How many people has Dr Wiebe killed who did not qualify for euthanasia?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Ellen Wiebe

A British Columbia judge halted the euthanasia death of a woman from Alberta who was scheduled to be euthanized by Dr Ellen Wiebe on Sunday October 27, 2024. (Link to the injunction decision).

The court has a publication ban on this case. The common-law husband is referred to as A.Y. and the woman is referred to as N.B.

1. The case is based on A.Y arguing that N.B. does not qualify to be killed by euthanasia because she does not have an irremediable medical condition.

2. The case suggests that Dr Wiebe inappropriately approved the death of N.B. How many people have been approved for death in a manner that skirts the practice of the law?

3. How many people has Dr Wiebe killed by lethal poison (MAiD) who did not have an irremediable medical condition or fit the criteria of the law?

[Please read my previous article: BC Judge halts euthanasia deaths scheduled by Dr Wiebe (Link).]

This case has not been heard in court. I am quoting from the decision by Justice Simon R Coval who granted a 30-day injunction.

Question 1: Did the woman qualify to be killed by euthanasia in Canada?

A.Y.’s position is that N.B. does not meet the legal criteria for MAID because her condition is one of mental illness or disability, rather than a physical malady, and because it is not an “irremediable” medical condition but in fact one that can be treated in a relatively short period of time.

N.B. had begun to explore MAID in January or February 2024. A.Y.’s evidence is that N.B.’s own doctors in Alberta would not approve it and so she began to search online for doctors who might. She eventually learned of the defendant, Dr. Wiebe, who has a clinic in Vancouver, and she contacted Dr. Wiebe in mid-July.

A.Y. stated that N.B. is living with "akathisia" a condition associated with changing doses of psychotropic or antipsychotic medication. "Akathisia" is a treatable condition but A.Y. states that N.B. was not following the advice of the specialists. A.Y. stated that:

We ([N.B.], Anna Maclnnes and myself) scheduled a second (emergency) consultation with Dr. Horowitz on October 17, where he reiterated his view that she might recover from her akathisia. He again told her to pause her medication tapering and let her body adjust. He said her akathisia might go away in a matter of months. Probably 2 to 6 months. Then, if she followed his advice, she could finish weaning off the drugs without akathisia. Dr. Horowitz appeared surprised that akathisia would justify a MAiD procedure, and gently attempted to discourage [N.B.] from pursuing this goal by suggesting for her to wait another 6 months.

Akathisia has significant chronic side-effects including suicidal ideation, but it is not an irremediable medical condition, which is what the Canadian law requires for MAiD approval.

Question 2: What did Dr Ellen Wiebe do to approve N.B. for death by euthanasia?

N.B. had begun to explore MAID in January or February 2024. A.Y.’s evidence is that N.B.’s own doctors in Alberta would not approve it and so she began to search online for doctors who might. She eventually learned of the defendant, Dr. Wiebe, who has a clinic in Vancouver, and she contacted Dr. Wiebe in mid-July.

To A.Y.’s understanding, N.B. had at least two video calls with Dr. Wiebe in July and August and Dr. Wiebe approved her for MAID at the end of their first call. His evidence is that Dr. Wiebe did not speak directly with N.B.’s doctors, though N.B. provided her with some of her medical records. Dr. Boodhoo has advised A.Y. that his records were not requested for delivery to Dr. Wiebe.

A.Y. saw N.B.’s MAID form, which she submitted on August 30, 2024. The form stated akathisia as her reason for seeking MAID. Because she could not get anyone she knew to witness her form, a volunteer from Dr. Wiebe’s clinic did so for her. A.Y.’s evidence is that, because N.B. did not have a second doctor to provide the requisite second MAID assessment, Dr. Wiebe arranged the second assessor, Dr. Elizabeth Whynot, whom N.B. met in a video call on September 23, 2024.

