No fluff in this Pollan
This article first appeared in the Minden Times and Haliburton Echo in June 2026.
I got started with Michael Pollan in search of an answer to the question of whether advance permission for MAiD (Medical Assistance in Dying) should be permitted on the sole basis of dementia. Because that debate is up-coming in the federal legislature by March 2027, and it’s a tough one, so best we get a head start on figuring out what we think about it.
From a legal perspective, the primary issues are ‘intolerable physical or psychological suffering’ as basis for granting MAiD, and ‘words, sounds and gestures’ as interpretation of wish to withdraw consent. Both imply mindfulness, a combination of identity and agency that comprise the self that could give and withdraw consent.
Pollan’s book, A World Appeared, is an exploration of consciousness: What is it? where is it? How does it work? That got me as close to mindfulness as I could get.
After turning over many stones and poking into what lies beneath (in an erudite but accessible, even chatty, way), Pollan concludes we really don’t know. And until we do, I think we cannot include people with dementia in MAiD.
Here’s my murky, convoluted thought path:
The Assistance part of Medical Assistance in Dying requires that the person whose death it is gives explicit permission. Their death belongs to them. Easy(ish) when the person is conscious and verbal. Harder when they’re not verbal and some agreed-upon behavioural definition must be negotiated. Really hard when they’re not conscious.
Because we aren’t sure how consciousness relates to being alive. We agree that lack of consciousness does not mean the person is dead: we sleep, we hit our heads or drink too much and black out, we undergo anaesthesia, we are in comas, we are absent-minded. There is no hard evidence of consciousness, so we have to guess whether or not it’s present. This lack of empirical evidence is why ‘mind stuff’ was long ago consigned to religion and the humanities.
But in the matter of deciding life and death, which we have now broadly taken into our legislated control, we have to decide whose mind will decide when the mind of the person whose body it is is not apparently available. ‘Apparently’ is an important word because we’re not sure where to look, and for what. It’s particularly difficult with the flickering nature of dementia, when the person is here now and gone again with no discernible rhyme or reason.
Is the absence of consciousness an indication of the death of the mind stuff that makes us who we are? If the mind is gone, are we as good as dead? Does that warrant the body being dispensed with? We think so: if we’re brain dead, science dead, no brain waves, it’s time to pull the plug on the machine that kept us breathing and pumping blood.
But what if there are brain waves but no external evidence of mind stuff happening? In pre-EEG days and for creatures lower on the evolutionary scale, no mind stuff means no ability to survive either internal or external uncertainty which led, naturally, to death.
But now we’ve decided we need to decide – we’ve MAiD our bed -- so here we are in this dilemma.
The debate goes to advance request of MAiD – the mentis compos right to say that when this-that-the-other is the situation, I want to end my life. This is not out of keeping with practice in other areas. We commit ourselves to future actions all the time – marriage vows, long-term mortgages, parenthood.
But we also, in all of these, acknowledge the necessity to change our minds if circumstances change: divorce, bankruptcy, estrangement. With MAiD on the basis of dementia? Very tough question.
An ethical question: who gets to decide whether the circumstances are what the person who pre-ordained MAiD had in mind, and on what basis do they make that decision?
The M in MAiD says it will be a medical professional who makes the decision. On what basis? Three general types come to mind.
‘I think this is what they would want.’ Getting inside the mind-stuff of the person whose life it is. Easier if there is pain or some empirical evidence of discomfort, really hard because none of us knows our own mind-stuff in fullness, let alone that of another.
‘There’s no value in a continued existence.’ The decider has to cloak themselves in Descartes’ I-think-therefore-i-am garment to go this direction, which we kinda know has opened the door to inhumanity in earlier times.
‘The ROI (Return On Investment) in not sustainable.’ This is really scary because the perspective in not mind-stuff friendly, and the imposed scarcity of late-stage capitalism gives credence to dispensing with the non-productive. It’s also the easiest of these three options to justify, precisely because of the Cartesian split between mind-stuff and body-stuff, the differential valuation of soul and science, that still reigns in our time.
So where does that leave us? To a further conversation another time.
