Who really wants to die ? (A Brief Quantitative Analysis of the Purported “Need” for Euthanasia)

Table of Contents

  • Part V : The Absence of Suicidal Desire amongst the Survivors of Catastrophic Injury
    • A few useful recollections
    • Refusal of care, and the original slippery slope
    • The required moral consensus on the desirability of (at least) some suicides
    • A case in point : Spinal cord injury
    • A personal, indignant resentment, evoked at the view of this drama
    • The terrible nature of such literary assault
    • A more faithful portrait of real life
    • A conclusion of infantile simplicity

Who really wants to die ? (Part I)

The euthanasia debate is now raging all around the “developed” world, at different stages, at different rates and with different points of contention. In some places, the question is about whether any “assisted” death will be allowed ; in others, whether admission criteria and formalities will now be adapted to allow greater access ; whether the modus of death will be suicide (only) or homicide (also) ; whether providing death is legitimate medical care ; whether death is a “right” for the mentally “capable” ; whether, therefore, the incapable shall also possess that right and benefit from that care ; whether the State will guarantee (and even provide) its delivery (as in Canada) ; and whether individual medical professionals will be effectively coerced to provide it.

In other words, efforts are going forward, in every country : to enlarge, to facilitate, and if I may say – to maximize – the recourse to assisted death in our contemporary society. But how is that possible ? Indeed how did we get here ? Let us take a step back to ponder these questions.

— From the beginning, then … Who really asked for euthanasia ? Who is it for ?

That to be sure, is a question of the utmost importance, because, in any economic theory, the scale of a proposed service (“supply”) must always be proportionate to its’ “demand”. And therefore, euthanasia, as a service, should never be allowed to occupy a place in our society – and certainly not in our medical practice — which is larger than can be justified by the number of those eligible individuals who actually desire it.

So what then, is the true “demand” for euthanasia ? And does it match the scale of the service now provided ? Can it justify the consequent transformation of medical culture in Canada ?

Apparently, and unfortunately in this regard, expectation has far outstripped observed reality. For overwhelming public perception now holds that suffering people have, indeed, collectively demanded and achieved (in the time-honored tradition of popular struggle) the “right” to die.

Now, I am sure that many reading this will take issue with the accuracy of that perception (and especially with the assumptions at its root). However, I do not doubt that the average supporter of assisted death truly believed (and indeed still believes) that in legalizing euthanasia, he (or she) has mercifully granted an informed wish for death, expressed on the part of a whole class of real people, who are afflicted with what seems (to them) unbearable suffering.

In other words, the prevailing public opinion, aided by an orchestrated urgency emanating from virtually all of mass media (itself under the influence of nearly unanimous intellectual fashion), holds that the sick and the disabled positively desire the voluntary right to die, and that assisted death was legalized in order to permit the satisfaction of that desire.

Clearly, if that were indeed true, the entire enterprise would also be justified (in an economic sense). But is it (true) ? And where did such a popular opinion originate in the first place ?

The Popular impact of Celebrity Suicide (Who really wants to die ? : Part II)

— The sources of popular perception examined : a great quantitative divergence between the portrayed importance, of celebrity suicide, and the observed facts

Because most people pass much of their lives (most thankfully) far from the realities discussed here, the first source of public opinion regarding suicidal actions, generally originates with the behavior of those celebrities, dear to our hearts, who do, suddenly, face real-life crises (including sickness and disability). First knowledge, then, comes only at second hand, and (unfortunately) even then with little benefit of pondered wisdom. For at these most difficult times, we usually see a marked tendency (in public commentary) to positively lionize those individuals who take their own lives ; even to the extent of lavishly praising their “courage” !

Such were, for instance, the cases of American actor Robin Williams (1951 – 2014), and the once national diva of Quebec, Pauline Julien (1928 – 1998).

Yet on the other hand, we also have heroic survival figures such as Canadian athlete Terry Fox (1958 – 1981), Quebecois politician Gerald Godin (1938 – 1994), or American actors Christopher Reeves (1952 – 1904), and Michael J. Fox (1961 – ). And these heroic characters, also, experience the exact same popular adulation… and from the exact same people !

To be fair, it would appear that the public actually vibrates with equal passion — and equal sympathy — regardless of the outcome : they love their celebrities and they support them, whatever they do. Moreover, to resolve the apparent contradictions raised by this inconsistency, public opinion has also adopted the notion of a sort of unjudgeable personal and existential choice : equally heroic, equally noble, and equally weighted (numerically speaking) on both horns of the suicidal dilemma.

But this last part, this crucial numerical part (and hence the validity of the whole description), is, in fact, grossly distorted : because ordinary survivors have a way of passing largely unnoticed ; and thus do not show their proper numerical weight.

Nor is any of this at all remarkable : for be they ever so famous in their prime, our “stars” are normally absent from the news for years at a time as they grow older. And the inevitable report of their natural deaths comes, often, as a surprising recall that they had ever existed ; while the younger generation, incapable even of recognizing their names, remain essentially ignorant of those who have passed. And whereas there are occasional life-blazing heroes, like Terry fox, who shine ardently in their moment of refusal and resistance, many more numerous are those who quietly hide their disabilities, as best they may, and then simply disappear into private life and oblivion. For each Terry, then, there are innumerable (though much less visible) people, of a similar inclination.

