1 in 20: Canada's Growing Cause of Death

Autonomy, Suffering, and the limits of Law and Medical Ethics

After ten years, I hope everyone knows that I believe in saying the quiet part out loud. It helps you understand if you’re arguing about the wrong thing. It prevents focus on the easier parts of the argument because the meat of the thing is too difficult.

In a way, I respect Jonathan Reggler for saying the quiet part out loud. Reggler, a family physician on Vancouver Island, was quoted in The Atlantic piece we spent so much time on in today’s episode:

“Once you accept that people ought to have autonomy—once you accept that life is not sacred and something that can only be taken by God, a being I don’t believe in—then, if you’re in that work, some of us have to go forward and say, ‘We’ll do it.’ ”

Once you accept that life is not sacred.

When I read that, I thought, “OK, now can we get somewhere.” Euthanasia encompasses so many complexities that it can be easy to lose our way, but I do believe whether or not life is sacred is at the crux of all that complexity.

It doesn’t mean that we have an easy answer. In fact, I am ready and willing to argue that the dogged pursuit of “sacred life” has led us to places in which life is completely disregarded and discarded. Sacred is so often code for “God is on my side,” and that means I’m right.

All of us have either read about or witnessed deaths made possible through euthanasia that can only possibly be described as sacred.

When I say sacred, I mean precious, valuable beyond words. The origin of sacred comes from the Latin adjective “saber” meaning holy or set apart by consecration. A life is not precious only because it is yours. Life is sacred because it is set apart. Set apart because it is mysterious, and we do not entirely understand what happens when you are born or when you die. Set apart because what we do here is not merely about the pursuit of our own individual wants and desires, but because everything we create finds mystery and meaning through the holy alchemy of other lives.

Debates are hard. Policy is complicated. But life is sacred. I appreciate Jonathan Reggler for saying the quiet part out loud so I could have this conversation with Beth on the podcast today, and I appreciate all of you for listening and sharing your thoughts.

Topics Discussed

• Canada Gave Citizens the Right to Die. Doctors Are Struggling to Meet Demand. (The Atlantic)

• Outside of Politics: Sharing our Life Stories

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Episode Resources

Pantsuit Politics Resources

• Save money on your annual Pantsuit Politics Premium Subscription with our summer sale

• We want to hear from you! On Friday, we’re discussing crime and the National Guard in D.C. Email us at hello@pantsuitpoliticsshow.com with the subject line: Crime if you’re in DC, work in law enforcement, are or know someone who is deployed with the National Guard, or have something to add to our conversation.

Medical Assistance in Dying

• Death with Dignity (Pantsuit Politics)

• Canada Gave Citizens the Right to Die. Doctors Are Struggling to Meet Demand. (The Atlantic)

• Noah Is Still Here (The New York Times)

• Opinion | What It Really Means to Choose Life (The New York Times)

Sharing our Life Stories

• The Hygge Game

Show Credits

Pantsuit Politics is hosted by Sarah Stewart Holland and Beth Silvers. The show is produced by Studio D Podcast Production. Alise Napp is our Managing Director and Maggie Penton is our Director of Community Engagement.

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Episode Transcript

Sarah [00:00:10] This is Sarah Stewart Holland.

Beth [00:00:11] This is Beth Silvers. You're listening to Pantsuit Politics. And today we are continuing a conversation about medical assistance in dying. We had a big picture discussion about this a few months ago, which definitely touched a nerve. And of course it did. How could it not? We're talking about the most raw aspects of being a person near the end of our lives. So it is a very tender subject and we are going to try to approach it with a lot of care. We're picking it up today to focus more on the policy side and specifically what we can learn from our Canadian neighbors’ policies. And then outside of politics, we're going to talk about bonding with new friends. So not like, "Hey, let's catch up. I haven't seen you in a while," but, "Hey, you're really important to me and I do not know key parts of your life story. How do we accelerate our relationships with one another by sharing those stories?"

Sarah [00:01:01] Now, friendly reminder, we are in the final stretches of our end of summer sale over on Substack; 15% off annual subscriptions means you can lock in a full year of our expanded content and community for less than the regular price. So go over there. We have amazing bonus episodes on Thursdays where we talk about all kinds of spicy subjects. You get More to Say, you get the News Brief, you get The Movie Club. There's just a lot going on Substack, including incredibly holistic (is what I'm going to call them) conversations in the comments of our episodes and bonus content. It's just the best community over there that really builds out, expands, dives deeper into all the things we talk about here on the show.

