← Conversations with Coleman
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Some follow the noise. Bloomberg follows the money. Because behind every headline is a bottom line, whether it's the funds fueling AI or crypto's trillion dollar swings. There's a money side to every story. And when you see the money side, you understand what others miss. Get the money side of the story. Subscribe now@bloomberg.com
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welcome to another episode of Conversations with Coleman. My guest today is Rupa Subramania.
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Rupa is a writer for the Free
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Press who focuses on Canada. She has a weekly column aptly titled this Week in Canada. In this episode we talk about Canada's assisted dying law known as maid, which stands for Medical Assistance in Dying. We talk about how a law originally intended for people with terminal illness has expanded to include lots of people with serious but not terminal ailments. We also talk about the ethics and trade offs involved in assisted dying laws in general. So without further ado, Rupa Subramania.
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On this show we spent a lot of time having honest, unfiltered discussions around Israel, Zionism and antisemitism. And if our conversations have made you more curious about any of these topics, I I have a recommendation for you. Wandering Jews with Mijjal and Noam is a podcast hosted by two of the leading Jewish voices of today, Noam Weissman and Mijal Biton. On their show, Mijal and Noam are finding fresh perspectives on tough subjects. They've explored the war in Iran from the viewpoint of Persian Jews, they've poked fun at anti Semitism with comedians, and they've asked prominent rabbis about the future of religion. If you value nuance over hot takes
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and want to get past all of
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the noise, this show is for you. Search Wondering Jews with Mijjal and Noam on Spotify, Apple Podcasts or YouTube and subscribe or find the link in the show notes.
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B
Okay. Rupa Subramania, thanks so much for coming on my show.
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D
Thanks for having me. Coleman. It's great to be with you.
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B
So the topic of this episode is Medical Assistance in Dying. This is the phenomenon of the government allowing you to choose to euthanize yourself. Essentially it's a policy we've seen explode in Canada. We're going to talk specifically about the MAID policy in Canada, but we're also going to talk, I think, about the phenomenon more broadly. We've seen different kinds of policies roll out in US States, in Australia, in New Zealand, in Europe with different results. And I just want to acknowledge at the top, this is a tough topic for a lot of people. It has to do with death and Dying it, for many people invokes, myself included, memories of the absolute worst moments in their life when you, you're watching someone you love most in the world suffer or die. And so, you know, it's understandable that people are provoked to very strong reactions and strong opinions. And all of that, I think, makes the public policy conversation more difficult than, than on other topics because the, the emotional stakes are so high. But you've been doing some incredible reporting on this, including talking to many people you know in, in the weeks and months before they undergo a medically assisted suicide. And you, there's plenty in the free press and people can just search your name to read those articles. I really recommend that. But I first want to, want to understand how did you get into reporting on this particular topic? Is it just because you're on the Canada beat, or is there another reason why you ended up spending so much time talking to these folks?
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D
Thanks, Coleman. Well, I live in Canada, and what first drew me into reporting on Canada's maid regime was I was seeing this growing disconnect between the way maid was described initially when it was first legalized, and the kinds of stories that were beginning to emerge. And Canada sold maid to Canadians and to the world as a narrowly tailored system for the terminally ill people who are within months and weeks of dying. It was billed as being compassionate and cautious. But as I began digging deeper into maid back in 2022, that's when my first piece on maid ran in the Free Press. We were called common sense. At that time, I found that the system in Canada had rapidly expanded far beyond that original promise of compassion and caution. It was increasingly involving people with mental illness, people who were socially isolated, people who were homeless, people who were on disability, and people who just felt a great sense of despair. But I want to be clear about something up front. I'm not opposed to the right to die. I feel that if you are of legal age, if you're of sound mind, and you express a wish to die, and if that is available to you, I would defend that right. But I also understand there are cases, very tragic cases, of unbearable suffering where allowing someone a peaceful death can be an act of mercy and compassion. But we're talking about people who are within weeks and months of dying. But what's disturbing, even for someone like me, who, and there are many people like me, I've spoken to over the years, physicians and doctors who are generally would support the right to die, but they're disturbed at what is happening out there, especially in places like Canada. Which is the rapid expansion of existing laws that go beyond terminally ill