Article
Assisted dying
Death & life
4 min read

The cold truth of Canadian lives not worth living

Canada’s implementation of medical assistance shows that a society considers some lives not worth living.

Mehmet Ciftci has a PhD in political theology from the University of Oxford. His research focuses on bioethics, faith and politics.

A IV drip bag hangs from a medical stand.
Marcelo Leal on Unsplash.

Alan Nichols’ application for euthanasia mentions only one health condition as the reason for his request: hearing loss. “Alan was basically put to death,” according to his brother. He was hospitalized after being found dehydrated and malnourished in his house. He asked his brother to “bust him out” of the hospital as soon as possible. A month after being admitting, he was euthanized through MAID (medical assistance in dying), despite the desperate objections of his family and his primary health practitioner. They were informed of the procedure over the phone only four days before it took place. They have since reported Alan’s case to the police; they argue he was not in a fit state of mind to understand the procedure or make decisions for himself. He had no life-threatening conditions. He was vulnerable. 

Canada’s relaxed laws around MAID came to international attention when CTV News reported that a fifty-one-year-old woman chose MAID after failing for two years to find housing that would allow her to manage her multiple chemical sensitivities. Despite the best efforts of friends and even her doctors to get her suitable housing in Toronto, letters left behind documented her desperate yet fruitless search for help. She begged officials at all layers of government to help find an apartment free from the chemicals and cigarette and marijuana smoke that worsened her symptoms. “The government sees me as expendable trash, a complainer, useless and a pain in the a**,” she said in a video days before her death. 

These are only some of the terrible stories that have been reported after Canada became the first Commonwealth country to legalise assisted suicide and euthanasia. Advocates of MAID will point to how comfortable Canadians are with it. As a recent poll revealed, MAID is supported by 73 per cent of Canadians, with 27 per cent supporting MAID even if the only affliction is poverty, 28 per cent for homelessness, and 20 per cent for any reason whatsoever. Those numbers may shift as disability activists and medical professionals continue to raise the alarm over the consequences of growing numbers choosing MAID, from 2,838 deaths in 2017 to 10,064 in 2021. 

MAID was introduced in 2016... Only those suffering from incurable diseases whose death was “reasonably foreseeable” were eligible, initially. 

There are two reasons why the Canadian example teaches us to remain firmly opposed to the legalisation of assisted suicide and euthanasia in the UK.  

The first is that the slippery slope in this case is real. Campaigners for Dignity in Dying claim they want only the legalisation of assisted suicide, not of euthanasia. The latter involves a doctor directly administering lethal drugs, without requiring the patient’s participation. (MAID permits both, although euthanasia is the method used in 99 per cent of cases.) They argue there is no evidence that legalising assisted suicide in the UK would lead to a loosening of laws over time. But this is contradicted by the timeline of events in Canada.  

MAID was introduced in 2016 following the Supreme Court of Canada’s ruling in 2015 that the criminalisation of assisted suicide violated the Canadian Charter of Rights and Freedoms. Only those suffering from incurable diseases whose death was “reasonably foreseeable” were eligible, initially. But the MAID evangelists did not wait long before complaining that this was too restrictive. The courts obliged, and in 2019 the court of Quebec found the “reasonably foreseeable” condition to contravene the Charter. In 2021 the laws were changed to allow MAID for those whose natural death was not foreseeable, but who have a condition considered intolerable by the applicant. Those suffering only from mental illnesses will be eligible for MAID in March 2024.  

The slope becomes more slippery still: the government is considering further expansion to allow “mature minors”, vaguely defined as children mature enough to make their own treatment decisions, to ask to be killed, even against a parent’s wishes.     

A society that kills those who ask to be killed has already made a choice to consider some lives not worth living,

The second lesson is about what kind of society we want to be. For a doctor to present the option of being killed, which Canadian doctors are now obliged to do whenever “medically relevant”, even if the patient does not bring it up first, does not expand patients’ freedom. It is rather an invitation to despair. This is frequently forgotten when some think that denying patients the choice to seek death is “imposing Christian values” as one cleric of the Anglican Church of Canada said. Roman Catholics, Evangelical Christians, and others have opposed MAID because a society that kills those who ask to be killed has already made a choice to consider some lives not worth living, and to invite those already made vulnerable by their pain and distress to see themselves as a burden to others. Not to mention the perverse incentives created to reduce medical and palliative care.  

