experiments, some of the research done by addictions researchers, alcoholism researchers, was profoundly unethical. So, for example, one experiment involved taking prisoners who had, while they're incarcerated, who had problems with alcohol addiction, and giving them unlimited alcohol to drink, monitoring their physiological processes,

and figuring out at what point they developed delirium tremens. Inconceivable today. Yeah, I mean, it would never pass a research ethics board. So I published a chapter in their book on research ethics, research ethics, and then subsequently wrote an article for the New England Journal of Medicine on the ethics of the randomized clinical trial. And some of the court cases in which I was involved, including one just a few years ago in Toronto, involved cases where the research went wrong, where research subjects were harmed, and where the family of the deceased, in some cases, argued that the experiment had been unethical. So my own personal research on research ethics sometimes got translated to the courtroom where I was retained

by a lawyer for one of the litigants as the courts tried to decide whether the doctors of the courtroom where I was retained by a lawyer for one of the litigants as the courts tried to decide whether the doctors of the hospital had conducted the research in an ethical way. Such cases will sometimes come up when private companies fund research that stands to benefit the public, a routine state of affairs now at hospitals and universities which have come to depend on corporate money, and one that's likely contributing to the waning faith in scientific expertise. The overwhelming majority of research in Canada up until about 1980 was government-funded. There was private funding, but it was so minor as to be insignificant.

But in the 1980s, governments decided that taxes were too high, and they began to cut back on research funding, which meant that universities and teaching hospitals were stuck. If scientists and universities and hospitals wanted to promote research, let's take biomedical research as an example, they had to find corporate sponsors. Today, it's very difficult to get government funding unless you also have a corporate sponsor. So governments do put a lot of money into medical research, into agricultural research, food safety research, aviation research.

But decisively, private corporations have become critical in the funding of such research, private corporations have become critical in the funding of such research, which means that if you want a career in research in medicine, but in other fields as well, you've got to have a corporate sponsor. So what's happened is that our largest, wealthiest teaching hospitals go cap in hand to the pharmaceutical industry primarily, also the makers of medical devices. Our agricultural faculties go to the food industry and the livestock industry and the chemical industry that manufactures the chemicals that are used in farming. And so Monsanto, now owned by Bayer, I was going to say Bayer and Monsanto, do almost all the funding of herbicides and pesticides in Canada.

And the scientists who are investigating whether these chemicals are safe, whether they're safe for the environment, whether they're safe for the people who consume the fruits and vegetables and end products, it's done by people who are funded by the corporations, whose career depends on pleasing the corporations. So that's generated what could be called conflicts of interest. The obligation of the researcher is to use her or his impartial best judgment on behalf of the truth, on behalf of the consumers, on behalf of the patients in pursuing the truth. And yet the funding may be contingent on pleasing a corporate

sponsor. And so in Canada, to give an example or two, we've had some really disturbing scandals, one of which involved the largest hospital in Canada, SickKids Hospital, Hospital for Sick Children in Toronto. Another scandal involved CAMH, the Center for Addiction and Mental Health. Both of these scandals involved the largest, wealthiest research university in Canada, the University of Toronto. And the scandals I'm thinking of involved researchers who discovered potentially harmful, even lethal side effects of the drug they were researching, and who reported their results or wanted to report them. and in the case of Nancy Olivieri at SickKids Hospital in the U of T, for example, she was threatened with all legal measures by the drug company Apotex that had funded her research. Pharmaceutical giant Apotex did sue Nancy

Olivieri after she revealed that the drug she was testing, deferaprone, had potentially lethal side effects. Arthur became involved as a pro bono ethical consultant for Olivieri and her lawyers. At issue was whether profits trumped patient safety and research integrity. When she appealed to her hospital, SickKids, and her university, the University of Toronto, for help in meeting the legal costs and in other ways, instead of being helped effectively, she was harassed. Coincidentally or not, at the very time that Apotex was threatening to sue her and her university and hospital were refusing to help her, Apotex was negotiating to give a $20 million

donation to build the new molecular medicine building at the University of Toronto. University presidents, university deans, hospital presidents, hospital board of directors are so focused, have been so focused in the last 40 years or so on fundraising so that they can build a new building, so that they can put the best equipment, so that they can attract the worldwide famous researchers. They want to be excellent. They want to be world class. If we want our hospitals to put research integrity and patient safety first, can we really allow them to be dependent on drug companies? If we want our faculties of agriculture to do research on the safety and the healthfulness of the kinds of

