MAID Unequal: What Christian Clinicians Should Know About Disability, Ableism, and Canada’s Expanded Medical Assistance in Dying Law
The recent expansion of eligibility for Medical Assistance in Dying (MAID) to include people with illnesses and disabilities who are not at end-of-life is frequently touted by the Liberal government and right-to-die advocates — who are often one and the same — as an important advancement in the right of ill and disabled people to exercise their autonomy. Despite the predominance of this rhetoric in public discourse around MAID, the reality is that this recent expansion of MAID in Canada poses many new and weighty challenges, both for Christian clinicians who have conscientious objections to being involved in providing MAID, as well as for people with disabilities who find themselves compelled to seek a medically assisted death, because they are unable to obtain sufficient disability supports to enable them to live in their own homes in the community, and consequently face incarceration in a long-term care facility.
Both Christian clinicians who have conscientious objections to being involved in providing MAID and people with disabilities who find themselves compelled to seek MAID for lack of adequate disability-related supports are impacted by systemic ableism — that is, discrimination because of disability — in society generally, and, more specifically, within the healthcare system. Obviously, the challenges posed by the introduction of MAID into a healthcare system plagued by ableism are very different for these two groups. For Christian clinicians, combatting medical ableism in the context of MAID involves recognizing and disrupting the predominant medical utilitarian conception of disability as rendering individuals inherently less than fully human, and thus rendering both the quality and the ultimate worth and worthiness of their lives virtually nonexistent. For people with disabilities, a request for MAID often comes as an ultimate capitulation to a lifetime of internalizing the ableist assumptions made by healthcare professionals, who attribute all of the challenges and deprivations that they experience directly and solely to their disability. Such conflations of biomedical conditions/disabilities with the socio-economic deprivations which often attend them willfully ignore the existence, entrenchment, and effects of ableism.
In this article, I will discuss ableism in the healthcare system, and consider some of the ways in which healthcare professionals, particularly Christians, can help to mitigate the lethal harms caused by medical ableism. More specifically, I will explore what a Christian response to medical ableism could look like. As part of this exploration, I will discuss the importance of Christian clinicians actively listening to their patients, and, when necessary, advocating to help their patients get the supports they need. This kind of advocacy is becoming all the more crucial in the context of expanded eligibility for MAID to include people with disabilities who are not at end-of-life.
Ableism: A Brief Primer for Clinicians
Ableism can be defined as discrimination and social prejudice against people with disabilities based on the belief that typical abilities are superior. At its heart, ableism is rooted in the assumption that disabled people require ‘fixing’ and defines people by their disability. Like racism and sexism, ableism classifies entire groups of people as ‘less than,’ and perpetuates harmful stereotypes, misconceptions, and generalizations about people with disabilities. Clear, yet unacknowledged, evidence of ableism can be seen in everything from the way in which buildings are built to exclude people who do not walk or see, to the way in which students with disabilities are taught that it’s better to look, move, and behave as much like their non disabled peers as possible, to the way in which terms associated with disability are used as insults in common parlance. Unlike racism or sexism, however, ableism remains, in the words of Canadian disability scholar, Gregor Wolbring, “one of the most societally entrenched and accepted isms.”
Ableism in the Healthcare System
Healthcare has traditionally been viewed as a benevolent discipline in which every human life is valued equally, without any form of prejudice or discrimination. While this may remain the ideal to which healthcare aspires, the reality is that, as individuals, healthcare professionals are not immune to the influence of dominant societal understandings of, and attitudes towards, individuals and groups of people deemed to be Others. Despite the major role that medical professionals play in the lives of people with disabilities, research indicates that people with disabilities frequently encounter discrimination in healthcare settings, even in ordinary, non-pandemic, times. What’s more, the COVID-19 pandemic has laid bare the systemic ableism that relegates people with disabilities to the margins of both society and healthcare. Studies have consistently shown that, as a group, health care professionals tend to substantially underestimate the quality of life of people with disabilities., Such erroneous judgments about the quality of life experienced by people with disabilities can result in their treatment options being either limited, or altogether eliminated. At the heart of such decisions is what disability scholar Joel Reynolds has termed the “ableist conflation” of disability, suffering, and death: “Wherever operative, the ableist conflation flattens communication about disability to communication about pain, suffering, hardship, disadvantage, morbidity, and mortality.”
