Lack of Housing is a Housing Issue
Banning MAiD would be unethical
Due to multiple factors, Canada is experiencing a housing shortage. The Canadian Mortgage and Housing Corporation, which is Canada’s national housing agency, estimates that 3.5 million new units need to be built by 2030 to restore affordability, including 1.85 million units in Ontario. Expensive housing is a serious problem since, if house prices outpace rises in income, people are forced to move or, in the worst cases, can’t afford housing and are forced into shelters or onto the street.
The very obvious thing we need to do is build more housing, especially in Ontario and British Columbia, where the housing crisis is the worst. People with low or no incomes are affected the most, so they should be given priority by increasing the amount of subsidized and below-market housing. But housing unaffordability affects middle income people as well, and, since building more market-rate housing lowers rents nearby rents, more housing will help both middle- and lower-income people.
Thankfully, people on both the left and the right are coming around to this. In Toronto, I remember the opposition many left-leaning people had to tearing down Honest Ed’s—a civic monstrosity that took up an entire city block—to build market-rate apartments, arguing that doing so was unacceptable gentrification. But, increasingly, people further to the left are arguing that we need more housing in general. (Noah Smith has an excellent description and rebuttal to left-NIMBYism here.) These are promising trends.
We should also increase other social supports. Again, progress is being made. A couple days ago, the Canada Disability Benefit Act passed the second reading in federal parliament.
During Canada’s housing problem, medical assistance in dying is legal, so we’re increasingly hearing stories about lack of housing playing a role in people’s MAiD requests. The most recent case is of Amir Farsoud, who’s in the process of applying for MAiD. Here are some quotations from a news article:
Amir Farsoud lives with never-ending agony from a back injury years ago. He tells CityNews at its worst he is “crying like a 5-year-old and not sleeping for days in a row.” Farsoud also takes medication for depression and anxiety.
He describes his quality of life as “awful, non-existent and terrible … I do nothing other than manage pain.”
But Farsoud said his quality of life is not the reason he is applying for MAiD. He applied because he is currently in danger of losing his housing and fears being homeless over dying. “It’s not my first choice.” […]
“I don’t want to die but I don’t want to be homeless more than I don’t want to die,” shared Farsoud.
The first point to emphasize is that lack of housing is a factor but isn’t playing a role in Farsoud’s qualification for MAiD (if he gets approved). He has “never-ending agony” and his quality of life is “awful, non-existent and terrible.” On those merits, MAiD makes sense.
There’s no doubt that this is a bad situation, but in what way is it bad? What’s the problem the article is describing? Pretty obviously, it’s a housing and financial support problem. Farsoud agrees. In a Twitter thread about his story, he supports MAiD:
However, for reasons, “lack of housing is a housing issue” isn’t the focus of the article. Instead, it focuses on MAiD, mentioning a United Nations letter about Canada’s MAiD policy and quoting Kerry Bowman, a University of Toronto bioethicist. Here’s one of Bowman’s quotations from the recent article:
I worry about this because it is people living with disability, people living with pain, people living in poverty, that are requesting medical assistance in dying, not because of the physical experience they’re going through, but because of the social circumstances themselves and this is wrong. It’s really a very terrible thing.
Bowman has said elsewhere that he “supports MAiD in principle” and he doesn’t give a prescription for Farsoud’s situation, but I want to address how some people might interpret the quotation, which might actually be what Bowman has in mind, though I’m not claiming that.
Some people think that MAiD should be banned in cases such as Farsoud’s. This is the vibe of the CityNews article, and others, including University of Toronto professor Trudo Lemmens and public health academics, have said so more directly.
But it’s a mistake. The argument is that “unaffordable housing is causing some people to choose MAiD sooner than they otherwise would, so we should ban MAiD in those situations”, but it doesn’t follow. The solution is to treat the problem, which means building more housing and subsidizing some of it. By analogy, consider these arguments, which all have the same form:
If there isn’t enough housing, then people will end up in shelters, which is bad. Therefore, we should ban shelters.
If people aren’t making a liveable wage, they’ll have to use food banks, which is bad. Therefore, we should ban food banks.
If people aren’t making a liveable wage, they might resort to sex work. Therefore, we should ban sex work.
These arguments all fail for the same reason, which is that they focus on the effect instead of the cause and try to solve the problem by banning the effect. Obviously, a person who can’t afford housing and can’t access a shelter is worse off than if just the former is true. I covered this in a previous post, referring to a couple cases of people who received an assisted death, in part due to poor social support:
In the system where MAiD was unavailable, they would have continued to endure intolerable suffering without relief, so their own choices show that it’s better that MAiD was an option.
Instead, these cases show a failure of social support, not an overly broad MAiD regime. MAiD access makes the other failures more salient, but that isn’t evidence that the problem is with MAiD, or that prohibiting MAiD in these cases would be better.
A ban on MAiD for low-income people is a bad idea for the obvious reason that income shouldn’t affect healthcare access, but also because people should be allowed to decide for themselves when they want to die. Holding them hostage while we wait for houses to be built or the government to increase funding is unethical.
People sometimes say that governments are pushing MAiD because it’s cheaper and easier than dealing with the other issues, but the evidence for this is lacking. If it were true, we’d expect governments that are otherwise fiscally conservative to take steps to increase MAiD access, but often the opposite is true. And, as a historical point, Carter, the original Supreme Court of Canada case on MAiD, and Truchon, the Superior Court of Quebec case that struck down the reasonable foreseeability condition, were court decisions, not government programs designed to cut costs.
Canada’s lack of affordable housing is a serious problem that needs to be addressed, but it’s a housing problem. Banning MAiD will just make things worse.
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