Late night talk show host Jim­my Kim­mel recent­ly exco­ri­at­ed GOP Sen­a­tor Bill Cas­sidy, the co-spon­sor of the GOP’s lat­est health care bill, for lying to Kim­mel back in July about Cas­sidy’s com­mit­ment to only back a health care bill that pass­es “The Kim­mel Test”. The “Kim­mel Test” is a term that Cas­sidy him­self coined when he promised Kim­mel that Cas­sidy would only sup­port a health care bill that ensured chil­dren born with expen­sive med­ical com­pli­ca­tions — like Jim­mey Kim­mel’s recent­ly born son with a con­gen­i­tal heart con­di­tion — would be able to get the med­ical treat­ment they need to live a full life. That includes treat­ment to address the imme­di­ate med­ical need, like mul­ti­ple expen­sive heart surg­eries, but also access to life insur­ance cov­er­age with­out life­time caps (caps which can eas­i­ly be exceed­ed for peo­ple with expen­sive con­di­tions). And the Kim­mel Test isn’t lim­it­ed to new born infants but is sup­posed to include every­one. In oth­er words, Sen­a­tor Cas­sidy promised Kim­mel dur­ing that inter­view that he would­n’t sup­port a health care bill that basi­cal­ly says, “Ok, this per­son­’s life it too expen­sive to main­tain.” It’s the kind of thing that should be a no-brain­er for a mod­ern, decent soci­ety.

And, Of course, Cas­sidy’s new bill com­plete­ly fails that test. It’s a “Let ’em die (even­tu­al­ly, when they run out of finan­cial resources)!” bill.

So giv­en the GOP’s seem­ing­ly end­less attempts to “repeal and replace” Oba­macare include seem­ing­ly end­less attempts to sig­nif­i­cant­ly gut Med­ic­aid and leave the Unit­ed States with­out any sort of mean­ing­ful health care safe­ty-net for the poor, elder­ly, and dis­abled, it’s worth keep­ing mind that these goals — goals which are guar­an­teed to send mil­lions of Amer­i­cans to an ear­ly grave — aren’t just moral­ly out­ra­geous on their own. They also end up com­pli­cat­ing an array of oth­er inher­ent­ly dif­fi­cult moral ques­tions. Ques­tions where the answers are pred­i­cat­ed on the basic decen­cy of the soci­ety ask­ing them. In par­tic­u­lar, the ques­tions sur­round­ing assist­ed sui­cide, allow­ing peo­ple to die com­pas­sion­ate­ly and on their own terms, and how many resources should be spent to keep peo­ple alive when doing so is expen­sive.

On their own these are inevitably going to be dif­fi­cult ques­tion, but they’re also the kinds of issues that become a lot hard­er to answer the more and more is seems like soci­ety does­n’t care if peo­ple die. And if there’s one over­ar­ch­ing theme to the con­tem­po­rary GOP’s agen­da it’s an agen­da to restruc­ture soci­ety in such a way where peo­ple with­out the finan­cial means are sim­ply allowed to fall through the cracks and die. A soci­ety where we are not ‘all in it togeth­er’. That’s the goal and it’s the kind of goal that’s going to inevitably make issues like assist­ed sui­cide and whether or not peo­ple with expen­sive med­ical con­di­tions should be giv­en those resources much hard­er to answer. Or per­haps eas­i­er to answer since the answer will inevitably be “we don’t have the resources to care for you...good luck!”

Ques­tions like “is health care a right?” are still open ques­tions for Amer­i­can soci­ety. And one of the two major par­ties appears to be deter­mined to gut Med­ic­aid, a pro­gram designed to be a last resort for not just the poor but for a wide vari­ety of peo­ple with life­long expen­sive con­di­tions. As such, it’s going to be trag­i­cal­ly impor­tant to not for­get that the dis­abled and those deemed to be phys­i­cal­ly unfit were the first vic­tims of the Nazis (and the US has its own his­to­ry in this area):

The New York Times

The Nazis’ First Vic­tims Were the Dis­abled

Ken­ny Fries
SEPT. 13, 2017

I sit fac­ing the young Ger­man neu­rol­o­gist, across a small table in a the­ater in Ham­burg, Ger­many. I’m here giv­ing one-on-one talks called “The Unen­hanced: What Has Hap­pened to Those Deemed ‘Unfit’,” about my research on Aktion T4, the Nazi “euthana­sia” pro­gram to exter­mi­nate the dis­abled.

“I’m afraid of what you’re going to tell me,” the neu­rol­o­gist says.

I’m not sur­prised. I’ve heard sim­i­lar things before. But this time is dif­fer­ent — the young man sit­ting across from me is a doc­tor. Aktion T4 could not have hap­pened with­out the will­ing par­tic­i­pa­tion of Ger­man doc­tors.

I have a per­son­al stake in mak­ing sure this his­to­ry is remem­bered. In 1960, I was born miss­ing bones in both legs. At the time, some thought I should not be allowed to live. Thank­ful­ly, my par­ents were not among them.

I first dis­cov­ered that peo­ple with dis­abil­i­ties were ster­il­ized and killed by the Nazis when I was a teenag­er, watch­ing the TV mini-series “Holo­caust” in 1978. But it would be years before I under­stood the con­nec­tions between the killing of the dis­abled and the killing of Jews and oth­er “unde­sir­ables,” all of whom were, in one way or anoth­er, deemed “unfit.”

The neu­rol­o­gist does not know much about what I’m telling him. While he does know that approx­i­mate­ly 300,000 dis­abled peo­ple were killed in T4 and its after­math, he doesn’t know about the direct con­nec­tion between T4 and the Holo­caust. He doesn’t know that it was at Bran­den­burg, the first T4 site, where meth­ods of mass killing were test­ed, that the first vic­tims of Nazi mass killings were the dis­abled, and that its per­son­nel went on to estab­lish and run the exter­mi­na­tion camps at Tre­blin­ka, Belzec and Sobi­bor.