Beth [00:01:42] And speaking of that ability of you all to build out and expand all the things we're talking about on the show, we would love your help preparing for Friday's episode. We are going to talk about crime and the president's decision to send National Guard members and other federal law enforcement personnel to Washington DC. And we would like to get as much as possible a 360 degree look at this. So if you live in Washington DC and have seen this in action, if you lived in Washington, DC and have a perspective on crime there, if you are in a family with people who are deployed to Washington DC right now or deployed yourself, if you're a police officer, if you have some connection to what's going on here or some insight you'd like to share with us, we would really love to hear it. So if you will email hello@ pantsuitpoliticsshow.com and put crime in the subject line, it would help us immensely.

[00:02:33] And now we are going to pick up where we left off talking about medical aid and dying. Sarah, if people haven't listened to our first discussion, I wanted to try to summarize it. I think we're both supportive of allowing people who are terminally ill and near the end of life to die peacefully and as much on their own terms as possible. And I think we both have concerns about where there are some limiting principles around that and making sure the policy is structured in a way that doesn't make us unintentionally casual about life and death. Do you feel like that's a fair summary?

Sarah [00:03:19] Yeah, I just think we were scratching at some stuff around cultural understanding, around suffering. That's what I would add, is both of us I would say-- well, I'll definitely speak for myself. I think it sounds good on paper to say all we care about is reducing people's suffering. The pursuit of life is to reduce suffering. But I think in practice that can put us in some really ethically complicated, morally simplistic, sometimes toxic places around our ideas with regards to human life and what role suffering plays in it, how much suffering should be present. Is that even a thing we should contemplate, is how much 'suffering' should be president in human life? And I think we were scratching at some of that because obviously talking about death, talking about why we're here, what we're doing with regards to all of that is really ever present in the conversation. And so this is really hard because you're talking about the entire spectrum of complexities we handle in anything on Pantsuit Politics, only the stakes are very high because we're talking about death. So you're talking about individual people.

[00:04:43] So some people came into that episode with individual experiences and if they heard something in the beginning that felt dismissive of their individual experience about this topic that is so high stakes, death or the death of a loved one, then they shut like a trap door. So you have individual experiences around this. You have your own individual ideas about your life, suffering, how you would like to die. You have governmental policies, you have religious principles, you have societal norms, ideas and ethics. You're just trying to shove a whole lot into a conversation on this topic.

Beth [00:05:21] And what pieces of that are appropriate to discuss as matters of public policy and which are better left for faith communities or your kind of individual family values, how you think about life and death. I think it's hard to want to hear about suffering when you are suffering. I think it’s fair to say this probably looks a lot different to you in your mid-forties than it looks to me because of this particular moment in my life, whether that's a moment that you've arrived at by age or by some kind of physical limitation or some type of experience. So all to say, as we get into the policy side, we're going to try to talk about what policy can and can't do and understand that our perspectives are limited as every person who ever talked about this would have a limited perspective in some way because it just contains so much. This month, The Atlantic, is running a piece called Canada is Killing Itself by Elaina Plott Calabro. It was released online on August 11th. You can probably find it at your library right now if you'd like to pick up the print edition and read the whole piece. It is a long one and I think worth reading. It really traces the evolution of Canada's medical assistance in dying or made laws, beginning with legalization in 2016. And coming to today when deaths through this MAID program account for 1 in 20 in the country, more than Alzheimer's and diabetes combined.

Sarah [00:06:50] So they started with this tier one policy procedure, which I would say describes what most people's popular conception of assistance and dying should include. Terminally ill patients who have been designated by a medical professional as legally capable of making this decision. They don't have a lot of options. They are facing a long, painful end. We will give them this option. I was really struck in the article by the description of all these popular stories, particularly at the beginning of this journey in Canada that really involved wealthy, white, highly educated people taking advantage of the system. On the beach, surrounded by loved ones, totally in control of how they wanted to exit this long and beautiful life. And, of course, who would argue with that? Who would argue? I mean, some people would, but most people wouldn't. Of course, we don't want to force people through long, painful end of life scenarios. Don't want to force them or their families through it. So that's how it started with tier one.

