Start Date: December 11, 2022
There is a saying to be careful what you wish for.
For much of the last few decades there have been discussions about providing universal free healthcare. Healthcare is considered essential and deemed by some a basic right. I occasionally find it odd that the thing we claim to value most highly is something we often don’t value in an economic sense. If you ask families with good household income how much they spend on all forms of entertainment, travel, more than basic transportation, and more than basic housing, it is a sizable amount of money. Yet some think they should not spend a fraction of that on basic healthcare for their children. Odd priorities?
Of course the larger issue is what I’ll refer to as big-ticket healthcare. This would be any major procedure, surgery, advanced medications, or disease treatments. They are all very expensive. In the United States these are financed through a complicated array of insurances, government programs (Medicare, Medicaid, etc) and in some cases charity hospitals such as St. Jude’s. It is complex and there are problems. But the notion that the systems in the Europe and Canada are a panacea may require a closer inspection.
Anecdotally I have heard stories of Americans visiting the UK and having family health emergencies which were well cared for at no cost. I have also known people whose UK relatives and friends were on wait lists of over a year for joint or vertebrae replacement despite disabling chronic pain. In some cases it appeared that actuarial calculations may have indicated that the aging patient might die of natural causes before the need for an expensive procedure. Converting healthcare into a civil service on par with the DMV may cause shortages of staff and lack of incentive for innovative care. If it is like American Medicare there are requirements for following standard protocols. By definition that means it is rare for breakthrough treatments to be applied. Inevitably none would be developed without other incentives.
The successful pop singer Michael Buble has a son, who, at age three, was diagnosed with a form of liver cancer. Mr. Buble is Canadian. He maintains a residence in Canada. He would have been eligible to have all of his son’s care in Canada, perhaps for free. Yet his family quickly relocated to Los Angeles to have his son treated at Children’s Hospital Los Angeles. If people who can afford to pay for private healthcare do not want free healthcare there is obviously a different standard of care, at least for more serious conditions. This is not an argument against providing taxpayer paid basic care. But if wealthy citizens of nations with public healthcare are leaving for treatment elsewhere, there must be limitations to what they can obtain for free.
When a fellow American overzealously waxes lyrical about universal free care I point to the fact that we do have such a system for a specific demographic of Americans. It is known as the VA, i.e. the Veteran’s Administration. No one deserves better care than people who swore to give their lives to defend the nation and have consequent health issues. There are not doubt caring medical professionals trying to do their best. But if ever a system has produced horror stories of patients dying while waiting to get appointments, poor care, and a broken system, it is the VA. You would be very hard pressed to find a veteran with access to private healthcare who would select the VA instead.
In America if you are 65 or over you are eligible for Medicare. While not unlimited it does spend a great deal on the care of senior citizens. As a baby boomer I have noted that my fellows are well enough to have fairly long life spans and active enough to want all of the requisite expensive joint replacements, heart care, etc. along the way. I have jokingly considered that when the next generation sees the deductions from their pay stub they may begin to think that assisted suicide is not such a bad idea.
THIS WAS SUPPOSED TO BE A JOKE.
Little did I know that assisted suicide is taking off like an Internet challenge in nations that provide government funded healthcare. In the EU Belgium and The Netherlands lead the way in facilitating suicide for patients. They have been providing euthanasia since 2002. Luxembourg since 2008. Other EU nations are considering following suit. I want to believe these patients are suffering from untreatable pain, are in late stage of disease or disability. I do think there is a place to show humans the mercy we provide our animals. Life is for the living.
However, in addition to innate ethical objections by some doctors, questions about standards for euthanasia became highly publicized when it became known that a 23 year old Belgian girl, Shanti de Corte, who suffered from PTSD after having seen fellow students killed in a terrorist bombing, was put down for having untreatable depression [1]. Her suffering was surely real, but 23 seems rather early to give up on a patient. Could her care givers have tried harder? Or was it just simpler, and cheaper, to end her life than to attempt to save it?
Nowhere has assisted suicide become an industry more than in Canada. MAID, or “Medical Assistance In Dying”, is a booming business. In 2016 when a law was passed to allow euthanasia for terminal patients there were roughly 1000 takers. By 2021 the number of cases increased tenfold to over 10,000 state assisted deaths [2], [3]. Canada is the 39th largest nation by population [4]. Yet it ranks number one in absolute count of deaths by state healthcare provided euthanasia. Vancouver Island is referred to, by some, as the assisted death capital of the world. In some provinces it accounts for nearly 5% for all death certificates [5]. If this percentage were applied to the annual deaths in the United States the toll would be roughly 150,000 lethal injection executions by the healthcare system. That is approximately the population of Savannah Georgia.
