I count myself lucky to have been born when death was still pretty much a mystery, more the prerogative of poets and other artists, philosophers and religious teachers than of scientists and doctors. I grew up surrounded by death. I served as an altar boy at dozens of funerals, attended the wake of my maternal grandmother in her parlour and experienced my own mother’s death at home in her bed surrounded by her six children and several grandchildren. Death may not have been welcomed but it was not a stranger.
I was reminded of death’s tug of war with mystery and science while reading the recent submission from the Vulnerable Persons Standard (VPS) team to Health Canada. They propose regulations to monitor the practice of medical aid in dying (MAID) for those who are vulnerable or whose autonomy has been limited by social, psychological, economic or physical factors. MAID is a medical technology legalized in 2016 that enables Canadian adults to choose a physician-assisted death.
The VPS submission reminds me that Canada has been blessed by a long line of thinkers who have cautioned that all technologies promise benefits but also have unanticipated consequences, some of them harmful. Technology refers to more than machines, tools and electronic, medical or scientific devices. It includes platforms, mediums, management techniques, commercial practices, social methodologies and protocols like MAID.
Economic historian Harold Innis was the first to chronicle the devastating impact of a technological promise in his book The History of the Fur Trade in Canada. While benefiting relatively few European capitalists, the fur trade destroyed the very culture and way of life of the Indigenous people that made that wealth possible. And for which Canada, particularly Indigenous people, are still paying the price hundred of years later.
Innis’s disciple Marshall McLuhan observed that it’s the technology itself (TV, Facebook, iPhones, cars), not its content, that subtly and silently shifts relationships, cultural attitudes, beliefs and values over time in favour of the indispensability of the medium or tool. When you’re a hammer, everything looks like and eventually becomes a nail.
In her Massey lecture, The Real World of Technology, renowned University of Toronto scientist Ursula Franklin distinguishes between two types of technologies: holistic technologies, which leave “the doer in total control of the process,” and prescriptive technologies, which shift control to the hands of managers or specialists. She argues that the dominance of prescriptive technologies in modern society discourages critical thinking and promotes “a culture of compliance.” Franklin, like Innis, argues that technology’s tendency is to suppress freedom and distance people from each other. Another Massey lecturer, Ronald Wright, describes this as the “progress trap.”
My thoughts then turn to the “Socrates of Quebec,” Jacques Dufresne, who reminds us that the loss of the soul is painless. Because technology provides so many benefits, we start to assume that it can fix anything. Thus we fail to notice when it ceases to serve and starts to transform us in its likeness. That’s when the mysteries of the soul are reduced to problems best left to experts and their technologies to solve. And we lose our autonomy and vitality.
Finally, I’m reminded of Nora Young, the thoughtful host of CBC radio’s Spark. She occasionally concludes her radio show with the wish that her listeners understand that all technologies come embedded with values and assumptions. She emphasizes that those values are not benign. Similar to McLuhan, she says they have an ideological bias. They amplify the dominant values of the status quo.
The conclusions of these and other thinkers about culture and technology provide a useful framework to evaluate and monitor MAID.
If you want technology to be your friend, make sure you learn everything about it: its values, side effects and track record. Science and medicine aren’t the only systems producing truth. Technology is about certainty – it doesn’t like mystery, humility, vulnerability, imperfection or tradition. Efficiency is not the dominant purpose of human relationships – interdependence, mutual respect, trust and loyalty are.
The VPS submission to Health Canada stresses the importance of monitoring the practice of MAID in Canada in order to prevent harm to individuals, to minimize any potential negative impact on our culture and to preserve the benefits of MAID for those who choose it.
Amidst the turbulence of the 21st century, their recommendations help to refresh our relationship with life’s one certainty: death. I read them as an act of faith in our future. And a profession of love for our capacity to address tough moral issues together.
What could be more reasonable than that? What could be more Canadian?
A version of this article first appeared in Policy Options.
Al Etmanski has been a disability advocate since the birth of his second daughter. He co-founded Planned Lifetime Advocacy Network helping parents plan for the future well-being of their disabled child. He is an adviser to the Vulnerable Persons Standard.