MAiD for Addicts and Mad People

by

T. Virgil Murthy

Months ago, I wrote an article for the Addict Collective blog titled “Does the 2024 MAiD Expansion Apply to Addicts?” I never published it—I reasoned it was probably unwise to remind the MAiD architects about our existence—but my confusion and worry steadily mounted. Press releases and public statements by Canadian officials have been extremely opaque; despite her job title, Canadian Minister of Mental Health and Addictions Carolyn Bennett hasn’t issued any memos on whether addiction will be a qualifying condition. But following the failed Conservative attempt to prevent the expansion, a Thursday Vice article indicates the answer: Yes, individuals diagnosed with substance use disorders (SUDs) will become eligible for MAiD. In fact, the annual conference of the Canadian Society for Addiction Medicine this week touted a presentation on “a framework for assessing people with substance use disorders for MAiD,” submitted by board member David Martell. (The abstract can be found here.)

I write this to make readers of BIOPOLITICAL PHILOSOPHY aware of and alarmed by the context for this political development. Solidarity between Mad, addict, and otherwise-disabled activists is necessary. In this statement, I’ll review the history of the relevant policies; describe sanism and anti-addict prejudice in relation to the carceralization of addict and Mad health and abled psychodramas thereof; and issue a warning about the disastrousness of this legislation. We must repeal C-7, agitate against law enforcement involvement in Mad/addict healthcare, and stop the push for mass institutionalization.

A history

Canadian euthanasia policy—“Medical Assistance in Dying,” or MAiD—has transformed rapidly. Euthanasia was illegal in Canada until the 2015 Supreme Court decision in favor of relatives of Kay Carter, a disabled end-of-life patient who fled to Zurich to obtain physician-assisted suicide. Initially its scope was limited to people diagnosed with a “grievous and irremediable medical condition” whose death was “reasonably foreseeable.” But in Jean Truchon’s 2019 case, the court found this restriction unconstitutional. Bill C-7, passed in 2021, drops the qualifier, making MAiD available to disabled people whose death is not foreseeable. Nowadays, dying people’s MAiD applications are described as “Track One” cases. Other disabled people are on “Track Two.”

There’s a common misconception that the 2024 expansion is a modification of C-7. Actually, Track Two has included Mad but otherwise non-disabled people since it went into effect in 2021, but delayed their eligibility. March 2024 is merely the time at which the delay will expire. While national support for the immediate-effect features of C-7 was resounding, heated debate persists about the 2024 expiration. It’s lambasted by right-wing and left-wing media outlets alike. Bill C-314, brought by a conservative Member of Parliament (MP) in November 2021, was intended to strike Mad eligibility (leaving the rest of C-7 intact). But the amendment was voted down in Commons last week. This probably surprises many Americans; I should briefly explain why it happened.

In the original version of Bill C-7, brought by then-Attorney-General David Lametti in 2020, Track Two didn’t include individuals whose only diagnosis was a “psychiatric disorder” or SUD. The bill was changed on the Senate floor after psychiatrist MP Stan Kutcher ironically argued that Mad exclusion was discriminatory. He suggested a compromise: include mental illness diagnoses within the scope of “grievous and irremediable medical conditions,” but place an 18-month “temporary restriction” against provision of assisted suicide to people diagnosed only with a mental illness to permit time for the development of safeguards. The delay was extended to 24 months, then by an additional year. It was always supposed to sunset. Meanwhile, MAiD was made available immediately for people whose qualifying diagnosis was not psychological or an SUD. In 2021 alone, 219 non-dying disabled Canadians were euthanized.