This is in part due to a significant expansion of the eligible conditions. In a few years the requirements have been loosened from imminent death, to inevitable death, to intolerable circumstances. A thirty six year old woman was “put down” for chronic anorexia which was deemed untreatable [6]. Elderly individuals are sometimes categorized as having “polypathology”, largely meaning there are multiple failure modes. As we age we suffer aches and pains, problems with hearing and vision and loneliness. It seems that some seniors were terrified of the isolation of COVID and preferred death. Some reports estimate that as many as 17% of deaths are in part driven by loneliness [2].
In the EU the patient is the one to initiate the discussion. But in Canada providers of assisted death have a guidance document suggesting it is the obligation of the physician to bring up the option, perhaps leading patients to think there is no hope [7]. Families have complained that their loved ones were given inaccurate diagnoses, excessively poor prognoses, or not enough time to respond to treatment before being terminated [8]. One patient In London Ontario was so concerned that he secretly taped conversations in which he was told how much it cost the hospital to maintain his daily care [2].
An extreme and blatant abuse took place when a 52 year old veteran and Paralympian was attempting to get a chairlift for her wheelchair. She received a written reply indicating that if she was so desperate they could provide her with medical assistance in dying now. Multiple other incidents have been heard in the Canadian House of Commons of veterans being offered MAID instead medical treatment [9].
For generations warfighters tended to die if they had major injuries. Now improvements in combat care have resulted in many returning home, but with catastrophic injuries requiring dozens of surgeries and years of treatment. Sadly, it seems that the government that sent them to war finds it cheaper to bury them than to treat them.
More mind boggling is a high fashion company that ran an advertising campaign celebrating the “beauty” of the death of a 37 year old single woman with a rare disease. Her friends seem to think that she just became exhausted from trying to get care and help from the socialized medical system. She lived in British Columbia where she had lost her primary care physician and had been unable to obtain palliative care. One reporter indicates that only 15% of Canadians have access to palliative care. Yet the same system was quick to approved her application for MAID [9] [10].
For the poor and disabled MAID has even been considered as a social welfare net. A man in St. Catherine’s with a back injury could not work. Yet his disability payments are insufficient to provide for housing. While not quite ready to die, he was terrified of being homeless in Canada, which is nothing like being homeless on the beaches of California. So he applied for MAID. He received the first of two required doctor signatures, suggesting a less than stringent oversight protocol. Happily his story made the news and a fundraising campaign provided enough money to house him for a time so he can reassess his situation. But there are other stories of people viewing MAID as a final resort when they cannot get needed services or pay basic bills [11], [12], [5].
Going forward there are plans to extend the eligible conditions for MAID to psychological illness in 2023. Mental illness is REAL and so is the pain that comes with it. Not every one in Canada has easy access to psychiatric care and/or evaluation for euthanasia. So should it be easy for the state to push you over the ledge because healing you might take too much time and money [6]? Will this extend to dementia? How will the system account for deeming mentally ill patients to be sufficiently competent to request their death, and yet justify the request based on a disease that renders them incompetent?
If all of this isn’t worrisome enough, the Quebec College of Physicians are indicating thoughts of greatly expanding the candidate pool in another dimension Discussions are taking place about allowing “mature minors” between 14 and 17 years of age to end their lives with the consent of parents or a tutor. Who doesn’t know, or wasn’t at one time, an angst ridden teenager who deemed life not worth living? What will happen to a culture that throws away its young people [13]?
Also in consideration is the termination of babies in the first year of life who are deemed to have grave disease or severe malformations. Killing infants crosses the barrier of requiring informed consent, as no consent is possible from a baby[13]. Where does this lead?
Remember this is a nation that pays for its citizens healthcare. So what does it save by killing them instead? One estimate was $100 million per year [5]. That is not irrelevant in Canada, particularly for a procedure whose patient base is growing exponentially.
There is yet another entity with vested interest in the termination of humans, particularly physically healthy young people. Organ donation centers certainly perform miracles. They bring new life from death. What could be more redeeming? But it is reported that patients suffering illness and requesting MAID do not get a call from a suicide prevention center, but instead from an organ center, letting them know the value of their death, should they allow their organs to be harvested [14]. I believe strongly in the final gift. But organs from healthy young people suffering depression should not be seen as a resource without any attempt to heal their present owner. The invitation for abuse and corruption seems boundless.
They are effectively telling people that the sum of their parts is worth more than the whole of their being.