people. And it's directed towards people who might have otherwise lived, perhaps for many years, if they had received the right kind of support, treatment and care. And also what alarmed me about all of my reporting on MAID was that how quickly all of the legal and moral boundaries had shifted, how rapidly that had expanded. So we have to go back to 2016. That's when MAID was legalized, and it was limited to people whose deaths were reasonably foreseeable. That's the legal expression. That's a legal term. And these are patients typically suffering from terminal illness or in the last stages of their life. That came to be known as Track 1 Maid. But in 2021, during the pandemic, Canada dramatically expanded this law through another piece of legislation, and it created what is now called track two, maid. That is, people who are not dying, but they qualify for euthanasia because they are deemed to be. Their suffering is considered intolerable. So you could have. You could be bound in a wheel, you could be in a wheelchair for the rest of your life, and if you find that suffering intolerable, you could be a candidate for MA under this track two expansion. So suddenly you have people with years, even decades left to live, and they become eligible for euthanasia. And now where we're at right now is that Canada is debating expanding the next. Debating the next expansion in maid. A committee is now studying MAID for mental illness, where the sole underlying condition is mental illness or psychological suffering. The implementation of this new track of MAID has been delayed many, many times. And the federal government, based on recent reports I've read, is reportedly preparing a legislation they're prepared to table legislation that would pause the expansion of maid, thereby pausing the expansion to mental illness. MAID for mental illness. And this is because of, you know, perhaps stories like mine that have made a difference out there, where physicians, doctors and physicians, psychiatrists, healthcare officials have expressed deep concern. And when it comes to mental illness, the eligibility is just incredibly complex and difficult. And how do you assess irremediability in psychiatric. Psychiatric illnesses, and. And all of that remains very, very uncertain. The fact that we've even arrived at this point here in Canada where we're seriously debating whether there should be made for mental. Mental illness alone, that this would have been unimaginable 10 years ago. But. But here we are.
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B
Yeah. Okay, so there's a lot of things I want to say here. I mean, so first off, I think it's really important for me to acknowledge, similar to what you said at the outset, I fully support the right of people who have an actual terminal illness, meaning you are going to die. You have an illness, a disease that is understood well enough that we know you're not coming back from it. And you are in, you know, you're in huge amounts of pain and you just don't, you don't want to spend your last month on earth in writhing agony, nor do you, you want to impose that trauma on, on your relatives to watch you suffer with no silver lining. And I've written in the free press about how this, this was my experience, losing my mother to stage 4 metastatic bone cancer, that she had just a totally terminal diagnosis and had pain that was resistant to opioids. And it was a really good thing that the doctors, at the appropriate time, allowed her to pass peacefully. Right. Because the only alternative we were looking at is just another week of watching my mother writhe in agony. Right. So I think it's really important to flag at the outset that is a case that we should approach with compassion and seriousness. And there is a huge amount of suffering to be alleviated in society if we can figure out how to create a transparent process for people to legally do that and circumscribe those situations and exclude other situations. The other situations that I think I would want to exclude, and I think you and I probably agree on this, Rupa is really the moment you leave the territory of terminal illness, you do open a door, right? The moment you make your eligibility for assisted suicide dependent on your subjective suffering alone, you lose any, you lose any ability to complain when someone says, hey, I'm suffering too. Right? I'm suffering too. I may not have a physical disease, but I have a mental disease. I have depression, I have this, I have that. Once you open that door, you no longer have an emergency break. You no longer really have a principle to stand on, to deny the next person. And this is when we get into some of the cases that you've covered where people that are, you know, either in some cases, like, physically healthy or have, you know, physical ailments, like, you know, you're blind, right? There's been plenty of happy blind people. But, but nor can I deny that for you to be blind could really cause you to suffer. Should you be allowed to kill yourself, like, you know, legally using state dollars and, and, and hospitals and so forth. So, I mean, my first question in the, in the case of Canada's law, which you said started in 2016, it seems to me that these, track one, this track one category did not use the language of terminal illness, and that at some level, to use what was the exact language you said it was reasonably foreseeable death.
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D
Was reasonably foreseeable death.
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B
Right. So reasonably foreseeable, was that meant to be a synonym of terminal illness? Because it seems to me reasonably foreseeable is already looser than the concept of being terminally ill, which means you're on your deathbed. Did they intentionally not use the phrase terminally ill?