The suicides of famous persons, however, are singular news events of the highest interest ; they are immediately reported, and profusely commented upon, throughout the world. Naturally, the result of this instant and enormous emphasis is to grossly inflate their true statistical importance. For one single suicide gains such notoriety, in this manner, that it will effectively outweigh the memory of literally thousands of other, equally famous people, who have lived and died in the more usual fashion.

Above all, the celebrities who commit these acts of suicide are deeply held in the affections of their “fans” : who have a naturel desire to “understand” them ; to identify with their fate ; to validate their purported reasoning ; to vindicate them ; and to stand in solidarity with their choice. They will, in any event, be fondly remembered. And there is a corresponding tendency in the media — on television, in the papers and in the magazines : to use a tone and a vocabulary which serve to positively glorify the meaning of such suicides (and that, regrettably, in the spirits of those most receptive and most vulnerable).

And yet, we must insist : these acts remain entirely atypical ; acts which should more naturally elicit our sadness and our disappointment, I would suggest, than a congratulatory admiration.

In any case (and however that may be) — from a purely quantitative point of view — while we recognize that we will always be deeply affected by such tragic events (and much more frequently than we would wish) : the dearly mourned celebrities who are lost, in these iconic suicidal episodes, are much fewer than those who quietly withdraw.

And such, clearly, is the enormous numerical distortion that we must recognize in the fashions of common perception. For contrary to popular prejudice and enthusiasm : the small number of celebrity suicides provides no objective justification, whatsoever, for idealizing (and still less for normalizing) the notion of suicide as a general solution (for the physical, and mental, incursions of time and fate).

But with all of that said, it might still be imagined that the demand for death among ordinary citizens, afflicted with natural suffering and decline — that is to say : among the ordinary mass of “the halt, the sick, and the lame” – could actually be greater than among the ultra-privileged, rich and famous.

Addressing that possible misconception, then, will be our next consideration.

Life choices of the common man (Who really wants to die ? : Part III)

— the prosaic commonality of perseverance in life

Objectively speaking, ordinary folk are in no way more likely to seek voluntary death than are their privileged counterparts ; and probably much less.

In actual fact, these simple people, who accept humbly the changes of time and fate, with philosophy and fortitude, are everywhere to be found. We all know them. They are our family ; our friends ; our workmates ; and indeed, ourselves.

The famous public obstinacy of Terry Fox, to remain standing regardless of the pain incurred, finds a more modest yet perfectly faithful reflection among that vast throng of ordinary people, for whom each active day is, also, a marathon : the waitress with swollen ankles ; the mechanic with stiff knees and a sore back ; all of those whose pressure is too “high” or whose sugar is too “low” ; those who consume phenomenal quantities of ineffective pain remedies ; all of those — when healthy neighbors are leaving for evening activities on a Thursday night – who can think only of bed (and dream of sleep), in the hopes that tomorrow, again, they will once more be able to take up the same extenuating tasks, responsibilities and satisfactions.

But such, to be sure, is the shared destiny of all mankind, and particularly as we grow older ; a destiny assimilated naturally (with greater or lesser serenity) by nearly everyone, including those, also, who have been unhappily placed — despite themselves — in that newly targeted class of individuals for whom medicalised suicide (voluntary euthanasia) is now presented as the preferred option.

It is these people, then, who bear the brunt of this extraordinary innovation in social and medical policy. It is they who are so particularly ill-served by the mainstream media renderings of “death with dignity” ; accounts which are biased in vocabulary and in tone ; a bias which undermines both the personal confidence, and the public perception, of such “everyday heroes”.

And yet it is they (and not their suicidal brethren) who so obviously comprise the overwhelming majority of those now designated, as the intended clientele for euthanasia !

Surely it must be possible to create a vehicle, by which these typical patients might benefit from the euthanasia free institutions (and from the unconditionally life-centric care), which they deserve and desire.

But here again, in making such sweeping and general statements, one might easily predict forthcoming accusations of scholarly malpractice, in a lack of rigorous quantitative argument. With the reader’s permission, therefore, it would now seem necessary to reveal a few hard numbers.

The true scale of demand for euthanasia in Canada (Who really wants to die ? : Part IV)

— What is really at stake here ?

Faced with the complete up-ending of the Canadian medical industry which has been forced upon us by the unprecedented legislative redefinition of medicalized suicide, as benign “care” – and presented, in fact, as a universal right ;

Faced with the resulting obligatory and omnipresent intrusion of this practice into every corner of our public healthcare system ;

Faced with a duty imposed upon every doctor to inform each eligible patient of their “right” to die by euthanasia (whether said doctor believes the procedure to be appropriate in a particular case or no, and notwithstanding the negative burden of inflicting such informational aggression upon those typical patients who have demonstrated no autonomous desire to be euthanized) ;

Faced, moreover, with an actual obligation (duty) to perform the act of euthanasia (when requested by an eligible patient) which can only be avoided by the affirmation of an “objection of conscience” founded in “deeply held” (ie, religious) beliefs ;

Considering, that this exemption explicitly excludes the invocation of professional, medical, or scientific motives of refusal (because the legislative definition of euthanasia, as benign care, automatically denies any such pretention) ;

Considering, also, that even in the event that a physician exercise this restrictive “privilege of conscience” (to refuse to perform a specific euthanasia contrary to his or her best professional judgement), that such doctor must STILL collaborate, to the extent of providing an “effective” referral to a more willing colleague ;

Faced, then, with all of these extraordinary circumstances, and with the extraordinary burdens they place upon the typical non-homicidal doctor (and the typical non-suicidal patient) : We would, I believe, be entitled to expect the demonstration of an overwhelming patient demand for this service ; entitled to expect, that is, that the ill and the disabled would accept this proffered clinical death, in near-unanimous fashion.

