The federal government is asking for your feedback about expanding access to “medical assistance in dying” (MAID), a euphemism for euthanasia or assisted suicide. Whichever term you choose, we are talking about the intentional killing of human beings, a matter of serious concern for the Christian.

Why now? What has prompted the online questionnaire? According to the website there are two main drivers: first, the Truchon v Attorney General of Canada[1]decision from September 2019; and second, the upcoming MAID review this summer.

In Truchon the Quebec Superior Court heard a constitutional challenge to the requirement that death be reasonably foreseeable to be eligible for MAID. That is only one of several criteria a patient must meet in order to be eligible. Currently, the patient must:

• Be at least 18 years old
• Have a grievous and irremediable medical condition (further defined as summarized below)
• Have made a voluntary request
• Give informed consent, even after being told about alternative options, including palliative care

It is the further definition of a “grievous and irremediable” condition that requires reasonable foreseeability of death. In addition, the patient must:

• Have a serious and incurable illness, disease or disability
• Be in an advanced state of irreversible decline in capability
• Experience, as a result of the illness, disease or disability, enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions he or she deems acceptable

The court declared reasonable foreseeability of death an unconstitutional requirement.

Although the court claimed to “fully understand” warnings about the danger related to social normalization of MAID and the societal perception of the value of people with physical or intellectual disabilities, it  concluded that “we cannot, in the name of protecting certain persons from themselves or of socially affirming the value of life, deny medical assistance in dying” to entire groups of people.[2]

The court also held that the negative effects of requiring reasonable foreseeability of death were “by far greater than the expected benefits to society as a whole” if a foreseeable death was not required. That requirement was held to violate the Charter, principles of self-determination, dignity and autonomy. To hold otherwise would be “forcing” people to “continue a life that no longer has any meaning.”[3]

I pause here to note that even as the Quebec court held that “forcing” people to live offends the Charter, an Ontario court last year held that forcing physicians to participate by referring patients for MAID does not offend the Charter.[4] This is a dangerous convergence: expanding state-authorized euthanasia while at the same time restricting conscientious objection.

Instead of appealing the decision (which it could have done), the federal government chose to let the decision stand. The ruling, and the elimination of reasonable foreseeability, will come into effect on March 11, 2020. As noted on the questionnaire website, “while this ruling only applies in the province of Quebec, the Government of Canada has accepted the ruling and has committed to changing the MAID law for the whole country.”

In what I think is a key phrase about the context and objectives of the questionnaire, the site explains: “updating Canada’s MAID law will expand eligibility for MAID beyond people who are nearing the end of life, and could possibly result in other changes.”

So, while this consultation is important, the government clearly made its decision about expanding MAID when it refused to appeal the Truchon decision. Now it is not a matter of whether eligibility will be expanded, but how far and what “safeguards” will be implemented.

Those questions will be essential for the MAID review this summer. The review is a requirement of the 2016 changes to the Criminal Code that created an exemption for MAID, as described above. It is important to observe that with this single legislative change, what was a criminal offence was transformed into a legal act; proponents would go further and say that MAID is not only legal, but moral, ethical, and good.

In terms of the review, the 2016 amendments directed one or more independent reviews to consider MAID requests for:

• Mature minors – children who are considered mature enough to consent to their own medical treatment
• Advance requests – where at the time of death the patient would not have the capacity to consent
• Mental illness – where mental illness is the sole underlying medical condition

The Canadian Council of Academies has already completed a review of these topics and released three final reports in December 2018. Each of these justify a lengthy discussion on their own, but that will have to await a future post.

As one of my CCCC’s colleagues observed, it is heartbreaking to see courts reflect and affirm the notion that life is meaningless for people with disability or illness; that suffering is meaningless; that suffering is to be avoided at all costs even if it undermines the inherent worth of each human being. It is also heartbreaking to see that we are quickly moving so quickly to expand MAID.

Dr. Kerry Bowman, a Clinical Ethicist at Mount Sinai Hospital who is generally supportive of MAID, recently expressed concern in a media interview that, “the day will come when we’ll see a person in a wheelchair, with whatever disability, and rather than think, ‘Can I be of any help to them?’ we’re going to think, ‘Why would they do that to other people and to society? Why wouldn’t that person move on?’”

As Christians we know that our worth is not contingent on utilitarian measures of what we can contribute, how our physical bodies function, our degree of happiness, or any other human metric we may develop. It is based on the fact that we are created in the image of God. We also recognize that Christ suffered for us; it is by his wounds we are healed. Our nation needs a message of healing and hope more than ever. Make your voice heard – complete the questionnaire and take the opportunity to provide important feedback about the value of life and the concerns you have.

The MAID questionnaire is open until Monday, January 27, 2020 at 11:59 p.m. (PST).

If you’re looking for more, here are a few additional resources to inform you on the issue of MAID, its expansion, conscience rights, and how you can engage on this issue beyond the questionnaire:

Barry Bussey, “The Right of Religious Hospitals to Refuse Physician-Assisted Suicide” (2018) 85 SCLR (2d)

Derek Ross and Deina Warren, “Religious Equality: Restoring Section 15’s Hollowed Ground” (2019) 91 SCLR (2d)

Barry Bussey, “Getting Serious About Conscience Rights”

Christian Legal Fellowship, Background Paper “Euthanasia and Physician-Assisted Suicide in the Case of Mature Minors, Advance Requests, and Mental Illness: Legal, Ethical, Cultural, and Clinical Considerations” (6 October 2017)

Christian Legal Fellowship, Submission to the Canadian Council of Academies on Medical Assistance in Dying in Canada (6 October 2017)

Evangelical Fellowship of Canada, Submission to the Canadian Council of Academies on Medical Assistance in Dying in Canada (3 October 2017)

Evangelical Fellowship of Canada, Briefing Notes on Euthanasia and Assisted Suicide (April 2016)

Evangelical Fellowship of Canada, sample letter to the Minister of Justice

[1] 2019 QCCS 3792

[2] Ibid, at paras 304-310

[3] Ibid, at paras 625-638

[4] For more on the CMDS v CPSO decision, see my Horizons column CCCC Bulletin (2019:3)

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