Right to Die: How to Decide?

I’ve long held reservations about “right to die” legislation. Canada, which has some of the most liberal laws in the world in this regard, is now set to expand them such that someone experiencing a mental illness may request and receive medical assistance in dying (MAiD). At present those getting MaiD need to have a terminal illness or chronic disability.

My reservation can be summed up like this — instead of caring for the suffering, which is expensive and hard, we allow them, and tacitly encourage them, to end their lives. Last year in Canada 10,000 people exercised their “right to die,” which accounted for 3.3 percent of all deaths in our northern neighbor.

When my sister was dying of terminal cancer, and I was caring for her, she said she wanted to explore “assisted suicide.” It is legal in Washington, along with a number of other states. She wanted “to have it as an option.” I understood and supported her in that. She was definitely terminally ill and experiencing some pain, although we were largely successful in managing the pain. As it happened, she did not ever feel the need for the assisted suicide option, for which I was grateful. Still, I understood her desire to have it available. I’m sure her situation is like that of some, but not all, Canadians, who have sought MAiD.

There is some slippery slope here. For example, hearing loss which is not a terminal condition qualifies as a disability that justifies MAiD in Canada. In a different case, a man who didn’t have the money to pay his rent, but did experience “chronic back pain,” got set up for MAiD. But when a Go-Fund-Me campaign resulted in contributions of over $60,000 toward his rent, he decided his back pain wasn’t that bad and that he would call off his doctor-assisted suicide. That may be an outlier, but I wonder.

Canada’s move to allow people experiencing mental illness to opt for MAiD comes as a different action with respect to the mentally ill is being taken in New York City. There, Mayor Eric Adams has authorized police and community health teams to take mentally ill people living on the streets, who are unable to take care of themselves, to be taken for psychiatric care, involuntarily if necessary. Yes, that could be misused. Still, that seems to me a step in the right direction and preferable to letting people deteriorate on the streets or elect to kill themselves.

I have some personal experience in that area too. Someone experiencing a severe mental illness cannot make a good decision about seeking care or seeking to end their life. By definition, their decisional capacity is impaired. I’ve known people who have a mentally ill family member who can do nothing for that person, though they are living a terrible life on the streets, because of legal prohibitions on involuntary commitment for psychiatric care. One woman in that situation died on the steps of a church I served. Her brother, who worked at a bank next door, had no recourse as she refused help or care.

When you allow people experiencing mental illness to elect MAiD, as Canada is set to do, you are going the opposite direction being taken in New York City. The mentally ill who receive treatment may, like the man with back pain but no money for rent, change their mind about MAiD if their health improves or situation changes. So I just worry that it will be, in Canada, easy to subtly encourage those ravaged by mental illness to elect MAiD and for society to avoid the cost of care.

“Right-to-die” legislation and prohibitions on involuntary care for those with a mental illness are both justified on the basis of respect for individual freedom. But might they also be a way of allowing the rest of us, and society as a whole, to neglect our neighbors in need?