Ruthless practicality

Living with a terminal husband has me thinking about the mystery of death. Armchair philosophers often say that death is simply part of life: becoming one with the universe, committing your matter to next year’s wildflowers and your luminous being to some eternal consciousness.

Or, alternatively, you rot.

How grateful I am to cling to something better than fuzzy eschatology or cold materialism! Still … this person I’ve traveled beside for 55 years, who has plowed deep furrows in time, co-created and nurtured other lives, influenced real events, and moved large objects (literally, as a railroad transportation consultant), will soon cease to be. Death is a profound contradiction, even as our earth testifies to it with centuries of buried bones. What does it take for an entire culture to embrace it voluntarily?

A very long article in The Atlantic raises that question with a stark title: “Canada Is Killing Itself.” Staff writer Eliana Plott Calabro begins with a jaw-dropping statistic: Canada’s Medical Assistance in Dying (MAiD) Act, passed in 2016, now facilitates 5% of all deaths. That’s “about one in 20 … surpassing countries where assisted dying has been legal for far longer.” Calabro attended a conference of MAiD providers, interviewed physicians and patients, and surveyed test cases to create a picture of a nation preoccupied with do-it-yourself death.

Patients plan “weekend house parties before a Sunday-night euthanasia in the garden; a Catholic priest to deliver last rites; extended-family renditions of ‘Auld Lang Syne’ at the bedside.” Children may be prepared for a family member’s demise by “a pajama party at a funeral home [or] painting a coffin in a schoolyard.” Physicians recall their mixed feelings when first performing a procedure that’s now routine, while some still wonder if it should ever become routine.

The guidelines that supposedly hedged the original law have stretched to include an ill-defined “Track 2” protocol. Since March 2021, applicants do not have to be terminal but can choose death after “serious consideration” that their lives are not worth living. Beginning in March 2027, mental illness will be considered a legitimate condition for euthanasia (although, in practical fact, it already is). Meanwhile, the Quebec College of Physicians has proposed euthanizing infants born with “severe malformations,” and a Special Joint Committee in Parliament has recommended offering MAiD to “mature minors” with serious medical conditions. Quebec has already legalized advanced directives from Alzheimer’s patients or others facing progressive dementia who would rather die than decline past a given point.

MAiD applicants often dread becoming a burden on loved ones. But what lurks beneath the surface is the burden on the state. Calabro cites the case of Sathya Kovac as a chilling reminder of where state-sanctioned death often leads. Kovac would have chosen to live longer if there were any way to stretch the 55 hours of home care support per week covered by her province. In her obituary she wrote, “Ultimately it was not [ALS] that took me out, it was a system.” Calabro spoke with Marcia Doherty, who has suffered most of her life from chronic illnesses and can no longer afford the cost of pain management. MAiD is not a benefit for her; it’s a “ruthless practicality.”

MAiD was sold to the public on the principle of autonomy. For example, a man in his 30s, diagnosed with treatable cancer, insisted on MAiD because he didn’t want to endure any pain or discomfort. Given the ambivalent Track 2 guidelines, how could he be refused? As one physician put it, “Once you accept that people ought to have autonomy—once you accept that life isn’t sacred and something that can only be taken by God, a being I don’t believe in—then, if you’re in that work, some of us have to go forward and say, ‘We’ll do it.’”

Whether through physical pain or emotional torment, life can seem unbearable. But once you accept that life isn’t sacred, it becomes almost weightless. George MacDonald wrote that the first principle of hell is, I am my own—the shrinking center of one’s existence. But autonomy as a guiding principle won’t last long because societies can’t be built on individual preference. If no other moral framework emerges, raw power is the default. Death becomes a ruthless practicality, not a dilemma solved by the living God. And the end is hellish, or even hell itself.