Three years ear­li­er, when I first arrived in Ger­many, I was con­sis­tent­ly con­front­ed with the treat­ment of those with dis­abil­i­ties under the Third Reich. But I soon real­ized I had to go back even far­ther. In the 1920s, the dis­abled were mis­treat­ed, ster­il­ized, exper­i­ment­ed on and killed in some Ger­man psy­chi­atric insti­tu­tions. In 1920, the psy­chi­a­trist Alfred Hoche and the jurist Karl Bind­ing pub­lished their trea­tise, “Per­mit­ting the Destruc­tion of Unwor­thy Life,” which became the blue­print for the exter­mi­na­tions of the dis­abled car­ried out by the Third Reich.

In Dr. Ewald Melzer’s 1923 sur­vey of the par­ents of the dis­abled chil­dren in his care, they were asked: “Would you agree def­i­nite­ly to a pain­less short­cut of your child’s life, after it is deter­mined by experts that it is incur­ably stu­pid?” The results, which sur­prised Melz­er, were pub­lished in 1925: 73 per­cent respond­ed they were will­ing to have their chil­dren killed if they weren’t told about it.

I am also Jew­ish. At the Karl Bon­ho­ef­fer psy­chi­atric hos­pi­tal in the Berlin sub­urb of Wit­te­nau, where the exhi­bi­tion “A Dou­ble Stig­ma: The Fate of Jew­ish Psy­chi­atric Patients” was held, I learned about, as the exhi­bi­tion title sug­gests, how Jew­ish patients were dou­bly stig­ma­tized by being sep­a­rat­ed from oth­er patients, denied pas­toral care, and were cared for not at the expense of the Reich but by Jew­ish orga­ni­za­tions. Jew­ish patients were sin­gled out for ear­ly exter­mi­na­tion; by Decem­ber 1942, the destruc­tion of the Jew­ish patient pop­u­la­tion at Wit­te­nau was com­plete.

...

It is only at the end of my talk with the neu­rol­o­gist that I notice he wears a hear­ing aid. I want to ask if he knows about “100 Per­cent,” the film pro­duced by deaf Ger­mans to show they could assim­i­late and be pro­duc­tive cit­i­zens who worked. Did he know the hered­i­tary deaf were sin­gled out not only by the Ger­man author­i­ties but also by those with acquired deaf­ness who tried to save them­selves? Too often, even those of us with dis­abil­i­ties do not know our own his­to­ry.

Not many peo­ple know about dis­abil­i­ty his­to­ry in the Unit­ed States. They do not know that in the Unit­ed States in 1927, Jus­tice Oliv­er Wen­dell Holmes wrote that “three gen­er­a­tions of imbe­ciles are enough” as part of his opin­ion in Buck v. Bell, in which the Supreme Court ruled that com­pul­so­ry ster­il­iza­tion of the “unfit” was con­sti­tu­tion­al. This deci­sion has nev­er been express­ly over­turned.

Many Amer­i­cans still do not know about the so-called “ugly laws,” which in many states, begin­ning in the late 1860s, deemed it ille­gal for per­sons who were “unsight­ly or unseem­ly” to appear in pub­lic. The last of these laws was not repealed until 1974.

Why is it impor­tant to know this his­to­ry? We often say what hap­pened in Nazi Ger­many couldn’t hap­pen here. But some of it, like the mis­treat­ment and ster­il­iza­tion of the dis­abled, did hap­pen here.

A read­ing of Hoche and Binding’s “Per­mit­ting the Destruc­tion of Unwor­thy Life” shows the sim­i­lar­i­ty between what they said and what expo­nents of prac­ti­cal ethics, such as Peter Singer, say about the dis­abled today. As recent­ly as 2015, Singer, talk­ing with the radio host Aaron Klein on his show, said, “I don’t want my health insur­ance pre­mi­ums to be high­er so that infants who can expe­ri­ence zero qual­i­ty of life can have expen­sive treat­ments.”

These philoso­phers talk about the drain on “resources” caused by lives lived with a dis­abil­i­ty, which eeri­ly echoes what Hoche and Bind­ing wrote about the “finan­cial and moral bur­den” on “a person’s fam­i­ly, hos­pi­tal, and state” caused by what they deem lives “unwor­thy of liv­ing.”

Experts point out the recent Repub­li­can health care pro­pos­als would strip Med­ic­aid fund­ing that helps the elder­ly, the poor and the dis­abled live health­i­er and more dig­ni­fied lives. A recent New York Times arti­cle quot­ed the Rev. Susan Flan­ders, a retired Epis­co­pal priest, as say­ing: “What we’re pay­ing for is some­thing that many peo­ple wouldn’t want if they had a choice. It’s hun­dreds of dol­lars each day that could go towards their grandchildren’s edu­ca­tion or care for the peo­ple who could get well.”

In the arti­cle, Flan­ders, whose father had Alzheimer’s, is described as “utter­ly unafraid to mix mon­ey into the con­ver­sa­tion about the mean­ing of life when the mind dete­ri­o­rates.” Prac­ti­cal ethi­cists are sim­i­lar­ly unafraid to do this. As were the Nazis. Third Reich school text­books includ­ed arith­metic prob­lems on how much it would cost to care for a per­son with a dis­abil­i­ty for a life­time.

Three years ago, I was the only vis­i­tor at a muse­um ded­i­cat­ed to the his­to­ry of the Reinick­endorf area of Berlin. The muse­um build­ing was once part of Wiesen­grund, which, in 1941, housed the “wards for expert care” of the Munic­i­pal Hos­pi­tal for Chil­dren.

Down a hall with flu­o­res­cent light­ing, in a white-walled room, were 30 wood­en cribs. On each of the cribs was a his­to­ry of a child, some as young as a few months old. This was the room in which these infants and chil­dren were exper­i­ment­ed on and killed: the 30-bed Ward 3, the “ward for expert care” at Wiesen­grund.

My heart raced; my breath short­ened. I couldn’t stay in that room for long. The room evoked the first four weeks of my own life spent in an incu­ba­tor. Nobody knew if I would live or die.

What kind of soci­ety do we want to be? Those of us who live with dis­abil­i­ties are at the fore­front of the larg­er dis­cus­sion of what con­sti­tutes a val­ued life. What is a life worth liv­ing? Too often, the lives of those of us who live with dis­abil­i­ties are not val­ued, and feared. At the root of this fear is mis­un­der­stand­ing, mis­rep­re­sen­ta­tion, and a lack of knowl­edge of dis­abil­i­ty his­to­ry and, thus, dis­abled lives.

