UNCOMMONS

The sky hasn’t fallen. MAID has been an overwhelming success, respecting freedom, reducing suffering, and providing a dignified death to tens of thousands of Canadians in need.

We legalized medical assistance in dying in 2016.

Opponents claimed the sky would fall.

In 2021, we extended access to MAID beyond situations where one’s natural death was reasonably foreseeable.

Opponents claimed the sky would fall.

Has the sky fallen? The answer is no.

Despite regular fearmongering, the numbers paint a clear picture: MAID in Canada has been an overwhelming success. It has afforded dignity to thousands of Canadians who made their own fundamental life choice to end unbearable suffering.

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Before we get to the numbers, here’s a quick summary of the rules:

• MAID is available to anyone in Canada who is suffering grievously from an irremediable illness, provided the individual is of a sound mind.

• Access to MAID requires an independent assessment by a clinician.

• In the case of an individual whose death is not reasonably foreseeable, there are additional safeguards, including a 90 day waiting period.

• MAID is not yet available to individuals where mental illness is the sole underlying condition (and the government has wrongly delayed extending it, yet again). Of course, it should be available, provided the mental illness in question doesn’t impact the individual’s capacity to consent. It’s worth noting that MAID is already available to individuals who suffer both from physical and mental illness at the same time, so these capacity issues are already being managed.

Now, to the numbers.

Here are ways you might see the issue framed to suggest that the numbers are cause for concern:

• The Star’s headline blares that a “Surge in medically assisted deaths under Canada’s MAID program outpaces every other country.” The article is based on a Health Canada report that breaks down the 2022 numbers, finding a 30% increase in MAID access vs 2021.

• A subsequent Star op-ed argues that Canada has moved too quickly to embrace MAID, and needs to put the brakes on.

Scary stuff, potentially.

So, let’s look under the hood at that Health Canada report.

In 2022, there were 13,241 MAID provisions in Canada.

96.5% of those cases took place where the person’s natural death was reasonably foreseeable.

The majority of people had cancer (63%), cardiovascular conditions (18.8%), or neurological conditions (12.6%) like Parkinson’s, ALS, MS, etc. We already know that cancer and heart diseases are the top two leading causes of death in Canada, so these figures aren’t surprising.

The average age of MAID recipients in 2022 was 77 years. Not a very slippery slope so far.

Health Canada reports that “Only a small percentage of individuals receiving MAID were between 18-45 (1.3%) and 45-55 (3.2%).”

But even this frame of reference overstates any potential concern. After all, those figures include situations where the person’s natural death was reasonably foreseeable, regardless of age.

If there’s a slippery slope concern here, it should be focused on people receiving MAID whose natural death is not reasonably foreseeable. These are, ostensibly, people who could have led long lives, cut short by the tragedy of state-sponsored assisted suicide.

In Parliament and in the media, we’ve regularly heard concerns that people will seek to end their lives via MAID too early as a consequence of poverty or a lack of social or mental health supports, and that the law has expanded too quickly.

What do the numbers tell us about these concerns?

Well, in 2022, 463 people took advantage of MAID when their natural death was not reasonably foreseeable, 3.5% of total MAID recipients.

In other words, while MAID accounted for 4.1% of all deaths overall, “MAID for individuals whose natural death is not reasonably foreseeably represents just 0.14% of all deaths in Canada in 2022.”

Half of these 463 people suffered from neurological conditions.

Over 70% of these 463 people were at least 71 years old.

Here’s a helpful chart that breaks down MAID by age:

Only 16 people younger than 45 accessed MAID where their natural death was not reasonably foreseeable. This represents 0.0012% of all MAID deaths in 2022, and 0.000048% of all deaths in Canada.

A total of 123 people under the age of 65 accessed MAID where their death was not reasonably foreseeable. This represents 0.0093% of all MAID deaths in 2022, and 0.00037% of all deaths in Canada.

And, again, every single one of these people received an independent assessment from a clinician to determine capacity, they were of a sound mind to make their own fundamental life decisions, and they were suffering unbearably.

To put this in even greater perspective, consider that 3,593 people committed actual suicide in 2022, including 26 people under the age of 15, and 2,917 under the age of 65. Or consider that 7,328 people died from opioid overdose that same year.

Are we showing any comparable level of attention and concern?

MAID, in contrast, has offered a dignified death to tens of thousands of Canadians since we regulated it. It has decreased immense suffering and it has increased respect for individual autonomy and freedom (and here I thought Canada should be the freest country in the world!).

The sky hasn’t fallen. The slope isn’t slippery.

Yes, of course we can and should continue to improve social and mental health supports. We would likely prevent more actual suicide deaths that way.