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D
I believe they did. I haven't checked. It's been a while since I actually looked at the legal language behind track one maid. But if I recall correctly, they did refer to terminal illness. In fact, that was the driving force behind track one maid. And. And reasonably foreseeable death was as in you are within months of dying. And that was pretty clear under track one made, and there was no confusion about it. So you couldn't go into a doctor's office where you have type 2 diabetes or type 1 diabetes and tell your doctor, look, I just, you know, my death is reasonably foreseeable, and the doctor would just laugh at you because that's not the case with these diseases. But so track one was pretty clear. Everybody agrees. Track one was not the problem. It's the expansion to track two. That's where the language gets. That's where the language gets a little tricky, right? When you say that your suffering is intolerable, it's a very subjective thing, right? It's not. How do you. One of the cases that I've written about, this young man recently died. Died in January. We can talk about that a little later in depth. But, you know, I spoke to the physician who euthanized him, and she said to me, well, who are you to decide if this individual's suffering is intolerable? If, you know, a hypothetical person. She was referring to a hypothetical person with a very similar condition as the person who had just died. That if this person had type 1 diabetes, if this person was blind or was in a wheelchair, who am I or who are you to say that their suffering is intolerable? That's where the language has gotten quite controversial, because all you need to do is just tell your doctor at this point, as has happened to this young man that I wrote about, is that, look, I just can't live with this condition anymore. I do not want to be blind. I don't want to live as a blind person. As I get older, I'm tired of dealing with my dad diabetes, and also I have seasonal depression. So these, you know, and this suffering is intolerable to me. And I just don't want to live with this anymore. And there are plenty of doctors out there in Canada who think that this is sufficient enough to approve an individual for maid.
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B
Yeah, I mean, so the obvious difference between someone like that and someone with a terminal illness is that, you know, we all know people in our lives or people, you know, who later become motivational speakers. And we see, you know, you see David Goggins talking about how he was horribly depressed as a 20 year old and now he's David Goggins or any of these people, right? There are people that have attempted suicide, failed, and then gone on to live happy lives after some combination of personal growth, therapy, the right drugs, increasingly with the psychedelic revolution that I think is coming, whether it's, you know, ibogaine, mdma, transcranial stimulation, I mean, all of these things are on the horizon. Some of them are having fantastic results with people with, with certain mental illnesses. The notion that the government should be involved in canceling that life which could go on to be a happy, flourishing life, is totally different than someone who is going to die regardless in the next few months. Right. So ethically those are two different cases and there should be an ironclad legal difference between those two cases. I'm curious, what is it about Canada's political culture? What beliefs and values are in the air such that so many people seem okay with the expanded policy which most places on earth I think would be a non starter?
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D
Well, I think this is a feature of a lot of western countries. I'm originally from India and I contrast so much of what I see here to what I've experienced in India. And I think one explanation that I've come to, I mean, there are several, but I can go through them. One is cultural. I think Canada has become like many western countries in an intensely individualistic society and places autonomy at the center of life. So suffering, one's suffering is no longer seen as something that you endure, something you endure collectively or spiritually, but you know, as a problem that needs to be solved through personal choice and in this case with some help from the state. The other thing that is Canada specific, I would say, is that our health care system here, our socialized healthcare system, state funded health care system, is overstretched and often unable to provide timely care for people who are desperately in need. So when I write about MAID and I speak to doctors who are against medical assistance in dying, they'll say, you know, Rupa, the problem really here is that we don't have enough money for palliative care. The doctors who are empowered to carry out MAID are better funded than we are. So therein lies. There's an incentive system in Canada, a structure in place that perhaps incentivizes doctors who perform MAID as opposed to doctors who provide palliative care. And so if you're a vulnerable person, you sometimes feel that the state facilitates death faster than it can provide meaningful care. And I also think another part of this is ideological. The language surrounding MAID has shifted over time. As I mentioned earlier, the moral and legal boundaries have rapidly expanded. It went from something that is tragic and something that is exceptional towards if you look at some of these right to die organizations, they will talk about dignity, they'll talk about empowerment, and they'll talk about the right to die. And that is about autonomy. And that autonomy becomes the highest principle. And so if unbearable, intolerable suffering justifies euthanasia for the terminally ill, why not for the chronically ill? If you can have MAID for physical suffering, why not for mental illness? And that's how the logic goes. And on autonomy, I was reminded of a point a Dutch professor of neurophilosophy made to me a few months ago. His name is Julian Kipperstein. And he said something very interesting about autonomy. And I'm not quite sure if I agree with him, but he said that we often speak about autonomy as though human beings are isolated. We're fully rational actors making these decisions entirely on our own. But in reality, our choices are. Are shaped by our relationships with people in society. It's shaped by the environment that we're in, and it's shaped by economic conditions, whether we feel loved or loved, supported or abandoned. So his argument is that autonomy is never fully independent because we make decisions within this context. And so I think with Canada, and then you have a political class, right, in a place like Canada that is more than happy to enable all of these things. And so I feel like all of these things have come together in Canada, in the Netherlands as well. I would say the Netherlands is on a different path altogether, where MAID for mental illness is legal in the Netherlands. And so they're. They're, you know, they have a very, very different perspective on dying in a way that would shock most North Americans. And so I think a lot of it also has to do with the fact that Canada is more like a European country in that sense, you know, culturally, when it prizes autonomy over everything else.