But such is simply not the case.

As a matter of fact, the true figures which represent the real choices statistically embraced by actual patients facing the prospect of medical “aid” in dying, diverge to an astonishing degree from the officially sanctioned narrative to which we have become so accustomed in recent years. May the reader be the judge.

— The instructive cases of Belgium and the Netherlands

Let us stipulate, to begin with, that it would be little enlightening to begin this analysis in the Canadian context, because the arrival of euthanasia practice, in this country, is still too recent to permit accurate forecasting of future trends. Luckily, however, we do dispose of a large body of data — much more informative – originating from two countries (and immediate neighbors), Belgium and the Netherlands, which are fairly similar to Canada culturally and economically, and which have now encouraged the practice of legal euthanasia for nearly twenty years.

Without any doubt, as concerns Europe (and perhaps the world), it is the Dutch, along with their cultural-ethnic Flemish cousins (living just across the Belgian border), who have shown the greatest enthusiasm for euthanasia. And much more, to be precise, than even their immediate Franco-Belgian (Walloon) neighbors. In fact, prior to the arrival of Canada (and the deliberately radical “Canadian model”) the systematic insistence of the Netherlands, and Belgium, on true euthanasia (rather than mere assisted suicide) represented a sort of singularity among nations permitting different forms of voluntary death. The least we can say, however, is that our policy and attitudes, in Canada, were strongly influenced by the Dutch experience and intended, even, as an extension thereof.

— Nothing but the facts…

Naturally, in the reporting of statistics, there is a journalistic tendency to deliberately present figures under their most dramatic aspect. And in the present case, the desire for journalistic hyperbole was further aided by a perception, on the part of both adversaries and promoters of euthanasia in Canada, that their respective causes would be assisted by the most extreme possible interpretations of Belgian euthanasia growth rates.

And objectively, also, we must admit that both were correct. For those who believe that even one act of euthanasia is wrong (categorically or medically) will also consider ever greater numbers, of euthanasia deaths, to be ever that much more wrong. And therefore, reference to rising death counts is a certain way of generating increased and continued outrage among those of us who share the required ethical reference points.

But on the other side, for the promoters of euthanasia — for those who would wish to espouse a contrary moral position : a rapid expansion of recently legalized euthanasia practice, in Belgium, would seem to indicate a strong and growing demand. And this, they believed, would support the pretention that legalized euthanasia is a necessary service — desired and desirable — rationally provided in response.

To be clear, then, no one was offering any critical analysis of the misleading trends described in those early years.

— The growth and stabilization of euthanasia rates in Belgium and the Netherlands

To take a particularly egregious example, journalistic reports in 2018 still made generous reference to the fact that the yearly number of Belgian euthanasia deaths had increased tenfold in the first 15 years of legality (up to and including 2017). Certainly, that does seem like prodigious growth ! However, a more prudent analysis would remind us that ten times nothing remains nothing still, or in this case : that ten times 0.2% (of all deaths in Belgium) became only 2.2% at the end of that 15 year period.

Now it is true, that 2.2% of all deaths in that country would make a lot of bodies were they all brought together in one place. But it is also the property of large numbers and proportional relations that 2.2% is only a marginal fraction of the whole. And while it should, quite naturally, dismay the unconditional defenders of life, it is not a number which, I submit, should bring any comfort to the apologists of voluntary death.

“But wait a minute”, some might exclaim, “at that pace of growth, the euthanasia rate would be 22% in another fifteen years, and ALL deaths would be due to euthanasia approximately 25 years out.”

Yes, of course. If we were talking about a straight-ahead exponential curve, there can be no doubt, that would indeed be so… But we are not. The greatest proportion of growth was observed in the first years, and has steadily declined thereafter, such that the Belgian rate has now been stable at the 2% level for several years. Nor is there any reason to believe that this rate will grow (unless new presently excluded client groups are subsequently granted access).

In the Netherlands, the portrait is similar. The rate of growth was slower, but the final proportion was actually much larger because of a higher starting point. To make the relation between the two countries easy to understand : after the first five years, the Belgians showed about half the Dutch number, and the two grew in lockstep thereafter, so that, as the Belgians stabilized at approximately 2 % of all deaths being due to euthanasia, so the Dutch number plateaued at 4% or a little more.

“And that”, as they say, “is that !” : 96 % of all Dutch deaths are NOT euthanasia ; 98 % of Belgian deaths are the same ; and barring changes in euthanasia policy in those countries, these numbers may be expected to remain constant.