industrial agriculture we're using, can we really allow them to have their buildings built by or the money for them donated by the chemical industry? We are allowing them. We are allowing them. It saves us money. We say we can't afford to pay for it. Too much of our income goes to taxes. But in the long run, it's way more expensive to have useless and dangerous drugs that aren't properly investigated. And what about the cost of the environment? The cost, I mean, we've got most of the environmental research in Canada at universities

is funded by the fossil fuel industry. I think as we've progressively moved away from universities as centers of intellectual integrity, where you could count on university researchers to be independent and critical in their investigations, we've now reached the point where if their research comes out with results which are negative for the company's products, they tend to file them away in the bottom drawer of their filing cabinet. Questions about deferaprone's use at Toronto's University Health Network still make headlines.

use at Toronto's University Health Network still make headlines. Olivieri faced down the threats and lawsuits, and in Arthur's words, became an international icon for standing up to big pharma. But the ethical questions about corporate funding of research remain. Is that a lost battle at this stage? I would say no. I mean, some of my colleagues would say yes. We've gone so far down this road. Everything is brought to you by imperial oil or Bayer or Pfizer or Merck. I think if the public insisted that we're happy to pay more money in order to get a safer, healthier environment, safer,

healthier medical care system, better drugs. In the end, we would save money in the long run. What we need is public science in the public interest paid for by public tax dollars. If you make researchers dependent for their careers, never mind the consulting fees and the first class travel and all the other perks that come with being funded by wealthy corporate interests. If we want integrity in research and public safety, we've got to have public science and the public interest paid for by public tax dollars. Tax the corporations. Use that money.

Don't let them dictate what gets researched and who gets to do the research. That's the critical point. We, of course, let the chemical companies and the drug companies and the device companies and the fossil fuel companies insist that they pay their fair share of taxes, but don't let them determine who gets to decide whether their products are safe and healthy and effective. Professor of Philosophy and Applied Ethicist, Arthur Schaeffer. You're listening to Ideas on CBC Radio 1 in Canada, across North America on US Public Radio and Sirius XM,

in Australia on ABC Radio National, and around the world at cbc.ca slash ideas. I'm Nala Ayed. Hey there, I'm David Common. If you're like me, there are things you love about living in the GTA and things that drive you absolutely crazy. Every day on This is Toronto, we connect you to what matters most about life in the GTA, the news you got to know, and the conversations your friends will be talking about. Whether you listen on a run through your neighbourhood or while sitting in the parking lot that is the 401, check out This Is Toronto wherever you get your podcasts.

It is surely safe to say that most of us think the idea of using patients in a medical sense, patients as guinea pigs, is immoral. There is huge division around both euthanasia and assisted suicide. The particular problems surrounding the case raise legal, moral, and ethical questions that touch us all. To discuss some of these issues this morning, I'm joined by Arthur Schaefer. Professor Arthur Schaefer is director of the University of Manitoba's Center for Professional and Applied Ethics. And he speaks to us again this morning from Winnipeg. Morning. Good morning, Peter. He joins me now. Good morning. Good morning, Sheila. Good morning, Professor Schaefer. Good morning, Warren. In countless media appearances, Arthur Schaefer parlayed his

award-winning teaching skills into communicating difficult ethical subjects to the public, including on CBC Ideas. No society, no cooperative enterprise can exist unless there is a level of trust. Arthur Schaefer has also written and lectured extensively on medically assisted death in Canada, also known as MAID, and has helped shape national policy on it. The federal government wavered in early 2024 on implementing groundbreaking but controversial new rules allowing for the possibility of MAID in some cases of severe mental illness. It is only the latest chapter in what remains an evolving policy.

