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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?    

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4 min read

Portofino’s real prisoners are not the beggars it is banning

The economic elite can’t exclude the poor from their privileged bubbles

George is a visiting fellow at the London School of Economics and an Anglican priest.

A colourful row of buildings in an Italian port.
Portofino's harbourside dining.
Slim Emcee on Unsplash.

I know Portofino a bit, because it’s nearby my Italian in-law family and we’ve been there a couple of times when visitors have wanted to see it. It’s a former fishing village on the Ligurian coast, a natural bay and beyond lovely. And its mayor, Matteo Viacava, has just banned beggars from its cobbled streets, as they irritate wealthy tourists and celebrity visitors, which is less lovely. 

Italy struggles with its relationship with tourism. Rome was sinking under a pile of rubbish a few years ago. The more literally sinking Venice tries to repel visitors with taxes, while providing a backdrop welcome for mega-wealthy weddings. The walled Tuscan town of Lucca recently cracked down on the buttodentri, the restaurant touts who hustle diners. As with any European tourist destination, Airbnb apartments drive rental prices up and the indigenous population out. 

There is something particular about the Portofino beggar purge though. Perhaps it’s a bit like Versailles before 1789 – in the case of Portofino, the poor have no clothes so let them wear Prada. It’s all designer boutiques and there isn’t a real shop, a paneterria or forno, to be found. No one carries any weight, naturally, but you do wonder how they eat at all, if not in one of the extortionately priced trattoria. 

To visit, as thousands will this summer, is to realise how much there is that you don’t require. It has everything a rich visitor wants, but nothing that they actually need. We’ve heard people call it Disneyland Italy, but I think it’s more like Patrick McGoohan’s The Prisoner TV series, shot in another, similarly named, dystopian village, Portmeirion in North Wales, where everything is laid on except freedom. Even that’s not quite right – as The Eagles nearly wrote, in Portofino you can leave any time you want, you just can’t afford to check out, unless you’re loaded. 

It strikes me now that the mysterious bubble that pursued the aspirant escapee McGoohan along the beach may have been a cunning metaphor. People who live in Portofino (and very few do), or who seek sanctuary there, or in Palm Beach, or on Long Island, or in St Moritz, or on Mustique, or in South Kensington, exist in a bubble.  

Joining friend and foodie Loyd Grossman at the Chelsea Arts Club a while ago, he told me he’d just walked down from his home in South Kensington and seen not a single person who actually lived there, but only people who cleaned their houses. Residents arrive from and leave for the airport, often from subterranean garages, in privacy-glassed limos. 

Like Portofino, these are bubbles from which anyone but their own demographic are excluded. It doesn’t have to have gates to be a gated community. The bubble is a psychological state, which is bought to protect us from those of lesser means and especially, God save us, from the poor. 

Simply to have them removed is to have head and hearts dwelling in gated communities.

And, increasingly for the economic elite, the poor are anyone who cannot afford to, or are not forced to, separate themselves for security, because they have no access to a privileged bubble. That the poor are always with us is a gospel injunction, which I used to take at face value as a statement of apathy or resignation, even acceptance, in an inadequate world, that the poor are simply poor and there is nothing to be done about it. 

Latterly, I’ve seen it far more in the post-modern sense of being present with the poor in their moment of poverty, in solidarity and in their corner. That means they share our space, as neighbours. We’re not just talking about the economically poor here, but the dispossessed and discarded; the vulnerable and volatile; the marginalised and maligned.  

We, the rich, can’t afford to exercise zero tolerance, to pretend they don’t exist, because – to coin a phrase of George Osborne’s when, hilariously, he claimed as Chancellor of the Exchequer to be making common cause in austerity – we’re all in this together. And by “this” I mean the one, shared bubble, which is universal.  

We’ve been considering tourists and beggars, but we can scale it up to famine in Gaza or Sudan; asylum seekers in small boats; prisoners in Guantanamo Bay or on death rows; those who face earthquakes and tsunamis. They can’t be made to disappear by magic or mayoral edict, only by addressing the circumstances of their poverty – of food, money or spirit – with practical, social and political policy, plus a dollop of compassion for the cause of their plight. 

Simply to have them removed is to have head and hearts dwelling in gated communities. It’s not sufficient, for sure, to notice the beggars this summer, to drop a few euros, but it’s a start along the street towards knowing that the poor are indeed always here, with us. Even in Portofino.

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