141: Does Canada Want Suffering Citizens to Die? (w/Taslim Alani-Verjee)
Is Canada trying to euthanize the mentally ill?
Self-professed "theocratic fascist" Matt Walsh says so. So does the OG anti-woke agitator, James Lindsay. Both cravenly distort Canada's proposed expansion of its Medical Assistance in Dying (MAiD) laws to include people suffering from mental illness.
But are they entirely wrong? From the left, Jeremy Appel writes in Jacobin:
I’ve come to realize that euthanasia in Canada represents the cynical endgame of social provisioning within the brutal logic of late-stage capitalism — we’ll starve you of the funding you need to live a dignified life, demand you pay back pandemic aid you applied for in good faith, and if you don’t like it, well, why don’t you just kill yourself?
Psychologist and ethics professor Dr. Taslim Alanii-Verjee joins Matthew to discuss the ethical labyrinth of MAiD expansion, and how the altruistic quest for patient autonomy and dignity can run afoul of the neoliberal state's failure to provide the necessaries.
Show Notes
Dr. Taslim Alani-Verjee
Federal government moves to delay MAID for people suffering solely from mental illness | CBC News
The Problems With Canada’s Medical Assistance in Dying Policy
Special Joint Committee on MAiD - Dr. Sonu Gaind
-- -- --
Support us on Patreon
Pre-order Conspirituality: How New Age Conspiracy Theories Became a Health Threat: America | Canada
Follow us on Instagram | Twitter: Derek | Matthew | Julian
Original music by EarthRise SoundSystem
Learn more about your ad choices. Visit megaphone.fm/adchoices
Remember that you can catch us on Apple Podcast Subscriptions, on Twitter, and on Instagram at ConspiritualityPod, and at Patreon.com slash Conspirituality, where $5 a month gets you access to hundreds of hours of bonus material, and you can pre-order our book.
It drops June 13th.
Through the link at the bottom of the show notes for this episode.
And I'll also say, Matthew, you've been doing a couple live streams a month, and we've been adding some sort of behind-the-scenes video of our process as we work on different episodes, and that's at the $10 level on Patreon.
So for anyone who just can't get enough, there's more there.
Conspiratuality 141.
Does Canada want suffering citizens to die?
With psychologist and ethics professor, Dr. Theslam Alani Vergy.
So, a warning before we get started.
We're going to be speaking today about Canada's expanding medical assistance in dying laws, or the MAID laws, and that means references to chronic mental illness, assisted suicide, euthanasia, chronic poverty, houselessness, racism, and state neglect.
One of the most important themes of our work here on Conspirituality Podcast and in our upcoming book is the exploration of how believers in conspirituality are not wrong.
They're not wrong that late capitalism is a predatory machine, that tech companies are engineering social behaviors, that corporations will lie about the harms they cause, and that with for-profit healthcare systems as in the U.S., we're only entitled to the survival we can afford.
Can spiritualists sing along with Leonard Cohen that the rich have got their channels in the bedrooms of the poor?
panel podcast puts it.
Conspiratualists sing along with Leonard Cohen, that the rich have got their channels in the bedrooms of the poor.
They are not wrong about MKUltra and CIA corruption. They know all about the fact that Jeffrey Epstein's sex
trafficking network has never been fully investigated, and that Cardinal Ratzinger became Pope Benedict in part
because he stonewalled on the issue of child sexual abuse in the Catholic Church.
They are not wrong that justice and accountability seem impossible to imagine, let alone achieve.
They are not wrong that the world seems unworkable.
And so it makes sense to turn to Spirit or Source for answers, and to do it now, because time is always running out.
no wonder they retreat into clouds of Palo Santo and New Age mantras.
Yeah, so these are all the general conditions, Julian, under which conspirituality flourishes,
but within the broad strokes, there are also intimate and personal moments of disillusionment
So we can consider the woman who joins a free-birthing Facebook group that just happens to be anti-vax, and that's after her birth care was intrusive and her postpartum care was neglectful.
Absolutely, or the parents who decide to homeschool because the needs of their neurodivergent child are ignored or punished.
And then once homeschooling, the family drifts farther towards medical libertarianism.
Or the case of the fat person who is denied healthcare until they lose weight.
Or the person who feels nothing but cold efficiency from the oncologist who reads a dire prognosis as if it were a financial statement.
It's in these moments that lives, ideologies, family cultures, community attachments, and political commitments can be changed forever.
It's in these moments that the body politic steps into a land of distrust and speculation.
What are they trying to do to me?
So at this point, Canadians are standing together on the edge of one of these moments because the federal government here is considering expanding the eligibility for medical assistance in dying.
To include not only people whose death from physical disease is not foreseeable, but people who feel death is their best option, despite having no physical ailments at all.
That is, people with mental health issues that they despair of resolving.
On March 23rd, a little over one month from now, Eligibility for MAID is scheduled to be expanded to include those who suffer from mental health issues.
Despite the fact that mental health care is not universally covered in Canada, and despite the fact that a person's unremitting chronic anxiety or depression might be causally related to their poverty, social isolation, or to the effects of structural inequalities such as racism.
Now, just in the past few weeks, Justice Minister David Lametti has responded to widespread concern about the expansion by tabling a bill to delay it.
And in many ways, this is how policy should work, with expert and public feedback influencing a moderate pace in things.
But the discourse around Made in Canada has become a political football south of the border.
The American right-wing pundit class has opinions about everything, and true to form, they've picked this up and run with it.
The first indication was this tweet from Matt Walsh that we saw back in November of last year.
He says, Canada's full-on embrace and glamorization of assisted suicide for physically healthy people is one of the most dire and consequential things happening in the Western world right now, and it's not getting nearly as much attention as it should.
