Have Assisted Dying Laws Gone Too Far? | The Walrus
This article contains discussions of suicide.
本文包含有关自杀的讨论。
If you or someone you know is having a suicide crisis, please call Talk Suicide Canada (1-833-456-4566), which offers 24/7 support.
如果您或您认识的人正面临自杀危机，请致电 Talk Suicide Canada (1-833-456-4566)，该机构提供 24/7 支持。
There is also Kids Help Phone (1-800-668-6868), the Hope for Wellness Helpline for Indigenous people across Canada (1-855-242-3310), and 1-866-APPELLE (for Quebec residents).
还有儿童帮助电话 (1-800-668-6868)、加拿大各地原住民健康希望帮助热线 (1-855-242-3310) 和 1-866-APPELLE（魁北克居民）。
T arra carlson’s plan for her old age is simple: to die before her husband.
塔拉·卡尔森的晚年计划很简单：先于丈夫去世。
She’s been nearly inseparable from him since they met thirteen years ago on a dating site.
自从十三年前他们在约会网站上认识以来，她几乎和他形影不离。
After a few messages and video chats, they learned they lived just blocks apart.
经过几条消息和视频聊天后，他们得知他们住的地方仅隔几个街区。
The revelation led to a long midnight drive together.
这一发现导致我们一起度过了一次漫长的午夜车程。
Soon, he moved in.
很快，他就搬进来了。
They got married a few years later.
几年后他们结婚了。
He is, without a doubt, the greatest and best thing in her life, she says.
她说，毫无疑问，他是她生命中最伟大、最好的人。
He is also, in some ways, her guarantee of life.
从某些方面来说，他也是她生命的保证。
Carlson, forty-eight, has autism and ADHD.
卡尔森四十八岁，患有自闭症和多动症。
She didn’t get a formal diagnosis until she was thirty-nine—“Only boys in my time had those disabilities,” she says—but her whole life has been marked by social exclusion.
她直到三十九岁才得到正式诊断——“在我那个时代，只有男孩才有这些残疾，”她说——但她的一生都充满了社会排斥。
She says that, when she was growing up, her teachers and school administrators sensed there was something different about her, but they didn’t know exactly what; some, she says, would use the r-word to describe her.
她说，在她成长的过程中，她的老师和学校管理人员感觉到她有一些不同之处，但他们并不知道到底是什么；她说，有些人会用“r”这个词来形容她。
Carlson attended separate classes for students with disabilities throughout elementary and parts of high school.
卡尔森在小学和高中的部分时间里为残疾学生参加了单独的课程。
She struggled in college because of a lack of disability accommodations.
由于缺乏残疾住宿，她在大学里处境艰难。
She remembers that when she was a child, a doctor suggested her parents send her to an institution; doctors also warned she’d never be able to live independently as an adult.
她记得小时候，医生建议她父母把她送到福利院；医生还警告她成年后永远无法独立生活。
Despite the warnings, she did achieve some degree of independence: at twenty-three, she moved to Alberta from British Columbia on her own.
尽管有这些警告，她还是实现了一定程度的独立：二十三岁时，她独自从不列颠哥伦比亚省搬到了艾伯塔省。
She makes a living as a caregiver for people with disabilities and people who hire and train their own support staff rather than rely on agencies.
她以照顾残疾人和雇用和培训自己的支持人员而不是依赖机构的人为生。
For several years, she also received payments under Assured Income for the Severely Handicapped, a provincial social assistance program for disabled adult Albertans.
多年来，她还收到了严重残疾人收入保障项目的付款，该项目是一项针对阿尔伯塔省残疾成人的省级社会援助计划。
It’s not a lot of money to live on—the maximum 2023 rate is $1,787 per month; in 2017, when Carlson last received it, it was $1,588.
生活费并不是很多——2023 年的最高费率是每月 1,787 美元； 2017 年，卡尔森最后一次收到它时，价格为 1,588 美元。
(By that time, she says, she was personally receiving well below that amount because of her husband’s salary and her pension plan disability benefits.) The amount decreased when she earned money, so the program did little to maintain her independence or help her plan for the future.
（她说，到那时，由于她丈夫的工资和养老金计划残疾福利，她个人收到的金额远远低于该金额。）当她赚钱时，金额会减少，因此该计划对维持她的独立性或帮助她规划未来几乎没有帮助。
By mid-2017, she lost access to the program entirely; her husband’s income made her ineligible.
到 2017 年中期，她完全失去了该计划的访问权限；她丈夫的收入使她没有资格。
She says she still receives about $800 a month in Canada Pension Plan disability benefits and can get by with her husband’s support, but the situation feels temporary.
她说，她每月仍然可以领取大约 800 美元的加拿大养老金计划残疾福利，并且可以在丈夫的支持下度过难关，但这种情况感觉是暂时的。
“I’m petrified of growing old with a disability,” she says.
“我害怕随着年龄的增长而残疾，”她说。
If her husband dies before her, she may have no way to access financial support.
如果她的丈夫先于她去世，她可能无法获得经济支持。
She’ll lose her biggest advocate and support system—and her home.
她将失去她最大的拥护者和支持系统以及她的家。
She’s worked in long-term care facilities and never wants to live in one.
她曾在长期护理机构工作，从来不想住在其中。
Applying for disability support programs, such as home care, can be cumbersome.
申请家庭护理等残疾支持计划可能很麻烦。
There’s no one-stop shop for disability services; they’re spread across government agencies and ministries.
没有一站式的残疾人服务；他们分布在政府机构和部委。
Wait lists are long.
等候名单很长。
Paperwork can be complicated.
文书工作可能很复杂。
Carlson doesn’t think she’ll be able to understand how to navigate social assistance programs without her husband to explain them to her.
卡尔森认为，如果没有丈夫向她解释，她将无法理解如何管理社会援助计划。
But if she dies first, she reckons, she won’t have to.
但她认为，如果她先死，她就不必这么做。
Compared with disability support, medical assistance in dying, or MAID, seems relatively easy to request.
与残疾支持相比，死亡医疗援助（MAID）似乎相对容易申请。
Written applications differ by province or territory but are fairly straightforward; most are only a few pages long.
书面申请因省或地区而异，但相当简单；大多数只有几页长。
For some of them, to confirm eligibility, an applicant simply has to sign and initial certain statements—for example, that they have an irremediable and grievous medical condition and are in a state of advanced decline.
对于其中一些人来说，要确认资格，申请人只需签署并签署某些声明即可，例如，他们患有无法治愈且严重的健康状况，并且处于严重衰退的状态。
If any more health conditions were to crop up on top of her disability, eroding her independence completely, says Carlson, she’s pretty sure she’d qualify for MAID.
卡尔森说，如果在她的残疾之外出现更多的健康问题，完全削弱她的独立性，她很确定自己有资格获得 MAID。
“It’s a one-way ticket,” she says, “because you have no choice.”
“这是一张单程票，”她说，“因为你别无选择。”
B efore 2015, providing medically assisted deaths was a criminal offence.