We can and should support those who are frail and in need of care at the end of their lives to die with dignity, without hastening their deaths, without deeming their lives no longer worth living. Dame Cicely Saunders and other pioneers of the hospice movement have shown us what an alternative to assisted suicide and euthanasia would look like. Hospices put into practice the parable of the Good Samaritan, who responded with pity to the man beaten by robbers, bandaging his wounds and giving him a place to rest and receive care. Jesus tells the parable to show what it means to be a good neighbour to someone and how to react with compassion to suffering. What would have been the message of the parable if the Samaritan had instead reacted to the sight of the suffering man by reaching for his dagger?    

Essay
Comment
Politics
War & peace
7 min read

What it takes to travel from ceasefire to peace

With Bertie Ahern, Kevin Hargaden explores an unlikely journey.

Kevin is a social theologian studying ethics and economics.

A TV graphic labelled 'ceasefire' lists bullet points
How the news was reported in 1994.
RTE.

August 31st marks the thirtieth anniversary of the historic IRA ceasefire. After decades of effective civil war in Northern Ireland, on this day in 1994, the nationalist paramilitary force announced “the complete cessation of military operations” and declared that they looked forward to a just and lasting settlement with “a spirit of determination and confidence”. While not without interruptions, that ceasefire has led to more than just a cessation of conflict. While still fragile, Northern Ireland has a functioning parliament, closer ties than ever with the Republic of Ireland, and the dissident threat – still present – is marginalised. 

One of the remarkable elements of that day at the end of summer 1994 was how unlikely it seemed just a year before. The intensity of “The Troubles”, as the conflict is called, varied over the years but a series of atrocities in 1993 left an already traumatised population in a state of desperation. In March of that year, the IRA exploded bombs in the market town of Warrington. This callous attack clearly sought to strike terror into the hearts of English civilians – people who had no real connection to whatever injustices had been inflicted on the nationalist communities of Northern Ireland. Two children, Jonathan Ball and Tim Parry, were killed and almost sixty people were injured.  

Another IRA bombing, in October of that year, caused outrage and disgust across Britain and Ireland. Again, hitting a civilian population, the Shankill Road bombing had been intended to target Loyalist leaders but ended up devastating a fishmongers. Ten people were killed.  

Brutal responses followed from the Loyalist side. Five days after the Warrington bomb, the Ulster Defence Association murdered four construction workers and a week after the Shankill Road bombing the same organisation descended upon a Halloween party held in a bar in rural Derry, killing 8 people and leaving 12 with dire injuries.  

Along with many other atrocities, the year ended with most people on the island dreading another generation of pointless violence. But below the surface, intense grassroots efforts and official negotiations were beginning to bear fruit.  

The viewer is bound to see the peace process that emerged as a kind of miracle. How could forgiveness reign in the face of such savagery? How can a society build a future out of the wreckage of such a past? 

This story is told vividly in the BBC documentary Once Upon a Time in Northern Ireland. Spread across five episodes, the show does not intend to offer an encyclopaedic analysis of how the Troubles emerged. Instead, it focusses on the experiences of the ordinary people embroiled – whether intentionally or not – in the conflict. The effect is deeply moving, even overwhelming at times.  

So often, our culture engages with war and conflict as abstract concepts to be debated. Even in the context of active, live battle, we are typically presented with “talking heads” offering expert opinion. But in Once Upon a Time in Northern Ireland you get to hear from the people who planned the attack, or who conducted the arrests, or who were just trying to buy some fish for dinner when a bomb exploded in the shop. This direct testimony from those were caught up in the Troubles allows the viewer a visceral understanding of what is at stake, without having to understand the centuries of colonialism, conflict, and oppression that generated the civil war. That human trauma, that is glimpsed in great poetry or felt as an echo in a folk song is captured in this series directed by the award-winning James Bluemel. 

There is a stubborn misunderstanding that the Northern Irish conflict was “Catholics against Protestants”. Once Upon a Time in Northern Ireland disposes of this myth, if in part by showing how those two groups were never distinct. It was a complex conflict fuelled by land and ideology, traumatic history and conflicting cultures. Religion was a component of course, but expressed through the lens of sectarianism, the almost racial animosity that grew up between the opposing tribes, the marker that differentiated them. When one man, named Michael, is shown tending gently to the racing pigeons he keeps, the effect is incongruous in the extreme because his story is one of unimaginable despair.  