[00:08:13] And then as we expand into tier two, where you don't have to be terminally ill, you don't have to be designated as basically end of life, that there is a more expansive understanding of who this procedure is available to. Well, then it gets more complicated and it takes off very, very quickly. There was a medical ethics expert who came from the European Institute of Bioethics and testified between Canada's Supreme Court in 2014 about what happened in Belgium and how you start with the strict criteria and then it gets looser, and looser, and looser. And then the expert said sooner or later, a patient's repeated wish will take precedence over strict statutory conditions. In the end, candidate's justices were unmoved. Belgium's permissive system, they contended, was the product of a very different medical legal culture. And it took Belgium more than 20 years to reach an assisted death rate of 3%. Canada needed only five. So yeah, they were different. They got there faster than Belgium did despite the warnings of so many experts.

Beth [00:09:27] You mentioned that at the beginning, a lot of stories were about wealthy white families trying to facilitate the dream funeral for people who were really suffering. Once this definition expanded, you started to get some stories about people who worried that their serious medical condition so burdened others that they should use this option to alleviate not only their own suffering, but any suffering that they might inflict on anyone around them, or any suffering that they couldn't afford to have tended to or alleviated in any way. And that sense of I don't want to burden others does get to some of what I think we were trying to talk about in our first episode, which is like we are here to burden each other. And we would never want anyone to go down this path for that particular reason. And if you decide that suffering unconnected to imminent death qualifies, it gets tough to assess what the real motivations are and what real consent looks like.

Sarah [00:10:38] Well, and I think the important part there is it's just that subtle shift, a medical condition. So we're not talking about a terminal condition. We're talking about medical condition, which is very different. And what Canada has chosen to do is basically offload all of this decision-making, what little there is and from the reporting in this article there is very little, on to medical professionals. And so this article spends a lot of time in conversation with medical professionals who said I had the same vision in my head and all of a sudden I'm in a room with a very, very poverty stricken person on a mattress on a bare floor, administering these drugs. And then you have physicians who have killed over 700 people, 400 people and feel that they are doing the right thing. That they are in pursuit of an end to suffering, a pursuit of people's autonomy, an agency, and that this was the natural progression of this and that there is absolutely nothing wrong with it.

Beth [00:11:50] And courts occasionally getting involved where family members have said, I don't think that my loved one did consent. I didn't think my loved was capable of consenting. There's a really difficult to read section of this piece that talks about a man who lost his ability to speak and had previously communicated his desire for this, but in the moment could only maybe gesture a little bit and the gesture read as ambiguous to the family members, but not to the medical professional. And so that went to court and the court was troubled by it, but also doesn't seem to have a lot of room under this law. It's not redressable. Once it's done, it's done. And that's why I think trying to figure out what the policy can be to as much as possible reduce situations where there's conflict about it and where-- I mean that's terrible for everybody, right? Just awful for that medical professional, awful for the family, awful for the court system. You just don't want that to happen. So how do you structure a policy that respects people in every dimension and leaves as little room as possible for those kinds of conflicts after the fact?

Sarah [00:13:04] Yeah, there are reports in this piece of medical professionals leaving the profession because they were so distraught and troubled by what they saw take place. And I want to stay on this medical professional before we get to governmental part because I think there's something really important here that I have struggled with in my own life. And I think it's important to excavate this because I actually think it's a lot of what's wrapped up in so many aspects of our questioning and frustration with the medical industry. I think we have decided or at some point a lot the way we decided being a physician or being a healthcare professional makes you an expert in medical ethics. And I do not believe that is true. And I believe those are two very different things. And I think this is going to show this. It doesn't make you without opinions. You can hear in this article how different these medical professionals, what different places they're ending up in, right? Because they're just human beings trying to work through the very complicated ethics of the situation. And that is a worthwhile exercise. It should not be placed completely in these individual human's laps just because of their job. Their job is to administer drugs and apply the knowledge of the human body they have. And I think this is true in so many areas of complex treatments and around birth. I read an incredible piece in the New York Times called Noah's Still Here and it was about trisomy 18.

[00:15:17] The understanding of we always thought these babies only lived a few hours, but that's not true. Some live years and years and years with the right amount of medical intervention. Well, what is the right amount of that medical intervention? Are we increasing their sufferings? Are we increasing their happiness and their lifespan? These are complex issues and because you're trained as a surgeon doesn't mean that you're qualified to make them. And it's been an unfair and harmful decision we've made to tell patients and doctors because you do this for a living, you are qualified to assess the complex medical ethics involved in all these decisions. You are the expert in this. Listen, and I think there's some hard questions about this even with regards to abortion. We say this should be a decision between a woman and her doctor. I believe that, but these are hard decisions and just because you went to medical school doesn't mean you're qualified to make them. You're human. And surely the medical training and you just being a human being, but some people make really, really bad ones. Like the doctors who inseminate 300 plus of their patients with their own sperm. I just think that this is really difficult stuff and because it's so hard we just go everybody decide for themselves. And I don't think that's working.