2015 年之前，提供医疗协助死亡属于刑事犯罪。
That year, the Supreme Court of Canada declared the Criminal Code’s prohibitions on assisted suicide unconstitutional insofar as they did not permit physicians to provide medically assisted death to consenting adults.
同年，加拿大最高法院宣布《刑法》禁止协助自杀的规定违宪，因为这些规定不允许医生向同意的成年人提供医疗协助死亡。
The following year, legislation came into effect that legalized MAID, allowing physicians to administer lethal drugs to patients who, as the law put it, had a “grievous and irremediable” sickness, disease, and disability and whose “natural death” was “reasonably foreseeable.” (Interpretations of the term “reasonably foreseeable” and what sort of timeline it denotes can vary, but it is generally understood by clinicians that it can mean several years.) This would, presumably, allow individuals with terminal illnesses to end their lives when they wanted and on their own terms.
第二年，MAID 合法化的立法生效，允许医生对患有“严重且无法治愈”的疾病和残疾且“自然死亡”是“合理可预见的”的患者使用致命药物。 （对“合理可预见”一词的解释以及它所代表的时间线可能会有所不同，但临床医生普遍认为这可能意味着几年。）这大概可以让患有绝症的人在自己想要的时候按照自己的方式结束生命。
Until recently, most of the public discourse and reporting about MAID has described it in positive and, some would argue, romantic terms.
直到最近，大多数有关 MAID 的公众讨论和报道都用积极的、甚至有人认为是浪漫的术语来描述它。
(A 2015 editorial in The Walrus called MAID “the last human right.”) Proponents say MAID gives suffering individuals a painless end.
（《海象》2015 年的一篇社论称 MAID 为“最后的人权”。）支持者表示，MAID 为受苦受难的人带来了无痛的终结。
Some say they feel relief knowing that their death will be controlled and that they can anticipate a peaceful exit.
一些人说，他们感到如释重负，因为他们知道自己的死亡将得到控制，并且可以期待和平退出。
MAID, they say, has given them an option other than prolonged suffering or a violent suicide—or perhaps an unsuccessful and traumatic attempt at one.
他们说，MAID 给了他们一种选择，除了长期的痛苦或暴力自杀——或者可能是一种不成功和创伤性的自杀尝试。
That rosy perception began to darken when, in 2021, the legislation was expanded to include people whose deaths are not considered reasonably foreseeable—an option now known as Track Two.
2021 年，当立法范围扩大到包括那些死亡被认为无法合理预见的人时，这种乐观的看法开始变得黯淡起来——这一选项现在被称为第二轨。
The development particularly angered many disabled Canadians.
这一事态发展尤其激怒了许多加拿大残疾人。
The change in legislation made it possible for disabled people to qualify for MAID even if they weren’t terminally ill.
立法的变化使残疾人即使没有患绝症也有资格获得 MAID。
Over the past year, according to news reports, people have considered applying for or have died by MAID for reasons such as insufficient housing and meagre social supports that have left them in perpetual poverty.
据新闻报道，过去一年，人们考虑申请MAID，或者已经去世，原因是住房不足、社会支持微薄，导致他们永远陷入贫困。
Carlson knows people with disabilities who have applied for MAID because they couldn’t find proper supports to live.
卡尔森认识因无法找到适当的生活支持而申请 MAID 的残疾人。
“Canada has made it so that it’s become the only resource or recourse that people who are marginalized or poor have,” she says.
“加拿大已经做到了这一点，使其成为边缘化或贫困人口拥有的唯一资源或追索权，”她说。
In 2024, Canada plans to further extend eligibility to people whose sole underlying condition is mental illness, prompting many to question whether MAID has gone too far.
2024 年，加拿大计划进一步将资格范围扩大到仅患有精神疾病的人，这促使许多人质疑 MAID 是否走得太远。
(The government was due to introduce this expansion in March 2023 but passed a law earlier this year to extend that deadline, citing the need to give medical professionals more time to prepare.) Ostensibly, there are legal and administrative safeguards in place to keep MAID from being abused, whether by patients or providers.
（政府原定于 2023 年 3 月推出这一扩展，但今年早些时候通过了一项法律，延长了这一期限，理由是需要给医疗专业人员更多的时间进行准备。）表面上看，有法律和行政保障措施来防止 MAID 被滥用，无论是患者还是提供者。
But, for a growing chorus of critics, it’s unclear whether any such measures can suffice to protect vulnerable people from being all but forced into MAID.
但是，越来越多的批评者认为，尚不清楚此类措施是否足以保护弱势群体免遭被迫进入 MAID 的境地。
Concerns about the legislation aren’t new.
对这项立法的担忧并不新鲜。
Some say it was flawed from the outset and that Canada’s assisted dying laws have always singled out disabled people by listing “disability” as a type of medical condition that could guarantee eligibility.
有人说，它从一开始就有缺陷，加拿大的安乐死法总是把“残疾”列为一种可以保证资格的医疗状况，从而专门针对残疾人。
In 2019, before Track Two was legalized, Catalina Devandas-Aguilar, then UN special rapporteur for the rights of persons with disabilities, wrote that she was “extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective.” In her report on the country’s compliance with the United Nations Convention on the Rights of Persons with Disabilities—which Canada ratified in 2010—she mentioned troubling accounts of people with disabilities who were institutionalized and offered MAID.
2019年，在第二轨道合法化之前，时任联合国残疾人权利特别报告员卡塔琳娜·德万达斯-阿吉拉尔写道，她“极其关注从残疾角度出发的死亡医疗救助立法的实施情况”。在她关于该国遵守《联合国残疾人权利公约》（加拿大于 2010 年批准）的报告中，她提到了残疾人被送入收容机构并为其提供女佣的令人不安的情况。
She recommended the government investigate such claims and “establish adequate safeguards to ensure that persons with disabilities do not request assisted dying simply because there are no community-based alternatives or palliative care.”
她建议政府调查此类说法，并“建立足够的保障措施，确保残疾人不会仅仅因为没有基于社区的替代方案或姑息治疗而要求辅助死亡。”
In February 2021, three UN experts on the rights of seniors and people with disabilities as well as on human rights and extreme poverty wrote a letter to the federal government, urging it not to legalize Track Two.
2021 年 2 月，三名联合国老年人和残疾人权利以及人权和赤贫问题专家致信联邦政府，敦促其不要将第二轨合法化。
“There is a grave concern,” the letter stated, “that, if assisted dying is made available for all persons with a health condition or impairment, regardless of whether they are close to death, a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability.”
信中指出，“令人严重担忧的是，如果向所有有健康问题或有缺陷的人提供辅助死亡服务，无论他们是否濒临死亡，可能会产生一种社会假设（或被巧妙地强化），即死了比带着残疾活着更好。”
The Canadian government nevertheless stayed its course.
尽管如此，加拿大政府还是坚持了自己的方针。
There are restrictions that are meant to keep the practice in check: for those deemed eligible for Track Two, for example, there is a mandated ninety-day period between when an assessment begins and when MAID can be provided.