In October 2024, N.B. had another online appointment with Dr. Wiebe, which A.Y. attended. A.Y.’s evidence about what was said is this:

Sometime in Oct 2024, [N.B.] had another appointment with Dr. Wiebe. I attended that meeting. As I am concerned that akathisia is not an irremediable condition, I asked Dr. Wiebe if she had ever carried out MAiD on someone with akathisia. Dr. Wiebe said that she did not. During the same Zoom session, I also attempted to describe [N.B.] as a person with unresolved mental health problems which were probably not considered during the MAID assessment. Dr. Wiebe responded by stating that diagnosis does not matter, and that only quality of life mattered, and that this was her [N.B.’s] right.

According to the A.Y. affidavit Dr Wiebe approved N.B. for euthanasia even though N.B. does not have an irremediable medical condition. Dr Wiebe was told that N.B.'s "wish to die" may be related to unresolved mental health problems. Dr Wiebe responded to the concern by stating that the:

diagnosis does not matter, and that only quality of life mattered, and that this was her [N.B.’s] right.

Question 3: How many people has Dr Wiebe killed who did not qualify for euthanasia?

I can't answer this question but a full investigation must be done. 

Dr Wiebe has been featured in several articles about Canada's euthanasia law.

Maria Cheng and Angie Wang reported for the Associated Press on October 16, 2024 that Ellen Wiebe stated:

while poverty inevitably exacerbates suffering, improved housing and social situations have never changed a patient’s mind.

“The idea that because I’m disabled, I should lose my rights that undisabled people have is outrageous,” said Wiebe, who suffers from heart disease and uses a wheelchair.

She predicted legal consequences if officials introduce more safeguards for euthanasia: “We’ll just be back in court with somebody saying, ‘You interfered with my basic human rights.’”

In a research article by Alexander Raikin titled: Canada How death care pushed out health care, Raikin reports Dr Wiebe commenting in a MAiD training video in response to a hypothetical question about a person who cannot consent at the point of death but shows signs of resistance. Raikin reports:

The moderator, Ellen Wiebe, is one of Canada’s most prolific “MAID providers” and a leader in the MAID community. On request, she has hastened the deaths of at least 400 people, including some cases that other assessors believed were illegal. She offered an answer: “I’m guessing I would bring in one of their other providers, you know, palliative care or, or whatever, and get them sedated. But what would you say?”

Another article by Alexander Raikin published by The New Atlantic in December, 2022 tells how Ellen Wiebe provided euthanasia to a man who had been rejected for euthanasia in his own city. Raikin reports:

In another CAMAP seminar recording, we learn of a man who was rejected for MAID because, as assessors found, he did not have a serious illness or the “capacity to make informed decisions about his own personal health.” One assessor concluded “it is very clear that he does not qualify.” But Dying with Dignity Canada connected him with Ellen Wiebe, a prominent euthanasia provider and advocate in Vancouver. She assessed him virtually, found him eligible, and found a second assessor to agree. “And he flew all by himself to Vancouver,” she said. “I picked him up at the airport, um, brought him to my clinic and provided for him,” meaning she euthanized him.

Amy Hasbrouck reported in May 2020 on a case of a woman who decided to stop eating and drinking, and was euthanized by Dr Wiebe. Hasbrouck wrote:

In June of 2016, just as medical aid in dying (MAiD) was adopted in Canada, a British Columbia woman known as Ms. S. who had Multiple Sclerosis was evaluated for MAiD by Dr. Ellen Wiebe. According to Jocelyn Downie, Dr. Wiebe concluded that Ms. S. met most of the eligibility criteria (incurable condition, advanced state of decline in capability, and enduring and intolerable suffering) but the doctor did not believe Ms. S. would die “in the foreseeable future,” so she was determined ineligible.

Dr. Wiebe exchanged correspondence with Ms. S. in December of 2016 and January of 2017, to the effect “that the patient’s life expectancy was not short enough to qualify for medical aid in dying.” Then in mid-February of 2017, “Ms. S decided to starve herself to death at home, with the support of palliative-care nursing.”

Her husband called Dr. Wiebe two weeks later, and Dr. Wiebe visited Ms. S. on March 3. At that time, Dr. Wiebe determined that she met all eligibility criteria, and she was euthanized on March 6, 2017.