Beth [00:16:43] I do think it's cruel to ask every physician and nurse to decide for themselves when the law is written in this respect. Because you hear shades of like real moral injury for these folks in situations where they're trying to respect the law and the autonomy that the law has granted to the patient, but something in them does not feel good about this. So I was trying to read this thinking, how do you respect the medical professionals? And the fact that they have some medical ethics training, I'm sure, but that's not their primary focus. But this isn't just about medical ethics either, right? It's about everyone involves understanding of life and death and what they want for themselves. Like there are so many layers and what does this do to the culture? It's an individual death, but it's part of a fabric that has changed aspects of Canadian society which I think comes through not only in this piece, but lots of others that I've read about this. So, to me, one way that maybe the physician could be more respected if you're going to have this kind of expansive definition is to make sure that the primary care physician is involved.

[00:17:58] It sounds like a number of these deaths take place often with someone who is meeting the patient for the first time. It's not always someone who really knows the person. And maybe that's because the person who does know them has said, no, I won't do it. And they've had to look for someone who will. But I just feel like there needs to be some kind of assurance of relationship where if a medical professional is being asked to carry this out with a patient, they can in some way satisfy themselves that they know the person well enough to know whether that kind of consent is present in as much as you can ever consent to this, which I think is also a really difficult question.

Sarah [00:18:39] Yeah, to me, the issue of consent is sort of at the end of a much harder assessment. It's like the final step. I think why this is so complicated and why even I think if you know the person, what we're talking about is so much deeper and harder than just that individual. That's, I think, why I'm like you cannot saddle doctors with deciding what life means inside a society and what a good life means and what good death means. Those are decisions that the medical industry at all to me is not well-suited to tackle. I have said before, I really respect the way Europeans put together these like commissions on medical ethics that involve religious figures and that involve ethicists and philosophers. These are hard questions. The part of the article that took my breath away because I thought this isn't just about every individual and whether this one was right and this one is wrong and how do we set up a procedure to make sure nothing of this ever goes wrong.

[00:19:53] This is much bigger than that. It was a doctor and he said, "Once you accept that people ought to have autonomy, once you accept that life is not sacred and something that can only be taken by God, a being I don't believe in, then you're in that work. Some of us have to go forward and say, we'll do it." And I thought, Canada, get together; is that what you think? Do you think that life is not sacred? Because you don't believe in God? I read that and I thought, oh, see, this is way more than just medical consent or way more than understandings of who's qualified to do this. You have to decide what are the values of your nation? And there's a part of me that thinks this is why the ridiculousness-- because I do believe it's ridiculous, this new found nationalism, ethno-nationalism is taking seed, finding fertile ground from MAGA.

[00:21:15] Because I think people understand that we're hitting a point where we have to decide what are we doing here together? And so they're giving a racist, terrible answer that I'm not on board with. But this shows me that the emptiness of no answer at all, that all we're here to do is protect each other's individual personal autonomy at all costs. I don't want that. I'm just going to say that. Personal autonomy is not the number one value I pursue in my own life or I want to pursue as an American. So I want to be clear about that. That's not my values. And so when he articulated that way, I thought, well then how do we gather up in a way and address like what are we pursuing together as a nation? What do we want our government to use its power to pursue? And I don't want the answer to come from JD Vance, but I don't want this answer either.

Beth [00:22:19] I do really value personal autonomy vis-a-vis the government. I also question though where its outer contours are. I don't think there's a bold black line around your personal autonomy. And so thinking about the policy decisions that Canada has made really helped me think through like what does it look like to honor that for real in these situations? So I was troubled that there were patients who were offered MAID without bringing it up themselves. That they would be having a consultation before a surgery or talking about a condition they were living with. And someone would say, have you considered made? That doesn't feel like it honors personal autonomy to me. Now, if they say, "|I feel like I'm at the end of what I can endure, I would like to talk about this option," I think they should have that option to talk about, but I don't think it should be presented to them in the first instance by someone who's there to provide care for them. And I don't think that medical professionals should be asked to present that to someone in the 1st instance.

