> will euthanasia become another "solution" for those who can't afford proper care and treatment?

This is all but guaranteed to happen to some extent; after all, criminals exist who killed people, so a legalised form of that will be used at least once in the history of Canada. I guess the question is more: will this become more normal than would've been preferable, but in 20 years will just be one of those facts of life? Possibly? Certainly that possibility was the main objection to MAID.

“Those who can’t afford treatment“

That’s a USA problem.

My experience with advanced cancer is that it is not. I routinely see people from the UK and Canada raising funds for legitimate treatments my insurance will cover because their governments won’t. To be fair, those treatments are paid for by the government in Nordic countries and France, so it isn’t universal that governments fail their sickest when treatments get expensive.

There is ultimately a monetary value of extended life.

In single payer systems, that’s determined by a body whose responsibility is to provide the most effective healthcare to all its citizens given a limited budget.

In the US, the monetary value of extending your life is proportional to the amount of money you spend on your health insurance (and appropriate actuarial tables).

Both systems have flaws.

Both systems have flaws? True, but it’s a false equivalence. There’s a reason why there’s only one country in the world where insurance company CEO’s have to hire security to walk around in public.

Not really. At the end of the day, in both systems, the person paying for the healthcare decides what healthcare options are available to the patient. In the US, the patient themselves (or their insurer) is paying.

In other countries, it’s often the health service itself that is paying.

Don’t get me wrong, I believe the single payer system is infinitely better, but for a small number of people, it will lead to worse healthcare outcomes.

It's not "both" systems, it's at least four. Canada is private doctors, public insurance. In the UK, the public system includes the doctors as well. France is not single-payer but has a system somewhat similar to the ACA, with private but nonprofit insurance, an effective mandate, a national price list for health services, and a prohibition of claim denials for anything on the list.

A great book comparing eight national systems in The Healing of America by T.R. Reid. It references stats showing the French-style systems get the highest quality results, with reasonable cost. Japan and Germany have similar systems.

Exceptions don’t make the rule.

That's a normal fact of life.

The underlying cause is that there is an almost infinite demand for medical costs - well beyond the economic capacity of any country.

Unfortunately facts are difficult, and politicians can't fix the facts regardless of how much they tax everybody.

In The Netherlands you can get cancer treatment even if you're homeless. And I don't mind paying extra insurance costs if it means I'm not running into inhumane and desperate go fund me campaigns everywhere I go.

Same in New Zealand.

But our public health system has to use a variety of techniques to limit the total healthcare expenses - such as waiting lists. Drug budgets are restricted which means that many expensive anti-cancer drugs are not available to the public.

Would you be happy to pay 100% of your income in taxes? That is the logical outcome of ever-increasing healthcare and nursing costs. Some wealth tax suggestions here in NZ approach 100% taxation over a lifetime (2% of wealth per year certainly crimps a 4% drawdown on retirement savings).

I wouldn't mind paying into it if there was some kind of balance.

If we broke healthcare spending down by person a small percentage of the population is probably consuming a huge percentage of healthcare. The average person just goes to the doctor once or twice a year and has a few large surgeries during their lifetime.

I would be ok with that if there was some kind of guarantee for those of us who didn't abuse the system and did our best to manage our own health. If I haven't gone to the doctor for 2 years and I need to wait 3 months to get an appointment that doesn't feel right.

At the risk of sounding sarcastic: the small percentage of the population consuming a huge percentage of healthcare is the older segment, and those with several comorbidities.

Live healthy, live long, die fast.

Live unhealthy, live short, die slow.

Throw in accidents and unexpected life events and boom, you can transistion from health to unhealthy quickly.

It's fairly common for governments to provide a basic level of care for free or heavily subsidized, but not cover more expensive treatments. It's certainly not exclusive to the US.

At least in Europe and the Nordic systems I have experience with, that typically applies to the very expensive novel treatments. There are gene therapies which can cost $2-3 million per patient and those aren't covered by any public healthcare system, AFAIK.

But it's not like there is some kind of upper limit on coverage. If you have cancer, you will get treatment regardless of how much your care has already cost.