Dr Wiebe has a history of controversial euthanasia cases. She is the doctor who entered a Jewish care home to complete a euthanasia death, even though she knew that the Jewish care home had a policy of not permitting euthanasia on the premises.

The Euthanasia Prevention Coalition urges authorities in British Columbia to conduct an in-depth review of Dr Wiebe's euthanasia practice. If they are unwilling to provide the necessary oversight of the law then the RCMP must be brought in to review the questionable acts of euthanasia performed by Dr Wiebe.

Until an investigation is completed, Dr Wiebe's medical license should be temporarily suspended in order to protect her patients. It is necessary to provide effective oversight of the law and to protect people from doctors, like Ellen Wiebe, who considers "euthanasia to be the best work" she has ever done.

Euthanasia is being used to kill people in poverty, isolation and social suffering.

What real choice does a person have who’s already suffering from mental illness, doesn’t have caring people nearby, isn’t getting adequate medical attention and social supports and may already be contemplating suicide?

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

Article: Ontario MAiD Death Review Stories. Do you have a MAiD death story? (Link).

Andrew Phillips, a staff columnist with the Toronto Star wrote an excellent opinion article titled: Assisted suicide is being used to relieve people of poverty, isolation and social suffering. This is not OK. Yes this article published in the Toronto Star.

Phillips is writing about the report issued by the Ontario chief coroner’s office on how medical assistance in dying (MAID) is being carried out in this province. Phillips refers to two of the six cases that were outlined in the report.

Mr. A, “a male in his 40s,” was suffering from inflammatory bowel disease. He also had “a history of mental illness, previous episodes of suicidality, and ongoing alcohol and opioid misuse.” No one offered him treatment for his addictions, but a psychiatrist gave him information about MAID. He was approved for death under what’s known as “Track 2” — cases where death is not reasonably foreseeable. A MAID provider personally drove him to the place where he was given an assisted death.

Mr. B, “a male in his late 40s,” was suffering from severe ulcers. He also “presented with multiple mental illnesses, namely depression, anxiety, narcissistic personality disorder, and bipolar mood disorder type 2. He had chronic suicidal ideations” — and indeed had attempted suicide a year earlier. Mr. B also applied under Track 2 and became one of 116 Ontarians to die that way last year.

Phillips then writes:

I spell out those details because the two recent reports on MAID from Ontario’s chief coroner are like that: detailed, clinical, dispassionate. They’re the opposite of sensational, at least in style.

But what they reveal ought to be shocking. Some patients are being euthanized while suffering from untreated mental illnesses and addictions. They’re more likely to come from poor areas (those with “high levels of marginalization,” as the reports put it) and be suffering from inadequate housing, a lack of social supports and simple loneliness.

Phillips, who supports euthanasia, states that 2.6% of the 4644 Ontario euthanasia deaths in 2023 were Track 2 deaths, meaning, the person wasn't terminally ill. Phillips then states:

But somehow we’ve turned a system that Canadians thought was supposed to spare people in the last stages of life from needless pain and suffering (a laudable goal, and one I share), to a system in which some people are being nudged toward death as a way to escape poverty, isolation and social suffering.

Phillips states that some members of the Ontario MAiD Death Review committee are not bothered by the cases outlined in the report. Philips writes:

they appear to think they are rare outliers and what should matter above all is a person’s individual autonomy — “my death, my choice.”

Phillips responds by stating:

What real choice does a person have who’s already suffering from mental illness, doesn’t have caring people nearby, isn’t getting adequate medical attention and social supports and may already be contemplating suicide?

Dr Sonu Gaind

Psychiatrist, Dr Sonu Gaind, is then interviewed by Phillips:

Dr. Sonu Gaind, a psychiatrist who’s deeply involved in the issue, says all this shouldn’t be surprising because Canada’s MAID system has been shaped by advocates wedded to the “right to die” mantra of individual choice. They’re constantly pressing to expand the criteria for MAID to include more and more people, leading to the slippery slope that opponents of assisted death warned of years ago.