Ah, the master of nuance.
Hundreds of comments on Walsh's post linked to propaganda sites that falsely claimed that the government was also removing consent procedures not only for adults but for children.
Yeah, total bullshit.
These themes fold tightly into existing conspiracy theories about poisonous vaccines being governmental instruments of depopulation or critical race theory being a mind virus that will push young white men toward suicide.
Then we have the original anti-woke crusader, James Lindsay, jumping on board with a couple of memes.
The first one has a sort of call center worker picking up the phone and saying, suicide hotline, how can I help you?
And then a photograph of Justin Trudeau, the Prime Minister, on the other end of the line saying, I'd like to place an order.
I think one of the things that's also interesting about this meme is that the suicide hotline, how can I help you image, is kind of one of those stock photos that you would use on a website where you have a particularly attractive young woman answering the phone because that's who you're going to be calling when you call to buy our products, right?
Well, there's that and there's also the notion of the sort of well-groomed, well-managed, neoliberal public servant.
Yes.
And we get that voice actually when I talk to Theslim.
I'm going to play the very chilling voice message that you receive in Canada when you phone the maid helpline.
It sounds like the voice is coming from this stock-photographed person.
Yeah, yeah.
So the next meme is a doctor, a young fellow talking to somebody, a man who looks to be in his 60s, late 60s maybe, and he's gesturing very sort of earnestly and saying, Have you considered our latest treatment, government-aided suicide?
You'll never have to worry about anything ever again.
Lindsay's platform ties made in with other moral panic issues, including whether gender-affirming health care is medical abuse.
And in a glaring example of the right-wing pizza effect, Conservative Party and opposition leader Pierre Poitlieu, fan of Jordan Peterson and last year's occupation of Ottawa, is now standing up in Parliament to push these same points, even in response to the government backing down.
So, it's clear that Canadian health law is now in prime right-wing conspiracy theory territory, set to trigger a wave of misgiving and distrust.
How will the government show that the alarmists are wrong or do they care?
Joining me in this interview to discuss the ethics of all of this as well as the new challenges faced
by mental health care practitioners in light of the possible made expansion is Dr. Theslam Alani-Virji.
She's a clinical psychologist and the director and founder of the Silm Center for Mental Health.
She teaches psychology and ethics at Adler Graduate Professional School and is adjunct professor at Lakehead.
Some of her concentration areas include intimate partner violence, stigma, social justice, and cultural humility.
Dr. Theslim, welcome back to Conspiratuality Podcast.
Thank you for having me, Matthew.
Now, as a clinical psychologist and ethics professor in a country where mental health conditions will soon be included, or they may soon be included in the eligibility for MAID, what were your first thoughts when I reached out to you about speaking to this issue?
This is something that I have been thinking about for some time ever since learning about MAID as it related to physical illnesses.
It has been something that I have been grappling with just to try to make sure that I know where I stand on the issue.
At first I remember thinking that it was unfair that mental illnesses were not included.
Yes, people with mental disorders should absolutely be eligible to access MAID.
However, after having spent some time, I think that there are a lot of nuances that do need
to be considered.
I do think that in an ideal situation with a system that works, yes, people with mental
disorders should absolutely be eligible to access MAID.
However, as it stands right now, it's a little murky.
And so I was excited to be able to come and talk to you about it today.
Some healthcare practitioners take a really clear position on MAID.
Some are advocates, some are cautious providers, some are conscientious objectors, and you're not a provider of MAID, and we'll get to where you might be increasingly involved nonetheless, but as a citizen, you've already indicated that, you know, you felt it initially unfair that mental health conditions were not initially But where would you say you fall on the spectrum of comfort with the practice in general?
As you mentioned, I'm not someone who would be part of that formal assessment process.
And for that, at this point in time, I am grateful.
I do not want that responsibility.
Those questions may start to come up in my practice, but as of right now, they haven't.
I do think that it is a big responsibility for anyone to be part of that assessment And I don't know that all people recognize the power that they have in that kind of assessment decision making, whether that is the decision to adequately assess a person's capacity and voluntary nature in making a decision to want to die with dignity, but also to withhold that from someone.
And so I think for anyone who's going to be engaging in it, it's a little bit confusing that we continue to have to give our power away to medical practitioners who get to make decisions about what we are allowed to do with our bodies and with our lives.
And yet, I can also understand why that system is in place.
If it does go forward next month, you are probably currently seeing clients who will now see this road open for them, and you're also going to be supervising psychology and psychotherapy students and future psychologists who will be fielding inquiries from their own clients.
How are you preparing for that?
I think it's important for us to talk about the autonomy of the person.
And so being able to sit with someone as they grapple with the difficulties of life, of living, of survival, of quality of life, and giving them the space to really talk about it freely.
Sometimes our automatic instinct is to want to protect people, want to comfort people in a way that prevents them from expressing themselves fully and from feeling safe In doing so, and so I think one of the things that has been important in my practice and something I try to instill with my students is that our values, our values around life, our values around how people should live in this world, they don't really matter in the therapy room.
And the moment we feel like we're trying to convince our clients of anything is the moment we really have to pause, step back and get some supervision or consultation.
Now, of course, it's going to be difficult conversations because there are a lot of clients who live with a lot of hopelessness, and some of that hopelessness is very much related to their mental health condition.
And for others, it's a product of mental health conditions.
Societal circumstances or social circumstances.
So when we put those things together, then are we talking about someone who wants to die because of their mental illness?
Or are we talking about someone who wants to die because life has not provided them or society has not provided them with what they need to be able to live a dignified life?
And so I think being able to teach my students, remind myself that this is such a
complex topic, and it is not my position to convince any of my clients that they should choose
either way. While I understand the value of being very careful about your interventions and your
values in the therapeutic space, there are many people I imagine that would seek out therapy
from a state of hopelessness and assume that they would be encouraging some kind of
encouragement in going forward.