But let’s not impugn a successful health system that respects individual freedom and autonomy and offers dignity in the face of incredible suffering.

MAID was set to be extended this March to situations where mental illness is the sole underlying condition. It would have applied to very few Canadians, and we could have further strengthened safeguards if needed.

Instead, under pressure, the government caved and will likely kick the can beyond the next election.

Unfailingly, many of the same opponents again claimed the sky will fall.

With the right safeguards, the numbers tell us that it won’t.

The ICJ interim decision adds little to what we already knew.

I sometimes sing “Blowin in the Wind” to my kids. One of Dylan’s lines is:

How many deaths will it take ‘til he knows that too many people have died?

I don’t know what the number is, but I do know that we’re well past it in Gaza.

In its interim decision today, the International Court of Justice recapped the destruction at paragraph 46:

While figures relating to the Gaza Strip cannot be independently verified, recent information indicates that 25,700 Palestinians have been killed, over 63,000 injuries have been reported, over 360,000 housing units have been destroyed or partially damaged and approximately 1.7 million persons have been internally displaced.

ICJ ad hoc Justice Barak notes at para 36 of his separate decision that the figures come from the Ministry of Health of Gaza, which is controlled by Hamas, and he further notes that they do not distinguish between civilians and combatants or between military objectives and civilian objects. In his words, “it is difficult to draw any conclusion from them.”

While IDF sources have called the numbers “fairly accurate” it’s still difficult to draw any conclusions from them as it relates to genocide. After all, as Justice Barak reminds us (at para 27), the drafters of the Genocide Convention clarified that “[t]he infliction of losses, even heavy losses, on the civilian population in the course of operations of war, does not as a rule constitute genocide.”

Whatever we call it, there’s no disputing the tremendous and tragic scale of death and destruction, including an overwhelming impact on innocent civilians.

In the introduction to its decision, the ICJ describes: “…massive civilian casualties, extensive destruction of civilian infrastructure and the displacement of the overwhelming majority of the population in Gaza.”

The ICJ ultimately concludes that, on a preliminary basis, there is a plausible basis for the case proceeding. And the impact of its interim orders seems non-controversial:

• In a vote of 15-2 (Justice Barak and Justice Sebutinde dissenting), the Court ordered Israel to adhere to its pre-existing obligation to prevent genocide (including a specific reference to its military), preserve any evidence related to these allegations, and report back in one month on compliance measures.

• In a vote of 16-1 (only Justice Sebutinde dissenting), the Court ordered Israel to prevent and punish genocidal incitement against Palestinians and to ensure the immediate and effective provision of humanitarian assistance.

I’ve done a deep dive on other occasions on questions of genocide, including with respect to the atrocities of ISIS, China’s treatment of the Uyghurs, and the slaughter and displacement of the Rohingya.

In this case, my view is that what we see in Gaza does not amount to genocide, particularly given the insufficient evidence on the question of intent.

As we’ve received a deluge of emails on the ICJ case (over 10,000 at last count), I’ve waited to comment until the ICJ interim decision was released, recognizing that 17 smart judges were dedicated to reviewing the evidentiary record in greater detail. Having reviewed today’s ICJ interim decision, it’s apparent that the evidentiary record remains weak on the question of intent, as even supporting justices issued separate declarations to express doubts about genocidal intent (Justice Nolte) and reiterate that this is a provisional decision that does not decide whether such intent exists or existed (Justice Bhandari).

It isn’t hard to find dehumanizing comments, including some from senior officials. And too many people, including Israel’s President, have been quick to ignore that Palestinians are not Hamas. No, it isn’t an entire nation out there that is responsible.

At the same time, while the security context doesn’t absolve Israel for its indiscriminate and disproportionate bombing campaign, it does provide a rationale for violence that is very different from genocidal intent. In other words, one needs to consider Israel’s response in light of October 7 and Hamas’ threat to “repeat October 7 again and again.”

Scrolling Twitter on the morning of October 7 felt a lot like sitting in my grade 11 science class when we heard about the Twin Towers. Here’s how Justice Barak describes that day, at para 18:

On 7 October 2023, on the day of the Sabbath and the Jewish holiday of “Simchat Torah”, over 3,000 Hamas terrorists, aided by members of the Palestinian Islamic Jihad, invaded Israeli territory by land, air and sea. The assault began in the early morning hours, with a barrage of rockets over the entire country and the infiltration of Hamas into Israeli territory. Alerts sounded all over Israel, civilians and soldiers took shelter, and many were later massacred inside those shelters. In other places, houses were burned down with civilians still in their safe rooms, burning alive or suffocating to death. At the Reim Nova Music Festival, young Israelis were murdered in their sleep or while running for their lives across open fields. Women’s bodies were mutilated, raped, cut up and shot in the worst possible places. Overall, more than 1,200 innocent civilians, including infants and the elderly, were murdered on that day. Two hundred and forty Israelis were kidnapped and taken to the Gaza Strip, and over 12,000 rockets have been fired at Israel since 7 October. These facts have been largely reported and are indisputable.