———-

“The Nazis’ First Vic­tims Were the Dis­abled” by Ken­ny Fries; The New York Times; 09/13/2017

“What kind of soci­ety do we want to be? Those of us who live with dis­abil­i­ties are at the fore­front of the larg­er dis­cus­sion of what con­sti­tutes a val­ued life. What is a life worth liv­ing? Too often, the lives of those of us who live with dis­abil­i­ties are not val­ued, and feared. At the root of this fear is mis­un­der­stand­ing, mis­rep­re­sen­ta­tion, and a lack of knowl­edge of dis­abil­i­ty his­to­ry and, thus, dis­abled lives.”

What kind of soci­ety do we want to be? Well, if the GOP gets its way we’re going to be a “let ’em die!” soci­ety. Which means we’re also going to the kind of soci­ety where any dis­cus­sions about assist­ed sui­cide and the com­pas­sion­ate end­ing of life is going to be mired in the hor­rif­ic pol­i­tics of health care aus­ter­i­ty and the GOP’s end­less war on the poor, espe­cial­ly poor dis­able peo­ple or oth­ers with expen­sive med­ical ser­vices. You know, kind of like the Nazis. The GOP is just a lit­tle less explic­it about it.

Adding to the sick nature of this polit­i­cal sit­u­a­tion is that a lack of ade­quate health care cov­er­age is exact­ly the kind of thing that’s going to put more and more peo­ple in the kind of med­ical sit­u­a­tion where they have to con­sid­er some sort of assist­ed sui­cide because a painful, slow or quick, death will be the only oth­er option they’re left with. The ethics of end­ing life is one of the most chal­leng­ing top­ic a soci­ety can grap­ple with and it’s going to a lot more dif­fi­cult to grap­ple with at the same time soci­ety is pon­der­ing whether or not we can pay to keep each oth­er alive. But this is where we are. Lot’s of eth­i­cal grap­pling is in store for Amer­i­ca.

So don’t for­get as we grap­ple with this night­mare sit­u­a­tion: the Nazis failed the “Kim­mel test” too. And they did­n’t casu­al­ly fail it. They failed it out of an ide­ol­o­gy that viewed entire cat­e­gories of peo­ple as not wor­thy of life.

The debate over the right to assist­ed sui­cide got a lot eas­i­er in many ways in Cana­da when the high court ruled in 2015 that the right is pro­tect­ed in the Cana­di­an con­sti­tu­tion. The debate over whether the right exist­ed was set­tled, to an extent. There’s still the inevitable debate over how to actu­al­ly imple­ment that right. A debate that the advo­cates for the rights to assist­ed sui­cide have been win­ning more in Cana­da than basi­cal­ly any­one else in recent years, with the right to an assist­ed sui­cide more acces­si­ble in Cana­da arguably than any­where else in the world today.

And as the fol­low­ing pair of arti­cles describe, Cana­da is poised to extend its glob­al lead in cur­rent­ly allow­ing access­ing to assist­ed sui­cides quite a bit in 2023 and it’s got ethi­cists and dis­abil­i­ty rights advo­cates alarmed. Because next year Cana­da is expand­ing that access to two groups: “mature” minors and peo­ple who are sole­ly suf­fer­ing from men­tal health con­di­tions.

It’s a poten­tial­ly a huge expan­sion of the pool of poten­tial appli­cants for an assist­ed sui­cide and it’s com­ing at a time when more and more sto­ries are emerg­ing that raise seri­ous ques­tions about whether or not there are enough safe­guards in place. That’s the eth­i­cal mine­field set to expand and maybe explode in 2023 for Cana­da. Or maybe explode lat­er. But it’s look­ing like a mine­field built to explode at some point:

Reuters

Cana­da pre­pares to expand assist­ed death amid debate

By Anna Mehler Paperny
Decem­ber 12, 2022 4:00 PM CST Updat­ed

TORONTO, Dec 11 (Reuters) — Cana­da is prepar­ing to expand its med­ical­ly assist­ed death frame­work to become one of the broad­est in the world, a change some want to delay due to con­cerns vul­ner­a­ble peo­ple have eas­i­er access to death than to a life with­out suf­fer­ing.

Start­ing in March, peo­ple whose sole under­ly­ing con­di­tion is men­tal ill­ness will be able to access assist­ed death. Men­tal ill­ness was exclud­ed when the most recent med­ical assis­tance in dying (MAiD) law was passed in 2021.

That will make Cana­da one of six coun­tries in the world where a per­son suf­fer­ing from men­tal ill­ness alone who is not near their nat­ur­al death can get a doc­tor to help them die.

Peo­ple will still need to apply and be deemed eli­gi­ble by two clin­i­cians who must deter­mine whether they have an irre­me­di­a­ble con­di­tion caus­ing them intol­er­a­ble suf­fer­ing and whether they have capac­i­ty — whether they under­stand and appre­ci­ate their con­di­tion, the deci­sion and its con­se­quences.

“Tired-of-life cas­es in Cana­da are hap­pen­ing,” said Made­line Li, a can­cer psy­chi­a­trist spe­cial­iz­ing in pal­lia­tive care who put togeth­er an assist­ed death frame­work for her Toron­to hos­pi­tal net­work.

“I’ve become very com­fort­able with MAiD for peo­ple who are dying. I am less com­fort­able for expand­ing indi­ca­tions. ... We’ve made MAiD so open you can request it for basi­cal­ly any rea­son.”

More than 30,000 Cana­di­ans have died with med­ical assis­tance since it became legal in 2016 – more than 10,000 of them in 2021, account­ing for 3.3% of Cana­di­an deaths that year, accord­ing to offi­cial data. The vast major­i­ty were deemed close to their “nat­ur­al” death. Last year 4.5% of deaths in the Nether­lands and 2.4% of deaths in Bel­gium were med­ical­ly assist­ed.

Clin­i­cians and experts are work­ing on a mod­el MAiD stan­dard of care for men­tal ill­ness for groups reg­u­lat­ing clin­i­cians.

But some are call­ing for the expan­sion to be delayed; oth­ers say the exist­ing sys­tem is flawed because peo­ple suf­fer­ing for lack of treat­ment or sup­ports may access assist­ed death.