It is only the latest chapter in what remains an evolving policy. So the issue of end-of-life decision-making really raises such important issues for every Canadian, I mean in particular for those in the geriatric set, but all of us have seen loved ones who've died, sometimes miserably, sometimes in a prolonged way, sometimes in a lot of pain or suffering. And so this has been one of the issues that for more than 50 years I've been lecturing on and writing about. And when MAID was legalized in Canada, I agreed to serve on the provincial territorial expert panel on medical assistance in death. And so we grappled with a whole bunch of issues advising the provinces and territories about how to handle, for example, hospitals or nursing homes, let's say with a religious affiliation who say, well, we're not going to let patients in our

hospital or our nursing home be assessed for MAID or we're not going to allow MAID to occur on our premises. Well, these hospitals and nursing homes are all funded with public tax dollars. Their patients are of every religion and none. Their medical staff are of every religion and none. So the idea that a Catholic hospital or an evangelical hospital or a Jewish nursing home should be able to say no maid because it's against our religion, that was quite controversial. It was one of the issues with which we grappled. Each province has gone its own way on this issue. Each province has gone its own way on this issue. There is no standardization in Canada, but I suspect over time there will be. What does an ideal-made law look like where you're concerned? legislation would respect the wishes of individuals to die according to their own values.

Your values may not be the same as mine. The way you live your life will likely be quite different from the way I live my life, and I will want the way I die to reflect the values by which I lived as you will. So I think the ideal maid law would be maximally respectful of individual choice. It would give individuals a range of options. It would make palliative care available to people and good housing and economic security. And when we're dying, when we're suffering intolerably and in an enduring way with a grievous medical condition which is incurable, and when we're competent, when we have decisional capacity, when we're able to make the decision for ourselves, for ourselves, I think we should respect the wishes of each individual.

Maybe it won't be the decision you would have made. My decision might not be. Your decision might not be the one that I would make. But we have to protect the vulnerable. We have to protect individuals from being abused or exploited. And at the same time, we have to respect their wish to make the basic decisions with respect to their own living and their own dying. How far are we from that version, do you think, currently? Well, I think there's still room for adjustments in our end-of-life legislation. Somewhere over 80% of Canadians think that the law that says you've got to be competent when MAID is administered, that that's too restrictive, that if I'm suffering from dementia, I'm still competent, I'm still clear-minded, and I know that when I can no longer recognize where I am, who I am, my spouse, my children, that I don't want my life to be sustained, that I want made. Most Canadians, indeed overwhelmingly Canadians, think I should be able to put in my advance directive, not just no CPR, no resuscitation, no breathing machine, no

antibiotics, only palliative care, but I should be able to opt for medical assistance in death. If I've got brain cancer, if I've got dementia, if I've got some kind of disease that's going to rob me of competence. So that's one area. Mature minors is another area where the law, I think, may well be reformed. At the moment, you have to be 18. So if a mature 17-year-old is suffering intolerably and incurably from, let's say, cancer that spread throughout her body. The fact that she's not 18 is going to prevent her from opting for an assisted death. I think we should allow children under the age of 18 who are competent, perhaps in the case of younger children with the agreement of their parents, to participate in the end-of-life decisions. So that's a second area.

There are more. So MAID for psychiatric patients is going to be, I think, the most controversial issue when it's going to be legalized. Medically assisted death for patients suffering solely from a severe mental health condition was supposed to be legalized in Canada in March of 2024. But the government announced a pause in implementing it. It's the second such delay, this time until 2027. It's the second such delay, this time until 2027. And as soon as you say the words mercy killing or medical assistance in death for mentally ill patients, people have a nightmare vision of vulnerable, mentally sick patients being bumped off. sick patients being bumped off. I think it's because it needs to be made clear that mentally disordered patients get made at the moment. If you've got cancer and you meet the criteria, you're mentally ill, but you're sufficiently clear-minded that you can say,

I want life support discontinued. Or even if your disease is grievous and incurable and your suffering is great, the fact that you're mentally ill won't preclude you from getting access to MAID. But what if the mental illness is the sole underlying mental condition? So you've not got cancer. You've not got congestive heart failure. You've not got a neurological condition that's going to rob you of all your capacities. What you've got is a major depression or perhaps schizophrenia. And you're suffering intensely. And it's prolonged, perhaps for 10 or 15 years,

you've had every treatment for your major depression. You've had drug pharmacological therapy and you've had talk therapy and you've had shock therapy. And after 15 or 20 years, you're still suffering. Should you be eligible for MAID? Well, I think there's a strong argument that if you're competent, if you can understand the choices before you, if you understand your options, notwithstanding your depression, if your disease really is incurable. So how do we know it's incurable? Well, 15 years of trying every treatment. The Netherlands and Belgium are two countries in which this applies only to a handful of people, but mentally ill people should not be automatically excluded from making end-of-life decisions. They can already say, I don't want life support,