[00:23:25] So it's kind of that specificity that I'm looking for. Like, how do you say, well, this is about values, because people on all sides of this debate say it's about values, and start to get specific like what does it really mean to honor someone's wishes, honor their life, honor their agency when that agency is in the process of eroding? Canada is considering offering MAID to people who only have mental health conditions. They aren't presenting with a physical condition. It is a mental health condition. And suicidality is a symptom of many mental health conditions. So how do we respect and honor that person's agency by offering to them something that cannot be undone when we and they cannot be exactly sure when they're operating from a place of I really understand what I'm talking about right now versus being subjected to the harshness of the condition that they live with. That feels like a road that you shouldn't walk down to me.

Sarah [00:24:38] Well, they use a very specific example in the article because it's easy to say, well, they're at the end of their life and they experience all this suffering and they are advocating for this or it's brought up by somebody else. But there's this really, really incredible middle ground where they tell the story of like a 37 year old man who was diagnosed with cancer. And they're like, great news, this has a great survival rate. These are the treatment options. And he said, "I want MAID." And they were like, no, no. You're not going to die from this cancer. We can treat your cancer. You'll have this round of chemotherapy, X, Y, Z. And he was like, “I don't want to experience any pain or discomfort from the treatment of my cancer. I would like MAID.” And pursued it until it was administered. And this was when a doctor was like I can't do this anymore. Like, it was a moral injury to her to have to complete this man's request. And so, I don't not value personal autonomy. Let me be clear. But that is a bad outcome to me, and I'm comfortable saying that. That is not what the levers of government should be used to pursue. That was an injury to her. That was a crime against her and anyone who had to participate in that. When people feel that that is their only option, or when people feel like the presence of any pain or discomfort is unacceptable, then that's in conflict with my personal values. It's in conflicts with values I hope that we hold as a nation. I hope we can all see that when someone is saying life is not sacred, that could go to some really bad places. Really bad places that go way, way beyond whatever's happening between an individual and their physician in a hospital room.

Beth [00:26:36] And that's really tricky because we learn about the slippery slope as a logical fallacy, but in so many places it does feel like we are living slippery slopes. Like we have lost the capacity to build in limiting principles to say my individual autonomy ends where yours begins. And in every relationship and interaction and certainly in every medical setting, the doctor, the nurse, is as real of a person as I am, and they're bringing all their own stuff to the interaction, and so am I, and how do we honor both of us and what we think is important in life? And I worry that this increasing expansiveness does the opposite of that. That it just is really eroding how you honor people as people with complete stories in a context that is irreversible. That is where I feel the most concern.

Sarah [00:27:31] I think there's something else here that gets to some threads I've been cooking up in multiple places. The story to me, particularly of the mid-20th century, is the triumph in so many ways of the social sciences. This idea that we can study in this objective way and find out the answer. We're going to find out the answer to economics and we're going to find out the answer to proper way to educate everyone. We're going to find these objective answers to how we behave as human beings. And some of those triumphs are true victories. The use of social science and Brown versus the Board of Education I think is one that comes immediately to mind where we said, no, no, no. Look, we can study what this is doing to people and this is what it's doing to people and it's bad and we should all agree on that and make some changes accordingly. But there's a part of me that feels like over the course of my life, and particularly the last 20 years, has been our inability to accept that there are limits and that the social sciences can provide observations and information, but they do not provide hard answers. And you can hear and I feel like I hear it so many places, it's like every other day, it feels like, well, now we've decided that this study says giving cash to people is bad. Well, two weeks later, this study says giving cash to people says it's good.

[00:29:25] And you just feel our desire to get to a place where we'll all decide that this study solved it for us and that's the answer and we can all move on. That feels like some of what's going on with the Canadian government. And it's just like, well, we decided that this is what we're doing. And this is people want. They want their personal autonomy and we polled it out and we have the statistics. And so we've got our answer and let's move on. And I feel that a lot in democratic politics. It's just clinging to like, no, the study says. Does anybody know what studies say right now as far as standardized testings and college admission? Because I don't. I feel like every day is something new. And so, there's a part of me I can feel that clinging inside this situation. No, there's a right way to do this. And I just want to be like I don't think there is, guys. I don't think we're going to hit a procedure or a process. What you're really just doing is dumping this on the closest expert you can find which is the medical professional and be like, well, these are the experts. We have our experts, we've got our answer, we have our stats, we got our study. So we don't have to grapple with the fact that there might not be an answer. And that sometimes this is going to be bad and wrong. Bad and wrong! What happened in some of these stories is bad and wrong. I don't know how to say it anymore clearly. I don't care what studies you can show me. But it's like that battling with expertise and if we can get the right expert in the room, none of the rest of us have to take responsibility for what's happening inside the society we exist as members.