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B
So I remember when I looked into this for the piece I wrote for the Free Press, there was a strict separation between Canada, Netherlands and Belgium, on the one hand, which had these loose laws. You didn't. You don't need terminal illness and therefore had case after case after case of people in their 20s who are effectively sad, for various reasons, offing themselves. There's a strict separation between that and the case of Oregon State, Australia, New Zealand, where there are death with dignity laws that are limited to those with terminal illnesses. And I really didn't see much reporting about, you know, people in their 20s. I actually didn't see any people in their 20s without a terminal illness deciding to kill themselves. Is that an accurate picture in your view of what's going on? And if so, does it just come down to having the right law with the right restriction around having to have a terminal illness?
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D
So if I've understood your question correctly, you're saying that the laws are weak and that's why you're seeing, you're, you're seeing people having this wish to die, and therefore they're applying to die. Is that, Is that your question?
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B
Yeah, yeah. Essentially, yeah. Because Oregon, I know Oregon has had a death with dignity law much longer than Canada has. And all the horror stories that you've reported on and that I've seen, they all come out of the countries with the loose laws.
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Right.
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B
With. With the Netherlands and Belgium and Canada. And it seems like they don't come out of the countries that have similar laws, but restrict it to the terminally ill. So is that the crux of.
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D
Sure, yeah. As I mentioned, track two expansion did open the floodgates, so to speak, in terms of people just, you know, applying for maid because they were socially isolated or they couldn't pay the bills or they couldn't. They were feeling despair. And certainly in the Canadian case, in Canada's case, the fact that track two came into being in the middle of the pandemic, that too, when people were especially vulnerable and young people especially. So that I absolutely would say that the. You can say it's all legal, but you have to then also question, well, where are we heading with this? What are we doing? What's the end goal here? Do we want to make death, do we want to make euthanasia so readily available under conditions, under any normal circumstance, common sense would suggest that, no, this person has many years to live, but that's not what's happening. Right. And so, absolutely, I do think that the slippery slope argument, which is what a lot of people point to in Canada's case and in the Netherlands for that matter, we're Already there people say we're more like in a water slide situation right now. And that, that does come down to the law.
- [26:49]
B
Yeah. So the slippery slope argument, though, I, I, when I was looking into it, I was skeptical of this because it seems to me, and I, I would like to double check what the original Canadian law said, but you have cases like Oregon, Australia, New Zealand, where it was, it's always been for the terminally ill only and it's never slipped. And then when I looked at the original law in the Netherlands and the original law in Belgium, the original laws were not restricted to the, the terminally ill. Correct me if that's wrong, but that's what I found when I looked at the original laws in those two countries. And so it seems to me there actually hasn't been, perhaps Canada is the exception, but there hasn't been much slippage between the two kinds of laws. There's just been laws that are rather capacious to begin with. And then therefore doctors have had this open door to creep through for years and perhaps the practice has expanded. And then there's cases like Oregon where it's just terminally ill, you've got six months to live, and it's never expanded outside of that. And I think, you know, I, I, I would caution against opposing all such laws because of the horror stories in cases like Canada, the Netherlands and Belgium, because it seems to me that you can have, you can have a law that is restricted to the terminally ill and doesn't creep outside of that. And that's important as well, given how much suffering people do experience who have terminal illnesses.
