Canadian legislators will be deliberating over Bill C-7 over the next few days. The bill would expand existing legislation regarding medical assistance in dying (“MAID”) to make it easier for people with disabilities to request and obtain MAID, and philosophers are weighing in on the discussion.

Medically-assisted suicide has been legal in Canada since 2016. Among the procedures and safeguards in place in current Canadian law is that in order for a patient to be granted MAID their “natural” death must be “reasonably foreseeable” given their medical circumstances. In 2019 a judge ruled this particular condition violated Canadians’ rights. The current legislation amends the law in response to this ruling. It distinguishes between requests made under circumstances in which natural death is foreseeable and circumstances in which it is not, and sets forth requirements for granting MAID in each.

Here’s a summary of the changes the bill, if passed, would bring:

There is a worry among some philosophers and disability advocates that the elimination of the “foreseeable natural death” requirement will lead to circumstances under which pressure is put on the disabled to seek MAID and that people will come to further devalue the interests and welfare of the disabled.

In her letter to the Canadian Senate Standing Committee on Legal and Constitutional Affairs, Shelley Tremain suggests that commentary on the legislation has been dominated by bioethicists and philosophers with insufficient expertise in disability issues:

I implore the Standing Senate Committee on Legal and Constitutional Affairs to expand the scope of the field of scholars and other interested parties from which it gathers views on the expansion of MAID. The current body of bioethicists and philosophers who have hitherto represented themselves as the professional and disciplinary experts on the subject for legislative purposes on the issue have little background knowledge on the social epistemology of disability and are not recognized as experts in philosophy of disability by practitioners in this subfield of philosophy. In short, they should not be regarded as authorities on the current social situation of disabled people and what is required to improve it.

In their letter, philosophers Rob Wilson (Western Australia) and Matthew Barker (Concordia University) tout their “distance from the professional community of bioethicists” and write that

In a peer-reviewed article “Well-being, Disability, and Choosing Children” published in the leading philosophy journal Mind in 2019, we expressed concern about the effects of mistaken assumptions in the general non-disabled population and amongst bioethicists about the relationship between quality of life and disability in the context of decisions about the creation of a family.  Simply put, the basic, widespread assumption is that having a disability leads to a lower quality of life.  That assumption is false, however, and problematically leads both policy makers and individual citizens to make decisions that devalue the lives of people with disabilities, sometimes with lethal consequences at the start of life.

We share precisely this concern about Bill C-7 and disability in the context of decisions about the end of life.  Here we concur with a wide range of Canadian disability advocacy organisations that passage of the Bill will have detrimental and dehumanising effects on the lives of vulnerable people living with disability and will problematically expand the reach of MAID.  Although we also share concerns about the Bill’s limitations in the provisions for safeguards in life-ending decisions, we believe that the flaws in Bill C-7 run deeper than that. 

You can read the full text of their letter here.

On the other side of the debate are those, such as Jocelyn Downie (Dalhousie),  who believe that the importance of people being able to choose when to end their lives speaks in favor of passing the bill, and for not enforcing the “foreseeable natural death” requirement in the meanwhile (see here, for example).

Udo Schüklenk (Queens), a supporter of the legislation, notes that “mentally ill” does not imply “decisionally incapable.” Since “the intensity of suffering in severe mental illness can be as terrible as that of the most severe physical conditions,” we have a strong reason to allow the decisionally capable mentally ill who are suffering to decide whether to continue doing so. “Who else could possibly make that judgment, surely not others who do not actually experience the suffering?”

Links to other writings by philosophers or bioethicists on Bill C-7 welcome.