Gaind notes some advocates are dismissing the troubling cases cited in the coroners’ reports because, they say, marginalized people already die at a higher rate than others so it should come as no surprise that more of them die from MAID as well. “Claiming that state-facilitated death fuelled by social deprivation is acceptable since more marginalized people die from social deprivation and structural inequities anyway is indistinguishable from eugenics,” he writes in the Conversation.

“My death, my choice” sounds good but it doesn’t let us off the hook as a society. We have a decision to make: do we ensure vulnerable, suffering people have the support they need to live decently? Or do we collectively decide that’s too complicated and expensive and usher them gently towards an early death?

Previous articles on this topic:

• Canadians with disabilities are needlessly dying by euthanasia (Link).
• Euthanasia for post Covid-19 syndrome (Link).
• Ontario Coroner's euthanasia report - Poor at risk of coercion (Link).
• Some euthanasia deaths are driven by homelessness, fear and isolation (Link).

Have you lost someone you love to euthanasia? November 20th healing retreat.

Have you lost someone you love to euthanasia?

Join us for a healing retreat, Project Anna and Simeon, which includes supper followed by a talk on grieving and providing an opportunity for sharing and memorial service. 

The first of its kind in Canada, this event will be on Wednesday November 20th, 2024, and will begin at 4:30 p.m.

This is a collaboration with St. John the Compassionate Mission, Euthanasia Prevention Coalition, St. Mary’s Refuge, and Compassionate Community Care. It will be at St. John the Compassionate Mission (155 Broadview Ave in Toronto). Please register in advance to assist@stmarysrefuge.org or call Compassionate Community Care at: 519-439-6445.

Please share this event and its details widely with your contacts and friends.

BC Judge halts euthanasia death scheduled by Dr Weibe.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Euthanasia Prevention Coalition is seeking to intervene in this legal case. Donate to the EPC legal fund (Donation).

On October 27, 2024 I reported on the BC judge who granted a 30-day injunction to prevent the euthanasia death of a woman. I was the first one to report on the case but I did not share the information that I had based on a publication ban. I did promise to provide information as soon as it was available.

On October 29, Lisa Steacy reported for CTV news Vancouver that Justice Simon R. Coval signed an injunction on Saturday October 26 which prevented Dr Ellen Wiebe from killing an Alberta woman on Sunday October 27. Wiebe is known to be Canada's most active euthanasia doctor. Steacy writes:

The injunction, signed by Justice Simon R. Coval, is the first of its kind issued in the province and was issued on Saturday, the day before the woman was scheduled to die.

It prevents Dr. Ellen Wiebe or any other doctor from “causing the death” of the 53-year-old woman “by MAID or any other means.” It followed a notice of civil claim alleging Wiebe negligently approved the procedure for a patient who does not legally qualify.

The injunction prevented Wiebe from killing the woman. Steacy explains:

“If the defendants proceed with MAID, the death will constitute a battery of (the patient), wrongful death and, potentially a criminal offence,”

Canada's euthanasia law does not provide a mechanism for challenging a negligent approval but the judge establishes the role of the court by stating:

“It is within the inherent jurisdiction of this honourable court to enjoin allegedly criminal conduct, in this case the termination of a patient's life where it appears that legislative criteria has not been met, and/or the protection of a patient from injury,”

Dr. Ellen Wiebe

The woman who was approved for euthanasia by Dr. Wiebe remains anonymous. The woman was refused approval in Alberta but went to British Columbia because Wiebe approved her death. Steacy reports:

“She could not get approval from her own doctors (in her home province), and so started looking online for other doctors who might be open to her request. She eventually found Dr. Ellen Wiebe,” the application says, adding that the woman had several Zoom meetings with the B.C. doctor and outspoken MAID advocate.

“At the end of the first meeting, Dr. Wiebe approved (the woman) for MAID.”

The claim, that was filed by her common law husband, states that the woman does not qualify for euthanasia, not even for a Track 2 approval. Track 2 approvals are based on a person who is not terminally ill but is suffering and living with an irremediable medical condition. Steacy reports:

According to the notice of civil claim, the woman has been diagnosed with “rapidly cycling bipolar 2 disorder.” However, she sought MAID on the basis of “akathisia,” a condition that is associated with changing doses of psychotropic or antipsychotic medication. According to the American Psychiatric Association, it manifests as “extreme restlessness characterized by an inability to sit or stand still and by fidgety movements or jitteriness, as well as a subjective report of inner restlessness.”