And so, how does the existence of MAID impact that balance between monitoring how you're intervening with your values and what the client might expect?
I suppose if a client were coming to me from a state of hopelessness and wanting to explore Maid from a therapeutic perspective, I would be curious about what they've tried and how they got to those conclusions.
But I don't know that it is even my role as a therapist to encourage people when they're feeling hopeless.
We'll talk to friends and family and they'll try to convince us not to feel hopeless and that can often feel invalidating.
So to be able to talk to someone who can just hear you and hear your hopelessness and help you access the feelings related to that, help you access the traumas that are often related to that without necessarily trying to make change other than experiencing it, I think that can be some of the most meaningful work that happens in therapy.
Now, there is a Health Canada line, telephone line, that people can call right now to start accessing MAIT.
This is what it sounds like.
Ontario Medical Assistance and Dying Care Coordination Service may be accessed through Health 811.
A free, secure and confidential service to get help advice from a registered nurse or find health services or information 24 hours a day, 7 days a week through one number to call.
811 or online at Ontario.ca forward slash Health 811.
For service in English, press 1.
Pour le service en français, appuyez sur le 2.
For service in another language, or if you are calling from a rotary dial phone, please hold while we transfer your call to an advisor.
The Medical Assistance in Dying Care Coordination Service is designed to provide information about end-of-life options in Ontario, and as well, referrals for medical assistance in dying.
If you would like to speak with an advisor to access the service or get more information, please press 1.
If you would like to provide your feedback regarding this program, Okay, so it sounds like any other helpline that you would phone about banking or taxes or anything else.
Under a maid expansion, a patient of yours could call that number.
Now, when you imagine them hearing that message, as opposed to, say, maybe bringing up their concerns in therapy with you, what comes up?
When someone is struggling and suffering, more than ever, warmth and a personable voice is so important.
Now, when I hear that recording, my body is already reacting to having to wait on hold for at least 20 minutes.
It's like calling the CRA.
I don't want that.
That's the Canada Revenue Agency, by the way.
And what kind of hold music do you think they would use?
Yeah, I don't want any of the hold music.
But it's a very important choice.
I mean, Theslam, you could probably advise the committee on Maid as to what kind of hold music would be most therapeutic on that helpline.
You know what, I think it's a funny proposition, Matthew, but I think, you know, so many people are dealing with such complex and diverse things that there is no right way to choose that hold music.
There's also no right way to pick up that phone.
Right.
Other than to say, it's probably good for someone to pick up that phone call.
I imagine that it's automated at this point because whoever is picking up that phone call may be fielding a lot of questions about suicide and may be dealing with some crises and that might not be something that people are equipped to do in that way.
However, I do think that there's a bit more that can be done from what I've looked at in terms of research in other countries around folks accessing MAID.
It's not, that line is probably not going to be busy like the Canada Revenue Agency I would imagine that there would be enough capacity for people to actually just pick up the phone and talk to whoever is calling and so I wish that that would have been the first step and then if it gets the volume of calls is too much then they can choose something automated but that operator voice
Tends to communicate a certain coldness and a certain lack of compassion that I think in these particular circumstances, knowing that people are calling because they are suffering and struggling, they could use that compassion, they could use that human voice, and they could use a process that feels less cold and generic.
It's a managerial voice.
And it's really the voice of the state saying, we'll take care of you if you wait on hold for a little bit, if you have the appropriate numbers available and if you have your card ready and stuff like that.
And of course, what we'll take care of you about is in a completely different category of experience.
And to your point about, you know, would live operators be available?
I think the most recent stats on those accessing Made in Canada But it's up to about 10,000 a year.
I don't know if all of those 10,000 journeys begin with that particular phone call, but that would be a lot of operator time.
That would be hundreds of people trained to answer that phone and pick up the call.
But it does make me wonder how important that first phone call actually is, and if you got somebody who was able to do a little bit of reflective listening and not immediately put you on hold, whether that would make a difference in outcomes.
It's a good question, Matthew.
I don't know the answer to it.
What I do know, though, is that when we're able to get the answers that we need without the stress and the burden of waiting on hold or pressing the wrong button or knowing whether it's four or five, I think that at least that is one less burden on someone who is already feeling burdened, whether a family member of someone who is suffering and struggling, or whether it is the actual person who is calling.
No one needs that additional burden.
And I do believe that if our government is trying to ease people's pain and suffering, Have someone pick up the phone.
I think that's an easy thing to do.
To your point, it might be a lot of operator hours, but it might actually decrease the amount of time people are spending on the phone and then the people on the back end actually fielding through all of that.
I also wonder whether the human operator, given the appropriate script and resources, ends up turning a significant number of callers towards other forms of community support, right?
Absolutely.
At that particular point.
What is your understanding of the assessment process should this expansion go forward for people requesting MADE for mental health issues?
What are the stages?
How many people would be involved in looking at the particular case and advising on it?
How does that work?
There are two people who would be required to participate in an assessment.
So how you access that assessment, I think that can come from your primary care provider, you're calling that phone number, whatever it is.
But eventually, once you're kind of screened, it's confirmed that you are eligible from like an insurance or funding perspective.
So whether that's your Ontario health insurance or wherever it is in the country.
And that you're over the age of 18, you get to start this assessment process.
And so some of the things I have learned about include that the person or the people doing the assessment have to be either a medical practitioner or a nurse practitioner, so primary care providers.
And that at least one of those people have to have expertise or significant experience in the particular presenting problem.
So, in this case, we would imagine when we're talking about mental disorders that we're talking about a psychiatrist or a family doctor that works specifically in the realm, or sorry, a nurse practitioner as well, in the realm of mental illness and mental health.