有一些限制旨在控制这种做法：例如，对于那些被认为有资格进入第二轨的人，从评估开始到可以提供 MAID 之间有一个强制性的 90 天期限。
(For those whose applications fall under Track One, there is no required reflection period; someone could theoretically be approved for MAID in the morning and be administered the lethal drugs in the afternoon.)
（对于那些属于第一轨申请的人，没有必要的反思期；理论上，某人可以在早上获得 MAID 批准，并在下午接受致命药物。）
But ninety days isn’t long enough for comprehensive reflection, says Virginia Duff, a Toronto-based psychiatrist.
但多伦多精神病学家弗吉尼亚·达夫 (Virginia Duff) 表示，九十天的时间不足以进行全面反思。
Most people, she says, would not likely reverse or even reconsider such a decision within that time frame.
她说，大多数人在这段时间内不太可能改变甚至重新考虑这样的决定。
This is especially true, she adds, for people who have recently acquired a disability and are adjusting to its impact on their lives.
她补充说，对于最近患有残疾并正在适应其对生活的影响的人来说尤其如此。
“They’re in a crisis at the beginning,” says Duff.
“他们一开始就处于危机之中，”达夫说。
“They’re going to be regarding their future in a certain light and often in a negative light.
“他们会从某种角度看待自己的未来，而且往往是消极的。
But they don’t know at that point what they don’t know.
但他们当时并不知道自己不知道什么。
And they don’t know that life with a disability can be very different from what they imagined it to be.”
他们不知道残疾人的生活可能与他们想象的有很大不同。”
The Special Joint Committee on Medical Assistance in Dying (AMAD), established by the House of Commons and Senate in 2021 to review MAID law and proposals for further expansions, received 358 written submissions from organizations and individuals.
下议院和参议院于 2021 年成立的死亡医疗援助特别联合委员会 (AMAD) 旨在审查 MAID 法和进一步扩展的提案，收到了来自组织和个人的 358 份书面意见。
One of them was from an elderly woman who wrote to the committee about her degenerative eye condition, saying there is a need for MAID to be expanded to include people who aren’t experiencing pain as a form of suffering—whether that be physical or psychological.
其中一位来自一位老年妇女，她向委员会写信讲述了自己的退行性眼部疾病，并表示需要扩大 MAID 范围，将那些没有经历过疼痛的人纳入其中——无论是身体上的还是心理上的。
She wants to apply for MAID once she is considered legally blind.
一旦她被认为是法定盲人，她想申请女佣。
Society, she wrote, isn’t built for blind people; she has no desire to learn Braille or how to use adaptive technologies.
她写道，社会不是为盲人而建的；而是为盲人而建的。她不想学习盲文或如何使用自适应技术。
For Duff, who is visually impaired, the way we talk about MAID expansions ignores the complexities and years it may take to treat conditions such as mental illness.
对于视力受损的达夫来说，我们谈论 MAID 扩张的方式忽略了治疗精神疾病等疾病可能需要的复杂性和时间。
The language we use around it is also euphemistic: “The title of the act is ‘medical assistance in dying,’” she says.
我们使用的语言也是委婉的：“该法案的标题是‘死亡医疗援助’，”她说。
“But these aren’t people who would otherwise be dying.
“但这些人本来不会死去。
We’re not just assisting them.
我们不仅仅是帮助他们。
We’re actually making it happen, which is very different.” (Some jurisdictions where medically assisted death is legal use terms such as assisted suicide, in which patients are given fatal drugs to ingest, and euthanasia, the process by which medical practitioners directly administer a lethal intravenous injection.
我们实际上正在让它发生，这是非常不同的。” （在某些司法管辖区，医疗协助死亡是合法使用的术语，例如协助自杀（即给予患者摄入致命药物）和安乐死（即医生直接进行致命静脉注射的过程）。
MAID effectively covers both, although the vast majority of MAID deaths in Canada are clinician administered.)
尽管加拿大绝大多数 MAID 死亡是由临床医生管理的，但 MAID 有效地涵盖了两者。）
For some, the availability of MAID isn’t so much a concern as the ease with which this country offers it.
对于一些人来说，MAID 的可用性与其说是一个问题，不如说是这个国家提供它的便捷性。
According to Health Canada, 31,664 people died by MAID in the five years after legalization.
据加拿大卫生部称，合法化后的五年内，有 31,664 人死于 MAID。
In 2021 alone, the number of medically assisted deaths in Canada—just over 10,000—was about twenty times higher than in California, a state with an assisted suicide program and similar population size.
仅 2021 年，加拿大因医疗协助死亡的人数刚刚超过 10,000 人，大约是加利福尼亚州的 20 倍，加州设有协助自杀计划，且人口规模相似。
(In California, eligibility is granted only to those who are terminally ill.) Track Two was introduced in Canada in March 2021, and in less than a year, 219 people who were presumably not imminently dying had received it.
（在加利福尼亚州，资格仅授予那些身患绝症的人。）第二轨于 2021 年 3 月在加拿大推出，不到一年的时间，就有 219 名可能不会濒临死亡的人接受了该计划。
“Canada has become a poster child for how bad MAID can become,” says Heidi Janz, a long-time disability rights activist and playwright.
“加拿大已经成为《女佣》变得多么糟糕的典范，”长期残障人士权利活动家和剧作家海蒂·扬兹 (Heidi Janz) 说。
An associate adjunct professor at the University of Alberta, she studies and teaches the ethics around end-of-life care and disability.
她是阿尔伯塔大学的兼职副教授，研究并教授有关临终关怀和残疾的伦理学。
Janz, along with Catherine Frazee, a professor emerita of disability studies at Toronto Metropolitan University, started the GRIM Project in 2022 to document the stories of disabled people who have considered MAID or have died by it.
Janz 与多伦多城市大学残疾研究名誉教授 Catherine Frazee 于 2022 年启动了 GRIM 项目，记录那些考虑过使用 MAID 或因此而死亡的残疾人的故事。
(Both Janz and Frazee appeared as witnesses for the AMAD committee, as well as several other sources I interviewed for this story.) The project takes its name from the Criminal Code’s language of a “grievous and irremediable condition.” Janz and Frazee have spent years listening to the stories of disabled Canadians, many of whom live in poverty and struggle with social isolation.
（Janz 和 Frazee 均作为 AMAD 委员会的证人，以及我为本文采访的其他几位消息人士出庭。）该项目的名称源自《刑法》中“严重且无法挽回的状况”的用语。 Janz 和 Frazee 多年来一直在倾听加拿大残疾人的故事，他们中的许多人生活在贫困之中，并与社会孤立作斗争。
MAID, says Janz, “has become an acceptable solution to poverty for people with disabilities.”
Janz 表示，MAID“已成为残疾人可以接受的解决贫困问题的解决方案。”
“These problems predate the MAID system,” says Frazee.
“这些问题早在 MAID 系统出现之前就出现了，”Frazee 说道。
She frequently hears stories of disabled Canadians turning to MAID out of desperation and thinks about them every day.