In most of the places I've been in SE Asia and South America, there are separate government hospitals that are the only affordable option for the poor. If you have cancer, they're not going to do much for you.

It depends. At some point often it switches to palliative care, rather than treatment. That point is not “there’s literally nothing else we can try”, it’s “the remaining options are inadequately proven, too expensive, high risk, or not effective enough (won’t extend life by long enough or improve quality of life enough)”.

Every single one of those criteria is subjective, which is why you see these fundraising campaigns for kids with cancer to go and a get a multimillion dollar treatment in the US, because as a parent, accepting that there’s more you COULD do if you just don’t give up is hard.

In Canada, while the hospital care is covered, the additional supplies and treatment are often paid for by the patient.

https://www.cbc.ca/news/health/cancer-costs-report-1.7404064

"During more than two years of treatment, which included surgery to remove part of the colon as well as 12 rounds of chemotherapy, Percoco paid more than $4,000 out of pocket for prescription drugs, including medications to cope with the side-effects and complications. On top of that, there were costs for colostomy bags, which she had to restock every four days, bandages, physiotherapy sessions and osteopathic consultations, as well as travel and parking."

Yes but undirectly.

-Can't afford therapy for curable or mitigable disease

-Let it worsen

-Death is the only charitable option as a cure is now impossible and life is miserable

I'm fairly sure a lot of conditions are incurable for you or me, but curable for billionaires.

Does that mean that the tax payer will have to spend billions on every human?

It's charitable. Cold snaps in Prairies can pretty easily hit -35, dropping down to -55 with windchill. You'll get frostbite on exposed skin in 2 minutes at those temperatures.

Most homeless will either take stay in one of the shelters available in the cities, or sneak onto the many freight trains heading towards the cities with milder climates when it starts getting cold. They'll head back when it starts to warm up again. A bus ticket is just enables the journey to be a lot more comfortable.

Charitable! Hah.

The process was operated more as a "don't provide shelters for these lazy bums, send them elsewhere."

https://www.wsws.org/en/articles/2001/12/can-d22.html

"In a 16-month period in 1993-94, the province’s welfare rolls were cut almost in half. One tactic used was to offer recipients a one-way bus ticket to leave Alberta."

> Worrying parallel: will euthanasia become another "solution" for those who can't afford proper care and treatment? Moving homeless people to warmer cities and offering euthanasia to those who can't afford treatment both avoid fixing the underlying problems.

Almost certainly. IIRC, in Canada there have already been cases where people got euthanasia mainly because their disability payments were insufficient.

I'm sure someone will try to frame it as a Catch 22: "If we knew for sure they would choose suicide if they didn't get the help they requested, we would prioritize them over non-suicidal applicants. But the only way we would know if they would actually choose suicide is if they actually committed to voluntary euthanasia".

...

No, there haven't been such cases, and no, people are not getting MAiD in Canada because they can't afford care. The eligibility criteria[0] are clear, and strict. This reeks of sensationalism and/or propaganda by people who are morally opposed to the principle of medical assistance in dying, and are using FUD and innuendo to advance their cause without stating it (because they know they lost the moral argument long ago). Maybe you inadvertently picked that up on your shoe and dragged it into this discussion? Hard to know without citations on your part.

[0] https://www.canada.ca/en/health-canada/services/health-servi...

This is the last line of the linked article:

"Canadian news outlets have also reported on cases where people with disabilities have considered assisted dying due to lack of housing or disability benefits."

Okay, they have considered assisted dying. People consider things all the time. That's a very far cry from getting anywhere close to approved for assisted dying.

This woman was approved: https://toronto.ctvnews.ca/toronto-woman-in-final-stages-of-...

What right do you have to say this woman shouldn't be allowed to end her life though?

She spoke to two different doctors and they both agreed to sign off on her death. Do you think the doctors are the ones pushing people to off themselves because they can't live a normal life?

Forcing someone who wants to take the state sanctioned approach to suicide (as opposed to a 9mm sandwich) to talk to two medical professionals seems fine to me. Maybe there's some infinitesimal chance both those two doctors want as many people to die as possible, but eh.