— A return to the Canadian experience

My point here, with regards to the Canadian experience, is the following : Our policy was formed in the initial years of Belgian legalization when the numbers were soaring. In the minds of Canadian euthanasia enthusiasts, at that time, it seemed giddily clear that we would be required to prepare for a veritable tidal wave of euthanasia demand, from the very moment that the floodgates of legislation were broached. In fact, Canadian policy was obviously designed to maximize euthanasia supply, as an “improvement” on the framework of our European cousins, and intended to remove certain “barriers” denounced by their most radical practitioners, in a progressive display of legislative “leap frog”.

However, as we have seen, all of this was based merely upon fanciful statistical interpretation, similar to that of the eager stock broker who is willing to blindly follow the projected rising curve of his holdings, all the way out of his 50th floor window. Moreover, the error is not blameless. Because euthanasia was legalized in Belgium in 2002, but the Quebec law (B-52) was only passed in 2014, Carter vs Canada was rendered 2015, and the Canadian law (c-14) passed as late as 2016. By the first of those dates the Dutch-Belgian growth curve was clearly “flattening”, and by the last, that curve already appeared stable. Unfortunately, however, it now appears that the Canadian judicial-legislative juggernaut was decisively in movement at that time, and impossible to stop, even if there were no underlying data (in 2016) to support the extreme implementation of euthanasia that was finally embraced.

— Canada by the numbers

If we look now at the little we do know of Canadian trends, after three full years of legality, we see the following proportions of euthanasia as a fraction of all deaths in Canada : 2016, 0.38 % ; 2017, 0.99 % ; 2018, 1.49 %

Clearly, even though the data are scant, we already seem to notice, here, the same pattern as that observed in the Netherlands and in Belgium. The rate of the second year is more than twice that of the first, but the third year is only half again that of the second. Apparently, the curve is flattening in Canada as well.

Belgium. we remember, began at 0.2% and stabilized at 2.2%. Netherlands began at 1.5% and stabilized at 4.2%. Canada began at 0.38% and has now arrived at 1.5% after three years. What could be more natural, then, than to speculate on a final stabilization, somewhere between our two overseas companions, in the 2% to 4% range ?

And if that is the case, what conclusion can we draw concerning current Canadian policy ?

— A sad portrait of quantitative over-reach

The opening paragraph of this piece consisted of what I believe to be a very substantial list of negative consequences stemming from the definition of euthanasia as basic medical care, and from the formal state promise of universal accessibility that accompanied it. This policy stands in stark contrast to that of a country like Switzerland which, by comparison, only permits assisted suicide and makes no formal declaration on the medical ethics of that practice. Our policy, obviously, is based on the projected satisfaction of a much greater patient demand than that imagined by the Swiss. But, once again : on what evidence is such a demand postulated ?

It is simply not rational, I would submit, for our entire traditional practice of medicine to have been turned upside down in this way, on the basis of a maximum client demand evaluated only at something between 2 and 4 percent. Nor can that life-centered medical care, which is required, and desired, by 96 % (to 98%) of patients, be rationally fragilized in such an uncompromising, obsessive resolve, to maximise the access and recourse to euthanasia. Clearly, as the expression goes : “Mistakes were made…”.

Terrible mistakes, in fact, that must now be rectified.

The absence of suicidal desire amongst the survivors of catastrophic injury (Who really wants to die ? : Part V)

— A few useful recollections

The idea of euthanasia has deep roots in modern thought. After the Second World War, however, when faced with the appalling evidence of what can really happen when the medical profession is instrumentalized in the pursuit of utilitarian public policy, support for euthanasia virtually disappeared.

There were, nonetheless, a few creative and powerful personalities who, for whatever reason, were deeply attached to this issue. And, frankly, I cannot help but compare their situation, at that time, to those who oppose euthanasia in Canada today. For just as we are now, those euthanasia apologists of the fifties and sixties found themselves firmly on the back foot, incapable of advancing as before, and comprehensively obliged to reinvent their goals and their methods.

In this extremity, the earlier insistence on the collective rationality of euthanasia was replaced with the ideal of individual patient choice. And so it was, that the Voluntary Euthanasia Society, founded in UK in 1935 (four years, to be sure, before the onset of war), transitioned (in the post-fascist period) to advocating (merely) for the first and most basic patient prerogative on the road to full access euthanasia : the right to refuse treatment.

— Refusal of care, and the original slippery slope

Today, of course that principle is universally accepted. We should, however, frankly realize that refusal of treatment has crucial suicidal implications ; and that by accepting refusal of care we must also be deemed to have credited the idea that suicide need not be, by definition, a wrongful act ; that we do not have an unconditional duty to prevent suicide ; that suicide is not necessarily “bad” ; that suicide can in fact, be “good”. In other words, I believe we can now see, in retrospect, that from the first formal acceptance of “refusal of treatment” (and with even greater effect the refusal of “care”), the road became clearly laid out — through the logical falling of successive legal dominoes — to that situation in which we now find ourselves. For beyond any doubt : categorical interdictions can not be (formally) breached without inviting far-reaching consequences.

— The required moral consensus on the desirability of (at least) some suicides

We must also realize, I believe, how difficult it was, for people at that time, to accept the idea of suicidal choice. Because, unlike today, there was still a perceived need to show that such a course would be “right” (absolutely) and hence that there were, indeed, suicides which could be objectively agreed upon (by all reasonable observers) to be justified also. It was not enough, three quarters of a century ago, to simply fall back on the sovereign personal right of capricious subjective choice. Those who wished to enable suicide, assisted suicide, and ultimately euthanasia, faced the very real challenge of convincing a democratic majority that suicide can be, and is in fact, objectively “good” in specific instances.