and if they're competent, the life support is withdrawn and they die. I think extending MAID with careful regulations, if they're not dying imminently, the regulations will say 90 days of careful assessment, 90 days at least. So we need psychiatric assessments, but there are psychiatrists who say we can make these assessments. We can distinguish who's competent from amongst those who are suffering from a mental disorder from who's not competent. So unless the federal government changes its mind again, mental illness as the sole underlying medical condition will not be excluded

automatically. It doesn't mean you'll get made, but it means that if you can persuade the doctors, the psychiatrists, that you meet all the criteria, that you will be eligible. So given how controversial that idea is, what's your best argument? What's the best ethical argument for this to proceed as planned? The best ethical argument is that patient autonomy is a fundamental value, even for those with mental illness, and that relief of suffering is a fundamental value. There are patients who have suffered terribly, are suffering terribly from mental disorders, who end up killing themselves. They starve themselves to death. They throw themselves off bridges. They drive their car on the highway

into a lorry. I mean, there are horrible consequences when people try to kill themselves. Sometimes they fail and their suffering is intensified. Sometimes they succeed and others have to clean up the mess. I think in general, we have to find a way of balancing our legitimate desire to protect the vulnerable on the one hand, and then on the other hand, to respect the competent wishes of patients, including those who have mental illness. Every year, the government of Canada produces statistics on how many MAID cases there are. It's about 3% of all deaths in Canada, slightly over 3, 3.3% of deaths. And who are those people? Who are those people?

Who are those people? Well, the critics of MAID said that MAID would be a cheap way of bumping off the poor, racialized minorities, women, the disadvantaged, the powerless. But if you look at the Canadian figures, you find that the people who are receiving MAID in Canada overwhelmingly are wealthy. They're the economically privileged. They're university educated. They are people who have had palliative care or at least have had full access to palliative care. It turns out that people who are good at gaining access, gaming the healthcare system, gaining access to healthcare resources, are also good at gaining access to MAID. They know about it. They know the language in which to present their request. And they seem to succeed much more often. I'm not saying we don't need to be concerned about poor and vulnerable people who could be exploited or abused, but all the evidence points in Canada, also in Oregon and Washington

State and those American states that have legalized physician-assisted suicide, the evidence does not point to a slippery slope and it doesn't point to red flags. When you look back to the young ethicist or philosopher who was walking around in the wards and contemplating the questions that were raised by that pig farmer's case, talking about this kind of autonomy for patients. I just wonder what goes through your mind. I mean, it's a very, very different world, isn't it? Yes. I think there's been a cultural revolution, mostly positive. So individuals expect to be able to control their own destiny. as consumers, as women. And I think we have progressively, as a society, moved towards greater respect for individuals. We control our own procreation. We control our own lifestyle

preferences. We insist that we should be able to express our sexuality as long as it's in consensual relationships without society interfering. What's happened, I think, is that John Stuart Mill's dream has come much closer to realization in 2023 than he might have dreamed it could when he was writing On Liberty in the 1860s. The dream is that unless we're causing harm to others, we should be allowed to make our own

life decisions. More than that, of course, as Mill also recognized, we need resources to be able to make our decisions effective. But unless we're causing harm to others, as a former Prime Minister of Canada famously said, the state has no business in the bedrooms of the nation. And I think we're now moving towards the position that the state has no place in the hospital ward when someone is dying, except to protect people against exploitation or abuse. But it does raise a question in my mind about our progress in ethical deliberation. Is it always a one-way street? You can't unknow what you know. Can we ever reverse progress, I guess, for lack of a better word, in our ethical deliberations? Yeah, I would love to say, no, you can't reverse progress. And that basic human rights and liberties once achieved and basic respect and dignity once achieved can never be reversed. But we've seen in many places in the world, including in many states in the country just to the south of us,

we've seen that fundamental human rights can be eroded, sometimes as a result of fear. eroded, sometimes as a result of fear. Fear does, whether it's economic fear or anxiety about one's own status or losing status or downward mobility or unemployment, the threat of aliens, foreigners, people different from us. So I would love to say progress can't be reversed, but I don't think that's true. It can be. So that puts on all of us an obligation to remain vigilant. Sometimes rights have to be infringed, but they should never be infringed lightly, unnecessarily. They should never be infringed more than is absolutely necessary. They should never be infringed more than is absolutely necessary. They should never be infringed at all if we can find a workaround that will achieve our objectives without violating anyone's rights.

