We Need to Talk About Death
Written by Paul Siluch
January 25th, 2023
We need to talk about death. Not ordinary, God-decreed-it death.
Planned death, as in Medical Assistance In Dying. Or MAID as we call it here in Canada.
I have seen three in my practise as an investment advisor in just the last year. That’s up from zero from just two years ago. It wasn’t a thing, but now it most definitely is a thing. A very meaningful, society-impacting, generational change thing.
The technical term for abandoning or ‘prematurely terminating’ the elderly is called Senicide. Stories of the Inuit abandoning their elderly on ice floes abound may or may not be true. The Japanese carted their infirm elders to the top of mountains, while the ancient Greeks sacrificed 70-year old fathers to the god Cronus.
The truth is, senicide was rare. It was only practiced in times of famine, for ancient societies actually valued their elders. Yes, I’m sure some elders “took a walk on the ice” when they felt it was time, but suicide carries moral negatives in almost every society. We used to call this ‘assisted suicide’ but the connotations were highly negative.
My experience is that the MAID decision can be the absolute right choice for the person dying, but those around them can struggle with the decision. A natural death is a proverbial “act of God” where choice is left to a higher power. With MAID, the dying not only choose to leave, they choose to leave you. Families can struggle with this.
Today, more and more countries are allowing MAID. Letting the elderly choose a way out for themselves is seen as progressive social policy. MAID has been around the longest in Europe but is now available in several states of the U.S. as well as across Canada.
Medically assisted dying is now available in 11 countries covering a total of 200 million people. Belgium leads the world with 4.8% of all deaths due to MAID. Canada is fast catching up. Canada’s MAID deaths are 3.3% of all deaths, although B.C. is now tied with Belgium at 4.8% and Quebec leads the world at 5.1% (source: BMJ.com). We do not yet allow advanced directives, where a person can ask for MAID if a condition were to occur in the future (such as Alzheimer’s), but one can see the eventuality.
A recent article in the UK’s Daily Mail stated that “only 486 people died using California's assisted suicide program, but that same year in Canada, 10,064 used MAID to die” in 2021. Canada’s total in 2021 is ten times what it was in 2016 when there were just 1,018 MAID choices (source: Dying with Dignity).
What changed up here? In March 2017, Canada’s parliament introduced Bill C-7 to widen the MAID qualifications from death that was not reasonably foreseeable. In simple terms, we moved from “terminal illness” to “quality of life.”
Compared to the United States, some have called Canada an outlier with its permissive policies. Perhaps Canada is not an outlier – where you differ from all other countries - but an inlier. An inlier meaning you are the vanguard of where the world is about to go in a much bigger way.
Consider the following:
- Humans seek to control their external environment. Food, clothing, and shelter have all been largely tamed with a variety of choices available to most of the world’s 8 billion people. We control how and where we live our lives.
- Increasingly, humans seek more and more control over their internal environment – our bodies. Cesarian section births were just 5% of all births in 1940. Today, 31.8% - almost 1 in 3 births - in the U.S. and Canada are caesarian (source: CDC). Why? Less damage to the mother, the child, and the ability to schedule a birth (within limits). An unplannable natural act became a planned choice. The birth control pill was invented in 1950 and by the 1960s became widespread. It allowed half the world’s population far greater control of their fertility and allowed them the choice of when to start a family.
- Humans now seek more control over their durational environment – our lifespans. People have always wanted to live longer, so we are seeing dramatic research on life extension, whether it be through diet, blood transfusions of youthful blood, or CRISPR alterations to DNA to allow cells to divide indefinitely. Death is a barrier humanity has yet to crack, but we have never tried as hard before.
When death is no longer avoidable, or indeed seen as a preferred choice, MAID is now an option. Viewed as another form of control over our body and our lifespans, MAID is simply a cesarian birth at the other end of life: less pain, the ability to schedule a major event (within limits), and more control over a life-altering, unplannable natural act.
Is it subject to abuse? Absolutely. We are humans after all. There are already reports that Canadian military veterans, a group we have treated with little respect and funding such that between 3,000 and 5,000 are homeless today (source: Veteran’s House Canada), are being counselled to accept MAID as an alternative to medical and psychological assistance. Just because it is an easy choice does not make it the right one.