And so, that's one of the things.
If neither of those primary care providers work or have experience with the presenting problem that the individual is showing up with, then they have to seek out consultation from folks who have that experience.
Now, that in and of itself, should anyone be making that decision if they are not experts in that field?
I don't think so, but we work with what we've got, I suppose.
In terms of the actual assessment process, from what I understand, there's no standardized protocol of questions that individuals are asking, but they are looking for a few different things.
One is incurability.
That means that there is no chance that This individual is going to be cured or alleviated of all of their symptoms.
Now, of course, one of the things we know with mental disorders is that we can't know that with any kind of certainty.
We can't know that there is some sort of magical intervention that's out there that this person may have not been able to access or may not have tried yet that would just get rid of all of their symptoms.
But what we do know is that's usually not the case.
Most folks who experience chronic and significant mental illnesses will probably live with some symptoms of that, but it might not impact them in the same way.
So the idea of curability is a little bit gray when it comes to this.
Does it have to apply to all symptoms?
From what I understood, that idea of curability means from meeting diagnostic criteria to not meeting diagnostic criteria.
So it's possible that the person could still be living with some of those symptoms, but it really depends on the assessor, which is what also makes it so difficult is that that assessment of curability or incurability is subjective.
There are no objective ways of knowing.
This is my next question.
With guidelines for assessing especially mental health issues of a severe and chronic nature being subjective, is an undue burden placed on the clinicians responsible as opposed to clinicians who would be able to speak to a cancer prognosis, for example, or another sort of physiological disease process with a foreseeable outcome?
Yeah, so I think perhaps one of the things that we often assume, I think, is that those calculations for physical illness are known or obvious.
We don't actually know, so when those kinds of prognoses are given, they're not given with a whole lot of certainty, and it would be the same for mental illness.
Now, we just know less about mental illnesses at this point, right?
So, at some point, we may have some data.
I don't know if anyone's doing that kind of research on prognostics, but I do think that there isn't enough data to understand prognosis for a lot of mental illnesses, other than to know things like the longer you've had your illness, the harder it's going to be to alleviate symptoms, the more episodes you've had, the more likelihood you're going to have more episodes, things like that.
But outside of that, there isn't a whole lot of information.
So to take an analogy, Clinical depression over time may be a contributing factor to a person's death by suicide, but unlike with cancer, where a pathology can be staged out in four stages, we don't really have a staging process for something like clinical depression.
Am I getting the idea?
Yeah, I think that that's accurate.
I haven't heard of anyone describing depression in stages.
We do have some information about the chronicity of it, right?
So someone who has had, for example, major depressive disorder from childhood that hasn't really been alleviated or hasn't been alleviated for longer periods of time.
They're going to have a poorer prognosis.
Someone whose major depression shows up regularly and without situational factors contributing to it, they're going to have a poorer prognosis.
But then we also know that there are so many social factors involved in that, right?
So folks who have lots of isolation, who don't have stable housing, who don't have access to food.
Who don't have access to mental health supports.
Those folks also have poor prognosis.
So, it's so complex, and to your point, there's way less that we know about, and therefore, we don't have as much certainty when we're talking about prognosis.
And maybe that is my question, too, about, like, does that mean that the role of the assessor is that much more grave, actually, in the mental health sphere?
Yeah, perhaps.
I do wonder around like the benchmark for things and how much a person's own narrative is allowed to contribute to that.
So if, for example, I'm applying to MAID with a mental illness, so maybe let's go back to the assessment process and then I'll try to tackle your question.
And if I go off on a tangent, Matthew, please bring me back.
Okay.
But they're looking to see if a person has tried interventions.
They're looking to see how long a person has been suffering with, what they have accessed, what has worked, what hasn't worked.
And obviously, if that person is coming for maid, nothing has worked at this point or nothing has worked as effectively as they wanted to.
If I'm a person applying for MAID with a mental illness, I think that my narrative around it is allowed to take up as much weight as it needs to.
If I say that I have tried everything and nothing has worked and I don't want to live this way anymore, there's no There's no reason for me to have to.
I think, I would hope that that assessor can really hear what's going on for a person.
And perhaps that is allowed to be enough.
Because if we're removing the subjectivity from that answer, then we are really giving all of that power to the assessor to make a decision about whether someone should have the power to live or to die.
So, what you're exposing actually is that, in my analogy, What I've done is I have actually taken out the subject's own story and I've replaced it.
The analogy of the four stages of cancer actually replaces the subject's story with a diagnostic protocol that they can be assessed with from the outside when actually they're sitting there in front of me saying, I've tried everything and I'm done.
So I think it's a little bit of both, right?
Because there may be folks who have, who are very late in their stages of cancer, who are having a hard time, who still want to live, and there will be people who don't.
And I think the same thing goes when we're talking about mental illness, right?
When we're talking about depression, there will be individuals who are really, really suffering and struggling.
I know I've seen clients who are having a very hard time with their lives.
And I can see it.
I can hear it.
And I think to myself, I don't know how things are going to get better for you, but they still have the will to live.
And so I think, I think we can talk about it from diagnostics, from prognosis, from symptoms, but then we can also talk about a person's lived experience with it and their will to live or to not.
Let's get into some ethical weeds.
I mean, we already are there, but let me start with just a nomenclature issue.
So, euthanasia is the practice of a doctor administering lethal drugs to a patient who is cleared for maid.
Now, this is legal in Belgium, in Colombia, in Luxembourg, Netherlands, New Zealand, and Spain, several states in Australia.
But assisted suicide is legal in more places around the world, and this would be the practice of the patient ingesting a lethal drug under their own power with healthcare preparation and supervision.