她经常听到加拿大残疾人因绝望而求助于MAID的故事，并且每天都会想起他们。
They tell her they don’t want to die yet the government seems to be pushing them to.
他们告诉她，他们不想死，但政府似乎在逼他们去死。
“But the MAID system makes it all a perfect crime because the MAID regime destroys the evidence,” she says.
“但 MAID 系统使这一切成为完美的犯罪，因为 MAID 制度销毁了证据，”她说。
“It destroys the lives of the people who were here to report their experience of poverty and alienation and stigmatization and devaluation.”
“它摧毁了来这里讲述贫困、疏远、污名和贬值经历的人们的生活。”
In September 2020, the federal government announced its intention to create a financial benefit for disabled Canadians who are working-age adults.
2020 年 9 月，联邦政府宣布打算为处于工作年龄的加拿大残疾人提供经济福利。
Bill C-22 passed unanimously in the House of Commons in early February this year and, as of mid-April, was still in the Senate.
C-22法案今年2月初在下议院一致通过，截至4月中旬仍在参议院审议。
When it was being debated in the House of Commons, Bloc Québecois MP Luc Thériault questioned the reliability of stories that report Canadians seeking MAID because of socio-economic hardships: “No one who appeared before the Standing Committee on Health told us up front that [these] claims are common practice,” he said.
当下议院对此进行辩论时，魁北克政团议员 Luc Thériault 对加拿大人因社会经济困难而寻求女佣的报道的可靠性提出了质疑：“没有人在健康常设委员会面前告诉我们，[这些]说法是常见做法，”他说。
Others said issues of disability, poverty, and MAID were “intertwined”—that it was impossible to discuss reducing poverty for disabled Canadians without also recognizing that many are requesting MAID because they live in poverty.
其他人则表示，残疾、贫困和 MAID 问题“交织在一起”——如果不认识到许多人因为生活贫困而要求获得 MAID，就不可能讨论加拿大残疾人的减贫问题。
Carla Qualtrough, the minister of employment, workforce development, and disability inclusion, responded to Thériault’s criticisms in an interview I recorded for Now with Dave Brown , a national TV show and podcast produced by Accessible Media Inc. “I believe that when someone says a decision was motivated by a socio and economic factor like poverty that it was,” she said.
就业、劳动力发展和残疾人包容部长卡拉·夸特罗 (Carla Qualtrough) 在我为《Now with Dave Brown》录制的一次采访中回应了泰里奥的批评，这是一个由 Accessible Media Inc. 制作的全国电视节目和播客。“我相信，当有人说某个决定是由贫困等社会和经济因素推动时，那就是这样，”她说。
“There’s no reason why somebody would ever say it wasn’t. . . . It keeps me awake at night.”
“没有理由有人会说不是……这让我彻夜难眠。”
Some advocates argue that Bill C-22 could keep disabled Canadians from applying for MAID.
一些倡导者认为，C-22 法案可能会阻止加拿大残疾人申请 MAID。
(The details around how much the benefit will amount to and who exactly will be eligible for it are yet to be worked out.) But poverty is just “one piece of the puzzle” of why disabled Canadians are considering or are being approved for MAID even when they’re not dying, says Kerri Joffe, a staff lawyer with Arch Disability Law Centre, a Toronto-based legal clinic that focuses on disability rights law and policy in Ontario.
（关于福利金额以及到底谁有资格获得福利的细节尚未确定。）但Arch残疾法律中心的专职律师Kerri Joffe表示，贫困只是加拿大残疾人在没有死亡的情况下考虑或被批准领取MAID的“谜团之一”。Arch残疾法律中心是一家位于多伦多的法律诊所，专注于安大略省的残疾人权利法律和政策。
The problems of disability poverty and the lack of affordable, accessible housing and proper home-care supports need to be addressed, she says.
她说，残疾贫困以及缺乏负担得起的、无障碍的住房和适当的家庭护理支持的问题需要解决。
But Joffe, and others, have raised concerns that Canada’s MAID legislation denies disabled Canadians equal rights to life.
但 Joffe 和其他人对加拿大的 MAID 立法剥夺了加拿大残疾人的平等生命权表示担忧。
The government needs to address this, she says, by removing Track Two altogether or changing the law “fundamentally so that it would comply with international human rights law.”
她说，政府需要通过完全取消第二轨或“从根本上修改法律，以使其符合国际人权法”来解决这个问题。
“I think that disability should have been absent from [the original MAID legislation],” says André Schutten, director of law and public policy at the Association for Reformed Political Action (ARPA) Canada, a Christian legal organization and lobby group.
“我认为[最初的 MAID 立法] 中应该没有残疾问题，”基督教法律组织和游说团体加拿大改革政治行动协会 (ARPA) 的法律和公共政策主任安德烈·舒滕 (André Schutten) 说。
The phrasing of a “reasonably foreseeable” death is also too vague, he says.
他说，“合理预见”死亡的措辞也过于模糊。
ARPA wrote to the joint committee requesting that a “reasonably foreseeable” death be defined as one backed by a prognosis that the patient is likely to die within six months.
ARPA 写信给联合委员会，要求将“合理可预见”的死亡定义为有患者可能在六个月内死亡的预后支持的死亡。
The organization also wants Track Two deaths eliminated so that only individuals whose natural deaths are reasonably foreseeable can die by MAID.
该组织还希望消除第二轨死亡，以便只有自然死亡可合理预见的个人才能通过 MAID 死亡。
ARPA isn’t alone in this request.
ARPA 并不是唯一提出这一要求的机构。
Inclusion Canada, a secular organization that represents people with intellectual or developmental disabilities, has also called on the government to remove Track Two for MAID.
代表智力或发育障碍人士的世俗组织 Inclusion Canada 也呼吁政府取消 MAID 的第二轨。
Arch Disability Law Centre, another secular organization, has expressed similar concerns about Track Two.
另一个世俗组织阿奇残疾法律中心也对第二轨表达了类似的担忧。
In fact, ARPA disagrees with MAID wholesale.
事实上，ARPA 并不同意 MAID 批发。
As a “foundational principle,” says Schutten, doctors should not be able to end patients’ lives.
舒滕说，作为一项“基本原则”，医生不应该能够结束病人的生命。
“When you say, ‘No, there are some situations where a doctor should have a licence to end the life of a patient,’ then it’s very difficult to say, ‘Well, in this situation, you can.
“当你说，‘不，在某些情况下，医生应该拥有结束病人生命的许可证’，那么就很难说，‘好吧，在这种情况下，你可以。
In this situation, you can’t.’ Every safeguard becomes arbitrary in a sense.”
在这种情况下，你不能。’从某种意义上说，每项保障措施都变得任意。”
But there is an understanding among the organization’s leaders that MAID has become a part of Canadian society, one that seems immovable.
但该组织的领导人有一个共识，即 MAID 已成为加拿大社会的一部分，而且似乎是不可动摇的。
“We also recognize the political reality that we live in,” says Schutten.
“我们也认识到我们所生活的政治现实，”舒滕说。
T his past February, the parliamentary joint committee released a report that recommended, among other things, that the government consider removing the word “disability” from the legislation altogether.
