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Episode 2: A Well-Founded Fear

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WORLD Radio - Episode 2: A Well-Founded Fear

Why would a physician, born and raised in Canada, flee his own country?


SOUND: TRUCK INTERIOR AND BLINKER

JASON BAILEY: My kids like coming to this downtown area because they just like to hang out at the coffee shop, meet a friend …

LES SILLARS, HOST: Ranya Bailey and her husband Jason were sitting in my truck parked in downtown Lancaster, Pennsylvania, last January. They’d been showing me around their new city.

LES: Do you think of yourselves as refugees?

RANYA BAILEY: In some ways, I mean, I think, on principle, yes.

Jason was reluctant to go that far.

JASON: Yeah, I wouldn't want to put myself in that category, because refugees have so many more hardships, you know? How can a middle-class physician say he's a refugee?

Jason and Ranya certainly aren’t typical refugees. They’re Canadians, for one thing. As a Canadian myself living in the U.S., I found it surreal even raising the question. According to the Migration Policy Institute about one million refugees have arrived in the U.S. in the last twenty years. Exactly one was a Canadian.

Under UN guidelines, refugees must have a, quote, “well-founded fear of persecution.” I can’t imagine coming down from Alberta and telling the American border officer, “I have a well-founded fear of persecution.”

He'd look at me like I was crazy. Canada is a wonderful place. And the Baileys had a very nice life. They left behind a beautiful nineteenth century home in Cambridge, Ontario. A good church. Good friends. They both graduated from medical school at Dalhousie University in Nova Scotia. Jason had a nice position at a hospital in Guelph. Ranya stopped practicing when they started having kids in 1998.

But in November of 2021—just before Thanksgiving—they packed up and headed south.

LES: So now where are we going?

JASON: Uh, let’s head toward the church …

And now they were giving me a tour. Lancaster is a charming old city. Jason has a job he loves at a “direct primary care” practice. They have a lovely home with a pool on a wooded, one-acre hillside lot. They have a great new church, a PCA congregation only a few minutes’ drive away. Their kids are settling in.

RANYA: We mentioned the grocery store yesterday? We have a cute one, but honestly we use Instacart a lot, so [laughter]

They would be embarrassed if someone compared their situation to, say, an Afghan family fleeing the Taliban. Settling in the U.S. with nothing but their clothes.

But the Baileys would say their fears about Canada are well-founded.

RANYA: I’m excited. But I’m also grieved. I mean, there’s a sense in which you feel like your country has let you down … and … Jason's been thinking this way for a long time, as things continue to change here, the things that he was seeing coming came, and there's just no thinking that's just being pessimistic. That won't really happen. It has happened.

The Baileys might be among the first to leave Canada because they feel threatened. They won’t be the last.

Today, the story of a family that had to decide if and when the dangers of staying home outweighed the risks of leaving. Their story unfolded over three decades in a country and a culture that’s a lot like the U.S. in many ways.

In fact, many people would say that their story is already playing out in this country.

I’m Les Sillars. This is Doubletake.

SEGMENT 2: MEETING IN MEDICAL SCHOOL

Jason Bailey just looks like a family doctor. Average height. Cheerful. Still jogs five miles a day. He grew up in a small Nova Scotia town. His parents took him to a mainline church until he was about 13. Then they stopped going and so did he.

After high school he went to St. Francis Xavier University, where he played for the soccer team. A friend in his biology program introduced him to the Intervarsity Fellowship group. They talked a lot of theology, and how it applied to life.

JASON: It was a small Intervaristy group, but they became my circle, even though I wasn't a believer, they were just bringing me along ...

In 1992 he headed off to medical school at Dalhousie in Halifax. He still wasn't a Christian, but his college friend introduced him to another believer who was already in Dalhousie’s medical program.

Jason also met Ranya, another med student. She was born in Montreal and grew up on Canada’s east coast. Her parents, both marine biologists, had immigrated from Egypt. Ranya has their dark hair and eyes. Olive skin. She thought she might go back to Egypt to practice.

RANYA: … going into like, Doctors Without Borders type of work, or some sort of work, to go to areas in the world where there wasn't so much prosperity and ease and see if I could equalize it a little bit.

They dated for about nine months, then got married in June of 1993. The following December Jason put his faith in Christ. Ranya became a believer in March of 1994.

JASON: Things were fairly fast. Marriage in nine months, became a Christian ... Ranya becomes a Christian three months after me.

SEGMENT 3: FORESHADOW OF DEATH

CTV ANNOUNCER: Another of the day’s big stories from Ottawa just a few minutes ago …

Right about then, in February of 1994, the issue of euthanasia burst onto the scene in Canada.

CTV ANNOUNCER: … An NDP Member of Parliament confirming he witnessed the doctor-assisted suicide of Sue Rodriguez. Sven Robinson appeared close to tears as he described her suicide Saturday night. Robinson: I held her in my arms …

Rodriguez was a 40-something mom and activist in Vancouver suffering from Lou Gehrig’s disease. She wanted a doctor’s help to take her own life, but at the time it was illegal in Canada.