He was raised Catholic; his mother was Protestant. She had ten children. And one day, two women showed up at their home and took his mother away and she never returned. The IRA killed her. It wasn’t because of her views on Papal primacy or biblical authority. Something even more absurd and terrifying was at work here, a hatred that at some point did not even need justification.  

The consequences of each callous and brutal attack rippled outwards, affecting not just the victims but their loved ones and then their community. By the end of the five episodes the viewer is bound to see the peace process that emerged as a kind of miracle. How could forgiveness reign in the face of such savagery? How can a society build a future out of the wreckage of such a past? 

That was their baseline assumption throughout – no one at the table was “happy with the fact that thousands of people had been killed and maimed.” 

This exposes one of the limitations of the format of the series. By placing the perspectives of ordinary people at the centre of the narrative, profound truths are exposed. But the mundane details of how the peace process developed – why it was the IRA agreed to a ceasefire and how things developed from there to the Good Friday Agreement and the years since – are unaddressed. Perhaps a sequel is required where the politicians and diplomats who made that possible are given the chance to tell that story? 

One of the undoubted architects of peace in Northern Ireland is Bertie Ahern, who was the Taoiseach (Prime Minister) of the Republic of Ireland from 1997-2008. I sat down with him to do just that – to hear his recollections of the process that brought about peace. Since his youth, he had always taken a keen interest in Northern Ireland – “I took a particular interest in the Civil Rights movement when we were in school; that was before it got into the violence.” Raised in a Republican family just north of Dublin city centre, once the Troubles began, it was hard “not to be subsumed into everything that was happening on the island.” As he became a political leader, he was keenly aware of how the violent conflict exacerbated underlying problems – even his vision for economic regeneration in the Republic was blocked because “part of the reason that it was difficult to get investment and to get people to come here was the Troubles.” 

As he remembers the process, it would be misleading to think it popped out of nowhere in the 1990s. There had been attempts through the years, notably with the Sunningdale Agreement in 1973 and the Anglo-Irish Agreement of 1985, but also through less publicised conversations between the peacemakers and paramilitaries, like the conversations led by Fr Gerry Reynolds at Clonard Monastery – which began to generate movement. He attributes the ceasefire to the Downing Street Declaration that was orchestrated by the British Prime-minister John Major and Ahern’s then boss, Taoiseach Albert Reynolds, on December 15, 1993. That showed a serious willingness from London to engage, and the 1994 ceasefire was the result.  

But when the ceasefire broke down in 1996, all that work dissipated. “That was a disaster, really.” With the election of Tony Blair, Ahern suggested they “take it up again”. With a concerted focus – “I was nearly doing the Northern stuff full-time” – progress was restored. He remembers that the negotiations involved ten different parties, including the British and Irish governments and the active and influential participation from the American government and “went on practically non-stop from September 1997 to Good Friday 1998.” The strategy sought to be as inclusive as possible – “we would try and get everyone in” – and “to be as comprehensive on the issues” as possible, so that no issue was off the table. Patience and resilience were central. Although there was “a huge amount of conversation and talks up to Christmas, it didn’t really gather momentum until February.” 

With the “totality of all the issues out on the table”, the dialogues began to bear fruit. How draconian legislation might be rolled back, how paramilitary prisoners could be released, how demilitarization would proceed and how the police could be reformed. He remembers that negotiations on that question – the reform of the corrupt Royal Ulster Constabulary police force – went on deep into the Good Friday night, April 10th. When an obstacle appeared, the London and Dublin governments reminded people of the goal of stopping the violence. That was their baseline assumption throughout – no one at the table was “happy with the fact that thousands of people had been killed and maimed.” The second guiding principle was that “you have to try to treat everyone with dignity, regardless of what views they have.” And slowly, rapport was built up between people who had been combatants.  

When the agreement was finalised, a kind of euphoria followed. “That week we were just at it night and day; we had been at it night and day since March.” But the celebrations, as intense as they were, did not linger. The agreement had to be passed by popular referendum in both the North and the Republic of Ireland. And the work continued even after that. Ahern notes that it took years to achieve an agreement “and then another ten years to implement it”.  

But the effort was undeniably worth it. “I think the big success of the Good Friday Agreement was that the Troubles have by and large ended.” And the story of how that happens traces back to a cassette tape released in August 1994 announcing the IRA ceasefire.