今年二月，议会联合委员会发布了一份报告，其中建议政府考虑从立法中完全删除“残疾”一词。
It echoed the need for greater social and financial supports for disabled Canadians.
它呼应了为加拿大残疾人提供更多社会和财政支持的需要。
Yet the report also spoke favourably of further expansions, such as permitting advance requests for MAID.
然而，该报告也对进一步扩张表示赞成，例如允许提前申请 MAID。
This would potentially allow people to stipulate under what circumstances they would want to receive MAID should they lose their capacity to consent to it.
这可能允许人们规定在什么情况下他们希望在失去同意能力的情况下获得 MAID。
The committee also suggested that MAID be made available in certain circumstances to “mature minors,” though it recommended further consultations.
该委员会还建议在某些情况下向“成年未成年人”提供 MAID，但建议进一步协商。
(Currently, Belgium and the Netherlands are the only countries with comparable provisions for those under eighteen.) There should be no age limit to who can consent to receiving MAID, the report states; applicants should qualify if they are deemed capable of making the decision, though it does not go further to define “capable.” The committee also recommended that parents and guardians be consulted during the process, though not that they be required to approve of their child’s decision: “the will of a minor who is found to have the requisite decision-making capacity [must] ultimately take priority,” the report states.
（目前，比利时和荷兰是唯一对十八岁以下儿童有类似规定的国家。）报告指出，同意接受 MAID 的人不应有年龄限制；如果申请人被认为有能力做出决定，那么他们就应该有资格，尽管它没有进一步定义“有能力”。委员会还建议在此过程中征求父母和监护人的意见，但并不要求他们批准孩子的决定：“最终必须优先考虑具有必要决策能力的未成年人的意愿，”报告指出。
The majority of Canadians—three out of five, according to a recent Angus Reid poll funded by Cardus, a Christian think tank that opposes MAID—are in favour of the legislation in its current state.
大多数加拿大人（根据反对 MAID 的基督教智囊团 Cardus 资助的安格斯·里德 (Angus Reid) 最近进行的一项民意调查显示，五分之三的加拿大人支持目前的立法。
This apparent public support doesn’t shock physicians who have been providing MAID in Canada almost since the beginning.
这种明显的公众支持并没有让几乎从一开始就在加拿大提供 MAID 的医生感到震惊。
When it was legalized, Konia Trouton, a doctor and MAID provider who was then practising in BC, had patients phoning her, asking for more information about medically assisted dying.
当它合法化时，当时在不列颠哥伦比亚省执业的医生兼女佣提供者科尼亚·特鲁顿(Konia Trouton)有病人打电话给她，询问有关医疗辅助死亡的更多信息。
“The legislation came about not because doctors were going to the courts and saying we need this option,” she says.
“这项立法的出台并不是因为医生去法院说我们需要这个选择，”她说。
“It’s because patients went to the court saying, ‘It is my right to die.’”
“这是因为病人到法庭说，‘死是我的权利。’”
That’s what motivated Trouton to start assessing patients for and performing MAID back in July 2016.
这就是促使 Trouton 于 2016 年 7 月开始评估患者并实施 MAID 的原因。
“Patient autonomy and choice is really important,” she says.
“患者的自主权和选择非常重要，”她说。
She has since helped found the Canadian Association of MAID Assessors and Providers, where she’s now vice president, and is a member of the clinicians’ advisory council for Dying with Dignity Canada, a pro-MAID lobby group.
此后，她帮助成立了加拿大 MAID 评估者和提供者协会，目前担任该协会的副会长，并且是支持 MAID 的游说团体加拿大尊严死亡临床医生咨询委员会的成员。
(Trouton also submitted a written brief to the AMAD committee.)
（特劳顿还向 AMAD 委员会提交了一份书面简报。）
Trouton, who now lives in Ontario, says she’s aware that some Canadians have received MAID even when the main cause of their suffering was a socio-economic factor not directly related to their qualifying medical condition.
现居住在安大略省的特劳顿说，她知道一些加拿大人接受了 MAID，即使他们遭受痛苦的主要原因是与他们合格的医疗状况没有直接关系的社会经济因素。
But that doesn’t technically make those cases ineligible.
但从技术上讲，这并不意味着这些案件不符合资格。
“The suffering and the irremediable disease don’t have to be the same,” says Trouton, citing the law’s language around safeguards: it does not explicitly state the need for suffering to be caused by a medical condition.
“痛苦和无法治愈的疾病不一定是一样的，”特劳顿引用了法律中关于保障措施的语言说道：它没有明确规定痛苦必须由医疗状况引起。
She points to other safeguards meant to ensure MAID applications are vetted appropriately.
她指出了其他旨在确保 MAID 申请得到适当审查的保障措施。
Applications go through at least two rounds of review.
申请至少要经过两轮审核。
Two clinicians have to separately assess the MAID request to determine whether the applicant meets the medical criteria for it as outlined in the law, a step that can be done virtually.
两名临床医生必须分别评估 MAID 的请求，以确定申请人是否符合法律规定的医疗标准，这一步骤可以通过虚拟方式完成。
Requests that qualify for Track Two require an opinion from someone with expertise in the applicant’s medical condition, and that expert can be one of the two reviewing clinicians.
符合第二轨资格的请求需要来自对申请人的医疗状况具有专业知识的人的意见，并且该专家可以是两名审查临床医生之一。
The assessors also have to determine whether a patient has reasonably considered all the treatments, therapies, or supports that could help alleviate their suffering.
评估人员还必须确定患者是否合理考虑了所有有助于减轻痛苦的治疗、疗法或支持。
“We don’t have to have proof that you’ve tried [them],” says Trouton.
“我们不需要证明你已经尝试过[它们]，”特劳顿说。
“But we have to feel that you’ve given reasonable consideration.” Some patients require multiple assessments; for Trouton’s most complex case to date, five consultations were completed before she was assured the patient was eligible for MAID.
“但我们必须觉得你已经给予了合理的考虑。”有些患者需要进行多次评估；对于特鲁顿迄今为止最复杂的病例，在她确信患者有资格获得 MAID 之前，已经完成了五次咨询。
She would like to see more training about MAID assessments incorporated into medical education so that clinicians—regardless of their area of practice—feel comfortable broaching the subject with their patients.
她希望看到更多有关 MAID 评估的培训纳入医学教育中，以便临床医生（无论其执业领域如何）能够轻松地向患者讨论该主题。
Trouton usually calls her patients the day before their scheduled death to make sure they still want MAID.
特劳顿通常会在病人预定死亡的前一天给他们打电话，以确保他们仍然需要女佣。
On the day of, to confirm that they understand what will happen to them, she asks them to tell her who they are and why they are there.
那天，为了确认他们明白会发生什么，她要求他们告诉她他们是谁以及为什么他们在那里。
“We do the same thing in surgery,” she says.
“我们在手术中也做同样的事情，”她说。
Even if the government does not expand MAID for those with mental illnesses or mature minors, and even if it doesn’t allow for advance requests, Trouton sees the number of Canadians dying by MAID only rising.