Beth [00:31:03] That limitation of data and observation in social science is really at its apex in this context because you can't study the whole picture because you cannot talk to the individual after and say, "Are you happy with this choice or not? How did this turn out for you?" You just hit a wall. There's an entire dimension of the problem that you are unable to study.

Sarah [00:31:22] I mean, we did get that one lady who wrote in her obituary, "My Parkinson's didn't kill me, the system did and that's why I took MAID." I mean, how much more do you need?

Beth [00:31:31] Right. That's another reason I think looking at Canada is so instructive because it's clear already that access to health care is a big component of what drives people to MAID. And Canada is ahead of us on that road. We are behind Canada in the States in a number of respects about that social support and access to medical care. So that's a piece of it. The data that we have is really about utilization. And that is only one part of the puzzle. And so I think that that is worth looking at, but to underscore your point, this cannot be a math problem because we will never have all of the inputs. Even assuming that the data itself could get us to a right answer, which I don't believe either, we can't even get to a sound answer based on the data because death cuts us off on one side of it.

Sarah [00:32:30] Well, and I think to me this is a really important aspect of the policy debates I often hear among Democrats, which is in progressives. We're a failed state. I mean, look at Canada, they have health insurance. How hard could it be? Look at Britain, they have health insurance. How hard could it be? Look at France. They have National Health Insurance; how hard could it be? And it's presented as, again, just that we we're not using the data the right way. We have this data. These other countries are doing this and it's perfect. And if we did this, it would solve all our problems. Not true. It's not true. It's not a fix-all. Go speak to people in these other countries, they're unhappy. There are still problems. Doesn't mean that's not a solution, but to advocate for a solution without accepting and acknowledging the problems that come along with that.

[00:33:24] I think there's an aspect of this with regards to our ideas about religion that it's all bad and a secular society would obviously be more highly evolved and everything would be better. But there is an aspect to this story about secularization to me personally. It doesn't mean I think everybody needs to be religious or go to church or believe a certain way. Human beings have been in pursuit of religion for mostly as long as human beings have existed. It's looked a lot of different ways for a reason because there has to be a place to hold. It can't be social science and experts that hold what does it mean to live. Is life sacred? What does that look like if it is? What does a good death look like? What happens when you die? We have to have these conversations. They have to be a part of a society if we want to continue to present solutions that address this most human moment.

Beth [00:34:32] I had coffee with a friend last week and we were talking about how in Kentucky in particular we got really obsessed with STEM about 20 years too late. And the training that our kids probably needed is more like how to be a philosopher than a coder because the ability to do means that we need people who can question the ability of whether it should be done or not and under what circumstances? And I think that's why this topic is so incredibly challenging. I wanted to ask you, Sarah, we have a number of jurisdictions in the United States where there is some kind of death with dignity law, and then a number of other jurisdictions considering those proposals. In Kentucky, it did not advance out of committee in our last session. But if you were designing a law like this, what kinds of things did you pick out from Canada's experience that you think, well, this would be an important consideration for me as a legislator and as a citizen?

Sarah [00:35:41] In think the reality in America based on what's happening in Canada is that these laws will just get more and more aggressive. And I'm not sure I'm opposed to that. I'll just be clear. I sat this weekend and a friend and I were explaining what's going on to two other friends. And I thought the fact that everybody from multiple different backgrounds and life experiences goes, oh no, whoa, uh-uh, is really reflective and will play out as more states, I think, look at these kinds of laws. But the ones in America are more aggressive and I think they should be. This should be a hard thing. Like not impossible, but hard. It should be hard. I personally, as a legislator, would keep it to mentally competent, terminally ill patients. And I would need more than one medical professional’s opinion on that. I would like us to try something new in America, which is not use our citizenry as a grand experiment or actually send this to a commission of designated medical ethical experts. Let's set up one of these committees that contains lots of different religious, ethical, philosophical perspectives, people whose entire lives are dedicated to these incredibly difficult questions. That would be interesting, don't you think, we tried it that way first?