ROBINSON: She peacefully lapsed into unconsciousness, and stopped breathing about two hours later.

Jason and Ranya knew euthanasia was an important ethical issue for doctors, but they were too busy with medical school to pay much attention. Not even when the second big case came in the fall of 1994. Saskatchewan farmer Robert Latimer went on trial for the second-degree murder of his own 12-year-old daughter, Tracy. From Global News Canada.

GLOBAL NEWS ANNOUNCER: His is one of the most polarizing cases in Canadian legal history, at the time raising the question, was Robert Latimer a compassionate father or a calculated murderer ...

Tracy had cerebral palsy and the mind of a three-year-old. She endured pain, frequent seizures, and required constant care. One day, when his wife and three other children were out…

… In 1993 the father placed his severely disabled daughter Tracy in the cab of a truck and filled it with exhaust, ending the 12-year-old’s life.

News reports typically described Tracy as being unable to walk, talk, or feed herself. Latimer claimed that Tracy was in constant, severe pain. Some observers disputed that. She had pain, but it wasn’t constant. She also went to school, liked campfires, and laughed at windshield wipers. Her doctor described her as, quote, “a fighter, a survivor.”

Latimer was convicted. He received the minimum life sentence with the possibility of parole after 10 years. But the verdict outraged Canadians. Various polls found the vast majority wanted Latimer to be acquitted or treated leniently.

HEIDI JANZ: I recall the Latimer case very well because for me, it was life changing.

The first voice is Dr. Heidi Janz. She has cerebral palsy. Just like Tracy. The second voice is her aide.

Janz is with the Council of Canadians with Disabilities. In 1994 Janz had just graduated from the University of Alberta in Edmonton. About then she saw a magazine cover with this question:

JANZ: “When is it right to kill somebody with a disability.” Not even, is it right? But, when is it right? All of a sudden I understood that the majority of Canadian society wouldn't consider me much different than Tracy Latimer.

Janz says that when she was little she cried a lot and was hard to take care of. After the Latimer case, she asked her mom if they ever considered gassing her to death, like Latimer’s daughter. Her mom told her ...

JANZ: “Oh no, no as Christians we believe that God gave you to us and that you're valuable.” And then in a very pragmatic German way she added, “Besides, we didn't have a car.” [laughter]

Her mom was apparently something of a kidder.

Janz says the Latimer trial revealed Canadian society’s deep disdain for the lives of disabled people. An openness to euthanasia. She calls it a form of discrimination: “ableism.”

JANZ: Instead of being behind closed doors, it opened the door and became a talking point for almost everybody.

As Latimer went to trial, euthanasia was boiling over in the U.S. That same year, 1994, Oregon voters approved by referendum the country’s first physician-assisted suicide legislation. The law was enacted in 1997. The campaign for so-called “death with dignity” got a big push from “Dr. Death.”

ANNOUNCER: Dr. Jack Kevorkian, who has acknowledged helping more than 130 people kill themselves, tonight reveals that two months ago he killed one of his patients himself, and recorded it on videotape. ...

This segment of 60 Minutes aired in 1998. The video shows him injecting a fatal substance into Thomas Youk, who had Lou Gehrig’s disease.

KEVORKIAN: Now there’s a straight line.

ANNOUNCER: He’s dead. Kevorkian: Yes. The heart is stopped. ...

Kevorkian was convicted of murder later in 1998, released in 2007, and died in 2011.

But doctor-assisted suicide has continued to gain ground in the U.S. Following Oregon’s lead, 10 states and the District of Columbia have now legalized physician-assisted suicide. Worldwide, in the last few decades about 20 countries—mostly in Europe, plus China—have legalized doctor-assisted suicide or euthanasia.

Robert Latimer has been in and out of the news. He was released on parole in 2010 and still denies he did anything wrong.

As the Rodriguez and Latimer and Kevorkian cases unfolded, Jason and Ranya continued with medical school at Dalhousie. For them, euthanasia wasn’t really a question. They were Christians. They knew that human life is sacred, a gift. God, not Man, decides when to end a life. And they were studying to be doctors. They were supposed to save life, not end it. It seemed pretty straightforward to them.

But an incident that year at the medical school hospital raised some questions.

RANYA: ... an internist panicked one day and gave a lethal injection of potassium chloride to a patient who was suffering.

Reaction at the hospital was mixed. The administration said publicly this was terrible. But behind the scenes, many doctors were saying something else.

JASON: And there were a lot of side conversations ... which surprised me as a naive medical student, which, we're, this, this is fine. This should be okay. In fact, this should sort of be celebrated. ...

…And I started to realize, oh, okay, there's a lot of medical politics and there’s a lot of opinions I’m not aware of.

It never occurred to Jason that ...

JASON: ... this is going to affect me somewhere down the line. I don’t know that I consciously thought that way. Maybe I should have, but I didn't.

SEGMENT 4: DO OR LOSE YOUR LICENSE

They graduated as family doctors in 1998, but Ranya decided to leave medicine when their first child came along. Jason practiced for a year in the tiny Nova Scotia town of Parrsboro. Since dissolved. Then they moved to Moncton, New Brunswick.

