Monday, December 4, 2023

Too Poor to Live, But Not Too Well to Die

 In March 2024, Canadians with mental health problems who haven't found significant relief from their condition will be able to get Medical Assistance in Dying (MAiD). 

As I wrote recently of the mental health crisis, 

"We no longer lock people up in asylums; instead, we give them less than they need to survive, and they end up living in tents that randomly get bulldozed into the trash by government officials. We're back to the pre-asylum days where people who couldn't work because of a mental health condition have to resort to begging in the streets. In just a few months, they'll be eligible for MAiD." 

Of course this is not to suggest that all homeless have a mental illness, but that many people with a mental health condition end up homeless because of a lack of supports. 

According to Stats Canada

"In the database, the underlying cause of death is defined as the disease or injury that initiated the train of morbid events leading directly to death. As such, MAiD deaths are coded to the underlying condition for which MAiD was requested, . . . In the case of a disability or mental health condition, deaths are coded to the underlying disability or mental health issue that MAiD was granted for." 

This means that if poverty-stricken people are more affected, that data set won't be accessible as they'll be spread out over the many different disabilities and mental health conditions they might have that enabled this option.

It definitely won't show up as death from a lack of alternative options, like providing low cost rent, or offering enough ODSP to actually cover the cost of food and housing. There also won't be any stats on how many have conditions exacerbated by a lack of adequate nutrition or by the constant stress of struggling to get by. 

We know that in 2022, MAiD was used by 13,241 people, which would make it the 6th leading cause of death if it were counted as a separate entity, but I'd like to see that broken down even further.  

There are two separate cases here that should be counted separately: 

MAiD is a fantastic resource for people who are suffering when there really is nothing that can be done to help them. For some people, the meds that relieve their pain also take away any joy they might find in life, and they want to be able to go in peace on their own terms. That's a contentious issue on its own, but I absolutely support that right to die. 

MAiD is also a means to end the lives of people who are suffering when there is so much that could be done, but it's seen as too costly. It's being used in a heinous manner, and that makes it feel like it's being made available to eliminate the riffraff. 

Aljazeera took up the cause with a 25 minute documentary, with one potential applicant getting to the crux of the problem:

"No other doctor was that accessible. You get the guy who's going to kill you's number so quickly, but the guy who can sign off on your pain meds is like a specter, vanishing into thin air. . . . Death is made more accessible than food to eat or getting something for the pain." 

Here's an excellent X thread from disability activist, Kelly:

"MAiD is a valuable program that I think many Canadians were proud of when it was first implemented. Terminally ill patients and those suffering without any hope of improvement deserve the option to die with dignity. The problem is that we've now expanded the program to allow people with socioeconomic issues and treatable conditions to access medically assisted death. We are offering MAiD instead of better medical treatments and/or social support, affordable housing, living wage, etc. Given we are still in a global pandemic where there's been ongoing concerns of triage in critical care - seeing people access MAiD who wanted to live but, simply needed additional support and care is a terrifying thing to witness. 

If a country is comfortable providing euthanasia can those with chronic illnesses and disabilities feel confident they will receive life saving treatment in a triage situation with limited beds? These are important questions that keep many of us up at night. There's legislation in the works to expand MAiD to mature minors - allowing patients as young as 12 access to medical euthanasia. It's also being expanded to include those with mental health issues at a time where the wait to see a psychiatrist can exceed a year and psychology services are prohibitively expensive. As we continue to allow the unmitigated spread of Covid we will undoubtedly see increasing numbers of people with chronic illness and disability with no increase in doctors or social support. Is MAiD in Canada going to be a means to deal with this excess number of 'sick people'? It feels like a genuine concern. I will include three relevant news articles that I encourage people to read and share. Every person is potentially one Covid infection or health issue away from severe illness or disability. Therefore lack of timely access to medical care and social supports should concern everyone. Guard your health at all costs - help may not be there if you lose it, and you too could be offered MAiD when you want to live. 

Canadian women dies via MAiD after she was unable to secure safe housing to deal with MCS (multiple chemical sensitivities) (August 2022). BC woman with cancer offered MAiD in lieu of treatment; received treatment in the US and recently got married (November 2023). Women with EDS (Ehlers-Danlos Syndrome) considering MAiD due to multi-year wait for neurosurgeon and inability to afford out of country healthcare (May 2022). . . . Another example of MAiD within EDS population in Canada (December 2022). EDS is not a terminal condition. It's a genetic chronic illness that can usually be managed with knowledgeable team. It's considered 'rare,' and I've said before - the rarer the condition, the less likely you are to find care." 

Furthermore, MAiD feels like it's the solution to a lack of transplant organs when we read about, in January 2023, "Canada performing more organ transplants from MAiD donors than any country in the world." This would be something to celebrate if everyone who accessed MAiD wanted to die. The fact that we're aware that some percentage of them, however small, would have liked to continue living but couldn't get the care they needed to survive, raises memories of the excellent book and film Never Let Me Go. Instead of harvesting organs from clones, we're using people who are struggling to support themselves. I recognize it's not the intention - at least, it's definitely not the stated intention - but it feels like Canada is aiming to kill many birds with one stone: reducing the number of people living in poverty, the disabled, and those on the mental health waitlist, while increasing the number of transplants that save lives! 

Yikes!

The ultimate irony is that we just launched a national 988 suicide crisis helpline, which is great. But is it ironic, or is it part of the plan to talk people with mental health issues into using MAiD?? I'm dubious because of how MAiD has actually been used to take the lives of real people who didn't want to die but couldn't afford to live.  

If we really want to reduce mental health issues, we need to make people feel like their housing is secure and that they have food security. We need more services that are accessible to everyone. We need to shore up financial safety nets to ensure people don't fall so far that they can't climb back up. Specifically, we need to return to price caps on food to stop CEOs like Galen Weston from hiking prices to add to their profits while blaming taxes. And we need a cap on rents that have enabled real estate investors to profit off of desperation and the spread of tent cities. Guaranteed Basic Income that comfortably covers food and housing would help if it were possible. It used to be reasonably affordable to implement here, but that's changed with the steep rise in accommodations. Even our health care is nickel and diming patients by suddenly charging for necessary services, leading those who can afford it to rant on social media, and those who can't to just walk away. The erosion of Canada's once lauded social programs is all part of the neolibertarian shift that calls for deregulation and privatization. Take away the rules, and a few get unfathomably wealthy while the many accept a less painful death. 

Imagine if one mandatory question on that intake form was something like this:

"If you could access and comfortably afford medication, needed equipment, therapy, housing, and food, would you still want to end your life?"

And then if they say No, they're immediately given funds to actually live a healthy life! I'm very curious how many would no longer qualify for assisted death because they don't actually want to die!  

Failing to address one end of the problem while using a very final solution at the other end, is creating an unnervingly dystopian view of our country. 

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