A Modest Proposal

For preventing the poor people in Canada, from being a burden on their community or nation, and for making them beneficial to the publick.

· Medical Assistance in Dying,Human Dignity

by An Unknown But Well-Meaning Source

It is a melancholy object to those, who walk through this great city, or travel in the country, when they see street corners, coffee shops, and even bus shelters crowded with the poor, and importuning every taxpayer for an alms. The poor, instead of being able to work for their honest livelihood, are forced to employ all their time in stroling to beg
sustenance for their helpless situation which, over time, places an intolerable
burden on the publick systems.

I think it is agreed by all parties, that this prodigious number of poor is in the present deplorable state of the nation, a very great additional grievance; and therefore whoever could find out a fair, cheap and easy method of making the poor sound and useful citizens, would deserve so well of the publick, as to have his statue set up for a preserver of the nation.

But my intention is very far from being confined to provide only for the poor: it is of a much greater extent, and shall take in the whole number of those who require others to support them, as those who demand our charity in the streets.

As to my own part, having turned my thoughts for many years upon this important subject, and maturely weighed the several schemes of our projectors, I have always found them grossly mistaken in their computation. It is true, that an elderly parent may be supported by family for a time, with little external assistance: at most not above the value of a part-time caregiver, which the family may certainly receive, by the lawful process of supplicating an underequipped publick health care service; and it is exactly when that caregiving becomes inadequate that I propose to provide for them in such a manner, as, instead of being a charge upon their family, or the nation, or wanting care for the rest of their lives, they shall, on the contrary, contribute to the nation, and partly to the benefit of many millions.

There is likewise another great advantage in my scheme, that it will prevent the physically disabled from the horrid practice of complaining, alas! too frequent among us, sacrificing our convenience for theirs in demanding accessible housing, sidewalks, and publick toilets, but aiming to cause us shame by looking upon them, which would move tears and pity in the most savage and inhuman breast.

The number of souls in this nation being usually reckoned 39 million, of these I calculate there may be about 2.4 million who live under the poverty line. The question therefore is, How this number shall be supported and provided for? which, as I have already said, under the present situation of affairs, is utterly impossible by all the methods hitherto proposed. For they can neither be used to contribute to the economy to the degree as is expected of every citizen; nor can they pay for the burden they exact on the publick; and many don’t enjoy the way they are living; as I have been informed by a notable social worker, who protested to me, that he never knew above one or two instances of those who were poor, physically or mentally ill, disabled or in decline, who enjoyed their lives.

I am assured by our merchants, that such people are a drain on society, and providing wholistic support for them will cause yet greater expense; the kinds of occupations needed to support them include work that few people are interested in carrying out because it is both laboursome and a reminder that we are subject to vulnerability. We prefer to make our own choices about our lives.

I shall now therefore humbly propose my own thoughts, which I hope will not be liable to the least objection.

I have been assured by a very knowing physician of my acquaintance in the Netherlands, that it is possible to swiftly and painlessness end a life through medical means in a cost-efficient way. It is called euthanasia, literally a “good death.” And there is no limit as to who can benefit from this: whether older people hampered by chronic ailments, younger people hindered by their mental health or disabled bodies, military veterans haunted by PTSD-afflicted minds, or the poor whose habitat is insufficient to their needs.

I do therefore humbly offer it to publick consideration, that of the 2.4 million who live in poverty, already computed, we begin by using white women’s tears to move the publick to sympathy; we take advantage of the decline in respect for physician authority to promote the autonomous choice of patients with the slogan, “Whose body is it, anyway?” And we provide “a dignified death” to those whose lives we simply cannot afford to make dignified. In such a way we may rein in the 10 to 20 per cent of publick health care costs spent on 1 per cent of the population: those declining in their last year of life. I estimate that, within four years, offering dignified death will save the tax-funded health care system 86.9 million dollars. Nevertheless, this opportunity for greater thrift should in no way be interpreted by the publick as suggesting that euthanasia is used to reduce health care costs.

I have reckoned however, that the word “euthanasia” bears too heavy a burden in the nation to be interpreted in a universally positive way. I suggest that death with dignity be termed “medical assistance in dying” or MAID. MAID, as a servant to our will, can enrich the autonomous choice of anyone whose autonomy is at stake, and it will be dignified by its place in the context of medicine, a worthy alternative to suicide—nay, the provision of a dignified suicide.§ There are no laws in our nation against suicide; we cannot try and convict a dead man (though this language of suicide bears too heavy a burden as well). We can encourage that MAID be integrated in advance directives, especially when there exists the fear of losing the capacity to consent prior to receiving MAID. It is splendid that, as we are assisted in being born to life, so we can be assisted in the ending of life.

I grant the costs of social supports in rural areas, along with the general understanding that rural life is quaint but not for all, make country folk struggle to find adequate health care. Many who live like this cannot afford to contribute even the smallest amount—dribs and drabs, really—that would make social supports possible. Therefore, MAID must be accessible to all. We will encourage its integration into palliative care regimes around the nation, aligning publick funds to that branch of care to the integration of MAID. MAID must be added to medical education and professional training as every physician, nurse practitioner and pharmacist must be equipped for this practice and compelled to carry it out; or, at the very least, refer the publick to accommodating professionals. We will leave this responsibility to the provinces and their medical colleges.