Unfortunately however, (and assisted, I believe, by inherent popular prejudice) the post-fascist apologists of euthanasia were ultimately successful in achieving that goal.

— A case in point : Spinal cord injury

As early as 1972, a television drama intitled “Whose Life is it Anyway”, by author Brian Clark (1932 – ), appeared in UK (once again), which was subsequently brought out on the stage (London 1978, Broadway 1979) and was ultimately produced as a Hollywood film starring Richard Dreyfuss (MGM 1981).

The subject of this film concerned the suicidal desires of a young man (Dreyfuss) who was rendered quadriplegic as the result of damage to his spinal cord. The point of the film however — it’s purpose — was to convince the average sympathetic spectator, that a life of paralysis is objectively unworthy of living ; or at least, that if he or she were to find themselves in such a case, that they would not wish to live.

In other words, “Whose Life is it Anyway”, as a political work of fiction, was presented as a sort of “thought experiment” whose fundamental goal was to solicit the spectator’s agreement with this essential euthanistic premise : that there do indeed exist extraordinary instances of “suffering” for which the act of suicide (and indeed of homicide also) must be postulated as a positive “good”.

But that, of course, is actually a lie — at least as far as the opinion of people who are actually suffering is concerned.

— A personal, indignant resentment, evoked at the view of this drama

Coincidentally, “Whose Life is it Anyway” appeared as a film only two years after I myself became paralysed in circumstances very similar to those depicted in the movie. In the same way, then, that Sue Rodriguez’ negative prejudice offended me ten years later, so this specific literary denigration of the paralysed condition affected me in a very personal way. However, while Sue Rodriguez was admitedly justified in expressing a personal choice regarding her own experience, Brian Clark had written a work of mere fiction by which he was deliberately attempting to sway popular opinion (including mine) towards a nihilistic view of all disabled life. And because my survival depended at that time on the confidence required to make positive choices, Clark’s propaganda (whether wittingly or no) posed a direct threat to my existence.

— The terrible nature of such literary assault

Without the will to live, even the strongest man, in the most favorable circumstances, will soon disappear. For that is the inflexible rule of all life, which has governed evolution from the very start : Life must be desired ; life must be nurtured ; life must be defended. Among humans, indeed, the capacity for adaptation is almost limitless, and the will to live, therefore, is not a secondary, but the first and determining predictor of outcome : for almost any situation is livable for the person who desires life ; but no situation will suffice for the one who does not.

How could anyone, I naively railed, fail to understand the mortal danger posed by such a work, to those vulnerable people, such as myself, who were at grips with their most intimate and personal adaptation to the deep reality of paralysis ? In that crucial first four, or five, years ? In that first devastating year ? How could anyone ignore the terrible implications of telling such people, at that most delicate time, that their lives were not worthy of life ?

To be truthful, of course, I then believed myself to be perfectly distinct from the general mass of “poor vulnerable creatures”, thanks to that special mixture of detachment, denial and deferred experience, which is characteristic of so many newly injured individuals. In retrospect, however, I must admit that such was far from the truth : The blow had indeed landed. The impact was real. And therefore, in full knowledge of what I speak, I vigorously maintain, today, that the production and distribution of that film (and the still very popular play from which it sprang) were (and are) acts of criminal assault upon all disabled people ; some of whom, sadly, will not succeed in repulsing this poisonous ideation.

More to the point, however, I also subsequently learned that I was not nearly as special as I had thought. Not because I was actually weaker, but because (statistically speaking) others tend to be so much more strong.

— A more faithful portrait of real life

People who have lived through these sorts of difficult adaptations, and also those who have been the intimate witnesses to such feats, naturally see them as heroic victories over misfortune. And they definitely are. But the superb level and intensity of the efforts made – and of the gains achieved — does not change their equally ordinary nature. It is simply a lie (albeit a nearly universally credited lie) that only a very few superior individuals can possibly overcome the challenges of catastrophic injury. In reality, that kind of amazing adaptive power reveals itself as a standard characteristic of humanity. Especially where it is expected and encouraged.

In crude figures : only somewhat less than one percent of the victims of spinal chord injuries will despair, renounce, and end their lives during the crucial first five years of recovery (after which, the suicide rate becomes statistically identical to that of the general population). That is, of course, a huge number of individuals (and roughly twenty times the normal expectation). But it remains, none-the-less, only one percent of the whole. Once again, as with celebrity suicide, and again with the general euthanasia rates observed around the world, we see that the practice of euthanasia has been grossly oversold, in terms of voluntary demand, on the part of its’ intended clientele.

And faced with this clear quantitative discrepancy, I believe we must now ask how Brian Clark (or anyone else) could possibly believe (and deploy so much energy in convincing others) that suicide is a desirable, appropriate, even noble, choice in the face of disability ?

What is more, I believe we can now begin to drop the fig leaf of “choice”, as concerns euthanasia. Because suicide and euthanasia are two fundamentally different concepts. Clark deliberately picked the very worst infirmity he could think of (and still get aesthetically photogenic shots). He didn’t care if real spinal cord injuries wished to die. He might easily have discovered they do not. And probably knew this perfectly well. Nevertheless, his first goal was to convince “normal” people that it was in the best interest of disabled people to die. And that, I submit, is a truly sinister proposition.