We've had a lengthy discussion where we haven't even talked about, you know, genetic engineering or, you know, CRISPR and all these amazing advances that have raised endless ethical questions. I just wonder when you look at the landscape now, and one that now includes artificial intelligence and the internet and all these different things, whether you ever wonder whether our own advances, our own technology might one day outstrip our ability to quietly consider the ethical considerations. the ethical considerations? Change is coming very fast. It's not that we need new principles, but we need reliable information about the implications, the possible benefits, the possible harms, the magnitude of the benefits, the magnitude of the harm, the risk that the benefits will come about, the likelihood that the benefits will come about, the risk that the harms will come about. We need much better information, and often we have to make decisions behind a veil of ignorance. We're catching up. Well, we're always catching up because society is changing so rapidly. I mean, in the Middle Ages, society could, over a period of hundreds of years, remain

virtually unchanged, the same agricultural methods, the same kind of individuals living in the same farms and villages, never moving very far away. But technology is presenting us with problems. And the trick is, I mean, we want to get the benefits of the new technologies. Some of them may be critical if we're to survive without the existential risks of destroying our environment or poisoning ourselves as we introduce the new technology. I mean, think of CFCs, the miracle coolant in our refrigerator. Think of asbestos, a miracle insulator. Technology, sometimes every new technology is a brilliant new breakthrough, and it sometimes

takes a little while before we discover what the costs and the harms are. They tend to be oversold by people who stand to make a lot of money from exaggerating their benefits and minimizing their harms. So as a society, we have to try to figure out a balance. We have to adopt the precautionary principle. We can't wait till we can prove that something is harmful because by then it may be too late. On the other hand, we don't want to stifle technological progress and say, well, okay, unless we can prove absolutely that it's safe. Well, crikey, how can you prove anything? Even dental floss might turn out to harm your gums or Gore-Tex clothing that's wonderful for cyclists in the rain may turn

out to have negative side. So we can't insist on absolute proof of safety, but I think we should have more respect for the precautionary principle. I mean, think of the folk saying, look before you leap. A stitch in time saves nine. There's something to folk wisdom.

We don't have to abandon technological progress to insist that people who are introducing it have done some good research on what the likely harms are as well as the likely benefits, and have assessed that the—and we've assessed and overseen the assessment—that the benefits are likely significantly to outweigh the harms, especially when the potential harms are existential, especially when they could be massively serious for the future of humanity.

To what extent do you want to still play a role in all of this, 50 years down the road? It's a very exciting time to be alive, but it's also potentially a fearful and threatening time. And all of us as citizens, as individual human beings, and as philosophy professors, have, I think, an obligation to be involved, to be as well-informed as we can, to be open-minded, to listen, to be critical, to think critically, to challenge our own biases and prejudices, and to try in the end to work for a kinder, gentler society. It's a wonderfully challenging time to be alive. A bit scary, yes. It's legitimate to be wary and frightened and cautious.

But I'm hopeful. That's a wonderful place to end. Thank you very, very much. University of Manitoba Professor of Philosophy, Arthur Schaeffer. We spoke at his office in Winnipeg. Many thanks to Arthur Schaeffer for generously sharing his time. Thanks also to Kate Zeman at CBC Radio Archives for all her help. This episode is part of an occasional series in which we highlight the careers and work of

eminent and enduring scholars. If you know of someone who should be featured in our series, please contact us at ideas at cbc.ca. our series, please contact us at ideas at cbc.ca. If you liked the episode you just heard, please visit our website, cbc.ca slash ideas, where you can find hundreds of our past episodes. This episode was produced by me, Nala Ayed. Our technical producer is Danielle Duval. Our technical producer is Danielle Duval. Our web producer is Lisa Ayuso. Acting senior producer, Lisa Godfrey. The executive producer of Ideas is Greg Kelly.

And I'm Nala Ayyad. For more CBC Podcasts, go to cbc.ca slash podcasts.