Beth [00:37:14] Yeah, I would want to hear a lot of testimony. I would want to see a lot of hypothetical workshopping among medical professionals. Okay, if this person walked in with this request, what pieces of it do we need to think about as we write these laws? And again that sense of how do we honor everyone in this equation? I also would want to make sure that our marketing culture doesn't take over here. Another piece of the Atlantic piece that is stuck in my mind is that an app was launched to help people plan their ideal made experiences. And I'm not trying to be ugly to anybody, but I can imagine that kind of thing happening on steroids in the United States and commercials for the specific drugs that are used in these deaths. And just an entire industry launched around helping people die that I think would be extremely destructive, just on so many levels. So I would want to have some real clear prohibitions against that stuff, and that's tricky. I'm also kind of inclined to libertarianism and free market economy, but this really tests that in me because once you say it's legal, then how do you restrict the market? And I think my answer has to be, you just do. You just have to. But I really would worry if we took what is one of our greatest assets as a country, our ability to sell things and trained it on selling death.

Sarah [00:38:48] Yeah, I don't want any marketing around healthcare in general. I would like to take it all the away. I don't want marketing around drugs. I don't want marketing around IVF. I don't want marketing around anything related to life, death or your health. I don't think it ends well.

Beth [00:39:04] Because we're too good at it. That's the problem.

Sarah [00:39:09] Yes. And I just think the part of our brain that capitalism has formed that tells us if you spend enough money you'll get out of the complexities of being human in the most human moments is just well formed, and it's fertile ground and I don't want that. And one of the aspects of Catholicism's ethics around life (and there are aspects obviously that I find problematic, but you got to give them props for being consistent. I'm also vehemently opposed to the death penalty) is they talk about the commodification of life, particularly around birth. But I think it could be true on this end, too. People can make money off this very vulnerable moment in a human existence. They will and they'll make a lot of it because it's a vulnerable moment in human existence. And so I do think when we know that, if we can avoid it, we absolutely should. I will say this for America, it might just be a numbers game that you just have a much higher percentage of people in America who have what some would argue are radical ideas around the sacredness of life.

[00:40:46] But I'm not really worried about us getting to a place where we say life is not sacred here in the United States of America. And I don't think every Canadian obviously believes that life is not sacred. I know that there are hundreds of thousands of Canadians, millions of Canadians who are horrified by having themselves represented in this article as saying life is not sacred, personal autonomy is all that matters. Now we love some personal autonomy in America, but we have such a complicated relationship with it. So I'm not really worried about us following in Canada's footsteps, one, because I think all this reporting and all these statistics just make it incredibly hard. And two, because, I think, we, for a lot of complex reasons, have some deep history with ideas around the sacredness of life that haven't always played out positively, but I think would be hard to detach at this point in American history.

Beth [00:41:52] I'm sure you all will have lots to say about this and we love hearing from you, even when you're on very different pages than we are. Please do keep the conversation going. Community is really important. There is a story within this Atlantic piece about a person who requested, MAID, and then notified family members. And they suddenly started showing up and objecting, and this was a person who was deeply lonely. And once this decision sparked new kinds of relationships, decided not to do it. And that happens. There are some statistics about how many people request this medication and never use it. But there is some comfort for them in knowing that it's there if they don't use it. But riffing off of that anecdote, David Brooks wrote an opinion piece in the New York Times about the cultural impact of this kind of policy framework. His wife was diagnosed with a very aggressive form of cancer. And so he saw a lot of the relationship side of that kind of suffering.

[00:43:03] And he wrote, "If cherishing the suffering can make a nation kind, then discarding the suffering makes it cruel. It can breed a sense of contempt. Why should we care for this hopeless cause? And when our own sense of control is shattered by our own inevitable frailty, it can breed panic and fear. Who will care for me as I walk this difficult path?" And I hope that talking about this and making space for others to talk about it increases our sense of connection to each other and increases the kind of conversations where you really get to know a person. When you're talking about life and death and suffering, that is when you form some of your closest bonds and better to do that and then be more confident that you're honoring every person's wishes and values when those tough decisions come near the end of life. So thank you for being with us through this conversation. We always end talking about something Outside of Politics. It's a kind of natural connection, though, from talking about relationships to a little exercise you had with some friends this weekend, Sarah.

Sarah [00:44:14] Yeah, this was my friend Raynelle's [sp] brilliant idea. So I have a Mahjong group and we've all known each other at different levels of casualty, I would say, for many, many years. But Raynelle was like, listen, we don't know each other's life story. I got to know everything. I want you to start with, I was born on July 28th, 1981 and end with, and then I went on this Mahjong girl's trip. And it was incredible spending hours listening to everyone's journeys and making the connection between different journeys. And obviously there has to be a lot of trust that all of this takes place in a cone of confidence. But it just was really beautiful and intense. People live a lot of lives, you know what I'm saying? And I just thought, yeah, she's so right.