JASON: I think that's where we really started to figure out the ethical things that were challenging in general practice.

For example, in Canada, family doctors are gatekeepers. Patients can’t see a specialist without a referral from their family physician. Doctors who refuse to refer a patient for a necessary medical procedure risk a fine or maybe worse from the provincial college of physicians.

Not long after coming to Moncton, a patient walked into Jason’s office and asked for a referral for an abortion. In New Brunswick, two physicians had to sign off on every abortion.

JASON: I was just thinking, I can't do this. And so I asked the person if they wanted to hear what I had to say or what the pro-life position was, and also hear them out and what their struggles were and why they were choosing this. The person, I recall, listened, but I said I really can't sign off on this or be involved. And they said, okay.

For a long time he worried that he might get in trouble. But nothing ever came of it.

Jason thought he could have lived with just sending women to a gynecologist for an unspecified reason. But a medical referral is an endorsement. You’re saying, in your professional, medical judgment, this procedure is in the patient’s best interest.

JASON: ... you actually then had to sign on a document that would go into the permanent medical record. So that's just a forever, I remember that really bothering me ...

He never did sign off on an abortion. Patients wanting one would go to a walk-in clinic or maybe get a chemical abortion, a.k.a. “emergency contraception.” Those didn’t need referrals. But Jason had the abortion conversation several times.

They always left him uneasy.

After Moncton they spent a year in Dartmouth, Nova Scotia, where Jason joined a hospital staff. He took that job in large part because abortion wasn’t likely to come up on the wards.

Ranya, meanwhile, was struggling with whether to return to medicine. But their third child was coming. And she’d seen Jason’s ethical struggles. They used to daydream about setting up their own family practice. Set their own terms. Ask their patients to acknowledge that they didn’t refer for abortions, for example, before signing up.

RANYA: We tried to float that idea by some sort of older and wiser people and they just said, that's not gonna fly, like, that's not going to protect you.

Here’s the problem. In Canada the system was, and still is, struggling to meet demand. Because of the gatekeeper model, patients can't just go down the street to another doctor. They might have to wait months for an appointment.

That’s why Canada’s socialized medical system polices access to medical services so strictly. Provincial colleges of physicians can issue fines, reprimands, and in extreme cases suspend or revoke medical licenses for doctors who refuse to perform necessary services. Patients often can’t get them otherwise.

Jason is a principled guy but he is not at all confrontational. He says he doesn’t want to force his opinions on people.

JASON: I think that's generally the story of many Christian physicians in Canada. We’re not confrontational people, we don't want to obstruct people from what is a freedom and a legal right these folks have. We just want to remove ourselves from the process.

They just want to have their say, not proselytize.

JASON: Surprisingly, people are pretty open to talking about it. And most patients don't feel threatened about it.

So, Jason was stuck. He loved family practice, but to continue risked seeing more abortion-minded patients. The Baileys were paying off student loans for two medical school educations. They couldn’t afford to put Jason’s income at risk. But neither would they compromise a deeply-held pro-life conviction.

They tried to explain the problem to other believers.

JASON: And they're like, oh, wow, I never knew the medical system worked like that or, I never knew a person just couldn’t go down the street and find another doctor, and I thought, You live in Canada? How do you not know that? I mean, there is a doctor shortage perpetually, nobody gets to choose ...

A patient denied a service could easily get upset—and file a complaint with the authorities.

JASON: And the person would be like, Do you understand, like, how hard that is? I can't go find another family doctor. It'll take years to get on a waiting list. I need to get into the specialist now to get this taken care of. And you're blocking me and bothering me. You know how long it is I waited to even see you. It's been like a month to get into your office. And now you're giving me this terrible news.

And you think you're not going to get a college complaint? This is like a setup. And I just remember thinking, I need to get out of this ...

MUSIC: Impending Boom Kevin Macleod

LES: Do you think a lot of Christian doctors feel this way?

RANYA: I would say we felt like we were in the minority. At the time, I, I feel that, I remember that a lot of the Christian doctors that we talked to had chosen not to let it be an issue. They would refer, they would write the prescriptions. They would say it’s the patient’s choice.

Many Christian doctors still say, in essence, abortion is the patient’s choice and responsibility. They just make the referrals. Keep their heads down. And hope to have a chance to serve the patient and maybe even share Christ at some later time.

But Jason thought, if he started referring for abortions, what else would he refer for in five or ten years? Where would he draw the line? And evangelism in the doctor’s office seemed unlikely.

JASON: You have 10 minutes with the patient a few times a year, to do some simple medical problems. You're not sitting down and spending hours poring over the Gospel. And maybe even that’s not even appropriate …

After a year in Dartmouth, they moved in 2001 from Nova Scotia to Cambridge, Ontario, to take a job working with acutely ill hospital patients. It paid well. Predictable hours.

JASON: It was great job. I loved working there ...

That’s where the Baileys settled in for the next decade. They bought a small house. Found a good church. Their last two children arrived. And then they moved to another, larger and much, much older house in the country.