Some indi­vid­u­als have come for­ward in local news reports say­ing they are seek­ing assist­ed death because they lack appro­pri­ate hous­ing or oth­er sup­ports.

The fed­er­al agency serv­ing vet­er­ans says at least one employ­ee sug­gest­ed assist­ed death unprompt­ed to at least four vet­er­ans between 2019 and 2022. It is inves­ti­gat­ing anoth­er such alle­ga­tion, a spokesper­son said in an email, adding advice on assist­ed death is not a depart­ment ser­vice. Some have point­ed to this as an exam­ple of sys­tem mis­use.

Some psy­chi­a­trists opposed to the expan­sion say it is impos­si­ble to deter­mine whether a men­tal ill­ness is “irre­me­di­a­ble.”

...

———-

“Cana­da pre­pares to expand assist­ed death amid debate” By Anna Mehler Paperny; Reuters; 12/12/2022

“Start­ing in March, peo­ple whose sole under­ly­ing con­di­tion is men­tal ill­ness will be able to access assist­ed death. Men­tal ill­ness was exclud­ed when the most recent med­ical assis­tance in dying (MAiD) law was passed in 2021.”

Assist­ed sui­cide for men­tal health con­di­tions are com­ing to Cana­da in a mat­ter months. It’s not the best time for major ques­tions about the safe­guards on the sys­tem. But tired-of-life assist­ed sui­cide cas­es are a real­i­ty and set to become a more com­mon real­i­ty when assist­ed sui­cides can be grant­ed based on men­tal ill­ness­es alone, like being so chron­i­cal­ly depressed that you ask for per­mis­sion to end it all to end the emo­tion­al suf­fer­ing. This is unchart­ed ter­ri­to­ry. But not so unchart­ed that we don’t have an idea of what might hap­pen if things aren’t han­dled well. Poor­ly han­dled euthana­sia is not unchart­ed ter­ri­to­ry:

...
That will make Cana­da one of six coun­tries in the world where a per­son suf­fer­ing from men­tal ill­ness alone who is not near their nat­ur­al death can get a doc­tor to help them die.

Peo­ple will still need to apply and be deemed eli­gi­ble by two clin­i­cians who must deter­mine whether they have an irre­me­di­a­ble con­di­tion caus­ing them intol­er­a­ble suf­fer­ing and whether they have capac­i­ty — whether they under­stand and appre­ci­ate their con­di­tion, the deci­sion and its con­se­quences.

“Tired-of-life cas­es in Cana­da are hap­pen­ing,” said Made­line Li, a can­cer psy­chi­a­trist spe­cial­iz­ing in pal­lia­tive care who put togeth­er an assist­ed death frame­work for her Toron­to hos­pi­tal net­work.

“I’ve become very com­fort­able with MAiD for peo­ple who are dying. I am less com­fort­able for expand­ing indi­ca­tions. ... We’ve made MAiD so open you can request it for basi­cal­ly any rea­son.”

...

Some indi­vid­u­als have come for­ward in local news reports say­ing they are seek­ing assist­ed death because they lack appro­pri­ate hous­ing or oth­er sup­ports.
...

Is it the case that Cana­da is poised to allow assist­ed sui­cide for basi­cal­ly any rea­son? If so, it’s hard not to be con­cerned when there’s already peo­ple com­ing for­ward for assist­ed sui­cides for rea­sons like a lack of appro­pri­ate hous­ing or oth­er sup­ports. This is Cana­da we’re talk­ing about. Imag­ine the num­ber of peo­ple who might be tempt­ed by that option in the US should ‘basi­cal­ly any rea­son’ assist­ed sui­cide become an option.

And as the fol­low­ing AP arti­cle from back in August describes, part of what makes the upcom­ing expan­sion of Canada’s euthana­sia laws so con­tro­ver­sial is the fact that anoth­er con­tro­ver­sy swirling around Canada’s euthana­sia laws are the grow­ing num­ber of reports about euthana­sia being inap­pro­pri­ate­ly pushed on patients who had­n’t at all expressed an inter­est in sui­cide. In fact, Cana­da stands out among the nations that allow sui­cide in that it does­n’t lim­it con­sul­ta­tions to those who seek it out but instead allows doc­tors and nurs­es to bring it up with patients just to let them know euthana­sia is a care option. It’s also the only coun­try to allows nurse prac­ti­tion­ers, not just doc­tors, to end a life.

And, impor­tant­ly in this new world where men­tal health alone can poten­tial be just cause for an assist­ed sui­cide, Cana­da stands out as a coun­try were sui­cide isn’t the last avail­able option after all oth­er options been pur­sued.

That’s all part of the con­text of the upcom­ing expan­sion of Canada’s euthana­sia laws to include men­tal health alone as a qual­i­fi­ca­tion for an assist­ed sui­cide. Cana­da real­ly is lead­ing the way on euthana­sia poli­cies and it’s set to lead even fur­ther in a major way soon. Which makes Cana­da the lead­ing can­di­date to trip over that fine line between com­pas­sion­ate assist­ed sui­cides vs ques­tion­able sui­cides that are less assist­ed and more coerced by a sys­tem that does­n’t see much val­ue in keep­ing them alive:

Asso­ci­at­ed Press

‘Dis­turb­ing’: Experts trou­bled by Canada’s euthana­sia laws

By MARIA CHENG
August 11, 2022

TORONTO (AP) — Alan Nichols had a his­to­ry of depres­sion and oth­er med­ical issues, but none were life-threat­en­ing. When the 61-year-old Cana­di­an was hos­pi­tal­ized in June 2019 over fears he might be sui­ci­dal, he asked his broth­er to “bust him out” as soon as pos­si­ble.

With­in a month, Nichols sub­mit­ted a request to be euth­a­nized and he was killed, despite con­cerns raised by his fam­i­ly and a nurse prac­ti­tion­er.

His appli­ca­tion for euthana­sia list­ed only one health con­di­tion as the rea­son for his request to die: hear­ing loss.

Nichols’ fam­i­ly report­ed the case to police and health author­i­ties, argu­ing that he lacked the capac­i­ty to under­stand the process and was not suf­fer­ing unbear­ably — among the require­ments for euthana­sia. They say he was not tak­ing need­ed med­ica­tion, wasn’t using the cochlear implant that helped him hear, and that hos­pi­tal staffers improp­er­ly helped him request euthana­sia.