— A conclusion of infantile simplicity

Once again, let us remember the main thesis of this present series of articles : that observed demand for euthanasia is wildly below what we would expect as a justification for the scale of the service offered (and by the sacrifices demanded of both typical patients, and typical doctors) in the satisfaction of what little demand exists. What is the reason for that ?

Why is this dishonest (and clearly false) messaging, epitomized by the film “Whose Life is it Anyway”, allowed to stand ? Where are the ninety-nine other films logically required (to faithfully portray the true proportion of sci survivors who are as attached to their own lives as anyone else) ? Where are the clever commentators eager to “set the record straight” ?

Whatever answers might be found for those intriguing questions, something has clearly gone wrong with the scenario imagined seventy years ago by post-fascist euthanasia apologists suddenly recycled as apostles of personal choice : Doors to the “service” have been thrown wide open. Doctors are now instructed to be on the lookout and to recruit as many clients as possible. Yet to their frustration (and, I believe, entirely predictably) : As long as euthanasia depends on choice it can never prevail over the normal human instinct of survival. Or to recall the familiar Children’s Tale :

The Little Red Hen said :

“I have convinced the general population that “suffering” is worse than death ;

I have changed the law to allow doctors to kill their patients ;

I have transformed the public healthcare system along utilitarian lines in order to maximize access to euthanasia ;

And now, who wishes to die ?”

“Not I”, said the Pig.

“Not I”, said the Cow.

“Not I”, said the survivor of catastrophic injury…

How long will it take (and how much damage will be done to our medical establishment) before judges, administrators and opinion-makers realize that they are attempting to force a “product” upon us, for which there is no corresponding market organically expressed ?

AIDS in the eighties and nineties : an overwhelming refusal of individual victims to personally embrace the collectively nurtured literary fashion of ritual assisted suicide (Who really wants to die ? : Part VI)

— A fundamental discrepancy between appearance and reality

Without a doubt, the historical and cultural phenomenon which most influenced public perception of the post-fascist “right to die” movement, was the horrendous AIDS epidemic of the eighties, and nineties.

Great sympathy was felt towards the victims of this atrocious disease, and great solidarity was expressed for those who chose to take their own lives. However, as we shall see, only one percent of Aids victims actually resorted to suicide, assisted or otherwise. And thus, as with the victims of catastrophic injury, the public vision of an ideal and noble suicidal response to the apprehended loss of physical function and control, was wildly at odds with real choices observed among those personally affected.

— AIDS and the homosexual community : a perfect storm

To understand the collective reaction of homosexuals to the original Aids epidemic (which affected them in such a massive and specific way), it is first necessary to recall the social conditions in which this sub-culture existed at that time. For today, thanks to the extraordinary cadence of recent social change, it is becoming increasingly difficult to communicate (or even to credit) the legal, social, and psychological conditions which were commonly imposed upon the members of this group, barely forty years ago, and that, even for those of us who remember these events at first hand.

Let us merely recall, in this connexion, that the behaviors typical of male homosexuality were entirely prohibited, as criminal offenses in Canada, until 1969 (while only then permitted, subject to residual conditions) ; and the homosexual orientation, itself, was defined in terms of mental pathology, by the American Psychiatric Association, as late as 1973.

Frequently met, therefore, with hostility from the heterosexual majority, the homosexual community was understandably animated by a powerful sense of injustice. These feelings, in turn, were embodied in a shared cultural mood which combined a traditionally resigned resentment, with a newer and politically articulated combativity — doubted by many, while desired by all – which still remained to bear conclusive legal fruit. And then suddenly, into this complex and unstable mix, came the terrible scourge of Aids.

— The primary epidemic of Aids

In 1992, Aids was recognized as the greatest cause of death among American (and Canadian) men between the ages of 25 and 45. Aids had no cure ; Aids ended inevitably in death ; advanced patients could expect to suffer the most atrocious of symptoms. Collectively, moreover, in a sub-culture deeply imbued with erotic ideals of youth and beauty, this was a disease which seemingly delighted in attacking precisely the most youthful, and the most beautiful.

— A secondary epidemic of suicide

Even without any consideration of Aids, the risk of suicide has always been a danger for young men, and even more so among homosexual youth. Indeed, much of the traditionally shared autobiographical and fictional representation of homosexual experience — while often romantic and even defiant – also demonstrated a strong tendency towards the tragic tone. With the arrival of this apparently ineluctable violence of fate, however, a new vision of reality emerged, of almost apocalyptic urgency, in which it seemed that only the choice of the time and of the manner — of his own death — remained as the inalienable right of the encircled hero.

And thus, in the continuing wake of the post-war countercultural revolution : where political consciousness was already coalescing around the notion of sexual identity, enshrined as a civil right in the image of race and gender ; where the word “choice” was found on the lips of all : it became inevitable that this last ultimate “right”, of voluntary death, should be revendicated with an ardor never matched before, or since. And so it is, that the conjugation of Aids and “right-to-die” produced the most far-reaching suicide trend ever witnessed.