Or, you know, they agreed that she deserved the ability to end her life on her terms. Most people do not take a year to plan and carry out their suicide. Speaking to a doctor is usually the only intervention necessary to help someone looking to suicide for temporary reasons.

When I was suicidal, having to get paperwork done would have stopped me from seeking out this method. Why would I want to interact with a doctor, another doctor, some bureaucracy, and now the news, when instead I could go to Walmart and walk out with a helium cylinder, a plastic bag, a hose, and some tape for $50?

A government doesn't HAVE to legalize euthanasia to push sad, lonely, poor, hurting individuals to kill themselves, they just have to continue defunding medical care and saying "Nope, nothing we can do here, you just have to suffer, can't afford to do better than that".

> What right do you have to say this woman shouldn't be allowed to end her life though?

Read the article. She really wanted appropriate housing, which was the care she needed for her condition. She tried for years, and they wouldn't give it to her.

So she chose assisted suicide instead.

That contradicts the claim "there haven't been such cases."

Her approval was based on an untreatable medical condition, and the suffering that ensued. That medical condition was made worse by the housing she had, but was not the cause of it.

You can't apply for MAID due to social conditions on their own, it has to be medically justified first and foremost.

It is an interesting case, but at the end of the day it was a medical decision made by doctors, and a completely separate housing decision made by social services. Neither can talk about the case publicly. It is entirely possible that her chemical sensitivity was so non-specific that it wasn't feasible to provide her with any housing.

The flip side of this is you don't want people to be able to use MAID as some sort of weird blackmail. This woman's stance was "I want a better place to live, or my only other option is MAID".

I'm in Canada and I have a relative in hospital who say they are either returning home or doing MAID, as they were not going into a home or "assisted living." coming to terms with your own death is part of the culture here now.

Many people clearly prefer death to being dependent on services. Doctors themselves are known to eschew chemotherapy and difficult surgeries. Most men don't even see the doctors their taxes pay for "free" because the system is so bureaucratic nobody with any responsibilities can afford the time to use it, or the risks of being caught up in the system. Dignity is a big deal for people and many prefer to die with some of it than to live without it.

I think MAID itself is poorly defined and implemented, as really, the health system had no problem killing thousands of young people with loose opioid perscriptions, I don't like that MAID requires allocating execution powers to doctors and their increasingly politicized delegates. death as a service doesn't seem ethical compared to prescription and technical options.

the heart of it is that the institutions don't provide dignity and so people are choosing death. this seems lost on the leadership and its aspirational classes.

Regarding your comment on loose opioid prescription, in Québec (I cannot talk about other province because health care is a provincial juridiction) , they are not a thing anymore.

20 years ago it was like you said: I received 40 pills of oxycodone 20mg for a strained muscle. But nowadays they're quite strict, too strict imo: a few month ago my wife broke a vertebrae and she only received only 20 pills of hydromorphone 1mg and a month of antacid coated naproxen.

Extraordinary claims... what's the evidence for that?

if we killed all the homeless people, would our social problems be over? Sick thought. I know. But a part of me blindly believes that our problems will become worse.

Be coming homeless isn't a problem with the person, it's an outcome of the system we live in.

The population of homeless people would end up probably where it was when you killed them all. Though I do wonder how long that would take

> Be coming homeless isn't a problem with the person, it's an outcome of the system we live in.

Like most things in life, I don't think it's as simple as that. I think it's a complex mishmash of systemic factors and individual choices that cohere into a big ball of suffering.

For example, I had a close family member who was an alcoholic. He couldn't keep a job because of his drinking problem, and wound up going through all his friends and family who would take him in (before wearing out his welcome at each place in turn). He was getting put out of the last place he had available, basically, when he died suddenly. But if he hadn't died he would've been homeless. Was this a problem with the system? Maybe - he had a pretty good support network, but you could make a decent case that if we had the right support system in place at the right time it would've helped him. But also, there was absolutely an element of choice to it. I have a lot of sympathy for the guy, because addiction is a bitch. But systems of life or no, he made choices at various points that led him to the point of homelessness. A different person in the same circumstances very well might have had a different ending to their story.