I am an amateur science fiction writer. Years ago, I wrote a story about a man who owed more than he was worth and elected assisted suicide to escape his debts. It was science fiction when I wrote the story, and yet we are already reading of ill people struggling to afford their rent and their drugs turning to MAID. So, fiction has become fact.
My story included an additional twist. The landlords and banks who were owed money by the protagonist sued to deny his death so that his paltry government pensions could keep servicing their debts. A form of economic indenture that no one yet expects. We haven’t seen this happen, but could we?
One question that is often asked in detective novels and investment research is who benefits?
My son is studying to become an accountant. He recently said something rather profound to me. He said “if we can count something, we soon account for it. And when we account for something, we eventually budget for it.”
The Office of the Parliamentary Budget Officer issued a report in October of 2020 to our federal government to determine the cost benefits of MAID to the public medical system. Does MAID help or hurt the government coffers?
It determined that the 6,465 “baseline” MAID deaths - the most expected ones - would save the system $13,441 per patient.
But Bill C-7 opens MAID to a much larger percentage of the population. The report extrapolated an 18% increase in assisted deaths. Because the physicians and protocols are already in place, the savings from these additional procedures are expected to be greater. And they are. Each additional MAID procedure over the baseline number was expected to save the medical system over $53,000 each.
That is a lot of savings to a medical system hemorrhaging money.
Were the estimated totals accurate? The Budget Officer’s report in 2020 estimated 7,629 MAID deaths by 2021 – an increase of 18% or 1,164 people from 2020 to 2021. The total was higher. There were 3,599 additional MAID deaths in just one year. Triple what was expected.
My reply to my son was “when we budget for something, we run the risk of incentivizing it.” In other words, can a cash-strapped government ignore such savings? We may be seeing the first signs of that now with counselling services listing this as an option.
Before getting too dark about this, let’s return to the original premise.
- MAID is a new choice being offered to an increasingly elderly population who are used to being in control.
- MAID can help a person avoid pain, unnecessary costs, and even become a form of estate planning in that more might be left to heirs.
- Humans desire control over their lives and MAID is just an extension of control at the tail end of our existence. We do it for birth, so why not death?
Since my lens of observing the world is primarily an economic one, I ask this question:
Other than the government, who benefits from this, and who is hurt?
I have already shown that government medical systems benefit from our early demise. The most expensive years of our lives in terms of medical care are our final two years, so cutting this in half would yield enormous savings to packed hospitals and overdrawn drug budgets.
And the Parliamentary Budget report only addressed health care costs. Has anyone yet calculated the savings to government pension programs? I bet someone in Ottawa and Washington has.
But what about retirement homes, funeral homes, drug companies, and everything related to the elder care industry? Will they be hurt with fewer high-paying residents and patients?
It is impossible to quantify today. In fact, it may be too diffuse an event to ever be quantifiable.
In the end, I think MAID will become like caesarian births – a procedure that is widely accepted and occurs about 30% of the time. Given the choice, many people at the end of their lives will choose a painless exit. And, like caesarian births, it is something that benefits society as a whole, but no one specific group or company.
However, the legal profession is sure to see an increase in will updates as MAID becomes more widely accepted. I expect estate plans will include death planning in the future, such as electing MAID if a certain illness or debilitating condition were to occur. Someday, the Living Will document, which today details how much life support you want, may evolve to enable MAID even if you can no longer ask for it.
It might become a tool to time tax benefits.
For example, people may choose to collapse half their retirement plan in December and then elect MAID in January, thereby splitting the income over two years instead of one, which lowers the tax bill. Passing away in January gains a taxpayer a full year’s worth of personal credits, as well.
Whatever tax angles there might be to timing a death, rest assured the accounting profession will find them.
Whether you agree with the concept or not, Medical Assistance In Dying, or MAID, is here. It is growing in usage and importance with each year and will become part of everyone’s future discussions. It will certainly be included in our estate planning questions in the future.
Plan on it.
Paul Siluch
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