What we are witnessing is the behavior of people bound to absurdity by the cold chains of consistency. Canadian Liberals’ rigid, formulaic defenses of the sunsetting give the impression that they are plodding forward as if tied. The Dying with Dignity Canada CEO calls the mental illness exclusion “stigmatizing”: it “suggests that if you have a mental disorder…your suffering can’t be as intolerable as someone with a physical condition.” Says Martell: “I don’t think it’s fair, and the government doesn’t think it’s fair, to exclude people from eligibility [for MAiD] because their medical disorder or their suffering is related to a mental illness.” In particular, it is unfair “to exclude people from eligibility purely because their mental disorder might either partly or in full be a substance use disorder. It has to do with treating people equally.” University of Toronto professor Justine Dembo similarly writes, “To exclude all individuals requesting MAID for psychiatric illness…falsely implies that everyone in that category lacks capacity.” What they lack in justice, MAiD supporters recoup in perverse fairness.

MAiD is (as Shelley Tremain’s critiques aptly capture) profoundly neoliberal. But much of its opposition at home stems from the same ideology. The debate about C-314 is a dispatch from a war carried out between two shades of liberal. One sort—the follower of the fixed-action pattern described above—prizes autonomy and opportunity. Of course, MAiD has never been about equal opportunity. It excludes abled people! But the ableist internal logic on which it rests is that being provided with another option always improves your circumstances, even if the added option is death. This claim, when added to the correct view that it is wrong to deny people assistance in virtue of their membership in an oppressed group, produces the asymmetry whereby MAiD must be made available to all disabled people in the name of equality. To opportunity liberals, C-314 was always dead in the water. They’re hoist by their own petard. Unless they are willing to admit it’s also wrong to provide euthanasia to sane disabled people (and they’re not), they can’t countenance excluding the Mad.

There’s another form of liberalism, a contractualist view, in which autonomy is a conditional privilege. The Conservative opposition consists mostly in this ideology. They’re “Puritans,” in the way I elsewhere use the term. They view physical, cognitive, and psychological disability as cleanly separable: the first two are natural kinds and the latter is a social disease, vaguely reflective of modernity. These are the people who criticize the upcoming expansion on the grounds that it’s “gone too far,” that it contradicts the concept of having suicide prevention services, that it’s unclear what it means for a mental illness to be “incurable.” They do not recognize these objections also apply to physical disability.

MP Ed Fast, who submitted C-314, seems of this view. “My bill will simply return the state of our law to what it would have been had the unelected Senate and compliant government not intervened,” he argues—namely, the pre-Red Chamber variant of C-7. Senator Denise Batters similarly claims, “Mental illness is not irremediable.” The unspoken contrast case is telling. To them, physical disability is natural, immutable: your life is inherently miserable. Madness, however, is a symptom of your life’s going badly, not a cause. Their disagreement with opportunity-liberals boils down to, e.g., they don’t believe such a thing as “treatment-resistant depression” exists. (Well, neither do I, but for better reasons.)

I often say of arguments about disabled people that the disagreement is a distinction without a difference. That’s true here, in a sense. Neither those in favor of sunsetting nor those against it seek to end Mad oppression. The Conservatives’ fixation on emergency mental health services and physician obligations betrays the belief that Madness does require institutional response. They aren’t aware, or aren’t critical, of the carceralization of (M)addict health. They agree Madness justifies oppression. It just doesn’t justify death.

Sanism and dampism

Sanism is the justificatory logic by which Mad oppression operates. It conflates Madness with value-deficiency, moral deviance, and dangerousness. On the institutional scale, sanism carries two important prescriptions. First, Mad people “should be segregated in large, distant institutions because their presence threatens the economic and social stability of residential communities.” Second—an opinion common in uncritical psychiatry and endemic to the cognitive model of mental illness—this goal can be offset or partially fulfilled by individual medical interventions that convert Mad people into, or make them behave like, sane ones.