And then, in 2011, Jason switched roles. He moved to the hospital’s rehabilitation wing, where he spent half his time. The other half he was doing palliative care in the community, often in people’s homes.

Palliative care is about pain relief rather than curing disease. It’s typically for patients with a terminal illness. The point is to help people face death gracefully. With dignity. To face it without trying to control it. He really enjoyed that work.

RANYA: Jason, honestly, when he started palliative care, he said, I'm looking forward to doing this. It's not gonna last long.

He was right.

SEGMENT 5: ASSISTED SUICIDE ARRIVES IN CANADA

BRITTANY MAYNARD: So if November second comes along and I’ve passed, I hope my family is still proud of me and the choices I’ve made.

A pro-euthanasia group released this compelling, tearful, and professionally-produced video of Brittnay Maynard in late October, 2014. Maynard had been diagnosed with brain cancer the previous April and given six months to live. She was 29. So she moved from California to Oregon to take advantage of that state’s doctor-assisted suicide law. She killed herself three days after making this video.

MAYNARD: The worst thing that could happen to me is that I wait too long because I’m trying to seize each day but that I somehow have my autonomy taken away from me because of my disease, because of the nature of my cancer ...

Maynard got an enormous amount of media coverage. Her message: suffering takes away her dignity and gives her the right to end her life.

That argument was also resonating in Canada. The Latimer case had prepared the ground 20 years earlier. A few months after Maynard’s death, in 2015, Canada’s Supreme Court struck down the law against assisted suicide as unconstitutional. Grace Pastine of the B.C. Civil Liberties Association said this at a press conference about Carter v. Canada.

PASTINE: What this decision means is that Canadians who are suffering unbearably at the end of life will have a choice now, the choice to seek the assistance of a physician if their suffering becomes unbearable.

Pro-life doctors say that is a gross misrepresentation.

Pain medications and methods are so effective that rarely does anyone die in severe pain. But the Canadian parliament legalized physician-assisted suicide anyway, in 2016. The euphemism is Medical Assistance in Dying. Cap M. Cap A. Small I. Cap D. MAiD. It sounds like palliative care. It’s not.

SEGMENT 6: ASKED FOR MAID

After assisted suicide was legalized, Jason knew that some of his palliative care patients would start asking for MAiD.

JASON: You could, you'd hear that right away walking into the first patient encounter, ‘I think I need to end my life.’ And that was quite staggering. ...

The law had some “safeguards.” The patient had to have a grievous and untreatable illness causing “unbearable” suffering. Death had to be likely in the “reasonably foreseeable” future, often interpreted as six months or so. There was a 10-day waiting period. The patient had to be mentally competent and sign a written order in front of two witnesses.

Jason says many patients who asked for MAiD were ambivalent. Once he started talking to people, working through the pain and symptoms, they’d back off their initial request. Or Jason would realize they didn’t qualify for MAiD because their pain wasn’t “unbearable” nor their death “foreseeable.”

JASON: And you know, the spouse would sometimes say often, I don't, I know he's calling out for help, can you please do something to help with his pain and symptoms and overall care, we don't want him to take his own life or to go down that road, even though we're not against it, it might be fine for other people. But now when it's in our family, this is going to be an existential challenge for us. We don't want to live with this history. I heard many people say things like that.

But for those who wanted to die, it wasn’t hard to get around the safeguards. One Canadian doctor who works with a lot of elderly patients spoke to me at length about this. Like a lot pro-life doctors in Canada, he was really, really skittish about being identified. He was worried about a backlash from colleagues. He asked I not say which province he works in or use his name or voice. We’ll call him Dr. Jones.

Dr. Jones says it appeared that a MAiD assessor approved one of his elderly patients for MAiD mainly because he was frail. Dr. Jones said, “He had a limited life expectancy but he wasn’t truly dying.” 

But the patient wanted to die because, basically, he could no longer go to the bathroom on his own. So the physician who assessed him for MAiD fudged the diagnoses a bit and found a way to qualify the man.

In another case, an elderly woman showed up at Dr. Jones’ facility diagnosed with a difficult form of dementia and approval for MAiD. It was still early and her symptoms were mild: she got confused sometimes. But she knew what was coming, and wanted to die before things got worse.

Dr. Jones told me that the physician approved her for MAiD because the patient, quote, “didn’t want to go to long-term care. That was one of the reasons. She was actually in very good physical health.” Unquote.

The politicians and the health bureaucrats had assured the public that MAiD would be used sparingly, Jason Bailey recalls.

JASON: And it was, ‘Well we won’t get that many cases,’ but it quickly took off.

And it took off far more quickly in Canada than it has in the U.S. According to the latest Health Canada report, between 2016 and 2020 the number of doctor-assisted suicides shot up from just over one thousand per year to over 7,500 per year. More than 21,000 deaths in total.

Compare that to California’s End of Life law. Its population of 39 million is comparable to Canada’s 38 million. Yet in those same five years doctors facilitated the suicides of about 1,800 Californians.