“Alan was basi­cal­ly put to death,” his broth­er Gary Nichols said.

Dis­abil­i­ty experts say the sto­ry is not unique in Cana­da, which arguably has the world’s most per­mis­sive euthana­sia rules — allow­ing peo­ple with seri­ous dis­abil­i­ties to choose to be killed in the absence of any oth­er med­ical issue.

Many Cana­di­ans sup­port euthana­sia and the advo­ca­cy group Dying With Dig­ni­ty says the pro­ce­dure is “dri­ven by com­pas­sion, an end to suf­fer­ing and dis­crim­i­na­tion and desire for per­son­al auton­o­my.” But human rights advo­cates say the country’s reg­u­la­tions lack nec­es­sary safe­guards, deval­ue the lives of dis­abled peo­ple and are prompt­ing doc­tors and health work­ers to sug­gest the pro­ce­dure to those who might not oth­er­wise con­sid­er it.

Equal­ly trou­bling, advo­cates say, are instances in which peo­ple have sought to be killed because they weren’t get­ting ade­quate gov­ern­ment sup­port to live.

Cana­da is set to expand euthana­sia access next year, but these advo­cates say the sys­tem war­rants fur­ther scruti­ny now.

Euthana­sia “can­not be a default for Canada’s fail­ure to ful­fill its human rights oblig­a­tions,” said Marie-Claude Landry, the head of its Human Rights Com­mis­sion.

Landry said she shares the “grave con­cern” voiced last year by three U.N. human rights experts, who wrote that Canada’s euthana­sia law appeared to vio­late the agency’s Uni­ver­sal Dec­la­ra­tion of Human Rights. They said the law had a “dis­crim­i­na­to­ry impact” on dis­abled peo­ple and was incon­sis­tent with Canada’s oblig­a­tions to uphold inter­na­tion­al human rights stan­dards.

Tim Stain­ton, direc­tor of the Cana­di­an Insti­tute for Inclu­sion and Cit­i­zen­ship at the Uni­ver­si­ty of British Colum­bia, described Canada’s law as “prob­a­bly the biggest exis­ten­tial threat to dis­abled peo­ple since the Nazis’ pro­gram in Ger­many in the 1930s.”

Dur­ing his recent trip to Cana­da, Pope Fran­cis blast­ed what he has labeled the cul­ture of waste that con­sid­ers elder­ly and dis­abled peo­ple dis­pos­able. “We need to learn how to lis­ten to the pain” of the poor and most mar­gin­al­ized, Fran­cis said, lament­ing the “patients who, in place of affec­tion, are admin­is­tered death.”

Cana­da prides itself on being lib­er­al and accept­ing, said David Jones, direc­tor of the Anscombe Bioethics Cen­tre in Britain, “but what’s hap­pen­ing with euthana­sia sug­gests there may be a dark­er side.”

___

Euthana­sia, where doc­tors use drugs to kill patients, is legal in sev­en coun­tries — Bel­gium, Cana­da, Colom­bia, Lux­em­bourg, Nether­lands, New Zealand and Spain — plus sev­er­al states in Aus­tralia.

Oth­er juris­dic­tions, includ­ing sev­er­al U.S. states, per­mit assist­ed sui­cide — in which patients take the lethal drug them­selves, typ­i­cal­ly in a drink pre­scribed by a doc­tor.

In Cana­da, the two options are referred to as med­ical assis­tance in dying, though more than 99.9% of such deaths are euthana­sia. There were more than 10,000 deaths by euthana­sia last year, an increase of about a third from the pre­vi­ous year.

Canada’s road to allow­ing euthana­sia began in 2015, when its high­est court declared that out­law­ing assist­ed sui­cide deprived peo­ple of their dig­ni­ty and auton­o­my. It gave nation­al lead­ers a year to draft leg­is­la­tion.

The result­ing 2016 law legal­ized both euthana­sia and assist­ed sui­cide for peo­ple aged 18 and over pro­vid­ed they met cer­tain con­di­tions: They had to have a seri­ous con­di­tion, dis­ease or dis­abil­i­ty that was in an advanced, irre­versible state of decline and endur­ing “unbear­able phys­i­cal or men­tal suf­fer­ing that can­not be relieved under con­di­tions that patients con­sid­er accept­able.” Their death also had to be “rea­son­ably fore­see­able,” and the request for euthana­sia had to be approved by at least two physi­cians.

The law was lat­er amend­ed to allow peo­ple who are not ter­mi­nal­ly ill to choose death, sig­nif­i­cant­ly broad­en­ing the num­ber of eli­gi­ble peo­ple. Crit­ics say that change removed a key safe­guard aimed at pro­tect­ing peo­ple with poten­tial­ly years or decades of life left.

Today, any adult with a seri­ous ill­ness, dis­ease or dis­abil­i­ty can seek help in dying.

Cana­di­an health min­is­ter Jean-Yves Duc­los said the country’s euthana­sia law “rec­og­nizes the rights of all per­sons ... as well as the inher­ent and equal val­ue of every life.”

___

The coun­tries that allow euthana­sia and assist­ed sui­cide vary in how they admin­is­ter and reg­u­late the prac­tices, but Cana­da has sev­er­al poli­cies that set it apart from oth­ers. For exam­ple:

— Unlike Bel­gium and the Nether­lands, where euthana­sia has been legal for two decades, Cana­da doesn’t have month­ly com­mis­sions to review poten­tial­ly trou­bling cas­es, although it does pub­lish year­ly reports of euthana­sia trends.

— Cana­da is the only coun­try that allows nurse prac­ti­tion­ers, not just doc­tors, to end patients’ lives. Med­ical author­i­ties in its two largest provinces, Ontario and Que­bec, explic­it­ly instruct doc­tors not to indi­cate on death cer­tifi­cates if peo­ple died from euthana­sia.

— Bel­gian doc­tors are advised to avoid men­tion­ing euthana­sia to patients since it could be mis­in­ter­pret­ed as med­ical advice. The Aus­tralian state of Vic­to­ria for­bids doc­tors from rais­ing euthana­sia with patients. There are no such restric­tions in Cana­da. The asso­ci­a­tion of Cana­di­an health pro­fes­sion­als who pro­vide euthana­sia tells physi­cians and nurs­es to inform patients if they might qual­i­fy to be killed, as one of their pos­si­ble “clin­i­cal care options.”