- [28:37]
D
Right, right. And we're seeing that in the UK right now with their assisted dying bill. I believe it was defeated a couple weeks ago, but that was just geared towards people who are terminally ill. But because MAID has been so controversial in these other countries like Canada and the Netherlands, that people in the UK are watching this, watching these stories, they're hearing these stories and watching these developments in these countries and they're like, do we really want this here? And so the unfortunate thing about the expansion is that in countries where track one MAID for the terminally ill could be an option, and you do it under the rarest of circumstances for people who are literally within weeks of dying. And those things can be easily determined. I think, I'm not a physician, but I think when your doctor tells you you have four months to live or five months to live and there's really no other treatment option left because of 4th stage cancer or whatever, I think for those people, their suffering can be. You could help them with a track one MAID like program, but obviously expanding it beyond that becomes very controversial. And that's when you hit the slippery slope argument. And that's exactly what we're seeing in places like Canada and the Netherlands. And so, yeah, I mean, absolutely, any expansion is bound to, especially in a state, Let me put it this way, especially in a place like Canada where the system generally seems to want to enable these physicians. Right. There hasn't been a single doctor in Canada who's been reprimanded or they've lost their license because there have been concerns about the fact that they approved someone for MAID when that person could have lived. There's been no consequences for anyone. There's been. And so in a sense, the law actually protects these doctors and physicians who approve people for maid. There's no real oversight, whatever oversight that exists in Canada. There's an incredible amount of pressure on these doctors to not ask questions. The Ontario MAID Death Review Committee is actually being kind of disbanded and they're going to put in doctors who are pro maid to be on the oversight committee. This is an oversight committee that is going to be, that's going to have doctors who are generally on board with medical assistance in dying, and they're going to get rid of the doctors who are not. So you have a situation where it's not just the legal expansion of maid, but you also have a state that is more than willing to go along with this. And they're saying, well, you know, can we expand this further? And that truly is chilling because, you know, if you're a vulnerable person and there are lots of people like that today, you're thinking of MAID as a way to overcome your problems. I suppose the other thing I want to point out is that in the Netherlands, for example, example for a lot of young people there, young people I've spoken to, they, they, you know, they've told me, look, Rupa, we, there's a reason why we're, we're applying for maid. And, and that reason is, you know, I don't want to kill myself. I don't want my parents or my family to find me in a violent state. And I don't want to leave them with that image. And so medical assistance in dying has become a way for people to. So that they don't kill themselves and avoid pain for their families. So that's another aspect of my reporting that came out when I was writing my story about the Netherlands.
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C
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podcast app or YouTube and subscribe today. So I remember reading in one of your pieces that some of these doctors account for a vast over proportion of the the deaths. In other words, doctors have different personal standards for when they will grant a maid request. And it looks like some doctors become known and sought out because of their extremely lax standards. Just like, you know, everyone knows in America you want to get an Adderall prescription and you don't really have adhd. There's certain doctors you can go to that basically hand them out, right? And those doctors become known. And you know, it seems like even some of the doctors that, that do a lot of these procedures and you know, euthanize. A lot of people feel ideologically that they are doing something important and good and they have a set of beliefs and values that make them almost an activist in their euthanasia.
- [36:31]
D
I think that some of the doctors I've spoken to think that they're basically God. I think they feel powerful in making these decisions. One doctor I spoke to, she's a prolific maid provider in British Columbia, in Vancouver. And she's, she loves the limelight, she loves talking about the patients she's euthanized over the years. And she started off, I think she went from delivering babies to now euthanizing people. And she told me, look, and she said this elsewhere as well, that I like to push the boundaries as much as I can when it comes to medical assistance in dying. And that was pretty extraordinary to me. And this is the same doctor that ended up euthanizing Keanu Wofayan, the 27 year old man from Toronto who had type 1 diabetes and had lost vision in both his eyes. And she performed made when he had been rejected by doctors in Ontario where he lived. So there's a bit of maid shopping as well, right? If you live in a province and you can't find a doctor to kill you, you can always go to another province and find a doctor who might be willing to do that for you. And that's exactly what happened here. And so, and you know, the expansion of maid in Canada has also meant that you can die the same day that you request death. And this was one of my more recent pieces, and this is reporting based on a committee report on maid, an oversight body that looked at cases in Ontario where people, you know, died like within a day of requesting MAID. And some, some insane number, like 30% of those deaths happen on the very same day or the next day. And so you, you know, you have, you have a system where, you know, where, where if you're even, even with track one, right, Even with track one, what's happened here is there's been a loosening of track can get made within a day.
- [39:14]
B
Yeah, that's a, that's a problem because I mean, I know there's, there's a stereotype of suicide attempts as like long planned, you know, like almost decision decisions that have been come to rationally. But I think, I think there's also research suggesting a lot of suicides are spur of the moment decisions and decisions that like, if you don't go through with it right now, you might not go through with it at all or for a very long time, something terrible has happened to you. And so the ability to get it signed off on when you don't have a terminal illness, again like that, to me that's the key variable. Because if you do have a terminal illness and you're dying within the next couple months or a couple weeks anyway, whether you can get a same day euthanasia or a same weak euthanasia, that difference matters a lot less. Because if a mistake is made, it's, it's, it's a, it's a rounding error on your whole life anyway. But if you're not terminally ill, then the notion of getting a same day euthanasia, if you're in an impulsive downswing or you are by, you are bipolar and you're having a manic episode or you're having the downturn after a manic episode, I mean, the notion that you could end it all right there is really scary.