即使政府不扩大针对患有精神疾病或成年未成年人的 MAID，即使它不允许提前请求，特劳顿也认为死于 MAID 的加拿大人数量只会增加。
“There’s been an increase already in the past seven years in MAID across the country,” she says.
“过去七年里，全国范围内的 MAID 数量已经有所增加，”她说。
“It doesn’t look like that trajectory is stopping.”
“看起来这条轨迹并没有停止。”
Other MAID providers are looking at MAID expansion differently.
其他 MAID 提供商对 MAID 扩展的看法不同。
Madeline Li, a psychiatrist at Princess Margaret Cancer Centre, which is part of Toronto’s University Health Network (UHN), says she has “grown increasingly concerned” about how MAID is practised in Canada.
玛格丽特公主癌症中心 (Princess Margaret Cancer Centre) 是多伦多大学健康网络 (UHN) 的一部分，玛德琳·李 (Madeline Li) 表示，她“越来越担心”MAID 在加拿大的实施方式。
“I’ve never been in favour of expanding MAID to non-terminal [cases],” she says.
“我从来不赞成将 MAID 扩展到非绝症[病例]，”她说。
Li developed the MAID program at UHN and says the law has always lacked sufficient safeguards, and this has only become more apparent as MAID has expanded.
李在 UHN 制定了 MAID 计划，并表示法律一直缺乏足够的保障措施，随着 MAID 的扩大，这一点变得更加明显。
Specifically, the law needs to be more clinically informed, says Li, who is also a scientific researcher.
身为科学研究人员的李说，具体来说，法律需要更加临床化。
The terms “reasonably foreseeable” and “incurability” must be defined medically, with specific time frames attached to the former and further explanations around the latter.
“合理可预见”和“不可治愈”这两个术语必须在医学上进行定义，前者附有具体的时间框架，后者则需进一步解释。
A patient shouldn’t be deemed to have an incurable illness, for example, if they’ve refused treatments, she says.
她说，例如，如果患者拒绝治疗，则不应被视为患有不治之症。
And providers need a clearer interpretation of what constitutes suffering in the context of MAID.
医疗服务提供者需要对 MAID 背景下的痛苦构成更清晰的解释。
“There needs to be clarification that the suffering needs to be medical suffering directly related to the medical condition,” she says.
“需要澄清的是，这种痛苦必须是与健康状况直接相关的医疗痛苦，”她说。
“And that sources of suffering indirectly related to the medical condition don’t qualify.”
“与健康状况间接相关的痛苦来源不符合条件。”
Li would also like an oversight body to qualitatively review complex cases.
李还希望有一个监督机构对复杂案件进行定性审查。
What she’s proposing currently doesn’t exist on the federal level in Canada.
她的提议目前在加拿大联邦层面并不存在。
She thinks clinicians need to be legally required to have more detailed conversations with patients who say they want MAID—conversations that don’t take the patients’ request at face value and aim to get at the best medical option for them.
她认为，法律上需要临床医生与那些声称需要 MAID 的患者进行更详细的对话，这种对话不会仅从表面上考虑患者的要求，而是旨在为他们找到最佳的医疗选择。
“I genuinely think clinicians are doing their best to help patients,” she says.
“我真诚地认为临床医生正在尽最大努力帮助患者，”她说。
But the law itself is inherently flawed, and that puts people at risk.
但法律本身存在固有缺陷，这将人们置于危险之中。
If concerns aren’t addressed through amended legislation, “they’re not going to be addressed [fully] through practice guidelines or training,” she says.
如果问题不能通过修订后的立法得到解决，“它们就不会通过实践指南或培训得到[完全]解决，”她说。
“The problem has been that the people who first entered MAID work are now very experienced, but they’re confusing experience with expertise.
“问题在于，最初进入女佣工作的人现在都非常有经验，但他们混淆了经验和专业知识。
They’ve been very focused on ‘Does a patient qualify?’ and not ‘Should a patient have MAID?’”
他们非常关注‘患者是否符合资格？’而不是‘患者应该有女佣吗？’”
T he looming expansion of MAID, under Track Two, to include people with mental illnesses has raised red flags for several psychiatrists, who say that allowing people with mental illnesses to die by MAID could rob them of the chance to find treatments that enhance their lives.
第二轨下的 MAID 即将扩大，将精神疾病患者纳入其中，这给几位精神科医生敲响了警钟，他们表示，允许精神疾病患者死于 MAID 可能会剥夺他们找到改善生活的治疗方法的机会。
According to Duff, it could violate the principles of suicide prevention.
达夫认为，这可能违反预防自杀的原则。
“One of the tools that we use to help prevent suicide is to eliminate the means,” she says.
“我们用来帮助预防自杀的工具之一就是消除自杀手段，”她说。
And if assessors comply with only the minimum requirements for the MAID expansions, “we’re just handing [patients] the means and not questioning why they want to kill themselves.”
如果评估人员只遵守 MAID 扩展的最低要求，“我们只是向[患者]提供手段，而不是质疑他们为什么要自杀。”
“To say this is not suicide inducement or that it’s not suicide, I find bizarre,” says John Maher, a Barrie, Ontario, psychiatrist who has spent twenty years working with assertive community treatment teams.
“说这不是自杀诱导或这不是自杀，我觉得很奇怪，”安大略省巴里市的精神病学家约翰·马赫（John Maher）说，他在自信的社区治疗团队中工作了二十年。
These twelve-person multidisciplinary teams work with people who have severe mental illnesses, including schizophrenia.
这些由十二人组成的多学科团队与患有严重精神疾病（包括精神分裂症）的人一起工作。
There’s no consensus among psychiatrists that mental illnesses are irremediable, that they never get better.
精神病学家们并没有一致认为精神疾病是无法治愈的，永远不会好转。
Maher argues that even patients with serious mental illnesses can improve; they often just need more time to find the right treatments that work for them—and for those treatments to be available to begin with.
马赫认为，即使是患有严重精神疾病的患者也可以得到改善。他们通常只是需要更多的时间来找到适合他们的正确治疗方法，并让这些治疗方法一开始就可用。
“If you’re saying ‘irremediable’ means they can’t be cured completely, sure, there are people who are irremediable,” he says.
“如果你说‘无法治愈’意味着无法完全治愈，那么当然，有些人是无法治愈的，”他说。
“If you’re saying it means there are people where you can’t reduce suffering . . . I don’t buy it.” The Centre for Addiction and Mental Health has echoed these concerns.
“如果你说这意味着你无法减少某些人的痛苦 . . . 我不相信。”成瘾和心理健康中心也表达了这些担忧。
Its June 2022 brief to the government committee that reviewed MAID states, “We do not believe that eligibility for MAID should be extended to people whose sole medical condition is mental illness at this time.”
其 2022 年 6 月向负责审查 MAID 的政府委员会提交的简报指出，“我们认为目前不应该将 MAID 的资格扩大到唯一的医疗状况是精神疾病的人。”
Mitchell Tremblay says he plans to apply for MAID as soon as it becomes available for people with mental illnesses.