What is your ethical analysis about the difference between these two actions, if there is one?
Yeah, so the idea of the assisted suicide or assisted dying, in my mind, generally just feels a little bit better.
If euthanasia is the only option, right, so that's having a healthcare provider be the administrator of whatever medication is going to induce death.
That continues to take away the autonomy and the power of the individual.
For an individual to have choice of whether to have a primary care provider or a healthcare professional administer that or for them to do it themselves allows a person to decide how it is that they want to die.
I think the other thing is that It could potentially remove the clinical nature of it, right?
I imagine that if someone is undergoing euthanasia, they're probably at a hospital.
They're probably not in a comfortable place.
I don't know if that's accurate, but that's just how I imagine it to be.
Whereas if it's assisted suicide, there may be the opportunity for a person to be in their own home and to be able to actually pass in the environment and with the people that they want around.
It seems like the threshold between those two things is the place at which somebody has to step in and say, OK, I'm going to do that for you.
OK, as the representative of medicine, as the state, as your society, I'm going to actually make this happen.
And that seems like a very big step.
It does.
Now, some of the things that I think about are, is the person capable of doing it themselves?
And that's not only, you know, taking the medication or the drug, but it's also, are they able to take it appropriately or accurately?
And what are the consequences of them not doing that?
And is that going to put them in a worse situation than the one?
That they were already in.
And so I think there is a role for healthcare providers in all of that.
But as you've mentioned with assisted suicide, that's under the supervision of a healthcare provider.
Now, I don't know if that's directly being observed by that healthcare provider or being sent home with a bunch of pills or an injection of sorts. So I do think that there is
a role for the healthcare provider to make sure that if this is what the person wants, that it's
done correctly so that their end goal can be met. But yes, I do think that that role of
the healthcare provider stepping in and saying, well, if this is what you want, I have the
authority to do this, so let me do it for you.
Yes, and to be rigidly opposed to that might be actually an ableist position.
And this is the thing, right?
If someone doesn't have the capacity to do it for themselves, do we take that power and autonomy away from them?
I think when we are trying to do what is best for everyone, we are assuming what everyone's best is.
And we don't have the right to do that as much as our government and our policymakers.
They're in positions where they have to.
I think a bit of humility and understanding that no one knows what is best for everyone and so there should be options.
So here's the stat that I referenced before.
In 2021, 10,000 Canadians accessed euthanasia, and that accounted for 3.3% of total deaths.
And apparently, euthanasia is far more preferred as a method of aid than assisted suicide.
Now, the most common requested reason for the request was for incurable cancer.
But by 2021, This had only been legal for five years.
In 2016, the number was under 2,000.
Does that rapid increase just reflect accessibility, or is there something there that you find alarming?
I don't know that I feel alarmed, so let me start with that.
What I am less sure of in those stats is, are we talking about from the time someone initiates the process of Maid, or are we talking about to completed deaths?
Because I think that there's also an administration time, and so I don't know if many of those people were just waiting for years before being able to access.
The actual procedure.
So, I think that there's maybe some grey in that, but I do think that when MADE first became accessible to Canadians, there were a lot of people who felt quite conflicted, primary care providers as well as individuals.
And as the process has continued, I imagine that both from a primary care provider perspective As well as from a person living with struggles, who doesn't want to be alive anymore, that that person, having heard other people go through the MAID process, having understood the process, and for the stigma around it to be decreasing regularly, may feel more comfortable accessing that for themselves, or at least talking to their family members and deciding what their next steps are going to be.
Since MAID came into effect in 2016, it's been widely reported that Canada's laws are among the most liberal in the world.
There's a great report in Jacobin by Jeremy Appel who mentions that Belgium and the Netherlands require doctors to have exhausted all treatment alternatives before offering MAID.
Both countries also have monthly commissions to review potentially troubling cases.
Another issue is that doctors are in some places allowed to mention it as a treatment option before the patient does.
In the Australian province of Victoria, for example, doctors can't do that.
Now, how has it evolved that Canadian law around maid is so permissive to begin with?
How did we get to the sort of front of the pack here, do you think?
To be honest, I don't know, Matthew.
I do think that one of the things that can potentially get in the way is the way our healthcare system is structured, right?
So in some countries, when we talk about exhausting all options, we're also talking about all options being accessible.
Whereas in Canada, those options are not.
And so to make that a criteria would then just exclude a lot of people from being able to access Maid.
Some folks have been quite alarmed by the proposed expansion.
So I'm going to quote from Tim Stainton here, who's the director of the Canadian Institute for Inclusion and Citizenship at the University of British Columbia, and he described Canada's proposed expansion of made accessibility as, quote, probably the biggest existential threat to disabled people since the Nazis' program in Germany in the 1930s.
Do you think that that is a reasonable statement?
It's a bold one, you know, and I think this goes back to how we started this conversation, Matthew.
I think that people should have the autonomy to decide how they want to die and when they want to die.
The problem here, and I imagine this is what is being alluded to, is that Our healthcare system is not structured for people to be able to, well not even our healthcare system, our society in general, is not structured to allow people to live with dignity or to access the help that they need to be able to live with dignity.
And so if we're giving people the option to die with dignity without having given them the opportunity to live with dignity, then yeah, that is problematic.
It is seriously problematic because then we're giving people an out.
And yes, they have every right to want that out, but we're giving people an out for their suffering when we know that our society and our government has contributed to that suffering without taking the necessary steps to try to alleviate it.
Well, whether Stainton is overstating his case or not, a lot of commenters point to exactly what you're saying.
They claim that the Maid expansion actually proves the cruelty of the neoliberal state in which, you know, you're free to do as you please unless it involves asking for health or mental health care.