- [40:41]
D
Well, absolutely. I mean, I mean, we're not even talking about the expansion of MAID to mental illness because that's not yet legal in Canada. But it is happening for sure within the system. You know, in Kiana Wofayan's case, his cause of death was type 1 diabetes, but really it was, I think it was mental health issues for which he could have received treatment, I'm sure. But let's go back to track one Maid, where you can get death within a day of requesting maid. And like with suicide, people can change their minds, right? People can have second thoughts about their decision to die. And so even with track one Maid, some of the stories that I saw in this committee report that I read in this community report, there was one case of a woman who had expressed an interest in maid. She had some kind of a terminal illness, but then later changed her mind citing religious beliefs and other personal issues. She didn't want to go through it, but the doctors in the hospital made her go through some assessments and they were concerned about this. And they were also concerned that her principal caregiver, who was her husband, was possibly facing burnout and maybe, you know, was possibly coercing her into, into, into, into dying. All of these, you know, this, this, this, this doubt should have been, you know, grounds for not going ahead with, with maid, but she was euthanized the same day. So, you know, we'll, we'll never know. You know, she may have lived for another few Days, another few weeks, but that life could have been meaningful. Who's to say that it wouldn't have been? And there was another case. Again, we're talking about track one, terminal illness. And this shows you that even with something like terminal illness, track one made with all of its precautions and so on, you do have cases where people can change their minds, but eventually the system decides that may should be the option. There was another case of a man with cancer who became delirious and very unresponsive in hospital. And according to this report, the doctors aroused him, shook his head and interpreted his blinks and the responses he was mouthing as consent, and then proceeded to kill him that very same day. So basically what all of this tells me is that there's a medical culture now which is hastening death. And as one ethicist put it to me, he said, this is the path of least resistance.
- [44:05]
B
Now, how does all of this work in the case of a do not resuscitate? Because we've long had, presumably, laws and policies allowing people to say in the event of a heart attack, I have made the decision, do not resuscitate me, allow me to die. Even though that would be malpractice for any other situation. Emergency rooms have to treat you by default. Right. So how do we allow people to come to that decision normally? Is it. Do you have to ask once? Do you have to ask multiple times? Is there a process? Do you know much about that?
- [44:40]
D
Well, I think in Canada and in the Netherlands and maybe even in the US I think do not resuscitate if you're wearing a do not resuscitate tag. In fact, one of the Zoraia Terbeek in the Netherlands who died a few weeks after I spoke to her, had a do not resuscitate tag. Wore it around her neck. And so if something had happened to her, her, that they would have respected her wish. I think. Don't quote me on it, but my sense is that, I mean, based on my research, but it's not something that I'm very clear about right now, is that I think that it would be respected. It's a bit like voluntary stopping eating and drinking. Did you know that voluntary stopping eating and drinking is actually legal? So if an individual were to say, look, I don't qualify for maid, but I'm going to just stop eating and drinking, that's perfectly legal. No one can stop you from.
- [45:48]
B
I would assume it's legal, right?
- [45:49]
D
Yeah, yeah, it's completely legal. And in the Netherlands.
- [45:54]
B
So is it actually practical to kill yourself that way. At some point, doesn't your body just sort of take control and make you sip some water?
- [46:05]
D
It's very painful. It's a painful death. I mean, this is why people who would prefer to get made instead of choosing voluntary stopping eating and drinking. But, you know, it takes a fair bit of determination, I suppose, to, to do that and discipline. And there's a story that I'm currently working on that actually looks at this, and I don't want to give too much away, but it is a very painful way to go. And your body shuts down. You get to the point of no return. That's when your body starts to resemble that of someone who is on their, you know, on their deathbed, and it just begins to shut down. And that's why it's called the point of no return. But you are, I think, encouraged to take small sips of water along the way. But obviously no food. And within, for Most people, within 10 days, your body just shuts down. And then also in the Netherlands, there are hospices. So if you're a person who wants to go, wants to do this, you can check yourself into a hospice. And the palliative care physicians there will make you feel comfortable. You know, they'll give you medication to make sure that you're not in pain as you stop eating and drinking. But it's perfectly legal. So for people who can't get made voluntary, stopping eating and drinking seems to be an option. And one interesting thing about it is that we don't really know. We don't really have hard data on how many people are dying from vsaid. We don't really know that from what, from voluntary stopping eating and drinking. We don't really know the number of people who've actually died that way when they could have died through made. And this is something that a lot of people are, you know, so in a way, actual, you know, the number of young people who are dying because they just don't want to, you know, they just don't want to live anymore could be a lot higher than official made data reveals to us. Because they could be just, you know, they're just stopping to eat.
