Central to the argument for expanding Medical Assistance in Dying (MAiD) has been that it enjoys broad popular support. This is the crux of Bill C-7, which is now before Parliament. Polling over the past five years has regularly measured support for MAiD in the 75 to 85 per cent range. Justice Minister David Lametti often cites these figures as providing a solid Canadian consensus in support of the practice. He is leaning on this idea of broad public support to expand MAiD beyond what a 2019 Quebec Superior Court decision required of the federal government.
However, as a new public opinion study and recent justice committee testimony on MAiD in Canada show, that public support is hardly the consensus it is often made out to be.
As expected, late October polling by the Angus Reid Group, commissioned by Cardus, reconfirmed national support for MAiD at 77 per cent for the question of whether Canadians support access to MAiD as a basic right that should be up to patients and their doctors. However, simply asking about one’s support of or opposition to MAiD without further exploration can conceal as much as it reveals. MAiD isn’t a binary yes-or-no question. Bill C-7 isn’t about introducing or cancelling MAiD. It is about the conditions under which MAiD should be available. And when you ask, as we did, about what weight should be given to various concerns relating to MAiD’s public delivery, the polling tells a different story.
Canadian views on MAiD fall along a polarized spectrum. Thirty-three per cent of Canadians are “enthusiastic supporters” of MAiD, while 19 per cent are on the opposite end in the “opposed” camp. The largest group is the 48 per cent of Canadians who are “cautious supporters.” They support the idea of MAiD and legal access to it, but they also express significant concerns and caveats.
Protection for the vulnerable tops the list. Two-thirds of Canadians (65 per cent) want policy-makers, the courts, and politicians to give significant weight to the concern that MAiD could increase pressure on people with disabilities or the elderly to choose death to avoid being a burden on family and others. Almost seven in 10 Canadians say policy-makers should give considerable weight to the concern that expanding MAiD may lead to people with mental-health issues like depression choosing an earlier death rather than dealing with the underlying causes of their condition. Ryerson professor emerita Catherine Frazee has argued that the mistake of Bill C-7 is that it creates “a special pathway to assisted death” for those with an existing disability. Her argument is that for many of the disabled who have sought MAiD, it is the poor treatment by society, with its lack of support, rather than their underlying condition, that is the catalyst for their desire to die.
Canadians, too, are worried that adequate safeguards may not exist to protect the vulnerable and those with disabilities who may be encouraged to choose death while in hospital because they are perceived as suffering due to their particular disabilities. Fully 68 per cent say leaders should pay attention to important concerns raised by a United Nations report critical of Canada’s lack of implementation of safeguards to protect people with disabilities and ensure access to supportive care.
What Canadians raised in polls were considerations also raised by witnesses in the justice committee’s recent examination of Bill C-7. Dr. Leonie Herx, head of palliative medicine at Queen’s University, told MPs about the unease physicians across Canada feel regarding easier and quicker access to MAiD.
“Bill C-7 proposes to further reduce (current) safeguards and put more Canadians at risk of wrongful death,” Dr. Herx testified. “Year after year there have been documented cases of noncompliance and misapplication of the law and policy with respect to MAiD in Canada. The Chief Coroner of Ontario, the End of Life Commissioner in Quebec, and very recently the Correctional Investigator of Canada have all reported on these issues. We also see instances of vulnerable patients being told by the health-care team that they should consider a medically administered death, because the cost of their care is too great. We know that many people requested medically administered death out of fear of being a burden to others. This sense of being a burden and demoralization is amplified when real options to support living do not exist.”
Other committee witnesses reflected Canadians’ concerns about expanded MAiD devaluing particular lives in the eyes of health-care practitioners.
“Bill C-7 is our worst nightmare,” Krista Carr, executive vice-president of Inclusion Canada said. “Inclusion Canada stands united with all national disabled persons’ organizations in calling for MAiD to be restricted to the end of life. The disability community is appalled that Bill C-7 would allow people with a disability to have their lives ended when they are suffering but not dying. This is not how we respond to the suffering of any other group of Canadians, much less any other Charter-protected group.”
Even before any committee testimony, Canadians had caveats and concerns about the longer-term effects on the health-care system and the quality of end-of-life care available to all Canadians. More than six in 10 Canadians in our poll (62 per cent) give considerable weight to the likelihood that the public health-care system will begin to ignore long-term care and chronic disease in elderly people as MAiD becomes more available (figure 1). This ranges from a high of 64 per cent in Alberta to a low of 50 per cent in Manitoba. Women (65 per cent) are more likely to share this concern than men (59 per cent). Those born outside of Canada (71 per cent) and visible minorities (70 per cent) also give more weight to this concern.
Regarding one’s own choice of a natural death or MAiD at the end of life, there is a sharp divide in the data between respondents in Quebec and the rest of Canada, with 40 per cent in Quebec responding they would choose MAiD compared with 25 per cent in the rest of Canada.
Over half, 54 per cent of Canadians nationwide, give “quite a lot” or a “great deal” of weight to the concern that patients’ confidence in their doctors could be compromised or undermined given that patients look to doctors “to heal, comfort, and fight for them.” Sixty-three per cent of people from visible minority groups share this concern.
This is the same concern Taylor Hyatt, with the Council of Canadians with Disabilities, raised at the justice committee.
“I would never want a medical professional to begin the conversation about life-ending initiatives as a result of assumptions they make about what it’s like to live with my disability,” Hyatt said. “I want to be seen by a doctor who will care for me as a whole person, including taking my status as a disabled woman into account and who will support me in living and thriving in the only life I have, which is as a disabled woman.”
Added to all this is the question of palliative care, which has lagged far behind the rapidly expanding MAiD regime. The federal government has acknowledged that 70 per cent of Canadians who want to receive traditional palliative care in order to die naturally at home are not able to receive it. When asked about this, seven out of 10 Canadians say policy-makers should give serious consideration to whether more and wider access to MAiD will mean less public investment in traditional palliative care for the dying.
Canadians have serious concerns about the breadth and expansion of MAiD, confirmed in extensive polling and expressed in the justice committee. However, in the haste to expand MAiD far beyond the requirements of any court ruling, it is not clear leaders are listening. The cost of that neglect is potentially very high. Rethinking or at least pausing the current push in favour of a more thorough review of Bill C-7 could prevent a slow-motion medical and moral disaster in the making.