What is meaning? How does one find it? Can one be wrong about what is meaningful? These seemingly innocent questions have become matters of life and death.
In a recent New York Times opinion essay, University of Toronto psychiatrists Madeline Li and Gary Rodin warn that Canada’s medical assistance in dying (MAiD) system has become too quick to accommodate requests for death. Physicians, they argue, should not act as mere conduits for patient preferences. Instead, they should offer counseling and reflective conversations that help patients consider alternatives and the possibility of more time to live meaningfully.
Their concern is welcome. Their solution, however, leaves the central moral problem untouched.
What makes a decision to die right? If a patient asks for death today, postpones the request after counseling, and renews it months later, why should the last judgment carry greater authority than the first two? The passage of time cannot answer this. Neither can the mere fact of reflection. We can deliberate at length and still be mistaken.
Li and Rodin recount the story of an elderly Holocaust survivor who initially sought MAiD partly because choosing the time of his death seemed a way to reclaim freedom. His family’s distress prompted him to reconsider. He adapted to illness and found further meaning in life. Later, as his condition worsened and he risked losing the capacity to consent, he chose MAiD with his family’s support.
This is offered as a model of good care. Yet it raises the question the authors leave unanswered. What made the final choice “good”? His worsening illness? His family’s agreement? His fear of losing the capacity to choose? These facts explain his decision. They do not, by themselves, justify it. Nor does the family’s eventual support prove that their earlier misgivings were mistaken.
The problem is not that counseling is useless. It may reveal neglected relationships, relieve distress, and avert deaths. The problem is supposing that more carefully considered preferences somehow acquire moral authority by virtue of being considered.
We do what we do because something appears to us worth pursuing — but appearance and reality are not identical. We can mistake what falsely appears desirable for what is good. The question is not merely whether a choice expresses a patient’s settled sense of dignity or meaning, but whether that sense is true to the goods of human life.
Consider another of Li and Rodin’s patients, a woman who sought MAiD after losing the ability to cook Sunday dinners for her family. Counseling helped her recognize that her family valued her presence, not merely her usefulness. She decided to live longer.
But what if she had remained unconvinced? Would her life have become less worthy of protection because she could not perceive its worth? Surely the lesson of the story is that the good of a person is not created by that person’s recognition of it.
There are at least three reasons commonly given for euthanasia: liberty, relief of suffering, and the wish not to burden others. None settles the moral question. Liberty permits us to choose, but cannot tell us whether our choice is good. Suffering may narrow our horizons without extinguishing our capacity to love or to receive love. And dependence on others, however difficult, is not simply an indignity: it can be an occasion for the generosity, patience and fidelity through which human relationships are sustained.
This does not require prolonging life by every available medical means. Refusing burdensome or disproportionate treatment and intentionally causing death are morally different acts. Nor does it require pretending that care is easy or that suffering is invariably redeeming. It requires recognizing that neither suffering nor dependence renders a person disposable.
Li and Rodin ask whether society has done enough to help people sustain dignity and meaning before assisting their deaths. But dignity is not something we sustain by “feeling” it, and meaning is not something we establish merely by choosing it. A person can be mistaken about the significance of their life, even at the end of a long and reflective conversation.
If medicine is to be guided by care rather than preference alone, it must be willing to ask not simply what patients want, or even what they find meaningful, but what we owe them because their lives are good even when they can no longer see it.