A Christian Perspective on Disability and Ableism
It is helpful for Christian clinicians who want to effectively serve as allies to their patients with disabilities in combatting the social, medical, and internalized ableism that can trigger requests for MAID to approach this, often overwhelming, task with a solid understanding of what constitutes a Christian perspective on disability and ableism. The Judeo-Christian tradition has been critiqued by some disability scholars as being inherently ableist in its conceptualization of disability as a defect, and a mark of humanity’s fall into sin. Specifically, this critique centres around the notion that, as those who visibly bear the mark and marring of sin on their bodies, disabled people are barred from coming into God’s presence (as in Leviticus 21:16-23) — unless the disability is eradicated by means of miraculous healing. Christianity is thus seen as promoting a biomedical model of disability, and viewing people with disabilities as unworthy and less than. However, Ros Bayes contends that, as with any passage of Scripture, the passages in Leviticus that appear to take an exclusionary and ableist stance towards people with disabilities must be interpreted within the context of the entire Scripture. Thus, we face the question, “Could the God who also said, “You shall not curse the deaf or put a stumbling block before the blind, but you shall fear your God: I am the Lord”, really have meant that disabled people were inferior to others and unworthy to offer worship? Bayes answers this question with an emphatic “No!” She points out that “the descriptions of the tabernacle and the worship that was to take place there are full of symbolism. Many of the details have been shown to have a meaning that points towards the coming ministry of Jesus, the Messiah. And so this instruction about temple worship is not a declaration of the inferiority of people with impairments; rather it is symbolic both of the perfection that God deserves from us, no half measures in our worship of Him, and also of the perfect, unblemished sacrifice that Christ was to offer in His death on the cross.”
Christian disability advocate, Joni Eareckson Tada, flips the critique of Christianity as being rooted in ableism on its head with her observation that, “Our Saviour chose to flash His credentials as Messiah through ministry to disabled people. […] A disability magnifies God’s grace. We in our wheelchairs get to prove how great and how trustworthy God is.” Indeed, a hallmark of Jesus’s earthly ministry was his practice of treating each disabled person with whom he interacted, not just as a nameless member of “the blind” or “the lame,” but rather, as a purposefully-created, individual bearer of God’s image, and that image is just as visible, just as valid before a healing as it is after. Ultimately then, within a Christian paradigm, the life of a disabled person is of no less worth or worthiness as that of a non disabled person. Hence, to denigrate the life of a disabled person through ableism is, in and of itself, a sin.
How Christian Clinicians Should Respond to Ableism-Induced Requests for MAID
How, then, should Christian clinicians respond when patients request MAID because systemic ableism prevents them from accessing sufficient disability supports to enable them to live in their own homes in the community, and/or as an ultimate capitulation to a lifetime’s worth of internalizing the ableism that they have encountered within the healthcare system, as well as within society more generally? First of all, it is crucial for clinicians to recognize that these are situations in which the life of the patient with disabilities is being imminently imperiled by ableism, and that such dire situations urgently call for clinicians to act as advocates and allies for these patients. Any and all efforts on the part of clinicians to act as advocates and allies for patients who they believe are requesting MAID as a result of ableism must begin with clinicians actively listening to patients as they talk about why they are asking for MAID. Specifically, clinicians need to attend to any gaps in disability-related supports that are causing or contributing to the intolerable suffering that their patient is experiencing, and be prepared to actively advocate for their patient to receive those supports. Unfortunately, as Iezzoni and Long-Bellil point out, “with limited exceptions, physicians have little training in addressing the wide-ranging needs of persons with disabilities. They know neither specific clinical needs nor basic fundamentals, such as how to: recognize disability in its full diversity; communicate effectively with persons with disabilities; identify various contributors to disability, including social and environmental factors; and understand where disability fits into individuals’ lives, values, preferences, and expectations about their health and futures.” It must be acknowledged that, for most physicians in Canada, including Christian physicians, the learning curve that it would require to attain these competencies would be very steep. Attaining these disability-related competencies would therefore also require a significant commitment of time from physicians, beyond what is generally seen as their regular duties. Nevertheless, given the dual lethal realities of systemic ableism and expanded eligibility for MAID, Christian physicians have both an ethical and a spiritual obligation to develop disability-related competencies.
For Further Reading
Campbell, F. K. (2009). Medical Education and Disability Studies. Journal of Medical Humanities, 30(4), 221–235. https://doi.org/10.1007/s10912-009-9088-2
Gill, C. J. (1992). Suicide intervention for people with disabilities: A lesson in inequality. Issues L. & Med., 8, 37.
Janz, H. (2016, Spring). The Things I’ve Learned. The Bridge, 57(1), 3–7. https://www.taylor-edu.ca/taylor/pdf/Bridge_2016Spring.pdf
Scully, J. L. (2008). Disability bioethics: Moral bodies, moral difference. Rowman & Littlefield.
Walker, M. A. (2021). Persistent Pain and Promised Perfection: The Significance of an Embodied Eschatology of Disability. Journal of Disability & Religion, 1–16.
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