米切尔·特伦布莱 (Mitchell Tremblay) 表示，一旦 MAID 可供精神疾病患者使用，他计划立即申请。
Based in Guelph, Ontario, he has a disability and has been vocal online about his financial hardship.
他居住在安大略省圭尔夫市，患有残疾，并在网上直言不讳地讲述了自己的经济困难。
He has had suicidal ideations since he was eleven; he has experienced cycles of homelessness; he doesn’t speak to his family; he says he has very few friends—and even those relationships are strained—and he doesn’t want to try to make more of them.
他从十一岁起就有自杀念头；他经历过无家可归的循环；他不和家人说话；他说他的朋友很少——甚至这些关系也很紧张——而且他不想结交更多朋友。
He’s keeping careful records of his mental health diagnoses: social anxiety disorders, generalized anxiety, and post-traumatic stress disorder, among others.
他仔细记录了自己的心理健康诊断：社交焦虑症、广泛性焦虑症和创伤后应激障碍等。
He doesn’t want his MAID request to be denied, so he intends to show that his condition truly is lifelong—that he’s not applying because he’s in a temporary situation of depression.
他不希望他的女佣请求被拒绝，所以他打算证明他的病情确实是终生的——他不申请是因为他处于暂时的抑郁状态。
But even though he wants MAID for himself, he’s concerned that some other MAID applicants will be approved when they don’t actually have a serious, diagnosed, chronic mental illness—people who are experiencing a major depressive episode, brought on by events like a romantic breakup or the loss of a job or home, and whose mental health might improve with the right treatment.
但即使他自己想要 MAID，他还是担心其他一些 MAID 申请者在实际上没有患有严重的、经诊断的慢性精神疾病的情况下会获得批准——这些人正在经历严重的抑郁症发作，由浪漫分手或失去工作或家庭等事件引起，并且他们的心理健康可能通过正确的治疗得到改善。
“I think it’s going to be a national blight,” he says about expanding MAID eligibility while people don’t have proper supports.
“我认为这将成为一场全国性的灾难，”他谈到在人们没有适当支持的情况下扩大女佣资格时说道。
“There has to be all the avenues explored before MAID is the final option there for them.”
“在 MAID 成为他们的最终选择之前，必须探索所有途径。”
Maher fears that if MAID for mental illness becomes legal, it won’t be clear how doctors should determine which suicidal patients will receive psychiatric care and which will be assessed for MAID.
马赫担心，如果 MAID 治疗精神疾病变得合法，那么医生应该如何确定哪些自杀患者将接受精神科护理以及哪些人将接受 MAID 评估将不清楚。
“Suicide prevention work is about giving people hope: helping them make sense of suffering, giving them a sense of purpose in life, putting in speed bumps at those points in time when things look like there’s no hope of recovery,” says Maher.
“预防自杀工作就是给人们带来希望：帮助他们理解痛苦，赋予他们生活的目标感，在事情看起来没有恢复希望的时候及时减速，”马赫说。
“The whole point of my team—our services, our care philosophy—is we don’t quit.
“我团队的重点——我们的服务、我们的护理理念——就是我们不放弃。
We don’t go away.
我们不会消失。
We don’t stop helping.
我们不会停止提供帮助。
We don’t stop trying to reduce suffering, we don’t stop helping people heal.
我们不会停止努力减少痛苦，我们不会停止帮助人们康复。
We’re a recovery model.”
我们是一个复苏模式。”
E ven those who want to support people in vulnerable situations can be left in the dark about their intentions to seek MAID—and feel powerless to stop it.
即使是那些想要支持弱势群体的人，也可能对自己寻求 MAID 的意图一无所知，并且无力阻止。
Gary Hertgers has spent months trying to piece together the final days of his older sister Wilma’s life.
加里·赫特格斯花了几个月的时间试图拼凑出他姐姐威尔玛生命的最后几天。
She was sixty-three when she died on January 30, 2022.
她于 2022 年 1 月 30 日去世，享年 63 岁。
The first indication that something was off was a cryptic voicemail message from a doctor he didn’t know—someone he would later find out was Wilma’s MAID provider.
出现问题的第一个迹象是来自一位他不认识的医生的神秘语音邮件消息——他后来发现这个人是威尔玛的女佣提供者。
He phoned the doctor back and left a voicemail.
他给医生回了电话并留下了语音信箱。
Then the manager of Wilma’s apartment building called to inform him that the coroner had just left.
然后威尔玛公寓楼的经理打电话告诉他验尸官刚刚离开。
That’s how he learned Wilma had died by MAID.
这就是他得知威尔玛被女佣杀死的原因。
He’d last seen Wilma two days before, at her apartment in Chilliwack, BC.
他最后一次见到威尔玛是在两天前，在她位于不列颠哥伦比亚省奇利瓦克的公寓里。
“She never mentioned a single thing about what was all organized and scheduled for that Sunday,” he says.
“她从来没有提到过周日的所有组织和安排的事情，”他说。
Currently, there is no requirement that family be informed of a MAID applicant’s request to die.
目前，没有要求将 MAID 申请人的死亡请求告知家人。
Wilma had been increasingly despondent since 2008, when her twin and long-time roommate, Jenny, died of cancer.
自 2008 年她的双胞胎、长期室友珍妮 (Jenny) 因癌症去世以来，威尔玛变得越来越沮丧。
Once a small business owner, Wilma had stopped working full time in the years after Jenny’s death.
威尔玛曾经是一名小企业主，在珍妮去世后的几年里，她不再全职工作。
She increasingly complained of pain, Gary says.
加里说，她越来越多地抱怨疼痛。
He remembers that she always seemed to be rotating through appointments with various specialists—oncologists, cardiologists, rheumatologists.
他记得她似乎总是轮流与不同的专家——肿瘤科医生、心脏病专家、风湿病专家——进行预约。
Gary wanted to help his sister, and he and his family tried.
加里想帮助他的妹妹，他和他的家人也尽力了。
But Wilma could be difficult at times, and he needed to set up boundaries for himself, he says.
但威尔玛有时可能会很困难，他需要为自己设定界限，他说。
Still, his grief over Wilma’s death is unlike anything he’s ever experienced.
尽管如此，他对威尔玛之死的悲痛与他经历过的任何事情都不一样。
This is Gary’s third time grieving a sibling—and perhaps the most complicated.
这是加里第三次让兄弟姐妹感到悲伤，也许也是最复杂的一次。
When he was almost sixteen, he watched his older brother, Martin, drown.
当他快十六岁的时候，他亲眼目睹了他的哥哥马丁溺水身亡。
It took him years to find some peace with respect to Martin’s death.
他花了好几年的时间才对马丁的死感到平静。
He hasn’t come to that peace yet about Wilma’s.
对于威尔玛的事，他还没有平静下来。
Gary called the numbers on a contact list Wilma kept by her phone and learned she had an “army” of people ready to help if she needed meals or company.
