February 16, 2021
Honourable senators, I rise today to speak to the third reading of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying).
The debate around medical assistance in dying continues to test us on some of the biggest issues we might ever be confronted with: the nature of death and dying and the role that personal agency plays in determining one’s end-of-life journey. A subject inherently difficult to discuss, it is one shaped by personal beliefs, morals and ethics. It is a conversation that involves courage and is deeply rooted in one’s values and lived experiences. It is both personal and societal in nature, those often conflicting even as we explore our own thoughts.
First, language itself helps inform thought. We are all aware of the subtleties of the words we deliberately choose and how they convey not only technical meanings but beliefs as well. Let us take a cursory look at the evolution and terminology used to describe MAID over the last few decades. Terms like “voluntary euthanasia” and “assisted suicide” have gradually been exchanged for “physician-assisted death” and “medical assistance in dying,” language that does reflect our ever-evolving society.
In 1994, the Special Senate Committee on Euthanasia and Assisted Suicide examined the wide-ranging and diverse terminology used in Canada and abroad in reference to assisted death and dying. In their final report, they concluded that:
. . . the differences in the definitions are seldom based on the literal meaning of the terms. . .
And argued that:
. . . the disagreement is essentially with respect to the moral significance of the words.
This was proven to be true 20 years later when the Special Joint Parliamentary Committee on Physician-Assisted Dying reviewed the very same terminology once again. Our committee heard from a number of witnesses who discussed the language that should be used in relation to MAID. Some witnesses held the opinion that the terms “physician-assisted suicide” and “voluntary euthanasia” are well-defined and clear and should not be abandoned, while others argued that these terms are stigmatizing.
After careful examination, our joint parliamentary committee concluded that medical assistance in dying was most preferable as it:
. . . reflects the reality that health care teams, consisting of nurses, pharmacists, and other health care professionals, are also involved in the process of assisted dying.
There were practical as well as legal reasons to use this language.
Over the last few months, Bill C-7 has attracted substantial attention across the country, giving rise to a contentious public debate, just as with Bill C-14. There has been a full range of opinions on the provisions of Bill C-7. Opponents of the legislation have raised serious concerns, calling for tightened safeguards at the very least, while proponents have praised the provisions and declared them an important development, yet not quite enough.
Viewpoints on the most fundamental and challenging questions of MAID are divergent. They always have been and always will be. The argumentation presented in this debate is rarely unreasoned, which makes the task of reaching a consensus on the matter of Bill C-7 more difficult. The personal and societal challenges will not diminish the moral difficulties of this debate for years to come because MAID will always provoke strong and deeply felt reactions.
Our own emotionally charged debate in this chamber about matters of constitutionality and morality should not come as a surprise. In fact, ancient philosophy can help us understand the influences behind our decision making as legislators.
Consciously or not, moral philosophy guides our choices and leads us to the most ethically correct resolution in accord with the ethical theories themselves. One class of ethical theories known as deontology derives from the Greek words for “duty” and “science.” According to this class of theories, a person has the absolute duty to do the right thing, no matter the situation or consequences. Simply put, there are right and wrong actions, and if we follow the rules, we are ethical. If we do not, we are unethical.
As Kant famously wrote in his essay Groundwork for the Metaphysics of Morals:
. . . I ought never to act in such a way that I couldn’t also will that the maxim on which I act should be a universal law.
In contrast to deontology is consequentialism, which is also known as ends-based thinking or utilitarianism. This class of theories requires a person to weigh the consequences of their actions and choose the one that brings the most good to the most people.
In ethical theories on rights and virtues, we find The Golden Rule and Aristotle’s Golden Mean, not to be confused with one other. The Golden Rule is instructive: “Do unto others as you would have them do unto you.” Meanwhile, Aristotle’s golden mean dictates that a virtuous act is the intermediate between two extremes.
Honourable senators, the reason to remind ourselves of this lesson in moral ethics is to emphasize the depth and conflicts of thought of such decision making that we are faced with here and now.
In his book, “How Good People Make Tough Choices: Resolving the Dilemmas of Ethical Living”, Rushworth M. Kidder, an American author, ethicist and professor wrote:
. . . these principles are useful because they give us a way to exercise your moral rationality. They provide different lenses through which to see our dilemmas, different screens to use in assessing
them.
As human beings, our thinking and perception of the world around us is shaped by our underlying value systems and the ethical framework to which we subscribe. As such, our debate on issues that are inherently values-based, such as MAID, reflects our fundamental differences. Just as Kant, Aristotle and Plato had different ways of rationalizing human reason, we too have similarly different codes of ethics.
In the preface to the first edition of his work, “Critique of Pure Reason”, Kant poetically wrote:
. . . Human reason, in one sphere of its cognition, is called upon to consider questions, which it cannot decline, as they are presented by its own nature, but which it cannot answer, as they transcend every faculty of the mind. It falls into this difficulty without any fault of its own. It begins with principles, which cannot be dispensed with in the field of experience, and the truth and sufficiency of which are, at the same time, insured by experience. With these principles it rises, in obedience to the laws of its own nature, to ever higher and more remote conditions. But it quickly discovers that, in this way, its labours must remain ever incomplete, because new questions never cease to present themselves . . .
While these words are difficult to digest, they are nonetheless valuable.
Kant makes an important distinction: the policies and standards that we create as legislators are a product of thoughtful discussion and reflect the wisdom of our collective experiences, but no policy is permanent and all-knowing. We cannot always anticipate questions and situations that may arise in the future.
This is to be expected as there is no such thing as an absolute agreement. It is hard enough to conceptualize morality and ethics, let alone operationalize them in the form of legislation with regard to MAID. Yet, understanding this concept — that human reason is ever evolving, non-absolute — can be a powerful antidote to our uncertainty over the right path forward.
Honourable senators, we have engaged in a lengthy and passionate debate. We have heard witness testimony and read the reports available to us. Now, we attempt to find a path forward, through our differences in ethics, morality and values.
And while we each possess our own individual codes of ethics, we should remember that what is most important is that we create a foundation, one that balances the autonomy, liberty and dignity of individuals who suffer from grievous and irremediable diseases while protecting vulnerable individuals. A foundation that will make space for both scientific and emotional realities, as well as the human spirit. This balance should allow Canadians the agency to make decisions based on their own personal codes of ethics and value systems.
Honourable senators, the time has come to move forward in the best interests of Canadians and take an initial step in the long process ahead of us to find solutions to the problems that the issue of MAID will continue to raise for years to come.