In a new interview, a Canadian doctor who commits euthanasia spoke about how “meaningful” her work is — but also criticized how easy it has become to euthanize someone, even if they aren’t sick or dying.
Madeline Li spoke with Macleans about her experiences, which she described as both “meaningful” and “maddening.” She is the head of Medical Assistance in Dying (MAiD) at University Health Network, and said she has overseen hundreds of cases. Yet she is not on board with the turn Canada’s MAiD program has taken as it expands to include those with mental illness.
“[M]y opinion is that we shouldn’t be providing MAID for mental disorders — and more broadly than that, for chronic illness. I don’t think death should be society’s solution for all forms of suffering,” she said. “Society needs to agree on what types of suffering are appropriate to respond to with MAID. If someone is suffering primarily because they can’t afford housing rather than directly from a qualifying medical condition, do we think that death is the appropriate solution for that? If your suffering is because you can’t afford your medication, or other structural vulnerabilities only indirectly related to a medical condition, is that a good reason for MAID?”
She also criticized the expansion of MAiD to allow people who aren’t dying to be eligible, even though she has personally participated in the deaths of such people since then:
I was on call recently and was consulted to see a patient admitted to the hospital for chronic pain. This patient has a complex medical and psychiatric history, significant trauma and a lot of psychosocial vulnerability. They are lonely. The patient was told there is nothing further that could be done for their pain, and so they asked to apply for MAID.
I was not their MAID assessor, but I was asked to consult as a psychiatrist for depression and suicidality. The patient told me that if they didn’t feel quite as lonely, if they felt that anyone cared about them at all, they probably could tolerate their pain better. I expressed to this patient that I thought it would be a great loss to society if they died because they had contributed and still had a lot to offer. In other words, I expressed caring, which seemed to mean everything to this person.
Yet the person in question couldn’t afford the treatment Li recommended — psychedelic-assisted psychotherapy — even though they wanted it. She said they went forward with their application for MAiD, which she said will almost certainly be approved.
Worse for Li was when she actually killed a patient who was young and healthy — but had been diagnosed with cancer. Though the patient had a 65% chance of survival, the patient still opted for MAiD, and refused any treatment. That patient’s death was approved, and though Li didn’t agree, she still killed the patient.
“They saw it as an expression of their autonomy; I saw it as dystopian,” she said, adding, “I didn’t regret it at first. But when I started thinking deeply about how to better safeguard this process, I regretted ending this young person’s life. I just parachuted in, I didn’t know this patient. And I didn’t take the time to have a meaningful discussion with them. I didn’t sit down and say, ‘Why don’t you just try this treatment? If it’s as bad as you think it’s going to be, MAID will be available.’ MAID was so new then, and we were all so focused on patient autonomy. The current law has no place for clinical judgement, and no stipulation for meaningful conversation. If it did, this person may be alive today.”
The number of people who have opted for assisted suicide or euthanasia in Canada since legalization has quickly skyrocketed, and though it has been temporarily delayed, the next step is approving MAiD for people with mental illness as their only diagnosis. Already, palliative care has suffered, while people with disabilities are pressured into death rather than medical treatment.
Today, Li expresses concern that Canada’s MAiD program has gone too far.
“I think we have forgotten, over the past several years, that our roles as health care providers is to help patients make the best decisions for themselves,” she said. “I’m not trying to deny patient autonomy — it’s their decision — but I don’t think I should blindly defer to autonomy. It’s so nuanced, because again, I have to keep my personal value system out of it. Helping someone die, especially when they wouldn’t otherwise, shouldn’t be a matter of checking things off a list.”