加里拨打了威尔玛手机上的联系人名单上的号码，得知她有一支“军队”，准备在她需要吃饭或陪伴时提供帮助。
She had friends from church and her volunteer work.
她有来自教堂的朋友和她的志愿者工作。
But Gary doesn’t know whether any of them were aware that Wilma had scheduled her death.
但加里不知道他们中是否有人知道威尔玛已经安排了她的死亡。
A semi-retired farmer, Gary isn’t sure what he can do to raise awareness about MAID’s overreach.
加里是一位半退休的农民，他不确定自己能做些什么来提高人们对 MAID 过度扩张的认识。
He wrote to the government committee studying MAID, asking its members to reconsider the legislation.
他写信给研究 MAID 的政府委员会，要求其成员重新考虑该立法。
“Rather than expand their definition [of who is eligible for MAID],” he says, “they need to retract it.”
“他们不应该扩大[谁有资格获得 MAID] 的定义，”他说，“他们需要收回它。”
There are some questions raised by Canada’s MAID laws that can’t be addressed through increasing mental health supports, reducing poverty, reverting to the previous MAID laws, or even eliminating MAID altogether.
加拿大 MAID 法提出的一些问题无法通过增加心理健康支持、减少贫困、恢复之前的 MAID 法甚至完全取消 MAID 来解决。
Fundamentally, says Thomas De Koninck, a professor emeritus in the faculty of philosophy at Université Laval in Quebec City, MAID forces people to think about death and what comes next.
魁北克市拉瓦尔大学哲学系名誉教授托马斯·德·科宁克 (Thomas De Koninck) 表示，从根本上来说，MAID 迫使人们思考死亡以及接下来会发生什么。
It also forces people to consider the meaning of suffering in life and whether suffering and hope can exist together.
也迫使人们思考生命中苦难的意义，苦难与希望能否共存。
And those are questions that laws can’t answer.
这些都是法律无法回答的问题。
“What people desire most is to be loved,” especially when they’re dying or are in pain, says De Koninck.
德科宁克说，“人们最渴望的是被爱”，尤其是当他们濒临死亡或痛苦时。
“And so many people are left alone in hospitals or in big houses, where nobody comes to see them.
“很多人被独自留在医院或大房子里，没有人来看望他们。
So they’re just stressed.
所以他们只是有压力。
They need friendship.
他们需要友谊。
They need concern.
他们需要关心。
They need palliative care in that sense.”
从这个意义上说，他们需要姑息治疗。”
For De Koninck, the existence of MAID should prompt questions about what is causing people to decide that death is better than life.
对于德科宁克来说，MAID 的存在应该引发人们的疑问：是什么导致人们认为死亡比生更好。
The law’s vast acceptance in Canadian society, he says, is evidence that people have lost hope, that they are alone, or that they don’t have meaningful relationships.
他说，这项法律在加拿大社会得到广泛接受，这证明人们已经失去了希望，他们感到孤独，或者他们没有有意义的人际关系。
Tarra Carlson is determined to enjoy her life with her husband.
塔拉·卡尔森决心与丈夫一起享受生活。
A voracious learner, she spends much of her free time reading the latest research in disability studies and psychology.
作为一个贪婪的学习者，她把大部分空闲时间都花在阅读残疾研究和心理学的最新研究成果上。
She loves learning about cultures around the world, including various beliefs around death and the afterlife.
她喜欢了解世界各地的文化，包括有关死亡和来世的各种信仰。
She’s pulled different pieces from what she’s come across and has settled on a form of reincarnation.
她从自己所遇到的事情中提取了不同的片段，并确定了一种转世的形式。
She likes the idea that the soul finds a new body after death, that every life is a chance to learn more about being a better person.
她喜欢这样的想法：灵魂在死后会找到一个新的身体，每一次生命都是一个机会来更多地了解如何成为一个更好的人。
It’s a reminder that life goes on.
这是一个提醒，生活还要继续。
She’s in no rush to die—“I want to live a very long and cantankerous life,” she says—but when she finally does die, she wants her ashes sprinkled in San Josef Bay at the northern tip of Vancouver Island.
她并不急于死去——“我想活得长久而脾气暴躁，”她说——但当她最终去世时，她希望将骨灰撒在温哥华岛北端的圣约瑟夫湾。
Until then, rather than dwell on her predicament of living in a world that doesn’t understand or accept her disability, she prefers to tell jokes, to laugh, to consider all the ways she’s “privileged”: her job, her home, and her husband—always, her husband.
在那之前，她不会沉迷于生活在一个不理解或接受她的残疾的世界中的困境，而是更喜欢讲笑话、大笑、考虑她“享有特权”的所有方面：她的工作、她的家庭和她的丈夫——永远是她的丈夫。
For her, at least, “not everything’s doom and gloom,” she says.
至少对她来说，“并非一切都是厄运和阴郁，”她说。
She pauses.
她停了下来。
But, she says, “what is happening to people with disabilities is doom and gloom.”
但是，她说，“发生在残疾人身上的事情是厄运和悲观。”
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× Fund Canadian journalism to help you make informed decisions.
× 资助加拿大新闻业，帮助您做出明智的决定。
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× Fund Canadian journalism to help you make informed decisions.
× 资助加拿大新闻业，帮助您做出明智的决定。
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At The Walrus, we believe trustworthy journalism helps safeguard democracy.
在海象，我们相信值得信赖的新闻有助于捍卫民主。
In the lead-up to election day, we were proud to provide the research, context, and analysis you needed to cast an informed vote.
在选举日之前，我们很自豪能够提供您进行明智投票所需的研究、背景和分析。
As the news cycle charges ahead, we remain committed to the independent, responsible journalism you trust to make sense of what matters and scrutinize Canada’s new leadership every step of the way.
随着新闻周期的推进，我们仍然致力于独立、负责任的新闻报道，您相信我们能够理解重要的事情，并审查加拿大新领导层的每一步。
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Every contribution helps keep fact-based, accessible journalism available to everyone—especially on the issues that define our generation.
每一份贡献都有助于让每个人都能获得基于事实的、易于理解的新闻——尤其是在定义我们这一代人的问题上。
At The Walrus, we believe trustworthy journalism helps safeguard democracy.
在海象，我们相信值得信赖的新闻有助于捍卫民主。
In the lead-up to election day, we were proud to provide the research, context, and analysis you needed to cast an informed vote.
在选举日之前，我们很自豪能够提供您进行明智投票所需的研究、背景和分析。
As the news cycle charges ahead, we remain committed to the independent, responsible journalism you trust to make sense of what matters and scrutinize Canada’s new leadership every step of the way.
随着新闻周期的推进，我们仍然致力于独立、负责任的新闻报道，您相信我们能够理解重要的事情，并审查加拿大新领导层的每一步。
If our stories have informed or inspired you, consider making a donation.
如果我们的故事给您带来启发或启发，请考虑捐款。
Every contribution helps keep fact-based, accessible journalism available to everyone—especially on the issues that define our generation.
每一份贡献都有助于让每个人都能获得基于事实的、易于理解的新闻——尤其是在定义我们这一代人的问题上。