Manitoba·Opinion

Liberty or equality? Unrestricted access to medically assisted death endangers vulnerable people

Unlimited access to a medically hastened death does not guarantee equality for all. If people don't start out equal, how does removing safeguards equalize them?

Quebec Superior Court ruling doesn't make us equal, it leaves us more vulnerable than ever, Ruth Enns writes

Nicole Gladu, 71, and Jean Truchon, 49, won the legal right to a medically assisted death even though they didn't meet the requirement for a "reasonably foreseeable" death. (Charles Contant/CBC)

By granting two people with disabilities a medically hastened death and insisting on legal changes, a Quebec Superior Court ruling reframes Bill C-14 safeguards as obstacles to free choice. 

Now a tiny minority of the people those safeguards were supposed to protect are being used to rationalize changing the law.

Jean Truchon, who has cerebral palsy, and Nicole Gladu, who has post-polio syndrome, fought for and won the legal right to medically assisted deaths before the Quebec Superior Court this year.

The judge ruled that disability alone, not imminent death, is reason enough to grant a medically hastened death — euphemistically called medical assistance in dying (MAID). She gave governments six months to amend the law that requires imminent death as a factor in granting medically assisted deaths.

Such a change leaves everyone more vulnerable than ever, pressured to follow suit.

The central issue has long been presented as a Hobson's choice: for or against free choice. However, the real issue is unrestricted individual choice versus equality. 

The assumption in cases like these is that unlimited access to a medically hastened death guarantees equality for all.

Even many members of minority groups believe free choice brings the equality they strive for, but it doesn't. 

If people don't start out equal, how does removing safeguards equalize them?

People who believe that removing safeguards equalizes everyone are blind to power imbalances: between bosses and employees; teachers and students; caregivers and care recipients. 

In medically hastened death, there is a huge power imbalance between the medical professional and the person requesting death. 

No matter how benevolent and compassionate doctors are — and most are — they are automatically the dominant authorities in the room.

Disability and free choice

The assumption that unrestricted individual freedom ensures equality for the powerless immediately surfaces when a person requesting an assisted death has disabilities. 

That assumption rests on other assumptions about life with disabilities: that it is burdensome and meaningless, worthy only of death. The result is cultural or even overt pressure to "die with dignity."

Some people with disabilities already face pressure to "choose" assisted death rather than life. 

Roger Foley in Ontario, who has cerebellar ataxia, recorded hospital staff offering him medically assisted death rather than the help he wanted to live outside the hospital, managing his own care. 

In Newfoundland, Candice Lewis's mother faced accusations of being selfish when she refused the doctor's offer of assisted death for Lewis, who has a number of conditions, including spina bifida, cerebral palsy and chronic seizure disorder. Her condition has since improved and she and her mother walked her sister down the aisle at her sister's wedding, the Northern Pen reported.

Unrestricted individual choice cannot coexist with equality. Individual freedom of choice requires the absence of restrictions, while equality requires restrictions.

Equality unites us. Unrestricted choice divides us into islands, uninfluenced and unsupported.

Or are we supported only if we make the choice others nudge us to make?

It looks as though these two individuals in Quebec are freely choosing a hastened death, but has that choice really been made freely, without influence or coercion? 

Has anyone investigated whether they are depressed or socially isolated? Social isolation and loneliness often lead to depression, and depression to suicide. 

Has anyone tried to find out why they seem to have lost any sense of purpose? Psychologist and author Viktor Frankl learned in the Auschwitz death camp that we can endure almost anything as long as we have a reason to go on. 

Has anyone shown these Quebecers alternatives? Have they received adequate symptom management? Pain is often associated with stress or psychological distress.

Or did these two get support and attention only when they asked for death?

The only thing I have heard about them is the negative features of their bodies. Who would not want to die if the only thing others notice is one's least desirable features? 

If non-disabled people received such treatment, wouldn't we consider it emotional abuse, a negative bias or even prejudice? Is death really their choice, or are they victims of disability stereotyping and social pressure?

Worthy or unworthy?

Like one of these two Quebecers, I am a polio survivor and deal with a number of negative things in my life. 

Changing the law to allow a medically hastened death for people not nearing death sends the message that the lives of people like me are of questionable worth. 

Although, like most other people, I want my choices to be honoured, I choose the restrictions enforcing equality. I refuse to bend to the growing social pressure that says my life is less worthy than other people's. 

Unrestricted access to a medically hastened death brings neither freedom from oppression nor equality.

This column is part of CBC's Opinion section. For more information about this section, please read this editor's blog and our FAQ.

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About the Author

Ruth Enns has been a teacher, a freelance writer for a rural weekly and is a published author. Following the death of her husband in 2007 she moved to Winnipeg from Sanford, Man., and switched from community-managed home care to the self-management program. She is a polio survivor and has glaucoma.

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