— Cana­di­an patients are not required to have exhaust­ed all treat­ment alter­na­tives before seek­ing euthana­sia, as is the case in Bel­gium and the Nether­lands.

Still, Duc­los said there were ade­quate safe­guards in place, includ­ing “strin­gent eli­gi­bil­i­ty cri­te­ria” to ensure no dis­abled peo­ple were being encour­aged or coerced into end­ing their lives. Gov­ern­ment fig­ures show more than 65% of peo­ple are being euth­a­nized due to can­cer, fol­lowed by heart prob­lems, res­pi­ra­to­ry issues and neu­ro­log­i­cal con­di­tions.

There­sia Degen­er, a pro­fes­sor of law and dis­abil­i­ty stud­ies at the Protes­tant Uni­ver­si­ty for Applied Sci­ences in north­west­ern Ger­many, said allow­ing euthana­sia based exclu­sive­ly on dis­abil­i­ty was a clear human rights vio­la­tion.

“The impli­ca­tion of (Canada’s) law is that a life with dis­abil­i­ty is auto­mat­i­cal­ly less worth liv­ing and that in some cas­es, death is prefer­able,” said Degen­er.

___

Alan Nichols lost his hear­ing after brain surgery at age 12 and suf­fered a stroke in recent years, but he lived most­ly on his own. “He need­ed some help from us, but he was not so dis­abled that he qual­i­fied for euthana­sia,” said Gary Nichols.

In one of the assess­ments filed by a nurse prac­ti­tion­er before Nichols was killed, she not­ed his his­to­ry of seizures, frailty and “a fail­ure to thrive.” She also wrote that Nichols had hear­ing and vision loss.

The Nichols fam­i­ly were hor­ri­fied that his death appeared to be approved based part­ly on Alan’s hear­ing loss and had oth­er con­cerns about how Alan was euth­a­nized. They lodged com­plaints with the British Colum­bia agency that reg­u­lates doc­tors and the Roy­al Cana­di­an Mount­ed Police, ask­ing for crim­i­nal charges. They also wrote to Canada’s min­is­ter of jus­tice.

“Some­body needs to take respon­si­bil­i­ty so that it nev­er hap­pens to anoth­er fam­i­ly,” said Trish Nichols, Gary’s wife. “I am ter­ri­fied of my hus­band or anoth­er rel­a­tive being put in the hos­pi­tal and some­how get­ting these (euthana­sia) forms in their hand.”

The hos­pi­tal says Alan Nichols made a valid request for euthana­sia and that, in line with patient pri­va­cy, it was not oblig­at­ed to inform rel­a­tives or include them in treat­ment dis­cus­sions.

The provin­cial reg­u­la­to­ry agency, British Columbia’s Col­lege of Doc­tors and Sur­geons, told the fam­i­ly it could not pro­ceed with­out a police inves­ti­ga­tion. In March, Roy­al Cana­di­an Mount­ed Police Cpl. Patrick Maison­neuve emailed the rel­a­tives to say he had reviewed the doc­u­men­ta­tion and con­clud­ed Alan Nichols “met the cri­te­ria” for euthana­sia.

The family’s par­lia­men­tary rep­re­sen­ta­tive, Lau­rie Throness, asked British Columbia’s health min­is­ter for a pub­lic inves­ti­ga­tion, call­ing the death “deeply dis­turb­ing.”

The health min­is­ter, Adri­an Dix, said the province’s over­sight unit reviewed the case and “has not referred it for any fur­ther inquiry.” He point­ed out that the euthana­sia law does not allow for fam­i­lies to review euthana­sia requests or be privy to hos­pi­tals’ deci­sions.

Tru­do Lem­mens, chair of health law and pol­i­cy at the Uni­ver­si­ty of Toron­to, said it was “aston­ish­ing” that author­i­ties con­clud­ed Nichols’ death was jus­ti­fied.

“This case demon­strates that the rules are too loose and that even when peo­ple die who shouldn’t have died, there is almost no way to hold the doc­tors and hos­pi­tals respon­si­ble,” he said.

___

Some dis­abled Cana­di­ans have decid­ed to be killed in the face of mount­ing bills.

Before being euth­a­nized in August 2019 at age 41, Sean Tagert strug­gled to get the 24-hour-a-day care he need­ed. The gov­ern­ment pro­vid­ed Tagert, who had Lou Gehrig’s dis­ease, with 16 hours of dai­ly care at his home in Pow­ell Riv­er, British Colum­bia. He spent about 264 Cana­di­an dol­lars ($206) a day to pay cov­er­age dur­ing the oth­er eight hours.

Health author­i­ties pro­posed that Tagert move to an insti­tu­tion, but he refused, say­ing he would be too far from his young son. He called the sug­ges­tion “a death sen­tence” in an inter­view with the Cana­di­an Broad­cast­ing Cor­po­ra­tion.

Before his death, Tagert had raised more than CA$16,000 ($12,400) to buy spe­cial­ized med­ical equip­ment he need­ed to live at home with care­tak­ers. But it still wasn’t enough.

“I know I’m ask­ing for change,” Tagert wrote in a Face­book post before his death. “I just didn’t real­ize that was an unac­cept­able thing to do.”

Stain­ton, the Uni­ver­si­ty of British Colum­bia pro­fes­sor, point­ed out that no province or ter­ri­to­ry pro­vides a dis­abil­i­ty ben­e­fit income above the pover­ty line. In some regions, he said, it is as low as CA$850 ($662) a month — less than half the amount the gov­ern­ment pro­vid­ed to peo­ple unable to work dur­ing the COVID-19 pan­dem­ic.

Hei­di Janz, an assis­tant adjunct pro­fes­sor in Dis­abil­i­ty Ethics at the Uni­ver­si­ty of Alber­ta, said “a per­son with dis­abil­i­ties in Cana­da has to jump through so many hoops to get sup­port that it can often be enough to tip the scales” and lead them to euthana­sia.