The allegation is that Canada is quite happy to encourage suffering or disabled people to die because it's cheaper than giving them the care that they need.
So, Jeremy Appel ties it to the neglectful orientation of governments towards COVID, writing, quote, I've come to realize that euthanasia in Canada represents the cynical endgame of social provisioning within the brutal logic of late-stage capitalism.
We'll starve you of the funding you need to live a dignified life, demand you pay back pandemic aid you applied for in good faith, and if you don't like it, well, why don't you just kill yourself?
What comes up when you hear that?
I should preface this by saying I'm generally an optimist and someone who likes to see the best in people.
So it's hard for me, and this is totally personal, but it is very hard for me to I don't think that this is government conspiracy.
I don't think that there is someone who is individually deciding that this is the easier way to eliminate people who may be a burden on our society.
Having said that, I am also very aware of how it doesn't take one person when everyone is thinking similarly.
And unfortunately, with the way that our governments often function, our focus on economy, our focus on trying to ignore those who are suffering and struggling the most, and most those who are unable to access those basic needs for survival, we are really talking about Exactly that, right?
We are talking about a lot of people who have been having a hard time and our government's response to that has been to be harsh and to ask more and to ask for them to pay back things, to create more barriers to accessing.
And in a time of hardship, That's not the response that our government ought to be making.
And yes, we can talk about that within the context of COVID, but when I think about programs like the Ontario Disability Support Program, which is, you know, a program for folks in Ontario who are looking for income due to their disability and they can't work otherwise, there are a lot of barriers.
People get rejected and it's kind of a commonly known thing that you will get rejected the first time you apply.
And just so that listeners know, the typical rates for ODSP, I believe, fall well below the median rental rates for apartments in markets like Toronto, but even smaller markets as well.
So really, when people can't work, And they're of working age and they don't qualify for Canada pension plan because they're not old enough and they have no means of support or income.
The only real benefit they will receive from the government will be less than the total amount that they have to spend on rent if they live in a particular city.
So just to make that clear for listeners.
Yeah, it's a brutal, brutal system.
Whether it's our government or the trickling down of government perspectives into society, but there is an assumption that there are more people who are taking advantage of a system than there are people who necessarily need it.
I think that there's the same kind of idea around food banks, right?
People who have access to food are still going to go and take all the food anyway.
People who can work are going to access ODSP.
But when we use examples like that, we're not talking about most people.
We're talking about outliers.
But when we are convinced that people who are Accessing social supports are taking advantage.
We're again continuing to marginalize and silence people's very lived experiences of not being able to survive in our society the way it is structured.
And then to give them the opportunity for M.A.I.D.
and to say, OK, now you can finally see a primary care provider, even though you haven't been able to access a primary care provider even for years.
But here, now let's give you two of them.
Now let's give you a diagnosis.
Now let's tell you about all of the things you could have done or should have done to alleviate this.
And then let's make a decision about what you get to do about it.
You know, I didn't even consider the possibility that access to made assessment might be faster than access to other forms of health care.
But is that actually happening?
Well, we know that there is a giant shortage of primary care providers across the country.
And so people are waiting years before they can access a primary care provider or they have one that they never get to see.
And so they have access to one without actually having access to one.
Now, I don't know what those wait times are to access a primary care provider through MAID, but I think they try to make the process quite efficient.
And so, yeah, that might that might indeed be the case.
Okay, so to put my tinfoil hat entirely to the side, it seems like the most generous kind of overall appraisal of what has happened in Canada would be that a very strongly altruistic medical movement that is committed to the autonomy of patient care has moved the main discussion forward during a time in which neoliberal policies have actually eroded the funding of healthcare in general.
And so what we have is this paradox where people's general access to proper care is declining, but now this window which actually has these very ethical and altruistic principles behind it is opening up and there's a mismatch there.
The optimist in me doesn't like that, Matthew.
But yeah, I think that what you're saying is not inaccurate.
Now, what the agenda is here, who is pushing what, I think these are things that remain unclear to me.
But what you are describing is accurate.
That is what we are seeing.
Yeah, I actually wanted to be clear that I was taking the tinfoil hat off and that actually that's a generous appraisal of what's happening.
It's that instead of thinking about people in Davos twiddling their mustaches and wondering about how they can get rid of disabled people, it's really about a kind of intersection between two different movements, one of like very high-minded considerations of progressive health care that include giving people this ultimate autonomy, you know, coming at a point in history when basically capitalism is saying, no, you really should be on your own.
And no, we really are going to reduce the social safety net because it's making you weak.
Okay, now Dr. Sonu Gend, who's the head of psychiatry at Humber College, put all of this into a fascinating intersectional perspective as he was speaking to the Special Joint Committee on MADE during the deliberation process last year, so we can have a listen to him.
I've come to realize our made expansion to non-dying disabled and those suffering from soul mental illness is a tale of two cities.
Two worlds, actually.
Evidence shows that when death is foreseeable, people seek MADE to preserve dignity and autonomy to avoid a painful death.
Those seeking MADE in these situations tend to be, in the researchers' words, white, more educated, and more privileged.
That's been used to suggest MADE is safe to expand to other situations.
However, when expanded to the non-dying disabled for mental illness, that association completely flips.
Then a different group gets made, the group of non-dying marginalized who have never had autonomy to live a life with dignity.
Rather than death with dignity, they're seeking an escape from life suffering, and they do overlap with those who are suicidal in the traditional sense.
Evidence shows this group is more marginalized, has unresolved psychosocial suffering like loneliness and isolation, and a terrifying gender gap emerges of twice as many women as men receiving death to avoid life suffering.
Introduced to help avoid painful deaths, MADE Expansion provides these marginalized non-dying people death to escape painful lives.
Worse, many of these people could have gotten better.
And he goes on.
