The Ethics of Assisted Dying

Happy Tuesday! We hope you experience as much joy today as DJ Khaled did upon receiving four TOTO Toilets as a birthday present from Drake. “This is the most amazing toilet bowl that I’ve ever seen in my life,” the hip-hop producer said in a thank you video. “This might be the best gift ever, like real talk.”

Quick Hits: Today’s Top Stories

• Widespread protests over draconian anti-COVID measures continued across China on Monday, with solidarity rallies cropping up elsewhere in the region, including Hong Kong. Chinese authorities have deployed police in large numbers to quash the protests in mainland cities. Although state media’s continued praise of the country’s zero-COVID pandemic approach seems to signal no major change of tack is imminent, local officials have started to walk back several regional measures— including the policy of blocking access to apartments where infected people are living—that have been particular targets of protesters’ ire.
• State Department officials said Monday that Russia had “unilaterally” postponed meetings to discuss ongoing implementation of the New START arms reduction treaty between the two nations. The talks were slated to begin today, and a State Department official said in a statement that the U.S. “is ready to reschedule at the earliest possible date, as resuming inspections is a priority for sustaining the treaty as an instrument of stability.”
• The Georgia Supreme Court reinstated the state’s six-week abortion ban last week, overruling a decision handed down a week prior by Fulton County Superior Court Judge Robert McBurney. McBurney had blocked the law on the grounds that Roe v. Wade was the law of the land when the six-week ban was passed in 2019.
• A Mogadishu hotel seized by al-Shabaab extremists over the weekend was recaptured by Somali forces Monday after a 22-hour siege that left the six attackers and at least nine civilians dead.
• After four key railway labor unions declined last week to ratify a tentative labor contract brokered by the White House in September, raising once again the possibility of a crippling rail strike next month, President Biden on Monday called on Congress to pass legislation implementing the September agreement without union ratification. In a statement, Biden said he was “reluctant to override the ratification procedures,” but that such a step was necessary to prevent a rail shutdown that “would devastate our economy.” House Speaker Nancy Pelosi promised her chamber would take up legislation this week.
• Democratic Rep. Don McEachin of Virginia died yesterday after a battle with colorectal cancer, his chief of staff announced last night. The congressman—who had represented his state’s 4th District since 2017–was 61 years old.

Canada Set to Expand Assisted Deaths

Michael Fraser—a fan of Pabst Blue Ribbon beer and a volunteer church handyman known as “Church Mike” around his Toronto neighborhood—died at the age of 55 this summer after his longtime doctor administered the lethal drugs Fraser had requested. His wife Ann hugged him and whispered “I love you, I love you, I love you,” as he died in his bed.

Fraser’s doctor isn’t sure his patient should have died this way. “Professional standards were met, it’s legal, but I do feel guilty,” Dr. Navindra Persaud told the Toronto Star. “Someone you know and care about is dead. As a doctor, there is doubt. Could I have done something differently to reduce the suffering?”

Since 2016, Canada’s medical assistance in dying (MAiD) laws have allowed severely or terminally ill and disabled people to choose to die by either euthanasia—lethal drugs administered by a physician—or physician-assisted suicide, which typically entails a provider prescribing lethal drugs a patient then takes independently. To be eligible, Canadian adults must: have an irreversible and advanced illness or disability causing “unbearable physical or mental suffering,” request MAiD voluntarily without external influence, be informed of other treatment options, sign a written request with a witness present, and get assessed and approved by two independent physicians or nurse practitioners. More than 10,000 Canadians died this way last year—up 32 percent from 2020, and accounting for 3.3 percent of all deaths in Canada. Already among the most lax in the world, the measures are set to grow even more permissive: Starting next March, the country will allow people suffering solely from mental illness to seek euthanasia.

Opponents of the laws argue they diminish the lives of people with disabilities and can create pressure on people to kill themselves. “Persons with disabilities may decide to end their lives because of broader social factors such as loneliness, social isolation, and lack of access to quality social services,” United Nations officials wrote in a letter to Canadian leaders last year warning the country’s expanding MAiD laws could violate the UN’s human rights declaration. “A social assumption might follow (or be subtly reinforced) that it is better to be dead than live with a disability.” 

