Sure. Thank you for the question.
I think a key issue is that suffering is highly subjective. It's not an objective benchmark. Severe pain can be more medically objective, but suffering is not, so without the patient's input, it's simply a myth that we will not make a value-laden judgment about which life is worth living or not.
Consider, in the province of Quebec, Quebec's Bill 38, which proposes to amend Quebec's act respecting end-of-life care to include advance directives. It says that the advance request must describe in detail the physical or psychological suffering that cannot be relieved in a way that the patient would find tolerable when they write the request. Then, a monitoring system would be put in place so that when the patient shows signs of that suffering, the MAID process can be started.
The problem is that, to come back to the example I gave before, if John at age 50 is able to consent and explain that he's experiencing an intolerable suffering such that death would be preferable in his mind, that's it. Doctors, judges and legislators don't have to ask the absolutely unsolvable existential question of what is a life worth continuing. They just need to respect the fact that John made his own existential choice that it is not worth living. However, the notion of intolerable suffering cannot just be transposed onto someone who cannot make this choice, including John at age 75 with advanced dementia. That is because suffering is a complex, subjective experience.
We can measure pain. We can treat pain, and ultimately we can eliminate pain completely if nothing else works through deep sedation, but we are not talking about a response to pain. MAID has been designed and is used primarily as a response to existential suffering such as the loss of ability to engage in meaningful activities, the loss of ability to perform activities of daily living, or other fears that have to do with hygiene.
Bill 38 in Quebec says that there is a special kind of suffering. That special kind of suffering justifies MAID or euthanasia, and patients can list that specific type of suffering on their advance request. Now, the point I'm making is that I am not clear on what that suffering is, nor is the Quebec bar, which produced a memorandum last summer stating that suffering is a subjective notion, not an objective standard.
The Quebec bar's working group on MAID said that they were wondering what Bill 38 meant by this “objectifiable” kind of suffering that is observable by a doctor, the way doctors observe the symptoms of physiological dysfunctions and diseases. Presumably it means something like “objective” or “objectively verifiable”, but subjectively intolerable suffering that is worse than continuing one's existence does not seem to be objectively verifiable. There's nothing objectively verifiable about the intensely personal leap someone takes above that abyss of disagreements about the value of life, when they move from experiencing specific social and physical issues on the one hand to the decision—