Mad people and addicts are mostly the same people, but subjugation in virtue of addict status isn’t reducible to sanism. There is a prejudice that is to addict oppression as sanism is to Mad oppression. It needs a definition. Our current hermeneutics don’t have one, at least not one that captures the way in which addict oppression operates on a scale beyond anti-drug sentiment. I’m calling it dampism, in keeping with the novel trend of “damp drinking.” It is embodied by the common exhortations toward responsible or mindful drug use: “thoughtful moderation of [one’s] intake.” (It is Sober October, after all.) Elsewhere I’ve written about the perception that addicts’ problem isn’t drug use, but improper drug use. “Don’t use drugs in the unusual fashion you do, but also don’t be abstinent, that’s prudish and weird. Goddammit, why can’t you just be normal?”

It’s common, though not universal, for addicts to describe their relationship to their substance of choice in binary terms: oscillation between total abstention and unusually extensive use. Dampism is the view that this relationship is inherently unhealthy, deficient, or immoral. It reflects the widespread conception of addicts’ use patterns as context-independently destructive in virtue of their atypicality (rather than contingently conducive to bear-trap oppression in virtue of marginalization). The prescriptions of dampism toward addicts are the same as those of sanism toward Mad people. We must be removed from society (especially through family separation and the lack of provision of resources) unless we perform long-term abstinence or moderation—that is, behave toward substances the way nonaddicts do. Just as sanism regards Madness as both curable and immutable, dampism at once entails that all addicts’ problems result from atypical use patterns and enforces a strict identity prejudice: “once an addict, always an addict.”

I claimed opportunity-liberals’ and Puritan-liberals’ argument is a distinction without a difference; their ableist justifications are not different in principle. The opposition is not advocating against the rest of Track Two designation—many of whose victims have already been Mad! No matter who wins, things will probably get worse than they are now. (For instance, even if the expansion is challenged successfully, the process may motivate increasing the oversight of, and diminish the legal liabilities of, long-term institutions.)

Nonetheless, we must agitate against the MAiD expansion. State euthanasia poses a significant worsening to Mad and addict conditions. Incapacitation threatens our ability to organize; death eliminates it altogether. In fact, given the sustained features of addict and Mad oppression, the 2024 sunsetting will likely be catastrophic on a scale even its most virulent sanist detractors do not realize.

The carceralization of (M)addict health

The ongoing conference at which Martell presented (schedule here) is in Victoria, British Columbia. This location is telling; it is—alongside N.Y.C.—ground zero of the rapid acceleration toward mass institutionalization of addicts and the Mad in North America.

B.C. is the epicenter of the Canadian toxic drug crisis. Pursuant to dramatic rises in overdose death rates, a public health emergency was declared in the province in 2016. Since then, premier and former Attorney General David Eby has endorsed legislation subjecting addicts to unparalleled oversight. Eby famously advocates expansion of BC’s civil commitment criteria to include repeat overdose—it was the issue he ran on. In early 2023, nurses were authorized to enable short-term involuntary admission to psych ERs under B.C. law. (Nursing professionals have penned open statements of concern.) The push for involuntary care also involves forced treatment for incarcerated addicts. Says Eby: “This is an opportunity for us to…provide medical support—so that when they’re released they’re actually in better shape than when they went in.” In 2022, he commissioned a report evaluating the feasibility of post-release “real-time electronic monitoring of individuals identified as chronic offenders,” among other interventions.

Eby’s carceral creep is not restricted to B.C. After strengthening bail regulations within the province, he’s now urging the federal government to pass Bill C-48, which would expand the list of charges that trigger “reverse onus.” (When reverse onus goes into effect, the presumption of innocence in bail determination is dropped. Arrestees must prove that the court shouldn’t detain them, not vice versa.) This policy echoes Conservative Leader Pierre Poilievre’s chant: “jail, not bail.” We are reminded of another mayor, 2,500 miles away, who weaponized the killing of Mad homeless addict Jordan Neely in order to advocate expansion of forced hospitalization policies. Such proposals have been sanitized through the vehicle of consent-manufacturing thinkpieces that paint the Mad as dangerous automata, yet always rest on the compassionate conclusion that their institutionalization is for their own good.