I have already computed the lower charge to be brought on other social systems that attend to publick concerns. A very worthy person, a true lover of his country, and whose virtues I highly esteem, was lately pleased in discoursing on this matter, to offer a refinement upon my scheme. He said, that many citizens of this nation, having no local sources for the organs and tissues they need to sustain their bodies, have been compelled to travel to other nations that traffick organs and supply them to foreigners. Travel wearies the compromised body, and the traffickers charge a pretty penny for their commercial goods. Now, MAID patients will be offered the opportunity to give the gift of life by having their organs harvested. This eases the pressures for donation put upon the healthiest of us. Consider also that cremating the bodies of those who opt for MAID will lighten our environmental burden where land is concerned; and a practice that will contribute to another of our needs: to keep human fragility out of site by tucking it away in decorative urns rather than displaying it gaudily on streetside cemetery stones.

This need is further supplied when the autonomous choice for MAID is provided to those who cause publick fear by expiring in bus shelters and over subway grates because they lack housing or mental health care. Consider how urban publick transit systems will benefit when riders receive a heightened sense of safety and a lowered sense of offensive smells. Consider how grocery stores will no longer be troubled by the frequent theft of shopping carts. With this risk abolished, carts will come at no cost and customers will no longer suffer the grievous hassle of fumbling through the pocket for a quarter. Consider, too, how those not in our way—institutionalized prisoners, for instance—can relieve our pocketbooks by choosing MAID when requests for release are denied.**

It is not improbable that some scrupulous people might be apt to censure such a practice, (although indeed very unjustly) as bordering upon cruelty, which, I confess, hath always been with me the strongest objection against any project, how well soever intended.

But in order to justify the practice of MAID, we simply need to raise the profile of persons who already ask the publick if we will continue to force them to suffer needlessly or allow them to die with dignity at home, surrounded by friends and family, laughing together over an aged Bordeaux. Or on a Tofino beach with cellos and balloons.††

Some persons of a desponding spirit are in great concern about that vast number of poor, aged, diseased or maimed citizens who may not desire MAID; and who make declarations that a slippery slope exists. That is to say, if MAID is provided to those suffering a serious and irremediable illness, disease or disability, whose death is foreseeable, who are in an advanced state of decline that cannot be reversed, and who experience unbearable physical or mental suffering from their illness, disease, disability or state of decline that
cannot be relieved under conditions that they consider acceptable, it won’t be long before persons who don’t meet one of these criteria will draw on the Charter of Rights and Freedoms to claim they too have the right to receive MAID. And that once one criterion is removed, all criteria will become subject to removal. But I am not in the least pain upon that matter, because as it is very well known, the philosophical argument of a slippery slope is fallacious; it is impossible to prove that hypotheticals will occur before they do, so the slippery slope is pure conjecture and nothing more than an appeal to emotion.

It will be important to implicate the churches as they, especially those of the Roman Catholick faith, already resist the dignifying medical practice of abortion. Rather than appeal to those among them holding clerical power, we will appeal to Roman Catholick families with an alternative to suffering the weight of their elderly parents’ burden and provide them a way to end their loved ones’ suffering; therefore, reckoning a decade after MAID is made legal, the resistance will be lessened by lessening the number of Papist objectors among us.

Another stumbling block is the raised by that many who are disabled and strangely do not want to die—even though theirs is a life of grievous suffering! As hard as it is to accept that such a desire for disabled life can exist in the full knowledge of the happy deliverance made possible by MAID, the argument must be leveled: Many others who
are disabled prefer to die. And MAID offers such persons the benefit of a dignified form of death that is socially approved and blessed.

A similar threat is made by many afflicted with mental illness. Many who have come through the worst of their suffering indicate they are glad the option of MAID was not available for their use. While their psychiatrists will argue that it is impossible to gauge whether such conditions can ever be deemed irremediable, given that the mind can wax and wane in its suffering; and that many citizens have low access to mental health care; certainly, we can progress in the science of mental health and conquer the causes of such afflictions, all the while allowing those who suffer from them an escape. Moreover, it should be clear to all that our nation values the rights and freedoms granted to every
Canadian in the Charter, and that the fear experienced by one citizen should not prevent others from making the autonomous decisions to which they are entitled.

Let us not forget those parents whose grief is caused by the poor and declining physical health of their children; no citizen wishes to impose suffering on sickly wee ones. We must allow for the mercy of MAID for minors when their parents provide consent; and, when they do not, allow that the will of the minor found to have the requisite decision-making capacity ultimately take priority.‡‡

I have too long digressed, and therefore shall return to my subject. I think the advantages by the proposal which I have made are obvious and many, as well as of the highest importance.

