Reuters World News - Special episode: The ethical debate over who can choose to die in Canada

Episode Date: July 15, 2023

WARNING: This episode contains material that some people might find disturbing. What happens when a country offers those suffering from mental illness the option to choose death? In this special episode, we’ll cover the debate raging over Canada’s decision to expand the right to die. Learn more about your ad choices. Visit megaphone.fm/adchoices

In Canada, medical assistance in dying is a way for people enduring intolerable suffering from incurable illnesses to receive medical help in ending their lives. But what happens when that illness isn't terminal but a chronic mental illness or a disability? Canada will soon allow people suffering solely from mental illnesses to seek out medically assisted death. In today's special episode, we're exploring the gray areas that come with end-of-life cancer. care, for the terminally ill, for those struggling with debilitating mental illnesses, and for those who want a say in when their life comes to an end. I'm your host, Christopher Waljasper, in Chicago. And I'm Anna Maylor-Poerner-Poerni in Toronto. Anna, tell me about some of the people you've been talking to who are considering taking advantage of this expanded access. So since

2016, the vast majority of people who've been accessing medically assisted death in Canada have been people whose so-called natural death is reasonably foreseeable. They're about 98% of the total. That remaining 2% are people whose death is not reasonably foreseeable. And that is where it gets messy. And the expansion into mental illnesses gets messier still. I spoke with a woman named Lisa, Lisa Polly, who has battled anorexia for most of her life. And she told me she is in agony over it. I mean, it's hell. It's every day is hell. It takes me literally an hour to get out of bed just physically. And yeah, I just, I have no energy. My mind is just constantly thinking about numbers. I'm so forgetful. And,

By like 2 o'clock, I'm ready for bed. If I do laundry, that's like running a marathon. She told me that she wants to die. And accessing assisted death for anorexia will be something new for Canada. And for some people, it's something deeply problematic. Yeah, yeah. I can see a lot of ethical challenges there.

So what are opponents saying to the idea of expanding this access? Disability advocates worry that effectively, for some people, it becomes easier to access a so-called dignified death than it is to access the supports that would make their lives bearable. Some people also argue that because we are so ignorant of mental illnesses, we're not very good at figuring out whether they're truly irremediable, whether they're really not going to get better, which is a difficult thing to say to someone who is in agony. and has been in agony for years, has tried treatments, but doesn't see a solution. I just don't think that like eight weeks of just eating meals regularly on a schedule is enough to help somebody that's had a 20-year history of disordered eating. There are a few aspects of medically assisted death that Canada still hasn't weighed in on, right?

That's true. a parliamentary committee recommended that Canada look into expanding medically assisted death to advance requests so that people who have neurodegenerative disorders, such as Alzheimer's, can make a request in advance and say, once I get to this predetermined point of incapacity, I want out. And I want to make my request now because I worry that by the time I want to access death, I will have lost my capacity. Right now in Canada, you need to say at that point, yes, I consent, this is what I want. So proponents of advanced requests say there are going to be people who want to keep on living up until they lose capacity. They say they should have the opportunity to access assistance dying, even once that point of incapacity has been reached. Anna and I called up Eric Matheson, an assistant professor of philosophy at the University of Toronto, and a clinical ethicist to help us unpack these ethical gray areas. Eric, what are the ethical concerns around broadening access to medical assistance and dying to

people with mental illnesses? The tension is really between giving people access to something that they might be entitled for as a point of autonomy. So the case for expanding access is that people have an autonomous choice to make decisions about their own lives. and also it can be a way of preventing suffering as it is in other cases. But on the other side of it is that if we expand too far or if we don't have the right safeguards in place, then people will be offered assisted dying or assisted dying will be available for people

who might not be able to make informed decisions for themselves. They might be at risk of being coerced and other concerns like that. So I spoke with this 47-year-old woman who's been wrestling with anorexia for decades. And she says she's tried pretty much everything. Nothing has worked. Nothing has attenuated her suffering. And she told me she wants to access assisted death. And I was wondering, how would you approach this from an ethical perspective? I think that what's important in this case, one of the things you mentioned is that this is a person who's been dealing with her condition for a long time. She's tried many different approaches. And so I think that that has a different flavor. than somebody who gets a diagnosis very quickly and then is making a decision in a quicker amount of time. So as she's had more time to think about it, as she's tried more options, and as she's been living with her condition for a longer period of time, she'll have a better understanding about her

situation and be able to make choices in a more kind of considered thorough way. So how does that case differ from, say, a person suffering from kidney failure? Their condition may not be terminal, but the thought of going through the arduous process of dialysis, you know, multiple times a week, that might lead a person to opt for medically assisted death. Should these two scenarios be thought about differently? I don't think it differs that much. I think that, you know, that in both cases they have a good sense of what their situation is. Of course, in both cases, we might hope that there would be some breakthrough cure or the kidney person with needing kidney dialysis would be. get a transplant, things like that. But we have to kind of look at the facts, look at the situation

as they are, and look at what's the most likely expected outcome. And so the fact that one of them is dealing with a mental disorder and the other person is dealing with a physical illness, I don't think should affect our assessment of the ethics of it very much. Do you see concerns here specific to mental illness? I think that one of the specific concerns that we should have about mental illness is that psychiatry just has more disagreement. that most people that I talk to who have been diagnosed with a mental disorder, that they might have had multiple diagnoses or diagnoses that disagree with each other, that require different treatments. They might have tried different treatments. And so I think with something like cancer or

kidney failure or many physical illnesses, that there's a better understanding about what it actually looks like. What do you see happening next? My guess is that the next thing after that is going to be advanced requests. So people who have Alzheimer's or dementia or other conditions, deteriorative conditions like that, are going to be able to make a request through an advanced directive and say, you know, when I'm no longer able to make a decision for myself, then I consent now to having an assisted death. That's the, receives the highest amount of support among Canadians in terms of expansion. So I suspect it'll go in that direction. So, Anna, where does this leave us? There are people who say, yes, our health care and our social services systems are deeply flawed.

And it is flawed so that it hurts vulnerable people the most. And it's flawed from a socioeconomic perspective. It's flawed from an access to health care perspective. But that should be an argument in favor of improving the system and improving supports. And they worry that if you go in the opposite direction and say, the health and social services systems are flawed. Therefore, people affected by those flaws should not be allowed to access assisted death. You're effectively leaving people to suffer without fixing the cause of the suffering

and also without providing them respite in the manner of their choosing. That's it for this special episode of Reuters World News. Special thanks to Anna for all her work on this story. It's Reuters reporters from around the globe, that make this show possible. To read on a story, visit roiders.com. We'll be back on Monday with our regular daily news show, with everything you need to know from around the world

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