We are reentering the twentieth-century world—the world well-meaning legal scholars told us would never reobtain—of carceral euthanasia. Addicts and Mad people aren’t just overrepresented in the North American prison population. We are the prison population. The very report Eby commissioned indicates that in 2017, 75% of the people processed by B.C. Corrections had a “mental health need and/or substance use disorder.” Moreover, it cites a study according to which 70% of Winnipeg residents who died in a “fatal encounter with police” were Mad or addicts.

In my work I characterize the “carceral-clinical seesaw,” a structural oppression central to Mad and addict oppression. As I write in a forthcoming paper in Feminist Philosophy Quarterly (FPQ): “Addict experience consists in ping-ponging between hospitals and prisons, emerging from one institution only to find oneself entering another.” Under the modern view of public health crises as wars on all fronts, police are authorized as clinical first responders, and encouraged to use the carceral cudgel to strongarm addicts and Mad people into institutionalization. Symmetrically, law enforcement involvement in long-term followup results in arrests. These dual incentives persist at every level. Drug courts pressure addicts into treatment; police offer overdose victims the choice between handcuffed and non-handcuffed hospital escort; individuals awaiting psychiatric evaluation, but not charged with any crime, are kept in jail.

The observation that addicts and Mad people are subjected both to incarceration and to institutionalization is not new. There’s a long literature on “transinstitutionalization.” What I emphasize is that the pattern illustrates a cooperative endeavor between prisons and hospitals, not a game of hot potato. They’re not trading off the duty of segregating Mad people. They’re working together. Moreover—contra the Penrose hypothesis—the seesaw is emergent. It didn’t arise in response to disproportionate Mad violence. The perception of Mad dangerousness facilitatesMad violence, through the initiation of adverse interactions with clinical and carceral power structures and the widespread destabilization of Mad people’s living conditions.

Maybe that sounds radical. But the report commissioned by Eby agrees with me! Discussing the case of a Mad individual whose rehospitalization is enforced through cyclic, monthly police visits each time he “stops his medications, becomes paranoid, [and] carries a machete,” the authors write:

[W]e would be remiss not to highlight how this repeated cycle of public police apprehensions and short-term hospitalizations without appropriate community-based supports represents a comprehensive failure of our system to protect and care for this individual and the community in which they live. This is an example (and one of many we heard) that reflect [sic] how our systems cause and perpetuate trauma, particularly among people with complex health conditions (31, emphasis theirs).

But the authors have no idea what to do about this. As I discuss in my FPQ paper, agents of state power seem to think they have a moral obligation to acknowledge the carceral-clinical cycle, but not to fix it. Carceral disengagement is unthinkable. The mechanisms for these institutional protestations of helplessness—“the world is terrible, but we can’t change it”—are sanism and dampism, by which the situation is recontextualized. The only thing we can change about the lives of addicts and Mad people is their interiority. Structural interventions are dismissed.

For instance, Eby writes, “When someone overdoses twice in a day and they show up in the emergency room for the second time—a second overdose in the same day—the idea that we release that person back out into the street to overdose the third time and die…seems very bizarre.” Instead, he thinks, treatment should be mandatory. But the overdose crisis is caused by drug toxicity, not overuse; its solution is decriminalization and safe supply. Eby has taken a harm affecting both addicts and nonaddict users, easily resolved by policy, and reinterpreted it as a behavioral choice fully downstream of addict status. In highlighting the phenomenon of repeat overdose, he wrongly attributes a consequence of drug carceralism to the atypicality of addicts’ use patterns. Using overfrequently becomes salient; as such, it follows that the remedy to the drug crisis is transforming addicts, not drug supply. The supposition that Mad people and addicts must be changed, by force if necessary—that possible worlds better than ours are ones in which they act or are located differently—illustrates how the undergirding prejudices facilitate carceral care.