[00:45:07] And I have had friends I can think of a couple now that I want to go to and be like, okay, well, we have to do this because I love you and we hang out a lot now and we jump off the deep-- and especially I think women do this-- with this level of intimacy, but I'm missing some pieces. And so I need to go back and understand you better. I think about my friend, Elizabeth Passarella. I became friends with Elizabeth because I was asked to endorse her book, which told a lot of her life story. And so, I was like me and Lisa we got to be friends. So I did pursue her and make her my friend and how that was like a shortcut of that. Because I've read two of her memoirs, so I understand so much of her story. And I just think that it's so easy to just dive in and realize no, I need the background. So everybody still Raynelle's brilliant idea. Next time you go to a girl trip with like new girlfriends, just go, "Okay, we're going to tell each other's life stories." It's so fun.

Beth [00:46:06] How did you do it? Did one person go at a time and just do the full thing?

Sarah [00:46:10] Yeah, it was like three, four hours. I started at breakfast and I think I was done by the time we got to our Mahjong lesson. And then, Raynell started right after that and we went all the way late into the night after dinner. We worked it out. It fitted all in. I was impressed with us. But yeah, we just went. But then it was funny because then the next person would go and you'd be like, "I forgot about this super major thing that happened to me, but her story reminds me I should probably add this." And you tell your story and they'd be like, you forgot to include that? You're like, yeah. right. It puts your own life in perspective too where you're trying to decide really what was formative for me in this time period and what really did change everything? And I thought it changed everything at the time and it's become a part of the story I tell over and over again, but really... And it was also very much like our flashback experience. It's easy to go back and tell the stories you've been telling for a long time, but then as you get closer to the end of the story, you're like, I don't know what just happened. I'm not really sure what really matters yet.

Beth [00:47:18] I thought of a couple of mini versions of this that maybe you could squeeze in if you're not going on a trip together. My friend Maggie and I met a couple of years ago and have become very close. And we were talking about how we wish that we had been at each other's weddings. Like that's a big piece of life that that we missed. And so we got cupcakes because that's what Maggie served at her wedding and set at her house and both just went through our whole wedding albums and just told the story of our wedding. How did we plan it? Who were these people? You go through your wedding album, you do get a lot of your life story out because it's like, well, this is Chad's grandmother and we did this because this is special to us or whatever. And so that was really, really fun. I think you and I had a really good version of this on one trip when we took the game Hugo with us that has little conversation cards and you draw those cards and answer questions. That's especially helpful, I think, for people who like us maybe talk all the time but don't get to certain things. Or people who have trouble of just knowing where to get started if someone says, tell me your life story.

[00:48:20] And then the other thing I have so enjoyed in my relationship with Chad, because I didn't meet him until my mid late 20s, just going to our hometowns and driving around. Here's the grocery store where I worked. This is the dairy freeze that has the best ice cream. Like that kind of physical tour of someone's geography I think is so fun. Our friends who moved here from Utah went home with me to visit my parents one weekend we went to a little amusement park and saw my family and then drove around a little bit and that was just a really cool way to get them up to speed on parts of my life. I would love to go with them to Utah sometime and do that same thing. So I think a lot of ways to do this, but it is an investment of time that pays off in just such big dividends in terms of just feeling like these really are my people who I love and they love me and this is how I want it to feel all the time.

Sarah [00:49:13] Well, I'd also just think it's not just good for the relationship, it's just good for you. I just think that type of inventory and review is really, really valuable. And I think as a person who's very future oriented and has a lot of forward momentum, I'm realizing how important it is for me to look back and think, yeah, that happened. That was a lot. What's the story I tell about that? You're not just reciting dates; you're telling a narrative about your life. You're telling this is why this mattered or this is what this was hard or this was why I was really proud of this. And I think that's a really, really valuable exercise just personally.

Beth [00:49:59] Go chat with your people, especially your new people and get caught up on each other. It's well worth it. We would love for you to chat with us too. A great place to do that is on Substack and we are having that 15% sale that we don't want you to miss out on. The link will be in our show notes through August 31st. We'll be back with you on Friday. If you have things to help us prepare for Friday to talk about crime, we would love to hear from you. Hello@pantsuitPoliticsshow.com with crime in the subject line and we will see you then. Have the best week available to you.