— Assisted suicide as spectacle and ceremony

In this movement, the entire homosexual community, including friends and family, and by extension the entire educated class, appeared unanimous in their agreement that suicide (and specifically assisted suicide), provided an ideal, noble response, to the infected state ; doctors and pharmacists collaborated on a scale never before imagined. Certain more charismatic individuals, moreover, (possessed with a taste for artistic or political exhibitionism) became inspired to transform the personal experience of death into a final gesture of social solidarity, whereby assisted suicide assumed the status of a community ceremonial.

Numerous suicides were thus accomplished openly, and celebrated publicly. In some cases, gatherings were held which brought together hundreds of people ; documentary footage was archived and shared ; literary renditions appeared in the pages of all print media ; books were produced ; and films.

— A cinema of ritual suicide : “Its My Party” (1996) and “The Event” (2003)

In addition to personal, memorial, and documentary footage of the Aids suicide epidemic, major films eventually appeared, and notably : “It’s My Party” (1996), which contains a romanticised account of the suicide of Harry Stein (1992) who had at one time been the intimate partner of Randal Kleiser (1946 – ), writer and director of the film.

Many diverse questions relative to the homosexual experience were also discussed in this movie. But well beyond this context, “It’s My Party” will, I believe, forever stand as the preeminent literary depiction of voluntary death, treated as a positive, and desirable, collectively celebrated phenomenon.

In particular, this film immediately demonstrates how far the notion of an authentic “right to die” actually diverges from the sort of naive thinking which characterized, for example, the untenable promises (optimistically referred to as “safeguards”) which were originally guaranteed to expedite the implementation of euthanasia in Canada. For exactly like Sue Rodriguez and Kate Carter, Harry Stein was nowhere near natural death (or even, in his case, gravely incapacitated). At bottom, the suicidal trend documented was not about medical suffering, not about medicine, or even about objectively verifiable suffering at all. Ultimately, it was simply about choice.

But there is more : for also at issue were the ambiguous relations of the surrounding entourage towards the intended victim, their endorsement of the suicide ritual, and their responsibility for the homicidal assistance provided. And while this aspect is present in “It’s My Party”, it takes a more prominent role in a later Canadian film, “The Event” (2003), where guests to the frankly bacchanalian celebration are shown actively (which is to say ritually) involved in preparing the material means and conditions required for suicide.

Most strikingly, however : when the protagonist’s body appears poised to win its unconscious battle with death (by involuntarily expelling the poisons previously ingested), his mother displays what is portrayed as a transcendent maternal love, in actually smothering her own child in order to prevent his awakening, and thus, in “putting an end” to any further torture of indecision.

And so it is that we see a conceptual door opened, here, not only to assistance in suicide, but also towards pure euthanasia (as now seen in Canada), as well as the much debated notion of “follow-through” on previously expressed wishes, where the patient is actually fighting to survive : unconsciously in this case, but also — as we now commonly see litigated around the world — in the eventuality of “confused” but conscious subjects, who, although signatory to prior consent, may yet physically fight to survive.

— An enlightened consensus surrounding voluntary death

The reaction to films such as these, and to their continued on-air presence, attest eloquently to the fact that a virtual unanimity existed at that time — and apparently still exists to this day among progressively attuned individuals — as regards the essential thesis exposed. Indeed, engaged intelligentsia, far beyond the borders of the homosexual community, enthusiastically took up the task of creating a positive and sympathetic narrative, of the personal and collective suffering engendered by Aids, as also, of the response evoked. And thus, from this special historical context (and from the literary mode it produced), there emerged a broadly mediatized “consensus” — built around an idealised rejection of imperfection in life — which attained to a popularity both entirely new, and in all respects unique ; a consensus which eventually resulted in the familiar practice of euthanasia in Canada today.

But what was the actual response to this collective enthusiasm, among those who were personally singled out to die ?

— The suicidal fact of a miniscule minority

     In actual fact — and almost exactly like the example previously given (of post-accident paralysis) — the suicide rate among Aids infected individuals stabilized at roughly ten times that of other men (during the initial, “incurable”, phase of the epidemic) ; and then returned to normal (following the introduction of life-saving retro-viral therapy circa 1996). In other words : in spite of the phenomenal wave of cultural enthusiasm (and of the complete societal unanimity displayed), only one percent of those who were expected to embrace this suicidal mode actually did so ; while fully ninety-nine percent preferred to continue with their lives as long as possible, suffering or no.

     For that is, clearly, the normal human default : an unconditional will to live. And while a life of suffering might appear unlivable (at a distance), very rare are the sufferers who will willing let go of their own.

— cultural enthusiasm becomes misinformation and unselfconscious irony

There is also a special irony, regarding the film “It’s My Party”, in that this film came out in 1996, which is exactly the moment when antiretroviral therapy gave new life to survival hopes among seropositive individuals, and hence, enabled the observed reduction, of actual suicide, to essentially normal levels. Which is to say : at precisely the same time that wider society was beginning to perceive suicide as the normal — even the preferable — option for infected individuals, these persons were no longer any more likely to seek death, than was anybody else !

And again, what can be said in this light, about a film like “The Event” which was only released in 2003, at a time when Aids was considered a fully manageable condition ? How could we justify the depicted mother’s grim determination, to make absolutely sure of her son’s atypically motivated death ? And how could we justify the film-maker’s obstinacy in perpetuating a narrative which had never had a legitimate grounding in proportional quantitative fact, even ten years earlier, during the worst phase of the epidemic ?

