By Maya Ishikura
Last March, the United Nations Committee on the Rights of Persons with Disabilities (UNCRPD) released a report illustrating their concerns with Canada’s Medical Assistance in Dying (MAiD) law. Committee Expert, Rosemary Kayess, explained that Canadians with disabilities were seeking MAiD due to unjust social conditions that the state should be addressing. Directing a question to the Canadian government, Kayess asked, “The disproportionate impact of these failures, which included poverty, and a lack of access to employment and services, underpinned the so-called choice for seeking medical assistance in dying as an alternative. How was this not State-sanctioned euthanasia?”
Kayess is referring to Bill C-7, a legislative amendment which expanded MAiD eligibility to include those without a reasonably foreseeable natural death in 2021. Although the bill was intended to reflect the autonomy and freedom of choice of all Canadians, it’s less stringent eligibility criteria has unintentionally allowed some Canadians to choose MAiD because they could neither access nor afford alternative means of reducing their suffering. Forty-four-year-old Sathya Dhara Kovac was one of those patients. On October 3rd, 2022, she died by MAiD because she could not afford adequate home care services. Sathya lived with amyotrophic lateral sclerosis (ALS), and as her condition deteriorated, she required an increase in support. Sathya was told by Manitoba’s ALS Society that she would only receive around-the-clock care if she moved into a long-term care home. Sathya emphasized that while she did not want to die, she would prefer to remain at home as she knew others who had died shortly after moving into long-term care. She also did not want to give up her dog, whom she lived alone with.
Insofar as living in circumstances of persistent injustice may render certain persons incapable of autonomous decision-making, there is also disagreement over whether Canadians whose autonomy may be impaired by the unjust social conditions in which they live should be restricted from accessing MAiD. For MAiD users like Sathya, the worry would be that she was not meaningfully autonomous because she requested MAiD for reasons that had to do with the unjust social conditions she was facing. On some theories of autonomy, self-determination –a capacity generally required for autonomy – necessarily requires freedom from oppression. The view is that in circumstances of persistent injustice, restricted options constrain an agent’s ability to make choices about what to value, what to do, and who to be, all of which are necessary for self-determination.
In my paper, I suggest that patients who meet the eligibility criteria but who request MAiD primarily due to the unjust social conditions in which they live can exercise autonomy. I do not take a definitive stance on whether patients should be permitted to request MAiD for primarily social reasons. But I disagree with the claim that patients requesting MAiD for primarily social reasons are necessarily incapable of doing so on account of the unjust conditions in which they live. I show that even if Canadians feel that MAiD should not be offered to patients like Sathya, she cannot necessarily be characterized as lacking autonomy because of the reason for her request.
Author: Maya Ishikura
Affiliation: Philosophy, University of Victoria, Victoria, British Columbia
Conflicts of Interest: None to declare