Canada has medicalized death — yet another reason we are getting assisted dying wrong
By: Rick Salutin
Medically assisted death has surprisingly emerged as one of the signature issues of our time and Canada is playing an unexpected role. We are the model of how not to do it. Most criticism centres on the slippery slope argument: how slack we’ve been about who may qualify and how unrigorous the decision-making process can be. I want to pile on by considering some broader issues.
I mean the way the process has been medicalized and professionalized beyond what may’ve been necessary. One firsthand account, for instance, says, “the compassionate and professional nurse practitioner who provided MAID encouraged us to ‘come closer’ at the moment of (a parent’s) death.” This is spoken in praise and I understand how some people nod sympathetically. But others will find it intrusive. Is there no way to do this thing without a credentialed outsider in a kind of priestly or even master of ceremonies role?
That’s hard to picture when you think about the injection involved but in fact there’s an alternative. Many places with assisted dying use an “oral protocol,” either alongside or instead of injection, where the person receives a package of meds that can be self-administered orally, surrounded only by family and other intimates. It’s extremely rare in Canada. In 2021 just seven of 10,064 deaths happened that way. But elsewhere, like Oregon or California in the U.S., it’s far more frequent.
Does it matter beyond the issue of intrusion? Probably. In those U.S. states, about 35 per cent didn’t use the prescriptions or meds they had. Why? At least partly because it opened a space to introspect and reconsider. This is surely a choice people should be able to change minds on yet here only about two per cent withdrew their requests. Why? Perhaps to some degree, from a sense of embarrassment and awkwardness about the doctor already being booked or present and having taken such trouble. Does that sound strange? Not to me. Don’t underestimate the role of awkwardness or embarrassment at every level of human behaviour.
Eliminate those concerns and patients will often feel freer to reweigh and reconsider their options right up to the last moment. It’s why it’s been suggested that oral meds should be the “default method” in this area.
From here on I’m going to get pretty speculative, but it seems to me that this is more of a human situation than it is a medical one. Death existed before modern medicine and it had to be dealt with in existential and spiritual ways as well as practically. It was about meeting your maker, there was no life without death and vice versa, it wasn’t primarily a medical sub-specialty. It’s been a while now since most people died at home and lay there afterwards. People saw it frequently then and made their peace with it. They didn’t have to ponder whether their kids should be kept away from open caskets or even funerals.
We now live in a highly medicalized reality and it’s for good reason: the achievements of modern medicine have been one of the few highlights in the human parade. I am one of the literally living examples of those epic feats. But anything can get over magnified, the normal human MO is to overshoot. Last week, the New York Times interview on Canada’s MAID experience spoke with a B.C. doctor as if no one else might have useful insights. It’s trended that way since young Dr. Kildare on radio through to the latest “Grey’s Anatomy.” If there’s a doctor in the house, the spotlight will gravitate toward them. I suppose it’s also part of the enduring human trait to create idols and worship them, and then sometimes backtrack to restore a proper perspective.
(I am indebted for much of the detail here to the research of Gideon Salutin, who works at a think tank in the UK and also happens to be my son.)