Duc­los, the nation­al health min­is­ter, told The Asso­ci­at­ed Press that he could not com­ment on spe­cif­ic cas­es but said all juris­dic­tions have a broad range of poli­cies to sup­port dis­abled peo­ple. He acknowl­edged “dis­par­i­ties in access to ser­vices and sup­ports across the coun­try.”

Oth­er dis­abled peo­ple say the easy avail­abil­i­ty of euthana­sia has led to unset­tling and some­times fright­en­ing dis­cus­sions.

Roger Foley, who has a degen­er­a­tive brain dis­or­der and is hos­pi­tal­ized in Lon­don, Ontario, was so alarmed by staffers men­tion­ing euthana­sia that he began secret­ly record­ing some of their con­ver­sa­tions.

In one record­ing obtained by the AP, the hospital’s direc­tor of ethics told Foley that for him to remain in the hos­pi­tal, it would cost “north of $1,500 a day.” Foley replied that men­tion­ing fees felt like coer­cion and asked what plan there was for his long-term care.

“Roger, this is not my show,” the ethi­cist respond­ed. “My piece of this was to talk to you, (to see) if you had an inter­est in assist­ed dying.”

Foley said he had nev­er pre­vi­ous­ly men­tioned euthana­sia. The hos­pi­tal says there is no pro­hi­bi­tion on staff rais­ing the issue.

Cather­ine Frazee, a pro­fes­sor emeri­ta at Toronto’s Ryer­son Uni­ver­si­ty, said cas­es like Foley’s were like­ly just the tip of the ice­berg.

“It’s dif­fi­cult to quan­ti­fy it, because there is no easy way to track these cas­es, but I and oth­er advo­cates are hear­ing reg­u­lar­ly from dis­abled peo­ple every week who are con­sid­er­ing (euthana­sia),” she said.

Frazee cit­ed the case of Can­dice Lewis, a 25-year-old woman who has cere­bral pal­sy and spina bifi­da. Lewis’ moth­er, Sheila Elson, took her to an emer­gency room in New­found­land five years ago. Dur­ing her hos­pi­tal stay, a doc­tor said Lewis was a can­di­date for euthana­sia and that if her moth­er chose not to pur­sue it, that would be “self­ish,” Elson told the Cana­di­an Broad­cast­ing Cor­po­ra­tion.

___

Cana­da has tweaked its euthana­sia rules since they were first enact­ed six years ago, but crit­ics say more needs to be done — espe­cial­ly as Cana­da expands access fur­ther.

Next year, the coun­try is set to allow peo­ple to be killed exclu­sive­ly for men­tal health rea­sons. It is also con­sid­er­ing extend­ing euthana­sia to “mature” minors — chil­dren under 18 who meet the same require­ments as adults.

...

Landry, Canada’s human rights com­mis­sion­er, said lead­ers should lis­ten to the con­cerns of those fac­ing hard­ships who believe euthana­sia is their only option. She called for social and eco­nom­ic rights to be enshrined in Cana­di­an law to ensure peo­ple can get ade­quate hous­ing, health care and sup­port.

“In an era where we rec­og­nize the right to die with dig­ni­ty, we must do more to guar­an­tee the right to live with dig­ni­ty,” she said.

———–

“‘Dis­turb­ing’: Experts trou­bled by Canada’s euthana­sia laws” By MARIA CHENG; Asso­ci­at­ed Press; 08/11/2022

“Tim Stain­ton, direc­tor of the Cana­di­an Insti­tute for Inclu­sion and Cit­i­zen­ship at the Uni­ver­si­ty of British Colum­bia, described Canada’s law as “prob­a­bly the biggest exis­ten­tial threat to dis­abled peo­ple since the Nazis’ pro­gram in Ger­many in the 1930s.””

That’s a harsh crit­i­cism: “prob­a­bly the biggest exis­ten­tial threat to dis­abled peo­ple since the Nazis’ pro­gram in Ger­many in the 1930s.” But that’s how the direc­tor of the Cana­di­an Insti­tute for Inclu­sion and Cit­i­zen­ship at the Uni­ver­si­ty of British Colum­bia sees this expand­ed new euthana­sia pol­i­cy com­ing into effect in a few months. The worst thing for the dis­abled since the Nazis. It was­n’t obvi­ous back in 2015 what kind of Pan­do­ra’s box was being opened when Canada’s high court ruled that assist­ed sui­cide was a con­sti­tu­tion­al right. But those chal­lenges are becom­ing more and more obvi­ous as Cana­da wres­tles with what that rul­ing means, gen­er­al­ly by mak­ing more and more relaxed poli­cies:

...
Canada’s road to allow­ing euthana­sia began in 2015, when its high­est court declared that out­law­ing assist­ed sui­cide deprived peo­ple of their dig­ni­ty and auton­o­my. It gave nation­al lead­ers a year to draft leg­is­la­tion.

The result­ing 2016 law legal­ized both euthana­sia and assist­ed sui­cide for peo­ple aged 18 and over pro­vid­ed they met cer­tain con­di­tions: They had to have a seri­ous con­di­tion, dis­ease or dis­abil­i­ty that was in an advanced, irre­versible state of decline and endur­ing “unbear­able phys­i­cal or men­tal suf­fer­ing that can­not be relieved under con­di­tions that patients con­sid­er accept­able.” Their death also had to be “rea­son­ably fore­see­able,” and the request for euthana­sia had to be approved by at least two physi­cians.

The law was lat­er amend­ed to allow peo­ple who are not ter­mi­nal­ly ill to choose death, sig­nif­i­cant­ly broad­en­ing the num­ber of eli­gi­ble peo­ple. Crit­ics say that change removed a key safe­guard aimed at pro­tect­ing peo­ple with poten­tial­ly years or decades of life left.

Today, any adult with a seri­ous ill­ness, dis­ease or dis­abil­i­ty can seek help in dying.

...

The coun­tries that allow euthana­sia and assist­ed sui­cide vary in how they admin­is­ter and reg­u­late the prac­tices, but Cana­da has sev­er­al poli­cies that set it apart from oth­ers. For exam­ple:

— Unlike Bel­gium and the Nether­lands, where euthana­sia has been legal for two decades, Cana­da doesn’t have month­ly com­mis­sions to review poten­tial­ly trou­bling cas­es, although it does pub­lish year­ly reports of euthana­sia trends.