But above all : how can we qualify the uncritical yet enthusiastic unanimity – which still persists among our cultured and educated classes — in support of an objectively marginal suicidal ideal ? How can we pardon the willingness of our Canadian policy makers, to prepare for real volumes of future euthanasia service delivery, based upon these entirely mythical, literary constructs ?

Who really wants to die? Part VII : The justification of Canadian-style euthanasia is not to be found in any rational dynamic of market economics ; not even terminal cancer patients statistically support the popular narrative

As a general principle, the means taken to address an issue should be proportional to the issue itself. We do not, for instance, use a baseball bat to swat a fly.

The specific point of this series of articles has been to demonstrate that no organic consumer demand exists for the service of euthanasia on such a scale as it is currently being developed and marketed in Canada.

Let us briefly resume our evidence :

A great deal of literary romance has been created around the idea that survivors of catastrophic injury, and particularly those paralysed by damage to their spinal cords would naturally rather die than live in such a diminished state. In actual fact, however, only about one percent of these people will really commit suicide (in the entire first critical five years following injury) and subsequent suicide rates for this group are statistically normal.

In the worst phase of the AIDS epidemic, that is in the late eighties and early nineties (before effective treatments were available), a literary romantic ideal of voluntary death arose within the homosexual community which sparked the most powerful suicide trend ever seen. Assisted suicide became a community ritual. Universal approval was shown throughout the literary class. However, in actual fact, only somewhat less than two percent of AIDS sufferers died by suicide during that period, and following that time, suicide rates among this group have returned, essentially, to normal (when adjusted for other factors such as high suicide among intravenous drug users who also belong to this cohort).

In sum, spinal injury and AIDS were the two most important areas where it was claimed that assisted suicide must be provided in order to satisfy a genuine (and justified) demand. “Normal” people were universally groomed to believe that “they”, also, would wish to die should they be injured, or become ill, in such ways. But none of that literary work of idealized voluntary death was based upon reality.

More recently, we have been assailed with literary depictions of death in circumstances of excruciating and unmanageable suffering. Euthanasia, we are told is the only route to humane end-of-life care. Terminal cancer, in particular, was described as a condition which could only rationally end in euthanasia. “Normal” people, once again, were groomed to believe that they would, indeed, wish to be euthanized at such a time.

(It is mysteriously omitted from this portrait that the control of discomfort is now infinitely superior to anything ever known before ; that people had been dying in much worse circumstances since the beginning of time ; and that, far from hastening death, the development of humane society had been characterized by a growing recognition of the need to protect the dying from the murderous instincts of their entourage).

In actual fact, however (once again), we noted that in the most euthanasia-prone area of the world (the Netherlands and Flemish Belgium), after twenty years of wide-spread access to legal euthanasia, only approximately ten percent of terminal cancer patients currently consent to die in that manner.

And therefore, bringing all of this information together, we see that the maximum organic demand for euthanasia (absent the powers of suggestion and institutional normality) would be : one percent of catastrophic injury survivors (spinal cord paralysis, amputees, etc.) ; perhaps two percent of degenerative illness sufferers (AIDS, ALS) ; and ten percent of terminal cancer patients. While for clarity, the corresponding rates of euthanasia refusal would be : 99, 98, and 90 percent respectively.

On the other hand, in order to provide euthanasia service in Canada, it has been decided : that the practice of medicine should be fundamentally altered by declaring euthanasia as a benign form of medical care ; that all patients possess a universal, state-guaranteed right to that care ; that all doctors and other medical staff be granted a literal “licence to kill” in the institutional context ; that euthanasia providers not even require individual selection or certification ; that euthanasia be performed in all medical institutions ; that, going forward, euthanasia be emphasized in training as a normal expectation of students and professionals ; that the new culture of euthanasia attain institutional dominance through the suppression and replacement of euthanasia opposition in positions of medical leadership ; and finally : that the imperative need for universal euthanasia access justifies the correspondingly inevitable development of therapeutic environments (hospitals and clinics) which will become increasingly (and predictably) more hostile to those patients (the vast statistical majority) who will still refuse to voluntarily receive the “assistance” in dying that has been so reasonably provided for them.

And all of this (the popular romantic literary pornography of “intolerable suffering” notwithstanding) done in order to address an organically expressed demand from one, two, or in some specialties, perhaps, a maximum of ten percent of the clientele.

In other words : conceived merely as a consumer-driven economic phenomenon, euthanasia (as currently provided through the Canadian public healthcare system) makes no sense whatsoever !

This is indeed an astonishing but largely unstated fact which is of the greatest importance for Canadian citizens ; because nothing in the realm of public policy happens for nothing ; and therefore : If the reason for maximizing euthanasia availability is NOT economic – is NOT meant to satisfy consumer demand — then what on earth IS it for ?

And with that question in mind, I now intend (with the reader’s permission), to begin a new series of articles entitled : What is the “Good” of Euthanasia ? Which will examine exactly what place (if any) assisted death might more appropriately claim to occupy among us, in consideration of the various moral (and other) justifications currently offered for providing (or restraining) this practice.

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