In October of 2023, the woman was prescribed a high dose of Quetiapine but soon after sought to reduce the dosage.

“As she was reducing her medication, (she) began describing distressing side-effects. She described having ‘the horrors’ or an inner sense of terror all day long, the inability to sleep at night, nightmares, the inability to lie down during the day due to a feeling of falling, the inability to sit or remain still, suicidal thoughts,” the application for the injunction says.

“At the same time, (she) continued to express her desire to die. She did not want to do it herself, and regularly begged (her partner) to end her life.”

According to the court documents, the woman and her partner – at an emergency consultation with a doctor in their home province 11 days before the medically assisted death was scheduled – were told that the condition is treatable and that the symptoms could resolve within months.

The claim states that the woman is being actively treated by a physician and yet was approved for euthanasia by Dr Wiebe. Steacy continues:

“This case raises serious questions about whether (the woman) in fact qualifies for MAID Track 2. Particularly concerning is that akathisia appears to be a cluster of symptoms connected to the changes in usage of drugs used to treat a psychiatric condition. It is treatable but (the woman) has not followed treatment recommendations.”

The case alleges that Dr Wiebe did not fulfill the requirements of the law. Steacy explains: 

In addition to arguing that the woman was seeking MAID based on a condition that disqualifies her from receiving it, the lawsuit raises a number of concerns about the process by which MAID was approved in this case.

According to the court documents, the woman’s partner allegedly questioned whether akathisia is “irremediable” and questioned Wiebe’s willingness to sign off on the procedure during a Zoom call.

“(The partner) asked Dr. Wiebe if she had ever carried out MAID on someone with akathisia. Dr. Wiebe said that she had not. During the same Zoom session, (the partner) also attempted to describe (the woman) as a person with unresolved mental health problems which were probably not considered during the MAID assessment,” the notice of application says.

“Dr. Wiebe responded by stating that diagnosis does not matter, and that only quality of life mattered, and that this was (the woman’s) right.”

The lawsuit alleges that Wiebe did not directly speak to any of the woman’s doctors, did not request her medical records, and only reviewed partial records provided by the patient via email.

Further to that the case alleges that Wiebe did not consult or have a second independent physician sign off on the euthanasia application. The case alleges that Wiebe arranged for a second doctor to speak to the woman and approve her death by Zoom. The case also claims that there was not an independent witness who signed the euthanasia. Steacy explains:

“The litigation seeks to address potentially serious failings in the application of the MAID regime,” the court documents say, summarizing the arguments.

This case will potentially set precedent related to the approval system for euthanasia in Canada, how a determination is made when the applicant is not terminally ill and establish some possible oversight of the law, which is currently lacking.

As I stated on October 27 - Similar to the WV / MV case in Calgary where a father was granted an injunction in the euthanasia approval of his 27-year-old autistic daughter because he claimed that his daughter didn't have an irremediable medical condition, this case the woman's husband sought an injunction claiming that his wife does not have an irremediable medical condition.

This case goes further because the woman's husband is also challenging the shoddy nature of euthanasia approvals in Canada.

Woman who died in Sarco pod had strangulation marks.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Miriam Kuepper and Elena Salvoni reported for the Daily Mail on October 28 that strangulation marks were found on the 64-year-old American woman who died in the Sarco death pod on September 23, 2024.

On September 24 I published an article stating that the Swiss police had made arrests related to the Sarco death pod and on September 29 I published an article explaining why the Sarco death method constitutes torture.

Kuepper and Salvoni reported that:

The first person to use the Sarco suicide pod in a Swiss woodland was allegedly found inside with strangulation marks on her neck.

The 64-year-old American woman died inside the capsule set up near a cabin in Merishausen, Switzerland, on September 23 after pushing a button that injects nitrogen gas into the sealed chamber, causing fatal hypoxia.

