The Myth of Competence: MAiD and End-of-Life Choices

At the base of Canada’s MAiD legislation is the assertion of individual choice as a bedrock human right: choice to assess one’s tolerance to pain and suffering; choice to gauge the way that one’s suffering and potential death might affect others; choice to evaluate the worth of one’s own life, alone or in relation to others, and thus perhaps to “choose death” rather than the costly burdens of suffering. And facilitating the functioning of such choice, in the legislation’s framework, is the “competence” of the individual to make such a choice in a free and informed way. The original 2016 Bill C-14 limited “eligible” candidates to adults “mentally competent (“capable”) to make health care decisions for themselves.”

On the face of it, one might well imagine that a 80-year-old person with terminal pancreatic cancer can “competently” assess their health care decisions: they are adults, they have lived in the world for decades, and know how things work and how other people sort out their own needs, and have, finally, determined the nature of life and death as realities to be faced, entered, or left behind, perhaps even in the light of religious claims, of God even. Competence is a “capacity, and in the case of an 80-year-old it attaches to maturity, mental and existential experience and understanding.

Things – on the face of it – get a little murkier when one imagines a younger person – say 40 years old – with the same disease. Yes, we let 18-year-olds vote on key matters of economic, social, and foreign policy (though mostly not allowed to drink alcohol). But what might 40 years more of “experience” add up to when it comes to assessing the nature of personal suffering, the existential demands of relationships, perhaps even the will of God? Nothing? And if not “nothing”, what? Is “competence”, in the most profound aspects of a human life, a steady-stage condition?

Matters get murkier still when, as has now happened, MAiD’s provisions are extended to those suffering from psychological or emotional illness – schizophrenia, depression. What counts as “competence” for these people, such that he or she, or a legal caregiver and medical-power-of-attorney might decide that humanly inflicted death is better than life?

My own family has been riddled by suicide [1]. In my young adult life, I made an attempt myself. And my daughter, across a span of years from her teens to her early 30’s, has struggled with some of the most burdensome forms of depression and its consequences. There are the well-documented stories of “unsuccessful” suicide attempts where the individual subsequently felt clearly enough that the attempt was grossly misguided (I have felt that way). But where, in any of this, is the reality of “competence” located? Does competence decide for death and for life equally, but just at different times?  And how does crushing mental suffering ever form the basis of competence decision-making in any case?

In this context, some of the earlier questions arise, now compounded exponentially: in what way does pain – and how much pain – affect the competence of one’s decisions about life and death? Is the pain of the (probably terminal) cancer victim the same as the pain of the depressed 18-year-old? Are older persons more competent to judge life and death matters than younger persons? On what basis? At what age? In what way do the relational responsibilities an individual has to family impinge on competence? Are other persons – like a father with respect to a depressed daughter – “competent” to object to or restrain the suicide, and under what circumstances? As state-sponsored suicide has already developed in other countries, these confusions will engulf the young, the disabled, the cognitively different.

The Christian faith does not solve all the dilemmas of suffering and despair, or of freedom and coercion. But that faith does place these dilemmas – real, deep, troubling as they may be – in a context that is simply other than the current legal morass of the MAiD legislation and its categories.

The two singular places our faith relocates these matters are Creation and Redemption. First, God, in his goodness, creates all things (“man and beast”), sustains them, and orders them (Psalm 36:6) – even the hairs on our head – according to his good will (Matthew 10:30).

Second, in the face of all that challenges this created goodness, a goodness that extends to every person – young, old, suffering, despairing, limited in this way or that – God redeems them, that is, makes good on the glorious purposes for which that creature was made. Only God does this, and this unique divine doing comprehends life and death both (Deuteronomy 32:39). “Only God” can create; only God can redeem (Psalm 49:7). Which means that only God owns us, whoever we are.

The notion of human or individual “competence” in the face of decisions over life and death is absent from the Christian faith. Historically, only the Law of God could touch these matters, and “judges” discerned only on the basis of these divine demands. Included in God’s Law are directives – revelations – regarding parental, filial, and communal responsibility as well as instructions on the gifts of patience and the transfiguring power of personal suffering in the witness to the love of God in Christ (see the whole of 1 Peter). Not only absent, the realm of competence is explicitly excluded: “Trust in the LORD with all thine heart; and lean not unto thine own understanding. In all thy ways acknowledge him, and he shall direct thy paths” (Proverbs 3:5-6).

MAiD, in all of its provisions, is a blasphemous and anti-Christian piece of developing legislation, one that would usurp from God that which is his, turning what is a good – human incompetence in the face of divine life – into an evil.

The whole legal contraption should be resisted.