IN SEPTEMBER THIS YEAR, addressing a gathering of young people in Assisi, Pope Francis said: “As long as our system ‘produces’ discarded people, and we operate according to this system, we will be accomplices of an economy that kills.”
Urging young people to “transform an economy that kills into an economy of life” he said: “Let us ask ourselves. Are we doing enough to change this economy or are we content with painting a house in order to change its colour without changing the structure of the house? It is not a question of paint strokes, no: you have to change the structure.”
It is now well-established that even in the richest countries, political and economic policies can lead to significant numbers of deaths. Whether it is the general assault on health and wellbeing of austerity, or the more focused attack of a punitive social security system, the link between policies and deaths is clearly apparent, but rarely direct. So when people crushed by social and economic injustice die, or choose to end their lives rather than live in a society which treats them so callously, politicians can obfuscate and deny responsibility. That is the current position in the UK.
But now, in some places and in some cases, the society and economy which drives people to desperation may not just fail to offer a remedy – it may openly facilitate their death.
Assisted dying is an extremely sensitive issue, and there are good people on both sides of the debate. When a disease is terminal and terrible suffering or indignity cannot be avoided, it is difficult to argue that people do not have the right to have their end of life hastened by compassionate medical assistance. There may be sincere religious objections, if one believes that life is God-given, and should never be ended by human hands. But is anyone entitled to impose that view on others, and thus compel them to suffer unnecessarily?
The debate in the UK has largely centred on such questions of religion, morality and medical ethics. But it would be naïve to think that such a debate, or such a policy, could exist outside the realm of politics and economics – particularly at times when ideologies of austerity and a small state hold sway.
In this climate, there must always be a fear that the availability of assisted dying could put pressure on sick or disabled people to ‘do the right thing’ by society and choose to die before they become too expensive. The Nazi propaganda poster which proclaimed how much a disabled person ‘cost the taxpayer’, and paved the way for the Aktion T4 programme, in which disabled people were systematically killed, should always haunt any such debate.
And then there is the ‘slippery slope’ fear; the fear that even if introduced on a very narrow and strictly regulated basis, assisted dying could gradually be expanded so that more and more people were eligible. There is a tendency to dismiss this fear as scaremongering – but internationally, this has happened. And it is in wealthy, liberal Canada where the slope seems to have become most slippery.
In Canada, Medical Assistance in Dying (MAID) has been legal for people with a terminal illness since 2016. In 2021, the law was revised to permit MAID for “intolerable” and “irreversible” but non-terminal medical conditions. After March 17, 2023, people with a mental illness as their sole underlying medical condition will have access to MAID.
As Canadian psychiatrist Dr Ralph Lewis says, this raises many troubling questions: “How will suicidal urges that are frequently symptoms of the distorted thinking of psychiatric disorders be differentiated from a rational, reasonable choice that is consistent with the person’s life values? How should suicide prevention campaigns be squared with the availability of medically assisted death for people with mental disorders? How will we confidently determine if a person is in a state of mental competence to make such a decision? How will vulnerable people be protected from subtle psychological and social pressures that might sway them toward feeling that they are a burden to their loved ones and to society? How shall we prevent the very existence and availability of an officially sanctioned medically assisted death for mental disorders from conveying a sense of hopelessness to patients regarding the likelihood of successful treatment of their condition? And how can we even predict whether a seemingly irremediable condition will continue to be irremediable?”
Besides these troubling questions, it is vital to recognise that inequality and poverty are huge factors here. As the Mental Health Foundation says: “there is a strong socioeconomic gradient in mental health, with people of lower socioeconomic status having a higher likelihood of developing and experiencing mental health problems.” The Samaritans’ report Dying of Inequality says: “Suicide is a major inequality issue. We found that income and unmanageable debt, unemployment, poor housing conditions, and other socioeconomic factors all contribute to high suicide rates… Tackling inequality should be central to suicide prevention”.
But there is growing evidence that in Canada, assisted dying is now being seen as a potential solution not just to physical or mental suffering, but to poverty and inequality. Examples are emerging of people choosing MAID not because their physical or mental disease is intrinsically unbearable, but because society makes living with it unbearable.
As in the UK, social security payments for disabled people who cannot work are too low to live on with any degree of comfort or dignity. Dr. Naheed Dosani, a palliative care physician and professor at the University of Toronto, says: “We’re hearing about people who are choosing medical assistance in dying or thinking about it more because they don’t have money to live.”
One such person is Les Landry, a former truck driver who had a good income. His physical health declined suddenly and he now uses a wheelchair and is in chronic pain. He says he is planning to apply for MAiD because his poverty makes living with his disability unbearable. “The numbers I crunch … I will not make it. Like in my case, the problem is not really the disability, it is the poverty. It’s the quality of life.”
Dr. Kerry Bowman, a bioethicist from the University of Toronto, says: “We were unbelievably naive as a nation to think that vulnerability, disability, poverty that we could parcel that off and it wasn’t going to be a problem. It’s a huge problem.”
“I worry about this because it is people living with disability, people living with pain, people living in poverty, that are requesting medical assistance in dying, not because of the physical experience they’re going through, but because of the social circumstances themselves and this is wrong. It’s really a very terrible thing.”
Helen Long, the CEO of Dying With Dignity Canada, which campaigned for assisted-dying laws, said: “the fact that people are feeling compelled to apply for MAID or even ask about MAID because they can’t get the basic fundamentals to live a life is just shameful.”
When a single individual can pay $44 billion for a social media platform, but ill and disabled people in a rich country consider death because they cannot afford a life that is tolerable, there can be no doubt that we are living in an economy that kills. And this, of course, is in addition to the millions who die in poorer countries due to the lack of even the most basic necessities, and from the effects of climate change. As Oxfam says “The “cost of living” crisis is more accurately a ‘cost of profit’ crisis – of rising billionaire wealth and corporate mega-profits – that is driving up poverty, hunger, indebtedness and deprivation around the world”
Anyone who becomes involved in the assisted dying debate (or indeed any debate on public policy) must take into account factors of social and economic justice. And those who proclaim themselves to be ‘pro-life’ must surely have a particular obligation to do as Pope Francis urges, and transform an economy that kills into an economy of life.
If you are in distress and need to talk to someone, please phone the Samaritans free, any time, on 116 123, or contact them here. If you are concerned about somebody else, there is advice and support from the Samaritans here.
————
© Bernadette Meaden has written about political, religious and social issues for some years, and is strongly influenced by Christian Socialism, liberation theology and the Catholic Worker movement. She is an Ekklesia associate and regular contributor. Her latest book is Illness, Disability and Caring: A Bible study for individuals and groups (DLT, 2020). Her latest articles can be found here. Past columns (up to 2020) are archived here. You can follow Bernadette on Twitter: @BernaMeaden