So: 21,000 in Canada; 1,800 in California. Twelve times as many Canadians as Californians chose doctor-assisted death over the same period.

Larry Worthen says that’s the difference between euthanasia and physician-assisted suicide. He’s executive director of the Christian Medical and Dental Society of Canada.

WORTHEN: And it seems those numbers are much higher than in the United States where it requires them to actually drink the cocktail that's going to end their lives.

He points out that in the U.S., the person ending his own life has to be conscious and take the drug themselves. In Canada, doctors usually drug the person into unconsciousness then deliver the lethal dose via injection. It’s just like going under for an operation. Only you never wake up.

WORTHEN: It seems that people don't want to take responsibility for ending their lives, and they just would prefer that the physician be the one taking the responsibility so that the person is just sedated. And that's the last thing they remember.

Worthen says that Canadians’ willingness to end their own lives speaks to a pervasive nihilism in the culture. And a refusal to accept that some things, like death, they just can’t control. That they shouldn’t control it.

WORTHEN: ... it kind of shows that there's a there's a price to be paid when we take God out of a society.

He says all this has a corrosive effect on doctors. On a medical system that can’t decide whether it wants to save life or end it. And on the culture itself.

WORTHEN: People are terrified to speak up against this. So the vast majority, even of doctors, have very serious ethical qualms about this. But rather than go public, and criticize legalization of it, everyone just lets it go.

What’s more, Worthen predicts MAiD is going to become even more common. In 2019 a Quebec superior court ruled that the MAiD law discriminates against people with disabilities. The court added that they have a right to be euthanized even though their deaths might not be reasonably foreseeable. The federal government declined to appeal, and in March of 2021 Parliament removed that clause from the Criminal Code.

WORTHEN: What that means is that persons with disabilities, persons with chronic illness, are now eligible for MAiD in Canada.

Some in the disabled community supported the change. Others were beyond furious. Monica Gartner lives in Vancouver, British Columbia.

MONICA GARTNER: And then this law comes along, and it's like a slap in the face.

Gartner was born with osteogenesis imperfecta. Her bones are extremely brittle.

MONICA: Okay, so yeah, um, I happen to be a person with a disability.

Monica is about three-foot-two. Confined to a wheelchair. She wasn’t supposed to live past her first year. When I spoke to her she had just turned 56. She works in human resources and loves to go out to concerts and plays. She likes her life and intends to keep living it.

MONICA: I'm very much aware that when I go to the hospital, I tell everyone, I want to wake up. I have plans. I, you know, I have to write my second book. I have to do this. I have to do that.

In 2012 she was at home, alone, and fell out of her wheelchair..

MONICA: Facedown. I managed to flip over, I hit my arm, on the way down, on my dining table. And it was broken, I felt it snap. It was toast.

She was lying on the floor, screaming. But somehow she reached her cell phone and called 911. The firemen broke her door down, got her to the hospital, and called her family.

MONICA: It's well after midnight. A nurse comes in. ... And she said, ‘So. Would you like a D-N-R on your account?’ A D-N-R. A Do Not Resuscitate Order. I'm like, ‘No. Why would I want that? I don't have a terminal illness. I have a broken arm.’ ‘Oh, we have to ask everybody,’ she says. I said, ‘No you don't.’

Actually, nurses often do have to ask that question. But to Gartner it seemed unnecessary. This sort of thing happened regularly to disabled people long before MAiD was legalized. She’s very afraid that a medical system that endorses euthanasia will have a bias toward ending her life instead of saving it.

MONICA: That's exactly what the disabled community feels. And it's, it's a scary thing.

I asked Gartner about the argument that MAiD is about personal autonomy, about giving people control over how they end their suffering. The kind of argument Brittany Maynard was making.

MONICA: Nonsense. Because then when you're in a vulnerable state, you will, can be easily manipulated. And there will be people—it's already happened—where people are trying to manipulate your decision.

The irony is hard to overstate. In the name of protecting disabled people from discrimination, Gartner says, the Canadian government left them even more vulnerable to manipulation than before. How does she feel about this?

MONICA: Angry. Upset. My hair rises in the back of my neck. It means that your life isn't worth living.

MUSIC: Dark Walk by Kevin MacLeod

The Canadian government is still not done. When it revised the assisted suicide law in 2021, it promised that within two years it would determine whether minors, those under 18, should be eligible for MAiD.

And the government has already decided to make MAiD accessible to those with mental illnesses. Criteria for that are coming next year. Critics charge that the state should provide help for mentally ill people, not help them kill themselves.

Worthen of CMDA Canada warns that unless Canadians stand up and fight this, it will not stop with the disabled, children, and the mentally ill.

WORTHEN: And then somebody will come along and say, Hey, I'm able bodied, like, how come I don't get the right to suicide? And someone, some judge will go, Yeah, that's right, you know, you should be able to get suicide.

Worthen says Christian physicians who see themselves as following in Christ’s healing footsteps are feeling a lot of pressure. Especially in Ontario, where doctors have to provide an “effective referral.”