- [48:56]
B
So then what's the, what's the solution in that case? Is it that you would force them to take an IV if an otherwise healthy person is refusing to eat and drink? That you have the legal ability to force them to do so?
- [49:10]
D
No, I mean, I think it's, it's, it's one of these things. It's actually Quite legal if you don't want to. There was a Canadian woman who didn't qualify for maid and she said, okay, I'm gonna stop eating and drink. I'm not quite sure what happened to her.
- [49:27]
B
And I think my question is, like what? Like, is this related to maid? Because if you want to kill yourself by not eating and drinking, you can just do that, right?
- [49:38]
D
Like, it is, it is. So it's related to maid in the sense that there's an overlap right there. These are typically young people who don't qualify for maid. They've applied for maid and they've been rejected because they don't meet the criteria, they don't meet the eligibility criteria. And so they don't want to kill themselves by jumping off a building or through other violent ways. This seems to be a more sort of humane approach and a legal approach, a legal way to end one's life. And I'm not sure how much of that is a phenomena in Canada in the U.S. but it certainly is something that is being studied a fair bit in the Netherlands.
- [50:28]
B
So I'm connecting the dots of what you're saying. Are you saying because of maid we are entering this culture of normalization of suicide? And in, and because of that, some young people, they form that expectation that, yeah, I have a right to die because of this culture. And then if they get rejected, they seek other, other means where like maybe in the past, without that culture of normalizing euthanasia and suicide, maybe they wouldn't have even gone down the road. Is that sort of what you're implying?
- [51:03]
D
Absolutely. There is for sure a normalization of suicide itself. It should belong in the realm of the tragic, but it's become increasingly normalized and there's consumerization of suicide itself. In one of my stories, again from the Netherlands, there's a Dutch group that is, I would say, at the cutting edge of this movement where members of this group openly advocate making assisted suicide cheaper and easier and eventually available outside traditional medicine altogether. They envision a future where suicide kits would be made of, made available and along with anti nausea medication and painkillers in these kits. And they could be purchased almost as routinely as over the counter medication at pharmacies and so on. And this one individual I spoke to who's spearheading this said that we've also discussed technological safeguards like fingerprint locks, so, you know, so as to prevent toddlers from accessing these suicide kids. It's just, you know, it's just extraordinary how all of this has evolved in how calmly and rationally, all of this is being discussed almost like, you know, it's the consumer convenience issue rather than there's something deeper going on here. There's, there's a. There's a moral and civilizational shift, in my view.
- [52:49]
B
So is, is this all downstream of the fact that, you know, Canada, certainly, and you know, half to two thirds of America, most of Western Europe, is no longer religious, no longer Christian, and so the notion a against, first of all, of a prohibition against suicide. There's no moral prohibition against suicide if you're secular, at least not coming from a spiritual point of view. And life is increasingly defined by how you as an individual experience pleasure and happiness. And to the extent that you as an individual are not experiencing pleasure, happiness, well, I would still argue from a secular point of view. Plan A should be to figure out how to become happier, even if it takes a really long time, especially because there are so many examples of people that have been just as miserable as you are, that have figured out the right formula in the fullness, whether it took years or decades to live a really happy life. And it would be a travesty if they had ended it all back at their lowest moment. But if you don't, don't have a religious view that life is sacred and that suicide is a sin, then it's possible to talk yourself into it and kind of reason your way into. Into ending your life if it really is. If you really are at a low point and you are suffering. Right. Is that what this is?