Note that the work done here by sanism and dampism is similar to that done by ableism in C-7. Disabled subjugation is an ineliminable consequence of institutionalization and segregation, which enact mistreatment and hermeneutically enforce the abled-disabled demarcation. But in popular opinion, the suffering of disabled people is incorrectly redescribed as downstream of a reified characteristic, disability, rather than of oppression. The idea is that the only thing we could, in principle, change about disabled people’s lives is whether they have to live them. Marginalized people must change; systems can’t.

Eby’s exhortations in favor of forced treatment persist despite evidence that it’s ineffective at best and murderous at worst. Such literature only motivates more scrupulous searches for any empirical justification of the policies we’ve decided to enact. One study puts it plainly: “We agree there continues to be no conclusive evidence that secure [i.e. mandatory] care is superior to voluntary treatment, but…a lack of evidence of effectiveness of an intervention is not evidence of a lack of effectiveness.” This is not evidence-based policy! It’s policy-based evidence—a stubbornly solicitous anticipation of Godot arriving to vindicate the status quo. I’m convinced people do this to feel better about themselves. The reason for addict and Mad institutionalization is convenience for sane nonaddicts; facially kind justifications are psychodramatic, existing only to allow the belief this is about securing addicts’ well-being. Sanism and dampism do not divide out.

The real reason for overhauls to B.C. policy is public outcry by the sane: they must be kept safe from Mad violence. Addicts, Mad people, the homeless—these people are the clearest distillation of Foucault’s dangerous individual. Eby is “white-hot angry” about the violence they perpetrate, but not about their material conditions. In his April letter to Lametti, he urged change to federal law in order to increase the detention rate of repeat offenders: “To have only half, or less than half, of the cases in which Crown Counsel show cause for detention result in a detention order is deeply concerning.”

In a media climate quite friendly to crime crackdown, dozens of articles criticize the so-called “catch and release” approach to justice, highlighting cases of briefly-incarcerated violent criminals who repeatedly reoffended within days of discharge. The B.C. Urban Mayors’ Caucus penned an open letter to Eby requesting harsher punishments for repeat offenders. In response to allegations that police have inflated crime statistics, Vancouver mayor Kennedy Stewart argued that regardless of B.C.’s ostensibly low crime rates, “if you are a victim of crime, it doesn’t feel that way…we have to listen to the folks that don’t feel safe in the city.” After a December 2020 vote by the Vancouver city council to freeze police funding, the city PD appealed—and won—the apparent $5.7 million shortfall. VPD police chief Adam Palmer professed his gratitude and promised to make residents feel “safe again.”

The majority of people considered high-frequency offenders are addicts, Mad, homeless, or all three. Public officials are careful to announce two-pronged intervention plans: more stringent penalties (for sane, abled criminals), greater availability of treatment and community assistance (for addicts and the Mad). But this is purely rhetorical. Researchers at Simon Frasier University sent a detailed reformist proposal to Eby in mid-2021, advocating a housing-plus-support program to prevent recidivism. But, they allege, they received no response save for a letter claiming their 17-year-old database should be replaced with a new program. Creative decarceralist theories that suggest noncoercive solutions will not receive uptake on the sanist view, wherein harm caused by Mad people can only be eliminated by displacing perpetrators individually.

Thus it’s totally consistent to pursue forced institutionalization and expansion of MAiD simultaneously. The system hangs together by an icy logic. Euthanasia would only undercut forced treatment initiatives if institutionalization were intended to make addicts better off. It’s not! It’s meant to promote feelings of safety, and people don’t worry that you’ll break into their houses if you’re dead.

Carceral coercion and euthanasia

The Expert Panel on MAiD and Mental Illness have released their vague, foreboding, and circular final report on “measures to support…safety, autonomy, and equity.” It’s uncannily similar in tone to the one commissioned by Eby: meticulously citing examples of sanist oppression but bringing no ideas about its prevention. The authors provide extensive, unnecessary evidence for the obvious—many Mad people are homeless; housing increases quality of life—but elucidate neither practice nor theory for making housing available or discerning whether an applicant needs it. They recommend interpreting “housing and income supports” as relief mechanisms that “should be offered to MAiD requesters, where appropriate.”