WORTHEN: It's like they're going out of their way to insist that we be involved, almost to say, well, we don't want anyone even suggesting that there might be something ethically wrong with this. Everybody's got to be involved. And that's just a … sign of evil afoot.

SEGMENT 7: THE NON-DECISION

Jason Bailey watched, alarmed, as all this developed. It was playing out exactly as he’d worried it would. Beginning in 2016, patients started asking for MAiD. Then in 2018 an Ontario court upheld an Ontario College of Physicians and Surgeons policy that doctors whose patients ask for MAiD must provide a, quote, “effective referral” to a doctor who would provide the service. Those who decline risk discipline. Doctors who didn’t want to participate, the College said, could find a different job.

It was the abortion issue all over again. The more requests for MAiD Jason got, the more he worried. It wasn’t just that a patient might complain. Nurses or other physicians also could turn him in to the college. Some of them, he says, were staunchly pro-right-to-suicide.

JASON: Like I had never thought that a colleague could complain against another colleague. But turns out it's true. Like really, ... nurses, health care coordinators, anybody. And this is becoming like a polarized issue in Canada, right, there were people who were staunchly for this, so …

Eventually nurses started bypassing him on his own patients. They called in doctors who would participate in MAiD when a patient seemed interested. Nurses would send him texts saying one of his patients was going to be assessed for MAiD.

JASON: And then it was like, Oh, dodged a bullet.

But he soon realized how vulnerable he was. What if one of his patients was in extreme distress, and no other doctor was available? What then? A medical emergency used to mean, go save someone’s life. Now, he worried ...

JASON: ... it would be like, This is an emergency, he needs STAT, you know, palliative care and MAiD. I heard stuff like that. You’d read it in the literature. You wouldn’t necessarily hear about it so much in your own clinical areas, but you'd hear about, it's happened, you know, through the grapevine of palliative care people who were on email chains and stuff, you know …

More and more often, he would come home and ask himself, is this the one? Am I going to lose my license over this case?

LES: Was it like once a month? Twice a year?

JASON: Oh, oh, probably, like, every, a couple of times a month. Yeah. ...

LES: A couple of times a month, you were asking yourself, something could go wrong here, and I could get in trouble for not aggressively pursuing a euthanasia option.

JASON: Right, because nurses could …

He’d tell Ranya he was going to get hammered over this. It was inevitable. And she’d say, no, it can’t be that bad.

JASON: And also, yeah, I just knew, we're going to be, we're going to be put in a corner at some point. And someone's going to say, I want you to do this. Yes or No. Microphone. Ticket somewhere.

He believed that the pro-assisted suicide crowd would never allow a space for pro-life physicians.

JASON: Even as gentle or as Canadian, or as unassuming. And as let's all get along-ish, we wanted to do, it doesn't come across that way. Because someone else feels like you're, oh, you're judging my decision, and you're not allowing good medical care to be done. You’re fringe, you know. You're extremist.

Jason stayed in palliative care as long as he could, but in 2019 he dropped that part of his practice and went full-time at the hospital. Ranya agreed.

But they realized that even working in rehab wouldn’t protect Jason for very long. The supposed “safeguards”—reasonably foreseeable death, grievous and terminal illness—were being systematically dismantled. With MAiD becoming accessible soon to the mentally ill and likely to minors, where could a family doctor find a safe practice? Did one even exist anymore?

By then he was already checking out positions in the U.S. He and Ranya never came to a point at which they said, OK, we’re going. They looked into openings in New Mexico and Virginia, thinking, well maybe. They talked it over with their kids, who seemed OK with it.

Jason kept looking, and thinking. And applying. In 2020 a practice in Lancaster offered him a job. The immigration visa came through in 2021. So they left Canada and moved to the U.S.

And that’s how they found themselves in Lancaster, sitting in my truck.

JASON: Ranya? Left? Or no? Oh, OK, Centerville Road, a little further over …

The Baileys had made it to Pennsylvania before Jason had to choose between his conscience and his medical practice. He hadn’t lost his license or been hauled up before the Ontario College of Physicians and Surgeons.

Were they safe? Yes and no, according to Dr. Jeff Barrows.

BARROWS: My first reaction is that they better be careful where they move to because they're going to get the same pressure here in the United States.

Barrows is a senior vice president at the Christian Medical and Dental Association in the U.S. He says this country is rapidly catching up to Canada on euthanasia, although it varies by state.

BARROWS: I mean, there are some locations where they can feel fairly safe. But there are many, many others that they can't, I mean …

Euthanasia hasn’t made much progress in Pennsylvania, so Jason is probably OK… for now. But so-called “death with dignity” activists have filed a lawsuit in California to allow doctors to administer lethal drugs. Like what happens in Canada.

BARROWS: And again, what happens in California doesn't stay in California, unfortunately. And that would be a model for other states around the country to open the door to voluntary euthanasia, which then leads to involuntary euthanasia, ...

SEGMENT 8: THE FIRST OF MANY

And other issues besides euthanasia are looming on the horizon.