There’s no dispute that Israel has a right to defend itself. That Hamas has embedded itself within civilian infrastructure means any war waged will necessarily make it difficult to minimize deaths of civilians.

And yet, the difficulty of minimizing civilian deaths is not a licence for excessive harm. Even President Biden has called Israel’s bombing campaign “indiscriminate.”

And as Justice Barak reminds us, at para 10, Israel’s Supreme Court has ruled that Israel must act consistently with international humanitarian law and that Israel must refrain from targeting terrorists when excessive harm to civilians is anticipated. At para 26, Justice Barak reiterates that “IHL provides that harm to innocent civilians and civilian infrastructure should not be excessive in comparison to the military advantage from a strike.”

If Israel’s indiscriminate bombing and destruction doesn’t amount to excessive harm to civilians, then what does?

Targeted campaigns against those involved in the October 7 attacks remain justified. Some civilians may well be caught up in those targeted attacks, and they could still be justified.

But we’ve seen no justification for this scale of indiscriminate destruction and death. Given the dehumanizing rhetoric and the histories of the far-right leaders in charge, it is unsurprising that this is where we find ourselves.

In aiming for the elimination of Hamas, Israel has caused a humanitarian disaster for Palestinians.

At para 47, the ICJ quotes a January 5, 2024 statement from the UN Under Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator:

Gaza has become a place of death and despair.

. . . Families are sleeping in the open as temperatures plummet. Areas where civilians were told to relocate for their safety have come under bombardment. Medical facilities are under relentless attack. The few hospitals that are partially functional are overwhelmed with trauma cases, critically short of all supplies, and inundated by desperate people seeking safety.

A public health disaster is unfolding. Infectious diseases are spreading in overcrowded shelters as sewers spill over. Some 180 Palestinian women are giving birth daily amidst this chaos. People are facing the highest levels of food insecurity ever recorded. Famine is around the corner.

For children in particular, the past 12 weeks have been traumatic: No food. No water. No school. Nothing but the terrifying sounds of war, day in and day out.

Gaza has simply become uninhabitable. Its people are witnessing daily threats to their very existence — while the world watches on.

At para 48, the ICJ references a December 21, 2023 World Health Organization report:

An unprecedented 93% of the population in Gaza is facing crisis levels of hunger, with insufficient food and high levels of malnutrition. At least 1 in 4 households are facing ‘catastrophic conditions’: experiencing an extreme lack of food and starvation and having resorted to selling off their possessions and other extreme measures to afford a simple meal. Starvation, destitution and death are evident.

Whatever we call it, it needs to stop now.

Violence radicalizes, as we should know by now. Further violence will only lead us further away from any possible path towards peace.

And yes, it is hard to see that path right now.

Hamas may never be defeated militarily, it is hostile and hateful towards the Jewish people, and it has no place in any future for Palestine. And yet it has greater support in the wake of October 7 and Israel’s response than it had before.

Netanyahu and his far-right ideologues, having presided over an illegal expansion of settlements, remain opposed to a two-state solution. And there is no serious plan for the ‘day after’ that isn’t a security presence in perpetuity. That is, the plan appears to be an occupation. Because that has worked so well before.

The violence needs to end, the hostages need to be freed, we need a two-state solution, and we need an independent accountability mechanism for any breaches of international humanitarian law by actors on both sides. Not an ICJ hearing limited to the very high threshold of genocide, to which Hamas is not a party despite its crimes.

I’m tired of signing letters. I’ve written to Minister Joly, signed a letter with 32 other Canadian MPs for a ceasefire, and signed a more recent letter with dozens of Canadian, US, and German counterparts for a ceasefire.

While Canada has a limited role to play here, all things considered, we do have a strong relationship with the one actor that can make a difference: the United States.

To put it simply, the Biden administration needs to do more to end this war. Its private diplomacy has worked to limit damage at the margins, but it has also enabled the death and destruction to continue for far too long.

And too many people have died.

It may not be genocide, but it is a humanitarian disaster. And it needs to end.

Nate is joined on this episode by Yasir Naqvi, a friend, a former opponent in the Ontario liberal leadership race, and a continued federal colleague.

