In 1998, Dr. Gregor Wolbring, then Bioethics Advisor to the Council of Canadians with Disabilities (CCD), wrote and published Why Disability Rights Movements Do Not Support Euthanasia: Safeguards Broken Beyond Repair. Wolbring, a disability advocate and scholar, was primarily concerned with the supposed “safeguards” designed to limit the use of euthanasia and alleviate concerns about its abuse. He identifies four in total: 1) limitation to those who are terminally ill, 2) limitation in purpose to abolish physical pain, 3) informed consent by the person and 4) a general goal of patient self-determination. Wolbring notes that even at the time of his writing, the definition of “terminal illness” had already been drastically expanded by Right to Die advocates due to the inherent level of imprecision in determining when a disease was truly terminal. So too had “physical pain” been expanded to include emotional anguish, including physical dependency on others alleged to cause psychic humiliation to the patient.
However, Wolbring reserves his most visceral and incisive criticism for the last two planks. He recounts with disgust the Latimer case, in which a Saskatchewan man’s decision to murder his 13-year-old daughter was met with widespread sympathy due to her suffering with severe mental and psychological disabilities. Wolbring was a vocal critic of public and political response to the Latimer case, considering it rooted in stigmas against disabled persons so deeply ingrained that “they foster a different morality.” He also discusses the Katie Lynn Baker case, in which a mother allowed her 10-year-old daughter with Rett’s Syndrome to starve to death. One of the symptoms of Rett’s Syndrome, a severe congenital neurological disorder, is a disinclination to eat, a fact used by the mother to insist that Katie Lynn had “chosen” to die. The Attorney-General refused to prosecute, a choice which outraged both Wolbring and the CCD.
Far from being an exercise in shock therapy, the grotesque nature of the cases is meant to illustrate Wolbring’s main concern. Namely, that the liberalization of euthanasia in Canada will ultimately interact with the dehumanizing way society as a whole treats people with disabilities to create tragedies that would in any other circumstance be regarded as plainly reprehensible. However, these concerns have been ignored, as is often the case with disability rights concerns, and the drive towards increasing the scope of access to euthanasia has continued apace.
In June 2017, Canada passed its Medical Assistance in Dying (MAiD) Act. MAiD recognizes two different methods: 1) clinician-administered medical assistance in dying, where a licensed medical practitioner administers a lethal drug – usually a barbiturate such as diazepam or pentobarbital – and 2) self-administered medical assistance in dying, where a physician prescribes the drug for the patient to use on themselves. The clinical language describes euthanasia and physician-assisted suicide respectively, treating them as two different methods of the same legal procedure. In March 2021, the eligibility requirements to seek MAiD were expanded, no longer requiring illness to be terminal. “Track Two” patients, as they are called to distinguish from the traditionally dying “Track One” patients, require only a “serious illness, disease or disability” that cannot be reversed, and is causing “unbearable physical or mental suffering” that “cannot be relieved under conditions that [the patient considers] acceptable.” Notably, this does exclude patients whose sole illness or disability is mental. At least until March 2023, due to the provision being subject to a sunset clause which will cause it to automatically expire at that time.
On April 9th, 2022, Toronto-based CTV News published an investigative piece titled “Death Wish: A rare look at Canada's growing demand for medical assistance in dying”. The article describes the rapidly expanding practice of physician-assisted suicide, a practice the article refers to as a “new area of medicine.” Highlighted is the family practice of Dr. Stefanie Green, author of This Is Assisted Dying: A Doctor's Story of Empowering Patients at the End of Life. The Victoria, B.C.-based doctor’s office is alleged to devote 90% of its time and effort to ending the lives of its patients. An emblematic case of a Track Two patient is discussed, one John Priddle whose qualifying condition was Friedreich’s ataxia, a congenital neurological disorder whose symptoms generally worsen with age.
On April 30, 2022, CTV published a subsequent article, detailing the pursuit of MAiD by a 31-year-old woman identified only as “Denise.” Denise, an indigent woman and wheelchair user with Multiple Chemical Sensitivity Syndrome (MCS), was granted eligibility for MAiD after 6 months of failing to find affordable housing that would not aggravate her condition. MCS is a poorly-understood condition that results in higher-than-normal sensitivities to environmental irritants such as smoke and fumes, management of which is largely a matter of trial and error. Denise’s particular sensitives stemmed from cigarette smoke, laundry detergents, and air fresheners, any of which can cause life-threatening reactions. Denise and her loved ones tried without success to find housing that she could afford on a meager, government-provided income that could guarantee her freedom from the pollutants that drastically reduced her quality of life. 10 different agencies declined to help. This is a stark contrast to the remarkable ease with which she was able to apply for – and eventually be granted – MAiD, in spite of the fact that her condition is eminently treatable by wheelchair-accessible housing with clean air.
Dr. Wolbring’s fears that the gradual erosion of safeguards in the provision of euthanasia would occasion the devaluation of the lives of disabled people have come to fruition in precisely the manner he predicted. Denise’s case can hardly be considered an isolated incident, given her frankness that “abject poverty” caused by her disability and the inability to have it adequately accommodated are the direct cause of her seeking government-sanctioned death. Disabled people in Canada experience poverty at nearly three times the rate of abled Canadians, a statistic that is chilling in light of this view of what the MAiD process can represent. And just a week before Denise was “Sophia,” another woman with MCS who sought death after a two-year quest to find affordable housing. In a heartbreaking video recorded shortly before her death, Sophia despairingly says, “The government sees me as expendable trash, a complainer, useless and a pain in the ass.”
Despite the high-minded language in the preamble to the MAiD bill about the inclusion of disabled people, despite the posturing of MAiD advocates about the alleviation of incurable suffering, this is the reality of physician-assisted suicide in Canada. Canada’s most vulnerable citizens have been repeatedly rejected by a society that refuses to accommodate them, encourages them to view their own lives as disposable, and tells them that the best relief that they can hope for is a cocktail of life-ending drugs. No just society treats its people this way; no healthy society accommodates such a blatantly instrumental view of the ability to kill its citizens with legal and ethical impunity.
The coda to Dr. Wolbring's article is a manifesto of sorts:
“We believe that every safeguard put forward at the beginning of the debate has already been broken beyond repair. We believe that as long as disabled people are viewed as a suffering entity, as an object of charity, as a life not worth living, we cannot accept the broadening of our access to death[...]We believe that the legalization of euthanasia will force people to be euthanized in a misbegotten effort to do the right thing: save their loved ones from financial ruin, remove family members from the care taker role, cease to be a burden on the state[...]We believe that the majority of death wishes are based on a lack of support and understanding for the individual by society. We believe that euthanasia is another technique to free society of unwanted members of society among them disabled people and another expression of the ableism in western societies.”
With another safeguard set to expire at roughly this time next year, yet another group of people will be categorically declared amongst the “unwanted.” We can only hope that the joint tragedies of Denise and Sophia will amplify Wolbring’s jeremiad and the unheard voices of the disabled.