The Baileys left in large part because they watched the erosion of their religious freedom. For the Baileys, the big issue was euthanasia. Other people are worried—maybe frightened is a better word—about a new law approved two weeks after the Baileys left Cambridge. It’s called C-4. And it’s sparked a small diaspora of conservative Christians from Canada.

The Canadian Parliament passed Bill C-4 on December 1, 2021. This is the House of Commons.

CANADIAN PARLIAMENT: Mr. Speaker, I’m asking for unanimous consent to adopt the following motion ...

Canada’s Liberal Party government devised this bill to ban so-called “conversion therapy.” Her Majesty’s loyal opposition, the inaptly-named Conservative Party of Canada, agreed to fast-track it, by-passing debate.

CANADIAN PARLIAMENT SPEAKER: All those opposed to the motion will please say nay. There being no dissenting voice I declare the motion carried.

It was sold to the public as a ban on coercive treatment of vulnerable teens. And abuse can happen. But this legislation goes way beyond that.

Under C-4, it’s a federal crime to provide anyone, child or adult, with therapy or counseling to become heterosexual or look and act like their biological sex. It’s illegal to provide such counseling even if an adult asks for it. It is, however, OK to counsel someone to adopt some other sexual orientation.

It’s also illegal to “repress” someone’s non-heterosexual gender expression, desires, or behavior. To do these things risks a fine and up to five years in jail.

To promote, advertise, or refer someone for such treatment, say on a church website, earns up to two years in jail. It makes no exception for pastors or religious leaders. No exception for parents, either, who might want to send a child for biblically-based counseling.

The standing ovation lasted well over a minute. Grinning MPs from all the parties crossed the aisle, shaking hands and slapping backs.

Some Conservative MPs had opposed an earlier version of the bill. But when it came back last fall, the Conservative Party’s bosses decided it was just too politically toxic to oppose it again. All the MPs fell into line. Not one said, “Nay.”

JOE BOOT: It was the most disturbing piece of political theater I've ever seen in my life.

Pastor Joseph Boot the founder of the Toronto-based Ezra Institute. It’s a conservative Christian advocacy group.

BOOT: No, you can see the religious fervor that lies behind this bill. It was like a celebration that they were going through as lawmakers in passing a totalitarian bill that is removing the basic Charter rights of Canadians. Religious freedom. Freedom of expression. ... It's like I looked at it and I thought, are we living in a one-party state?

The bill’s preamble says conversion therapy causes harm because it “propagates myths and stereotypes” about sex and gender.

BOOT: So this is the most radical, I would say, the most totalitarian piece of legislation to pass in any major Western democracy.

As a Canadian, I felt a little defensive when he said that. Canada is not yet a totalitarian state, I said. It’s not China.

BOOT: And I would agree, it hasn't yet come with the jackboot of full authoritarianism, but the legal structure, the sleeper laws are now all there for those to be activated by a state, so that what they say is for the best of intentions now can be used for the most evil of intentions further down the track. And so no, this is not a harbinger of totalitarianism. This is an expression of a statist totalitarian view of society.

About 20 U.S. states and many cities have similar bans. But they’re typically limited to licensed counselors treating minors. And they don’t send people to jail. After Boot spoke to me in January, France passed a law similar to Canada’s.

Boot adds that conversion bans are always one way. That is, it’s now a federal crime in Canada for anyone to help someone gain freedom from gender confusion. But the state will pay for sex-changes.

Some conservative Christians hope the law will be overturned. But Colin Postma says Canada’s courts are not serious about defending free speech or freedom of religion.

COLIN POSTMA: So this is kind of becoming par for the course in in Canada ...

He’s the Federal Issues Manager for the Association for Reformed Political Action, ARPA, based in Ottawa. The Canadian Supreme Court has...

POSTMA: ... been very strong on religious freedom when it's in isolation. But it seems like when it comes into conflict with sexual identity, or gender expression, then all of a sudden, that trumps anything else.

The Canadian justice minister and others have said that the law won’t be used against parents and pastors.

POSTMA: It's hard to believe him. I mean, ... there were people pushing back and saying, if that's what you think, if that’s what you're saying, include it in the legislation, include it in this bill. And I think their refusal to do so is an indication of at least where their thoughts are.

Postma says proponents of this bill clearly have churches and religious organizations in mind. Randall Garrison, an MP from British Columbia, gave a Parliamentary speech last September on C-4's earlier version.

SPEAKER OF PARLIAMENT: The honorable member for Esquimalt—Saanich—Sooke.

RANDALL GARRISON: Mr. Speaker, this government is dragging its feet on banning conversion therapy ...

If Canada adopts comprehensive sex education that affirms all sexual orientations and gender identities, Garrison concluded,

GARRISON: ...then we have a chance to stamp out not only conversion therapy, but also the attitudes which cause it.

Both Postma and Boot have heard from Christians who, like Jason and Ranya Bailey, are getting ready to flee.

BOOT: And I’m not 100 percent sure how I feel about it, because it obviously gives you mixed feelings … I'm hearing of, just in the last few weeks, as I've come across university professors, people in politics, ... lawyers, and doctors, and senior professionals in their field, very highly placed, known in their local communities who are leaving the country ... because they no longer believe that freedom can be protected in Canada in the short to medium term, and they want their families out of the country.