Such concerns are not hypothetical. Roger Foley, hospitalized with a degenerative brain disorder in Ontario, recorded his conversation with a hospital director of ethics earlier this year in which the ethicist reminded him a stay at the hospital would cost “north of $1,500 a day.” According to Foley, hospital staff raised the idea of assisted dying unprompted. Canadian Sheila Elson—whose adult daughter Candace Lewis has several medical conditions including cerebral palsy—said in 2016 a doctor brought up assisted suicide for Lewis in front of the young woman and told Elson she was “being selfish” when she rejected the idea.

Even when protocol is strictly followed—Fraser reportedly initiated the MAiD conversation with his doctor, confirmed his desire several times, and qualified for the program based on multiple non-terminal ailments including liver failure—it’s not always clear a medical condition is at the root of someone’s desire to die. Living on disability payments, Fraser couldn’t afford a more accessible apartment than his second-story walkup, leaving him increasingly homebound as his physical health deteriorated. By the time he died, he hadn’t left his apartment in weeks. “There’s a social aspect to poverty, a hierarchy, that affected his psyche,” Persaud, his doctor, said. “He told me that it did.”

In other cases, financial considerations have played an even clearer role. Facing eviction, Ontario resident Amir Farsoud cited chronic back pain in his application for euthanasia, only to reconsider weeks later when a GoFundMe campaign raised over $60,000 to keep him housed. “I’m a different person,” Farsoud said in November. “I had nothing but darkness, misery, stress, and hopelessness. Now I have all the opposite of those things.”

Farsoud’s story isn’t unique. “Medical assistance in dying cannot be a default for Canada’s failure to fulfill its human rights obligations,” Canadian human rights commissioner Marie-Claude Landry said in May after reports emerged of people seeking euthanasia because they couldn’t find proper housing. “In an era where we recognize the right to die with dignity, we must do more to guarantee the right to live with dignity.”

That phrase—“die with dignity”—is central to most MAiD proponents’ support for the practice. Advocates of assisted death argue it allows people to end suffering on their own terms and timing, rather than having no choice but to endure long illnesses or disabilities they find unbearable. Belgian Paralympic athlete Marieke Vervoort—whose degenerative muscle disease caused seizures, partial paralysis, and other symptoms—waited eleven years after obtaining euthanasia authorization to make use of it and said she benefited from knowing she had control. “I just wanted to have the paper in my hands for when the time comes that it’s too much for me, when, day and night, someone has to take care of me, when I have too much pain,” she told New York Times reporters. “I don’t want to live that way.” 

Likewise, advocates for expanding assisted death options to people with mental illnesses argue that mental illness can be just as debilitating as other afflictions, produce painful physical symptoms, and resist even decades of treatment—and that excluding people with mental illnesses from assisted death options is discriminatory.

Assisted deaths are allowed in a handful of other countries—Belgium, the Netherlands, Spain, New Zealand, Colombia— but Canada has one of the world’s most permissive programs. While doctors are frequently prohibited from suggesting euthanasia to patients, Canada’s ban on “pressuring” patients doesn’t forbid offering the option. A Veterans Affairs Canada employee offhandedly raised medically assisted suicide as an option to a veteran who called for help dealing with post-traumatic stress disorder and other injuries, for example. And in 2021, Canada removed the mandatory 10-day waiting period between MAID approval and assisted death for patients whose natural deaths are “reasonably foreseeable,” such as those with terminal conditions.

Assisted suicide laws are also spreading across the United States—California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, Washington, and Washington, D.C. all allow some medically assisted deaths, and Montana courts have ruled the state’s constitution doesn’t expressly prohibit them. Oregon recently ended its requirement that terminally ill people seeking assisted death be state residents. In February, Dr. Jennifer Gaudiani, a Colorado physician specializing in eating disorders, published a paper arguing some people with anorexia who give up after years of failed treatment should have access to assisted death. In March, Vermont began allowing patients to get prescriptions for lethal drugs via telemedicine appointments.