“Where appropriate”?! What does that mean, pragmatically? The liberal, stigma-informed approach cannibalizes itself. The Panel rejects that “persons in situations of structural vulnerability should be excluded systematically from access to MAiD.” Rosamund Rhodes’s quote that “classifying people as ‘vulnerable’ denies them respect” comes to mind; already it’s been quoted in MAiD-apologetics research papers. It seems we are meant to believe the mere presumption that MAiD applicants may be driven by structural vulnerability—a presumption likely required in order to motivate clinicians’ inquiring into whether requesters should be provided material relief—is ableist. But in that case, how is it to be evaluated whether supports would relieve suffering?

The document contains meaning-changing mistakes—for instance, it recommends assessors for institutionalized people’s MAiD requests “do not work within or are associated with the institution” (emphasis mine). Clearly it’s meant to be “do not work within and are not associated with.” The potentiality of our coercive killing by ethically compromised assessors thus becomes a typo, not worthy of the extra word necessary for clarity. My fury about this, I think, is evocative of much disabled rage about MAiD and reflective of why parliamentarians should not have this oversight. For some this is a season’s worth of stressful bureaucratic afternoons; for others, their lives. Provider status offers only marginal improvement to epistemic positionality. According to a recent survey of physicians in the American Society of Addiction Medicine, about 30% of the respondents did not know whether their state permitted involuntary institutionalization for SUDs.

What is really telling is the section on MAiD for incarcerees (4.3), which breezily claims that the Correctional Service of Canada “is not aware of any instance where a person has requested MAiD as a means to avoid completing their sentence.” But incarcerated people have already been euthanized under MAiD and internationally rather than being granted parole by exception, despite attorneys’ claims that this would never happen. Autonomy/consent frameworks ignore the reality of carceral subjugation. U.S. judges still order Mad people’s and addicts’ sterilization. (Yet it’s inconceivable that they’ll recommend euthanasia.) Police refuse to release footage of our deaths in custody. (Yet it’s inconceivable that similarly suspicious circumstances will arise under MAiD.) Pregnant U.S. women on medication for opioid use disorder (MOUD) have reported not only that they were “forced” to remain on opioid agonists, but that their clinicians neglected to inform them that a positive test at birth—the likely consequence of MOUD—merited a mandatory report to child services. One relayed a provider’s suggestion that her wanted pregnancy was “selfish” and she should seek late-term abortion. (Yet it’s inconceivable that a clinician would tell an addict their continued life is selfish.)

Every year another couple hundred addicts are paid $200 for proof of sterilization by the operating U.S. nonprofit Project Prevention. (Yet it’s inconceivable that eugenics crusaders like Barbara Harris will successfully incentivize MAiD application.) Pregnancy is illegal in Alabama for addicts in active use; a recent article indicates that an Etowah County addict gave birth on a jail shower floor after being denied care. A lawsuit filed on her behalf alleges that while she lay unconscious, jail staff photographed themselves with her newborn. Coercion, subjection to opportunism, and incrementation toward unbearableness are not wrongs wrought by individual bad actors. I cannot emphasize enough that these are not one-offs, that so many stories of this sort are just things that happened last week, that they are structural. The unconscious, systematic enactments of this default mode of engagement with addicts and Mad people are insensitive to the prettiest imaginable PowerPoint on frameworks and heuristics for compassionate care.

Mad people have been warning about this for years (but, we’re told, they’re crazy); so have addicts (but, we’re told, they’re high). The devaluing of disabled testimony is nothing new. Tremain describes how people with power over the disabled “discount and dismiss the criticisms” we levy against the encroachment of the euthanasia regime. Often such dismissals consist in the patronizing reminder that MAiD (allegedly) requires active solicitation, and thus respects norms of consent and choice. But, as Tremain argues, modern subjugation operates “through coercion and incremental normalization, accomplished by the production of subjects who understand themselves as autonomous and free.”