I don't think blaming the homeless is productive, certainly. Their lives are shit and they don't need someone smugly telling them "just do better bro". So I do think that trying to improve the system we live in is just about all we can do (that, and be compassionate to people we meet). But unfortunately I also think it's not realistic to expect any amount of systemic change to be able to solve the problem.

>will euthanasia become another "solution" for those who can't afford proper care and treatment?

Yes, and I would argue that despite the awful connotations, this is not a bad thing.

It’s simply a fact of life that some people have more than others. Sometimes it’s not fair, but it’s still way better than any other social/economic alternative. And those who have more can afford better treatment, that is expensive.

So, assuming we can agree on this, would it not be better to offer some solution, even if not ideal? Remember, it may not be something that you would ever opt for, maybe because you have the means for better solutions, but for many this is a blessing compared to their only alternative which is to suffer. As sad as it may sound.

That is psychopathic.

It would be a bad thing.

> Fifteen years ago, flying into Vancouver, a local told me charities would give homeless people one-way bus tickets there from colder regions of Canada to prevent winter deaths

This is kind of one of those urban myths btw. Like yes it has technically happened before but if you chase down the stories it's not at all common and it's more of a situation of someone having some family or relationships in a province away and people trying to help by connecting them.

No. It was 35 years ago, but it's not an urban legend.

Back in '88, when he was just mayor of Calgary, Ralph Klein had the city "solve" their homeless problem for the Olympics by buying one-way bus tickets to Vancouver.

It is back in the news because it's started happening again in 2s and 3s.

https://edmontonsun.com/2013/03/29/remembering-ralph

https://globalnews.ca/news/2567494/reports-2-homeless-men-fr...

As I said,

> Like yes it has technically happened before

So the reason it's important underline the "urban myth" status here is that while you've correctly pointed to the few concrete examples where this has occurred, in general many people casually, incorrectly throw these statements around as if this is frequent and constantly happening and this is a really toxic and bad habit that our society has. At best it's lazy innuendo, but at worst intentional misinformation.

The reason that this urban myth of the homeless from somewhere else is so toxic is that it enables people to dismiss homeless people as not really part of their community and thus enables people to not care about poverty in their community or the impacts of poverty on their neighbours. Thus people can freely disengage themselves from the issues of poverty. It's not their neighbours it's some Other People.

I don't quite understand your point. I contradicted you because I'm old, and I'm getting tired of people calling things that I vividly remember "urban legends". Lizard people in the sewers is an urban legend. That mean old drunk giving one-way tickets to Vancouver is history.

The point is that there's a difference between "this is a thing that has happened" and "this is a thing that happens". The latter thing is the toxic exaggeration of the truth IMO.

Like you're absolutely right that this particular rare event has happened before and I'm not discounting that, but the phrasing of the OPs story more suggests at the form of this story that is the myth that this is a trend and frequent occurrence.

I follow your point. Certainly this is more real than lizard people in the sewer, but not as real as people would have you believe when they casually exaggerate and insinuate that all the homeless around are from elsewhere and are being trucked in to this day.

Please don't call real events that you acknowledge "urban legends". You demean our cognitive commons with language like that, and undermine your own credibility.

I decline to join you in your brave fight against context but good luck sir

> Fifteen years ago, flying into Vancouver, a local told me charities would give homeless people one-way bus tickets there from colder regions of Canada to prevent winter deaths. No return tickets in spring. Calls into question what we consider "charitable" when the solution is just moving vulnerable people elsewhere.

Does it? Given the number of homeless deaths caused by Canadian summers, I'm not seeing the urgency of homeless people returning to colder locations.

This obviously isn't a solution to the problem of homelessness: the solution to homelessness is homes. But it is a solution to the (much smaller) problem of homeless people dying due to seasonal weather.

Incidentally, this program was never large and fell out of practice due to bad press in both the US and Canada, and thousands of homeless people have frozen to death in its absence.

I'm reminded of the South Park episode where they bus all the homeless to California.

>harities would give homeless people one-way bus tickets there from colder regions of Canada to prevent winter deaths. No return tickets in spring

This, as far as I'm aware, still happens in the US nowadays[1].

[1] https://www.youtube.com/watch?v=048BUjNWZa8