There's one more bit here.
You know, I grew up hearing the story of the Komagata Maru, about those who were refused entry to Canada and sent back to India, some to their deaths.
As a child, it showed me that the same policy, the Continuous Passage Act, could ostensibly be the same for everyone, yet in actuality be racist towards some.
I view our current made expansion the same way.
That's the tale of two worlds.
Same law, different impacts on different groups.
It's a myth that expanded made is just about autonomy.
The planned expansion and sunset clause may increase privileged autonomy for some to die with dignity, but it will do so by sacrificing other marginalized Canadians to premature deaths for escaping painful lives that society failed to allow them to live with dignity.
That's not my Canada and it should not be yours.
What's your perspective on this argument, Teslim?
Yeah, I think that Dr. Gane makes really good points and I agree with them, right?
And this is why I preface this by saying that I believe in the autonomy of the person, but not under these circumstances, right?
The way that our society and our healthcare system is structured, we are Increasingly excluding people, we are stopping them from being able to access healthcare, and then we're giving them the option of MAID.
And it is, it is going to continue to target those who experience marginalization, who experience poverty, and who don't have access to social supports.
Or, I mean, even who do have access to social supports, because as we've talked about, those social supports continue to be inadequate.
Now, I know that you're an optimist, and I'm not sure how deeply you want to get into the politics here, but I do want us to listen to what Pierre Poilievre, the leader of the conservative opposition, is making of all of this.
We're going to hear him now in the House of Commons question period.
Followed by a response from Dr. Carolyn Bennett, who's the Minister for Mental Health and Addictions.
And I want to listen to this in the context of how media and political communications around these issues is falling out.
After eight years of growing poverty and desperation, more and more Canadians are suffering with depression.
Some of them are going to food banks asking for help ending their lives, not because they're sick, but because life has become so miserable and they want to end their lives altogether.
This government has suggested veterans should end their lives instead of getting help that they need.
And now they've announced that a year from today, they will introduce measures to end the lives of people who
are depressed.
Will they recognize that we need to treat depression and give people hope for a better life
rather than ending their lives?
The Honourable Minister for Mental Health.
Mr. Speaker, I think it is totally irresponsible for the Leader of the Opposition to misrepresent what this means.
All of the assessors and providers for MAID are purposely trained to eliminate people that are suicidal.
And so this is for We'll get to the crossed wires there in a moment, but what comes up for you when you hear this very, very complex issue politicized?
When someone presents with suicidality, this is something that I see regularly in my practice and for folks who are working in the mental health field, this is something that we often see.
Not all people who experience suicidality want to die.
Most people who experience suicidality do not want to die.
Most people who are experiencing poverty and marginalization do not want to die.
And most people who are experiencing mental illness and poverty and marginalization do not want to die.
So this idea that we're trying to, or our government is just trying to eradicate or eliminate the folks who are experiencing poverty and marginalization through the MADE process, I don't know if that's accurate.
However, going back to Dr. Gaines' perspective on that, it's definitely not doing a good job, right?
We are introducing this policy at a time where we are seeing a lot of human suffering.
And so, is the timing problematic?
Yes.
Is the system problematic?
Absolutely.
However, does that mean we get rid of it altogether?
I don't think so.
I think we just need to do a better job at setting people up for success and strengthening our social support so that people are not accessing Maid because of the human suffering due to social circumstances.
And I do think anybody who's involved in the communications of this at any level has really got to be careful with their words.
I mean, what Minister Bennett intended to say was that maid assessors are trained to screen people who are suicidal for eligibility for maid, and that some of them would be excluded based on eligibility criteria.
Now, of course, her poor word choice is now rocketing around the conspiracy sphere,
as though she meant that maid assessors are aiming to eliminate suicidal people.
Now, public communications are more of a shitshow every day.
Theslam, if you had to step into that role, if you were forced to, how would you approach it?
Yeah, you know, that realm of communication where everything just needs to be so, every word needs to count.
And that puts a lot of pressure on someone, especially with all of the booing and cheering going on in the background.
But I think that word choice is so important.
And so, as you've mentioned, Matthew, I think what Mr. Bennett was trying to say is that The intention of MADE is not to put people in worse circumstances than they are, but rather there is a screening process to ensure that people are not making these decisions solely based on their social circumstances and solely based on their suicidality.
However, I think that there was an opportunity for Minister Bennett to also bring up some of the recommendations that were made from the expert panel on MAID as it relates to mental disorders.
And one of them was specifically around access to social supports.
And so this expert panel did mention that if this is to move forward, we We have to make sure that people have access to the social supports they need in order to live a dignified life before a decision can be made around Maid.
Now, what this looks like in real life, who knows?
Housing doesn't magically show up.
Food and income don't magically show up.
And if they were going to show up, ideally that would show up before a person got to the point of suffering and hopelessness that led them to want Maid in the first place.
But that is one of the recommendations and the optimist in me would like to think that that means that if someone is living in poverty, that they will be magically granted their housing and some sort of economic stability.
But we also know that the chances of that happening in a meaningful way are probably really low.
You say that there was an opportunity for Minister Bennett to list some more points, but of course that would mean probably not also being a senior doctor with 40 years of experience in policy and in healthcare provision, who's now 72 and dealing with The steel cage match of contemporary politics.
I mean, it's this really, it's a situation in which expertise and the ability to, you know, trade punches is not matched.
There's like a category error there, and it's just so frustrating to watch.
It is, and not to go off on a tangent, Matthew, but I think that that speaks to how we really need to change the way our politics are conducted in Canada, right?
We're valuing the most powerful voice as opposed to the most informed voice, and that is problematic.
And when you hear cheering and booing when people are sharing their perspectives, that that's not respectful.
And so I think that there is some room for modification there.