ARPA’s Postma.

POSTMA: I think there's just all around a number of issues here where people are starting to really panic, I think, and really not know what to do. I've heard of numerous individuals, friends of mine, that are starting, there is a bit of an exodus to the States, like you've mentioned already with, with that doctor ...

But, as with euthanasia, Canadians who leave over gender issues may find the situation little better in the U.S.

Jeff Barrows says CDMA members at teaching hospitals have lost jobs and positions for questioning the ideology of personal pronouns. For testifying against a transgender bill at a state hearing. For refusing to do gender transitions with minors.

BARROWS: So we're seeing this all over the country.

A 2019 CMDA survey found that a third of respondents had felt pressured to participate in a training program or perform a procedure that violated their ethical or religious beliefs. Barrows thinks it’s gotten worse since 2019.

BARROW: So if they're moving from Canada to the US and thinking, Oh, we're going to be able to escape this, the news I have for them is, no, you're not. It's here as well.

MUSIC: March of the Mind Kevin MacLeod

SEGMENT 9: HOW THEN SHOULD WE LEAVE?

For now the Baileys think Pennsylvania is pretty safe. Jason has a “direct primary care” practice. Patients pay a modest monthly retainer directly to the office. He doesn’t deal with insurance companies, drastically reducing costs.

JASON: There's myself and another physician and a physician assistant, who works in there. And we each have a nurse. And that's it.

Instead of seeing a patient every ten minutes, he sees one every half hour or hour. The atmosphere is relaxed. There’s a warm, personal connection with patients. Jason loves it. Ranya calls it, “the way family medicine should be.”

And they love their new church. Compatible mission and theology.

RANYA: don't want to be too idealistic, but it felt like what we've been looking for.

But. There are moments.

Last winter I went up to Ontario to see the Baileys in Cambridge. This was before I met them in Lancaster. Their oldest daughter was off to college, but their other four would make the move with them. Ranya told me that she worried a bit about her kids. How they’d adjust. How they’d handle leaving.

Jason told me a sense of loss comes and goes.

JASON: That comes periodically. And in waves, and it's not that easy to explain. It's just a feeling, it's an emotion. Sadness.

I’m a permanent resident of the U.S. But I often miss Canada. Especially the Rockies. Sometimes people ask me when I’m getting U.S. citizenship. I usually say I deeply appreciate America, but Canada—that's my country. Those are my people.

I asked Jason if they intend to become U.S. citizens.

JASON: In five years. As soon as I can.

They have practical and legal reasons. But they also feel pushed out of their home and native land.

RANYA: Well, I think I mean, there's an emotional attach…there is part of an identity and a sense of having been brought up in Canada and thinking about what it means to be Canadian. [voice chokes]

MUSIC: Oh, Canada / Our home and native land / True patriot love / In all of us command …

RANYA: And I think that, ultimately, as believers, our identity is in Christ. But there is ways in which you want to see that identity work out in practical ways in your real life, and you think of a nation like Canada as being an opportunity, and to be supported and nurtured, nurtured in that. And then to look back and say that my country really didn't nurture my faith, give me an opportunity to practice my faith and really became the point at which it basically said, If you want your faith, you need to leave. So there's sort of that rejection. I guess.

MUSIC: Oh Canada / We stand on guard for thee!

The Baileys’ dilemma is likely going to become more and more common for Christians in many fields. And many countries.

I had lengthy conversations with Boot and Postma about how Christians should react to all this. Boot calls it “totalitarian creep.”

BOOT: And we shouldn't jump ship simply because we think, Well, this is a really concerning situation, I want out ...

Boot says that whether you stay or go is a matter of God’s calling on your life. Leaving is a legitimate option if you can’t live in peace and teach your children or the Word of God in freedom.

BOOT: ... but another legitimate response is to stay. And if we're going to stay, then we need to act and the complacency, the status quo, the business as usual, can no longer be the norm for the Church.

He says Christians who stay need to build strong communities of faith that can live out the Gospel. That can withstand the pressures of the culture and the modern state.

BOOT: 2022 and the passage of Bill C-4 is a seminal moment in two ways. I think it is sparking a small migration of Christians out of Canada. ... And I think it will, it will also enliven, I think, a movement of a sifting a, a purifying, a shaking within the church, to a faithful remnant, to stand faithfully, and face the consequences...

ARPA’s Colin Postma cites Psalm 121: Our help is in the name of the Lord, maker of heaven and earth.

POSTMA: And so I think there is hope to be found in the Gospel message, there is hope to be found in our ability to continue speaking the truth and that having an impact. But that might require us to be Jeremiahs for a while. And I don't know how long that will—that will be.

OUTRO

LES: I’m Les Sillars, and I reported and wrote this episode. Doubletake is produced by the journalism program at Patrick Henry College, with the help of the creative team at WORLD Radio and Jeff McIntosh at Creative Genius.

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