Illinois Gov. JB Pritzker Signs Bill Legalizing Assisted Suicide for Terminally Ill

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Have you ever watched a loved one suffer with debilitating pain for months? The type where they soil themselves?

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It was not long into her practice, however, that Li’s confidence in the direction of her country’s MAID program began to falter. For all of her expertise, not even Li was sure what to do about a patient in his 30s whom she encountered in 2018.

The man had gone to the emergency room complaining of excruciating pain and was eventually diagnosed with cancer. The prognosis was good, a surgeon assured him, with a 65 percent chance of a cure. But the man said he didn’t want treatment; he wanted MAID. Startled, the surgeon referred him to a medical oncologist to discuss chemo; perhaps the man just didn’t want surgery. The patient proceeded to tell the medical oncologist that he didn’t want treatment of any kind; he wanted MAID. He said the same thing to a radiation oncologist, a palliative-care physician, and a psychiatrist, before finally complaining to the patient-relations department that the hospital was barring his access to MAID. Li arranged to meet with him.

Canada’s MAID law defines a “grievous and irremediable medical condition” in part as a “serious and incurable illness, disease, or disability.” As for what constitutes incurability, however, the law says nothing—and of the various textual ambiguities that caused anxiety for clinicians early on, this one ranked near the top. Did “incurable” mean a lack of any available treatment? Did it mean the likelihood of an available treatment not working? Prominent MAID advocates put forth what soon became the predominant interpretation: A medical condition was incurable if it could not be cured by means acceptable to the patient.

This had made sense to Li. If an elderly woman with chronic myelogenous leukemia had no wish to endure a highly toxic course of chemo and radiation, why should she be compelled to? But here was a young man with a likely curable cancer who nevertheless was adamant about dying. “I mean, he was so, so clear,” Li told me. “I talked to him about What if you had a 100 percent chance? Would you want treatment? And he said no.” He didn’t want to suffer through the treatment or the side effects, he explained; just having a colonoscopy had traumatized him. When Li assured the man that they could treat the side effects, he said she wasn’t understanding him: Yes, they could give him medication for the pain, but then he would have to first experience the pain. He didn’t want to experience the pain.

What was Li left with? According to prevailing standards, the man’s refusal to attempt treatment rendered his disease incurable and his natural death was reasonably foreseeable. He met the eligibility criteria as Li understood them. But the whole thing seemed wrong to her. Seeking advice, she described the basics of the case in a private email group for MAID practitioners under the heading “Eligible, but Reasonable?” “And what was very clear to me from the replies I got,” Li told me, “is that many people have no ethical or clinical qualms about this—that it’s all about a patient’s autonomy, and if a patient wants this, it’s not up to us to judge. We should provide.”

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