The federal government should continue to be a strong partner for Toronto, and both the feds and the City should act like the partners we are.

Based on recent events, you might have the wrong impression of Toronto Liberal MPs, the federal government, and the City of Toronto.

With a proposed fiscal plan that already includes a 10.5% property tax increase, Toronto’s budget chief Shelley Carroll threatened an additional 6% “Federal Impacts levy” if the feds don’t provide $250 million for Toronto’s shelter system.

The Star, quoting mostly anonymous sources, declared that “Trudeau’s Toronto MPs are furious at Olivia Chow over her property tax gambit.” I’m not furious, for what it’s worth, and I’m never the anonymous MP, in case you’re ever wondering.

Liberal MP Yvan Baker then did a bit of a media tour rightly highlighting federal investment in Toronto, fairly said “this feels a little bit like a shakedown”, and went way too far in accusing the Mayor of “lying to Torontonians.”

Causing good trouble for the rest of this Parliament.

If you’ve followed me at all, you know that I believe politics to be one of the most important ways to make a difference.

It’s why I left an early career as a commercial litigation lawyer to run in a Liberal nomination back in 2013-14. It was a bit of madness at the time, but I wouldn’t trade the last 10 years for anything else. It can feel a bit like pushing boulders up hills, but I’ve also had my share of success in shaping policies and making a difference.

On our first episode back, Nate is joined by the founder of Bellingcat Eliot Higgins. Bellingcat is an investigative journalism website that specializes in fact-checking and open-source intelligence. Elliott himself began blogging about the Syrian civil war over 10 years ago. His work individually and as part of Bellingcat has ultimately created an incredible citizen-led community of journalists and fact-checkers. 

If nothing else, Elliott is intent on restoring our collective concern for the truth. And it’s hard to think of something more important than that, especially as we all now increasingly live our lives in a world of such fast-moving information.

Nate is joined on this episode by David Crombie for a discussion on the Greenbelt, the protection of the Greenbelt, and the Ford government corruption surrounding the Greenbelt.

David Crombie is the former mayor of Toronto from 72 to 78. He’s a former cabinet minister, and Clark and Mulroney governments, and most importantly for this conversation. He was the chair of the Greenbelt Council, and resigned at the end of 2020 because he saw the direction that the Ford government was heading.

This episode marks a new season where we will be shifting focus to Ontario politics as Nate continues to run for the Ontario Liberal leadership.

To learn more about his campaign, and sign up to vote, visit MeetNate.ca. 

Nate is joined on this episode by former Mayor of Toronto, David Miller. 

Before running for public office, he was a partner at the Toronto law firm Aird & Berlis, where he specialized in employment and immigration law and shareholder rights. He became a Metro councillor in 1994, and in 1997 he was elected to the new City of Toronto council where he served two terms prior to becoming mayor.

Following his time as Mayor, Miller briefly returned to law before serving as president and CEO of the World Wildlife Fund Canada from 2013 to 2017, after which he began working as the director of international diplomacy at C40 Cities Climate Leadership Group.

As you may know, there’s an unexpected Mayoral race here in Toronto, so the conversation does cover some of that ground. As well as issues affecting municipalities all across Canada – housing, transit, how we should see the relationship managed between municipalities and provincial and federal governments, and how we should think about ambitious city building.

Nate is joined on this episode by Kimberly Murray for a discussion on her ongoing work to address trauma, realize justice, and advance reconciliation. Kimberly is the Independent Special Interlocutor for Missing Children and Unmarked Graves and Burial Sites associated with Indian Residential Schools. 

Prior to this new role, Ms. Murray was the Province of Ontario’s first ever Assistant Deputy Attorney General for Indigenous Justice. From 2010 to 2015, she was the Executive Director of the Truth and Reconciliation Commission of Canada. Prior to that, she was a staff lawyer and then executive director of Aboriginal Legal Services of Toronto. 

She is a member of the Kahnesatake Mohawk Nation. She is currently the Executive Lead for the newly created Survivors’ Secretariat at the Six Nations of the Grand River, working to recover the missing children and unmarked burials at the Mohawk Institute.

Content Warning: This episode includes detailed discussions of personal accounts of residential school survivors. 

Nate is joined on this episode by Dr. Isaac Bogoch for a discussion on Neglected Tropical Diseases, global health equity, pandemic prevention and preparedness and his advocacy during the pandemic.

He’s a professor of medicine at U of T, an infectious diseases specialist with a focus on tropical diseases and HIV, and he became very public facing in his work and regular commentary through the COVID pandemic.

Click here for more info on NTDs

& click here to learn more about Nate’s pandemic prevention & preparedness bill