— Cana­da is the only coun­try that allows nurse prac­ti­tion­ers, not just doc­tors, to end patients’ lives. Med­ical author­i­ties in its two largest provinces, Ontario and Que­bec, explic­it­ly instruct doc­tors not to indi­cate on death cer­tifi­cates if peo­ple died from euthana­sia.

— Bel­gian doc­tors are advised to avoid men­tion­ing euthana­sia to patients since it could be mis­in­ter­pret­ed as med­ical advice. The Aus­tralian state of Vic­to­ria for­bids doc­tors from rais­ing euthana­sia with patients. There are no such restric­tions in Cana­da. The asso­ci­a­tion of Cana­di­an health pro­fes­sion­als who pro­vide euthana­sia tells physi­cians and nurs­es to inform patients if they might qual­i­fy to be killed, as one of their pos­si­ble “clin­i­cal care options.”

— Cana­di­an patients are not required to have exhaust­ed all treat­ment alter­na­tives before seek­ing euthana­sia, as is the case in Bel­gium and the Nether­lands.
...

But it’s the instances where finan­cial con­cerns — like a lack of ade­quate gov­ern­ment sup­port or point­ing out how much cheap­er euthana­sia would be than get­ting the care to stay alive — are part of the euthana­sia deci­sion that real­ly under­score just how per­ilous this ground is becom­ing. And those instances are hap­pen­ing:

...
Many Cana­di­ans sup­port euthana­sia and the advo­ca­cy group Dying With Dig­ni­ty says the pro­ce­dure is “dri­ven by com­pas­sion, an end to suf­fer­ing and dis­crim­i­na­tion and desire for per­son­al auton­o­my.” But human rights advo­cates say the country’s reg­u­la­tions lack nec­es­sary safe­guards, deval­ue the lives of dis­abled peo­ple and are prompt­ing doc­tors and health work­ers to sug­gest the pro­ce­dure to those who might not oth­er­wise con­sid­er it.

Equal­ly trou­bling, advo­cates say, are instances in which peo­ple have sought to be killed because they weren’t get­ting ade­quate gov­ern­ment sup­port to live.

...

Some dis­abled Cana­di­ans have decid­ed to be killed in the face of mount­ing bills.

Before being euth­a­nized in August 2019 at age 41, Sean Tagert strug­gled to get the 24-hour-a-day care he need­ed. The gov­ern­ment pro­vid­ed Tagert, who had Lou Gehrig’s dis­ease, with 16 hours of dai­ly care at his home in Pow­ell Riv­er, British Colum­bia. He spent about 264 Cana­di­an dol­lars ($206) a day to pay cov­er­age dur­ing the oth­er eight hours.

Health author­i­ties pro­posed that Tagert move to an insti­tu­tion, but he refused, say­ing he would be too far from his young son. He called the sug­ges­tion “a death sen­tence” in an inter­view with the Cana­di­an Broad­cast­ing Cor­po­ra­tion.

Before his death, Tagert had raised more than CA$16,000 ($12,400) to buy spe­cial­ized med­ical equip­ment he need­ed to live at home with care­tak­ers. But it still wasn’t enough.

“I know I’m ask­ing for change,” Tagert wrote in a Face­book post before his death. “I just didn’t real­ize that was an unac­cept­able thing to do.”

Stain­ton, the Uni­ver­si­ty of British Colum­bia pro­fes­sor, point­ed out that no province or ter­ri­to­ry pro­vides a dis­abil­i­ty ben­e­fit income above the pover­ty line. In some regions, he said, it is as low as CA$850 ($662) a month — less than half the amount the gov­ern­ment pro­vid­ed to peo­ple unable to work dur­ing the COVID-19 pan­dem­ic.

...

Oth­er dis­abled peo­ple say the easy avail­abil­i­ty of euthana­sia has led to unset­tling and some­times fright­en­ing dis­cus­sions.

Roger Foley, who has a degen­er­a­tive brain dis­or­der and is hos­pi­tal­ized in Lon­don, Ontario, was so alarmed by staffers men­tion­ing euthana­sia that he began secret­ly record­ing some of their con­ver­sa­tions.

In one record­ing obtained by the AP, the hospital’s direc­tor of ethics told Foley that for him to remain in the hos­pi­tal, it would cost “north of $1,500 a day.” Foley replied that men­tion­ing fees felt like coer­cion and asked what plan there was for his long-term care.

“Roger, this is not my show,” the ethi­cist respond­ed. “My piece of this was to talk to you, (to see) if you had an inter­est in assist­ed dying.”

Foley said he had nev­er pre­vi­ous­ly men­tioned euthana­sia. The hos­pi­tal says there is no pro­hi­bi­tion on staff rais­ing the issue.

Cather­ine Frazee, a pro­fes­sor emeri­ta at Toronto’s Ryer­son Uni­ver­si­ty, said cas­es like Foley’s were like­ly just the tip of the ice­berg.

“It’s dif­fi­cult to quan­ti­fy it, because there is no easy way to track these cas­es, but I and oth­er advo­cates are hear­ing reg­u­lar­ly from dis­abled peo­ple every week who are con­sid­er­ing (euthana­sia),” she said.
...

Final­ly, note that nex­t’s year’s poli­cies will also include “mature” minors:

...

Next year, the coun­try is set to allow peo­ple to be killed exclu­sive­ly for men­tal health rea­sons. It is also con­sid­er­ing extend­ing euthana­sia to “mature” minors — chil­dren under 18 who meet the same require­ments as adults.
...

The pen­du­lum is con­tin­u­ing to swing in the direc­tion of more access to euthana­sia. And that’s great for those who have now oth­er option. It real­ly is the com­pas­sion­ate option in those cas­es. It’s when there’s still oth­er options, like just being able to pay your med­ical bills, where it’s start­ing to sound a lot less com­pas­sion­ate and a lot more like a kinder, gen­tler T‑4 pro­gram. We’re going to get a lot more clar­i­ty on which of those sce­nar­ios we’re going to get for Cana­da in 2023. Let’s hope there’s a whole bunch of “don’t unleash a T‑4 pro­gram” New Year’s res­o­lu­tions in Cana­da this year. And, well, every year. That’s a gen­er­al­ly good thing to resolve not to do.