And that maybe also reflects the way our government is making policy decisions at a greater level.
So I'd like to finish up with maybe some of the toughest questions if this hasn't been hard enough already.
We've said that sitting with patients who suffer suicidal ideation and chronic depression is part of your regular job.
If the maid door opens for your patients, I am trying to imagine myself in your position.
I can imagine getting the training that it would take to hold space for a suicidal client, but I think my imagination is limited by this basic assumption that ending one's life at the age of 20 or 30 or 40 would be a choice to gently discourage.
You've spoken a little bit about this already.
But I am struggling with this assumption that I have that I think I believe that the care of a therapist or a friend or just experiencing the simple pleasures of life should be able to turn things around.
But behind that assumption, I think, is another assumption that society and the government would generally stand behind me in feeling that way and taking that same position of encouragement.
Are those assumptions ableist, and do they compromise the freedom and the agency of the person?
I think when we're talking about grave human suffering, that love or compassion or moments of connection with someone, are enough for some and are definitely not enough for others.
When you are waking up every single day wishing you didn't have to or wishing you were dead and just waiting for, you know, the universe to take control over the situation, having a moment of connection is probably not the thing that's going to turn things around.
And I think this is where we sometimes get into a bit of an ableist trap, right?
Is that we don't necessarily have the nuanced understanding of what it means to suffer with a mental illness and to have chronic hopelessness.
And when you are an individual that has tried as many things as you know how to try, when you've spoken to the people who are supposed to have answers and they continue not to, even though you may feel loved and accepted by those around you, That doesn't get rid of your suffering.
It may make it more tolerable, but for how long should someone have to be able to tolerate life just because they can't access death?
And so, I do think that it is an ableist way at looking at the situation.
Having said that, I also want to say that When I think about the clients that I work with, and as I mentioned, many of them experience suicidality, many of them live in poverty and marginalization, I can't imagine that I would be having a maid conversation with any of them.
I think that the people who are accessing maid or who are going to be accessing maid due to their mental illness, we're talking about a very small proportion of people.
And so I imagine I will have conversations with clients who are curious, who want to understand it more, But at least from what I know about the people that I work with and the people I know, my team members who are working with folks, this kind of human suffering is not the same kind of human suffering that leads people to want to end their lives.
They think about it a lot.
But for many folks, Their thoughts about it, their hopelessness around it, if they wanted to die by suicide, they would.
And it is not my job to stop them.
I mean, it is my job if they are sharing with me that they are at acute risk and then I have to take certain measures.
But at the end of the day, people get to decide what they're going to do with their life.
MADE provides them an opportunity to do that in a dignified way.
But at the end of the day, most people who are coming to me are coming to me because there is still a part of them that has hope, that wants to continue to live, and that does believe that things are going to get better.
Listening to you, I'm realizing that one of the more painful assumptions behind the scenario that I just laid out is that I think it reveals my belief that if I could express love and care for a person, that if I personally could do that, that that would be enough.
And that somehow, if it wasn't enough, that that would reflect poorly upon me.
That if I was able to offer love and care to a person and they still wanted to leave in a way, that I would somehow be abandoned.
And I think that's why I'm not a psychotherapist, right?
Because isn't that a big part of your training is you have to recognize what you're doing when you have those feelings.
Yeah, you know, I don't know that I would call it a part of my training, but I think it's part of what makes an effective therapist.
And I don't think we have these conversations enough.
I think my training teaches me that I should have the capacity and the skills to help everybody.
And what I have learned through my actual experiences as a psychologist is that I don't have the skills to help everyone.
Some people have treatment-resistant depression.
Some people are going to be living with their mental illness for the rest of their lives.
And do I have the skills to perhaps make their suffering decrease?
Sure.
Is that enough to make someone want to live?
That's not mine to say.
And so I think for so many of us, we carry this weight of wanting to make people feel better.
And for our loved ones who we see suffering, we take that personal responsibility.
But in doing that, I think we're mistakenly continuing to make it about us and our power when it's really about the individual in front of us and their suffering.
And if we try our best to throw our love and our care at them, we're making it about us.
We're making it about our goal for them rather than what they really need in that moment.
Lastly, do you have any personal beliefs, you know, be they psychological, moral, or even spiritual, that either help you or hinder you as you consider these things?
Perhaps a story.
When I first started grad school, I was taking my very first ethics class, and I should have known better than to speak so early on when people didn't know me, but we were talking about the responsibility that healthcare providers have to report when someone is at risk of seriously harming themselves.
And I remember asking my professor, but shouldn't people just be allowed to do what they want with their lives and their bodies?
And her answer has stayed with me, and that is that yes, people are allowed to do what they want with their lives and their bodies.
But when we're talking about mental illness, we're also talking about a known distortion in the reality of things.
And that's what mental illness does.
It distorts the way we see our reality.
Now, that doesn't mean that the reality is significantly different from how the person is seeing it, but as a healthcare provider, I have a responsibility to make sure that a person is making a sound decision and when they are coming with me, When they are coming to me and they are not seeing the world accurately, then it is my job to do my best to help them see the world more accurately.
To not have them miss seeing things, jumping to conclusions, living in fear or anxiety all of the time.
And I think this is the role of the therapist.
It's not to stop people from dying, but to help people Accurately assess whether they want to live or to die and mental illness can get in the way of that.
And so I keep that with me all of the time so that I let go of that personal responsibility that I used to walk around with around keeping people alive and instead I make it my job or my intention to help people see the world as accurately as possible so that they have the autonomy to choose in an informed way.
Dr. Theslin, thank you so much for diving into this very difficult topic with us here on Conspirituality Podcast.
Thank you for having me, Matthew.
Thank you so much for joining us on Conspirituality.