Meanwhile, in Canada, some family members of people who died by assisted suicide or euthanasia are raising alarms about insufficient or poorly enforced safeguards, despite officials’ insistence that there’s no evidence of abuse. In 2019—when Canada still only allowed assisted death for terminal conditions—Alan Nichols, 61, received a lethal injection after listing only hearing loss on his euthanasia application, and despite his family’s alarm over his impaired mental state in the lead-up to his death. 

Nichols had a history of depression and other health conditions, his sister-in-law Trish Nichols said, but none were terminal. In June, Trish testified against expanding euthanasia access further: “Would you feel safe now, bringing your suicidal loved one to seek medical care for recovery when there are no oversight or stringent safeguards surrounding a procedure that kills people?”

Worth Your Time

• National Review’s Jim Geraghty went joyriding at the Washington Post this week to offer future Republican candidates a warning on the dangers of relying on an “angertainment” electoral strategy. If you’ve got your eye on higher office, building a brand via tireless ground work is difficult, while getting noticed for saying crazy things on Fox News is easy. But the near-upset of Rep. Lauren Boebert in a heavily Republican Colorado district shows the limits of that approach. “During the Trump presidency and into 2022,” Geraghty writes, “a lot of Republican candidates believed that what appeals to the Fox News audience would appeal to enough people in the entire electorate, districtwide or statewide, to win a race. The midterms showed how mistaken that is.”
• “Road fatalities per capita” isn’t the sort of statistic where you want your nation to excel, but the United States, once middle of the pack, now leads all developed countries in the measure—showing only marginal improvements since the mid-90s while many countries have grown far safer. Why? Emily Badger and Alicia Parlapiano report in the New York Times that while cars have continued to grow safer for those inside them, there’s been comparatively little planning in U.S. cities to make it safer for cars to share space with those outside—specifically, pedestrians and cyclists. “We are not the only country with alcohol,” Beth Osborne, director of the advocacy group Transportation for America, told the reporters. “We’re not the only country with smartphones and distraction. We were not the only country impacted by the worldwide pandemic.”

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• It’s Tuesday, which means Dispatch Live (🔒) returns tonight at 8 p.m. ET/5 p.m. PT! Join David, Declan, and Andrew for a conversation about the anti-lockdown protests in China, Congress’ lame duck to-do list, and other top headlines of the week. And as always, there will be plenty of time for viewer questions.
• Banning assault weapons isn’t the mass-shooting panacea President Biden routinely makes it out to be, Kevin argues in this week’s Wanderland (🔒)—and it’d be unconstitutional, too. “The gun-control debate is not about guns,” he writes. “It is simply another front in the culture war, oriented not toward the criminal misuse of guns—about which our federal, state, and municipal governments do approximately squat—but about the kind of people who tend to own guns, or at least the gun-owning villains of the progressive mind.”
• Donald Trump’s recent dinner with Kanye West and Nick Fuentes was a lot of things, but perhaps most of all, it was embarrassing. “The MAGA establishment is an endless freak show, and freak shows are scary—but also ridiculous,” Nick writes in his latest edition of Boiling Frogs (🔒). “It’s become immensely embarrassing to be a conservative in the United States.”
• On today’s episode of Advisory Opinions, David and Sarah dive into the latest free speech debate, as politicians, academics, and journalists on the left and right fight over who gets to censor whom. Plus: Some updated thoughts on the latest leak allegations involving Justice Samuel Alito.
• On the site today, Kevin argues that political bickering over the fate of abortion post-Roe v. Wade means that Dobbs—which handed the debate back to elected officials—is working exactly as the Supreme Court intended. And Matthew Germer breaks down how ranked choice voting can contribute to a healthier, more moderate political culture, evidenced by Alaska’s recent Senate races.

Let Us Know

Do you believe in a so-called “right to die?” Is it ethical for physicians to assist in ending the lives of their patients?