For First, As I have already observed, it would greatly lessen the number of Papists, with whom we are yearly overrun, and who benefit from their position as a non-taxable entity.

Secondly, The poor would have a valuable promise: that MAID will always be there for them when they can no longer avoid distress or afford to pay their landlord’s rent, when their assets are seized, and when money a thing unknown.

Thirdly, Whereas the maintenance of the poor, the sick, the aged, and the disabled is growing in cost due in part to scientific progress that allows the healthy among us to live longer, the nation’s stock will be leveled through the consistent diminishment of publick service to the most demanding of the needy and replaced with MAID, besides the profit of safe and accessible health care for those whose needs are easier to meet. And the money will circulate among our selves, the goods being entirely of our own growth and manufacture.

Fourthly, The organ providers, besides the gain of the knowledge that others will benefit from their deaths, will rid us of the burdens of travel in maintaining our own health.

Fifthly, This practice will be of great benefit to the environment, lessening the land used for cemeteries with a rise in demand for cremation.

Sixthly, This would be a great inducement to encouraging MAID as a part of a person’s living will; a measure that could be provided should a patient be in no condition to offer informed consent at their time of death.

Many other advantages might be enumerated. For instance, the lowered cost of senior care; the freedom to use personal assets toward enjoyable activities such as vacation rather than medical care and equipment; and the surety that we will all have dignified deaths. But these, and many others, I omit, being studious of brevity.

I can think of no serious objection, that will possibly be raised against this proposal, unless it should be urged, that the number of people will be thereby much lessened in the nation. This I freely own, and was indeed one principal design in offering it to the country. I desire the reader will observe, that I calculate my remedy for this one individual nation of Canada, and for no other that ever was, is, or, I think, ever can be upon Earth.
Therefore let no man talk to me of other expedients: Of taxing our wealthy at greater rates: Of creating consistent, whole-person, mental, physical, and palliative health care across provinces: Of increasing low-income housing and transitional programs for those who require social assistance: Of designing our cities to be more accessible to those whose mobility is affected by their current structures; Of encouraging flexibility in the workplace that allows family members to care for loved ones in the home: Of viewing people who do not contribute to society as having inherent dignity despite this. Lastly, of
putting a spirit of generosity, care, self-sacrifice and love into our citizens, who, if allowed to see themselves as valuable no matter their condition or lack of contribution will certainly resist.

Therefore I repeat, let no man talk to me of these and the like expedients, till he hath at least some glympse of hope, that there will ever be some hearty and sincere attempt to put them into practice.

But, as to myself, having been wearied out for many years with offering vain, idle, visionary thoughts, and at length utterly despairing of success, I fortunately fell upon this proposal, which, as it is wholly new, so it hath something solid and real, of no expence and little trouble, full in our own power, and which can trouble no other nation as they see the positive results in the very limited annual studies we will perform.

After all, I am not so violently bent upon my own opinion, as to reject any offer, proposed by wise men, which shall be found equally innocent, cheap, easy, and effectual. But before something of that kind shall be advanced in contradiction to my scheme, and offering a better, I desire the author or authors will be pleased maturely to consider two points. First, As things now stand, how they will be able to find money and resources for 2.4 million useless mouths and backs. And secondly, There being a general tiredness regarding the burden of care suffered by the well among us; I desire those politicians who
dislike my overture, and may perhaps be so bold to attempt an answer, that they will first ask the caregivers of those mortals, whether they would not at this day think it a great happiness to have been relieved through MAID, in the manner I prescribe, and thereby have avoided such a perpetual scene of misfortunes, as they have since gone through, by the oppression of taxes, the impossibility of providing personal full-time care, the want of publickly provided care, the disgust at the sight of beggars and the disabled, and the most inevitable prospect of intailing the like, or greater miseries, upon their breed for ever.

I profess in the sincerity of my heart, that I have not the least personal interest in endeavouring to promote this necessary work, having no other motive than the publick good of my country, by advancing our trade, providing for infants, relieving the poor, and giving some pleasure to the rich. I have no elderly parent, by which I can propose to get a single penny; and my wife and I live a stable life and are in perfect health.

* An update to Jonathan Swift’s essay of the same name penned in 1729. Original language has been maintained where possible.
Government of Canada, “Canadian Income Survey,” 2020.
Office of the Parliamentary Budget Officer, “Cost Estimate for Bill C-7 ‘Medical Assistance in Dying,’” October 20, 2020.
§ MAID is “a species of suicide, and suicide in and of itself is not against the law.” David Lametti. Interview. By Gillian Findlay. The Fifth Estate, CBC. January 17, 2023. See esp. 36 – 38:08 min.
** Correctional Investigator of Canada, “Remarks on Bill C-7” to the Standing Senate Committee on Legal and Constitutional Affairs, February 2, 2021.
†† Muse, “Why a Fashion Retailer Chose to Tell a Dying Womans Difficult Yet Beautiful Story,” November 9, 2022.
‡‡ Report of the Special Joint Committee on Medical Assistance in Dying, “MAID in Canada: Choices for Dying,” February 2023: 9.