If we haven’t yet fully plumbed the depth of depravity, one physician writes of sitting in medical conferences where the discussion of “donation after death” transitions to the possibility of “death by donation”. The premise is that if a patient has chosen to die and to donate their organs, why not simply anesthetize them and surgically remove their organs while they are still alive, in order to reduce blood loss to viable organs. In this case the cause of death would be the organ removal itself [15].
Society has always had members who give their lives for others. The military, police, and firefighters all risk death to serve the greater good. But the medical profession has historically been forbidden to terminate a viable life. I suppose the assumption is that the line has already been crossed with assisted suicide. Yet the thought of a surgeon cutting into a living human being to carve out their organs seems the stuff of terror movies or episodes of The Twilight Zone.
Putting all of these observations together my cynical mind wonders at what point is the cost of “free” healthcare being balanced by simply terminating the expensive patients.
Recall the pop singer with the critically ill toddler. What if Michael Buble was a Canadian plumber dependent on national healthcare. One wonders if his child would today be the healthy son in school that he is, or would he be in a Canadian graveyard?
Would his fellow grave dwellers be the elderly, the poor, homeless, and the disabled, deformed babies, damaged veterans and depressed civilians, cancer patients without proper pain management, lost adolescents and perhaps the developmentally challenged? How high will the bar be placed for a life to be deemed worth living?
Just be careful what you wish for.
REFERENCES
[1] Murray, Douglas, “The West’s Uncivilised euthanasia policy, 29 October 2022, https://www.spectator.co.uk/article/the-wests-uncivilised-euthanasia-policy/
[2] Mettler, Zachary, “Tragic Case in Canada Highlights Problems with Permissive Euthanasia Laws” August 23, 2022, https://dailycitizen.focusonthefamily.com/tragic-case-in-canada-highlights-problems-with-permissive-euthanasia-laws/
[3] Smith, Wesley J., “10,000+ Canadian Euthanasia Killings in 2021”, August 3, 2022, https://www.nationalreview.com/corner/10000-canadian-euthanasia-killings-in-2021/
[4] https://www.worldometers.info/world-population/population-by-country/
[5] Subramanya, Rupa, “Scheduled to Die: The Rise of Canada’s Assisted Suicide Program”, October 11, 2022, https://www.thefp.com/p/scheduled-to-die-the-rise-of-canadas
[6] Kirkey, Sharon, “Canada will soon offer doctor-assisted death to the mentally ill. Who should be eligible?”, April 4, 2022, https://nationalpost.com/health/canada-mental-illness-maid-medical-aid-in-dying
[7] Kirkey, Sharon, “Canadian doctors encouraged to bring up medically assisted death before their patients do”, November 2, 2022, https://nationalpost.com/news/canada/canada-maid-medical-aid-in-dying-consent-doctors
[8] Coelho, Ramona, “Medical assistance in dying overused in Canada even before expansion”, July 9, 0222, https://lfpress.com/opinion/columnists/coelho-medical-assistance-in-dying-overused-in-canada-even-before-expansion
[9] Hopper, Tristan, “ Woman featured in pro-euthanasia commercial wanted to live, say friends”, December 5, 2022, https://nationalpost.com/news/canada/woman-euthanasia-commercial-wanted-to-live
[10] Mettler, Zachary, “Canadian Retailer Launches Disturbing Advertising Campaign for Euthanasia”, November 29, 2022, https://dailycitizen.focusonthefamily.com/canadian-retailer-launches-disturbing-advertising-campaign-for-euthanasia/
[11] Mulligan, Cynthia and Bond, Meredith, “Ontario man applying for medically-assisted death as alternative to being homeless”. October 13, 2022, https://calgary.citynews.ca/2022/10/13/medical-assistance-death-maid-canada/
[12] Quill, Kevin, “Canada’s euthanasia laws are a moral outrage”, November 17, 2022, https://www.spiked-online.com/2022/11/17/canadas-euthanasia-laws-are-a-moral-outrage/
[13] Levesque, Catherine, “Quebec College of Physicians slammed for suggesting MAID for severely ill newborns”, October 11, 2022, https://nationalpost.com/news/quebec-college-of-physicians-slammed-for-suggesting-maid-for-severely-ill-newborns
[14] Smith, Wesley J., “Euthanasia Without Brakes”, HUMAN EXCEPTIONALISM, December 7, 2022, https://www.discovery.org/a/euthanasia-without-brakes/
[15] Ely, E. Wesley, “Dear by organ donation: Euthanizing patients foe their organs gains frightening traction”, Internal Care Med., September 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750276/