- [54:24]
D
Yes, I think religion is certainly one institution. When you look at the fact that, as I mentioned earlier, we've become a very individualistic society where suffering is no longer done communally. It's not experienced communally, but on your own. Where previously you'd go to the church or to the temple or to the mosque or whatever religion you belong to. But now a lot of us live in isolation, especially young people who are. I think we're still seeing some of the effects of the pandemic right now, where young people been struggling with loneliness and alienation and mental health issues, and then where suicide is not treated as something that you prevent, but increasingly something that you facilitate. So religion for sure, if you're talking about how institutions once played a very important role in making us feel connected, that's changed quite a bit. And you no longer even need to be outside and make friends. You know, you can just be on your computer all day and chat with people online. And so those changes have certainly made a difference on religion. I'll give you an example in the Netherlands, you know, I was told repeatedly by religious scholars who said that, you know, we live in a post religious society here in the Netherlands, you know, we don't. And they, you know, when my story about Zariah Turby came out two years ago, the Dutch reaction to the story was very different from the American reaction to the story. The Americans were mortified. They were mortified at how this was going to, that this was being facilitated her death. This woman was only 28 years old. Whereas the Dutch reaction to it was, well, you know, it's all about autonomy. And you Americans, you know, with your religion and your morals and you know, we don't have time for that. You know, we are an evolved society, you know, and you people are backwards in thinking in that manner. You're so old fashioned and so on and so forth. So at least in the Netherlands, not so much in Canada. I'm not quite sure how to, you know, I wouldn't say the average Canadian thinks like the way the average Dutch person thinks when it comes to death, but certainly in the Netherlands it's something that they're very proud about. It's a value, Euthanasia is a cultural value in the Netherlands. It's not something that they're embarrassed about or something that they necessarily worry about. It is the ultimate expression of autonomy.
- [57:45]
B
So what is the, I mean the truth is in America we have euthanasia very frequently, but it's reserved for pets. And you know, it's, it can, it can be easy to misunderstand what I'm saying here. So I'm not comparing humans to, to other animals, but I am noting that definitely in America people love their dogs, especially also their cats, but people really love their dogs as if they were family members. And I think it's a, it's a real love. And in, in those cases it seems we are okay with, with euthanasia. What marks the principal difference between how people should think about euthanasia with their pets and how people should think of euthanasia with terminally ill family members?
- [58:40]
D
Well, I mean, I had to my cat two years ago, coincidentally around the time I was writing about Zariah developed kidney disease suddenly. And I did everything to save his life. I spent tons of money because he meant everything to me. But in the end I saw his suffering. I saw that he was not the way he used to be. He was just not, you know, he wasn't, you know, he didn't want to be held. He just wanted to sit in the Dark, he wasn't eating, he'd lost a lot of weight. It was very painful to see him suffer that way. And he just looked unhappy and miserable. And it was one of the most painful decisions I've had to make. And so. And I watched him die in my arms, you know, as the vet that injected the chemicals into his body. It was a very difficult decision and it was a very painful decision. But I think it was the right decision because I just didn't see how it could have been humane for me to humane to see him continue that way. He was not meant to live a life like that. I just couldn't see the see that happening to him. And I think with terminal illness it's the same thing. But again, here, you know, I've been. If you don't mind, I can share a personal story. So around the time that I heard that Keanu Ofayan died in January, got a phone call from his mother saying that her son had died in Vancouver and that he had finally found a doctor who was willing to carry out the procedure. Around the same time, I learned that my father in India was diagnosed with primary central nervous system lymphoma. They found a cyst in his brain and he needed a very urgent brain biopsy. As I was writing about Keanu's death, this 27 year old young person with type 1 diabetes and blindness and that he had given up on life, I was watching my own father fight desperately to hold onto his. And five months later, my father can't speak because the part of the brain on which they operated controls speech. He has undergone chemotherapy and radiation. He's doing really well. His cancer is in remission. But what strikes me most is not just merely his resilience, it is his desire to live. I mean, despite the pain and exhaustion, the loss of speech, the humiliations that he's experienced that serious illness brings about in people. As you mentioned, your mother who died of cancer, he's soldiering on. He still loves life and he wants more time. He's fighting for every single day and he finds joy in ordinary moments. So as for me, as someone who's written quite extensively about death, I look at my father and I wonder, why is he so different from someone who's 73 years old here in Canada, perhaps given a similar diagnosis and chooses maid? Or why does a 28 year old give up on life? And I don't think my father in India is an outlier in the sense that he wants to live as much as possible. I think in places like India, you still have strong cultural family ties. I think religion continues to be extremely important. And I think these are factors, these are things that are increasingly they're disappearing in the West.
- [62:53]
B
Okay. Rupa Subramania, thank you so much for your reporting and for coming on my show.
- [62:57]
D
Thanks, Coleman. Thank you for having me.
- [63:02]
E
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