In the case of addicts and Mad people, even the fictionof autonomy is unsalvageable. When healthcare is inherently carceral, how can we maintain the illusion that decisions made under its oversight are free? How ironic and hypocritical are the claims that “slippery slope reasoning” about euthanasia is fallacious, that we are hysterical and paranoid (sanist concepts in themselves). The empirics are what they are.

The total absence of heuristics

The juxtaposition of Canadian officials’ stated pessimism about the realities of addict and Mad experience with their optimism about the possibility of ethical state practice of imprisonment, treatment, and euthanasia is bizarre. For instance, Grant Charles, a social work professor who has spoken in favor of Eby’s policies, writes: “We can get stuck in this argument that people with addictions have free will and we should respect their human rights, but the nature of being addicted means we don’t have full free will.” In that case, even by the lights of neoliberal autonomy it should be unacceptable to offer euthanasia to addicts! Analogously, the Expert Panel concludes that “the fact that people with mental disorders can be subject to laws allowing coercive treatment…underscores the importance of recognizing their right to capable decision-making on a par with all other Canadians.” This would make sense only if the Panel passed (negative) judgment on involuntary commitment laws. Instead, they describe their approach as “consistent with existing legal and ethical norms concerning…involuntary hospitalization.”

Martell problematizes his own framework by pointing out that assessors for MAiD must be able to distinguish between episodic suicidality and the “calm and measured” decision to die. But individuals might display signs of both, he adds, and an intoxicated person would be “fairly impossible” to categorize. This incoherence—how are the health needs of (M)addicts to be evaluated?—extends to a general tension between the view that clinicians can provide euthanasia in accordance with (M)addicts’ best interests and the observation that Canadian facilities, as they currently stand, are ill-equipped to satisfy their health needs whatsoever. According to a recent commentary in the Canadian Journal of Emergency Medicine, again quoted in the report Minister Eby commissioned:

[T]he goals of concurrent medical, psychiatric stabilization and engagement in substance use disorder treatment require expertise and resources not readily available in either hospital or community settings in Canada (630).

Any heuristics are smoke and mirrors. Disabled people’s interactions with clinical structures are largely oppressive; addicts and Mad people are no exception. The circumstances in which they interact with health services are, non-incidentally, contexts in which they are believed by clinician “knowers” to be threatening, unstable, suicidal, and/or irrational. We have never successfully implemented widescale norms for the responsibilities of judges, law enforcement agents, and clinical care providers in these situations. Such norms will not spontaneously spring into existence now.

It is not sensationalist to suspect incarcerated Mad people and addicts will be offered assisted suicide as an alternative to imprisonment, not absurd to worry that people sent to facilities will be euthanized there. The abuse of power inherent to the carceral-clinical seesaw already facilitates forced sterilization, medication, and institutionalization. Death is far neater and more complete a compliance-ensuring mechanism than those. It would be ahistorical to suppose that when their powers are extended to the vehicle of euthanasia, legal and medical bodies will break with all previous patterns and begin to deploy rigorous ethical practices. All the evidence indicates the opposite. Addicts and Mad people will be systemically coerced into euthanasia on a broad scale. If you think otherwise, I don’t know what to tell you. I cannot argue with people who don’t believe in induction.

__________________________________________________________

T. Virgil Murthy is a Pittsburgh-based addict activist and graduate student, and the co-founder of the Addict Collective blog.

Description of photo below: A smiling Virgil sits in a restaurant booth facing the camera. A brick wall can be seen to their left behind them, as well as a chandelier and ornate mirror. They are wearing a sleeveless top and their long hair is tied back in a ponytail that falls over their left shoulder.