Dr Florian Willet, the president of Swiss Sarco operator The Last Resort, was among several people arrested at the scene.

Kuepper and Salvoni explain that Willett remains in jail.

He still today remains in custody - nearly five weeks after the US woman's death. Willet was the only person present when the mother-of-two died.

Investigators are now probing the woman's death, with chief prosecutor Peter Sticher raising the suspicion of 'intentional homicide' after suggesting in court that the 64-year-old may have been strangled, Dutch newspaper de Volkskrant reports.

The woman had suffered serious neck injuries, according to a forensic doctor, who spoke to the prosecutor just hours after her death.

A spokesperson for The Last Resort stated:

The woman had reportedly been diagnosed with skull base osteomyelitis.

The disease could manifest as an infection of the bone marrow, which could have been responsible for the marks on her neck resembling strangulation marks, according to a person close to The Last Resort who spoke to Swiss outlet NZZ.

Eleni Salvoni reported in the Daily Mail on October 29 that:  

The Last Resort and Exit International - the organisations behind Sarco - have insisted that its first user voluntarily entered the pod and pushed a button to fill the chamber with nitrogen, triggering her own death.

The Sarco death pod was invented by Philip Nitschke, who had lost his medical license in Australia. The 64-year-old American woman who died in the Sarco pod that was organized by The Last Resort Swiss assisted suicide group that is led by Florian Willett, a former spokesperson for the euthanasia group Dignitas and Fiona Stewart, the wife of Philip Nitschke.

My key reasons for opposing assisted dying (euthanasia and assisted suicide) Part II:

Patients overwhelmingly refuse the option of assisted death.

Gordon Friesen

By Gordon Friesen
President, Euthanasia Prevention Coalition

In an earlier post on this blog I began a list of key reasons to oppose euthanasia and assisted suicide (Part 1). I started with the social importance of maintaining a categorical prohibition of homicide.

Our adversaries predictably respond to such arguments with their own primary claim: that an exception must nevertheless be made because the people directly concerned truly wish to die.

I believe we may ourselves emphatically reply to this claim with one word: NO. 

That leads us to my Key reason #2: People eligible for Assisted Death (meaning euthanasia in Canada and assisted suicide in US) do NOT typically wish to die, nor will they typically consent to die in that fashion.

To be more precise and according to present clinical observations: at least NINETY PERCENT of all patients eligible for assisted death DO NOT WILLINGLY SUBMIT to that procedure REGARDLESS OF MEDICAL CIRCUMSTANCES.

(N.B. Such a bold claim of fact obviously demands clear proof, and I am pleased to present that proof in the concluding section of this commentary. To preserve a fluid narrative, however, I will first jump to the practical significance of these facts, in argument and in practice.)

What does it mean for euthanasia that (statistically speaking) people don't want to die that way?

Prior to widespread legalization of assisted death, all debate was wrapped in theory and conjecture. But as hinted above, that is no longer true. From a scientific perspective we must now concede that the hypothetical identification of a natural death-wish among certain patient populations has been rigorously tested, by an extended period of experimental legalization which has conclusively refuted that hypothesis.

Considered from a majority perspective therefore: the science (as they say) would unambiguously counsel us to stop this failed experiment and repeal all euthanasia-enabling legislation at once.

None of this, to be sure, should be taken to imply that the euthanasia phenomenon is actually too small to be of consequence. Not at all. Over 15,000 people died of euthanasia in Canada in 2023. That is an astounding number of medical homicides. And yet there is an equally important difference between the absolute size of a number and its proportional meaning in context.

It is only suggested here, that a proportional request rate of 1 in 10 eligible patients (even if entirely voluntary) cannot possibly justify the prioritization of assisted death which we observe today. Indeed, there is something deeply sinister (with far reaching political implications) about imposing this utilitarian medical agenda under a justification by personal choice, but against the clearly demonstrated collective will of those concerned.

(Our adversaries, of course, will surely retort that minority desire, also, deserves expression and respect.)

The proper place (if any) for a minority accommodation of assisted death.

In the modern policy lexicon we find a very interesting concept of "centering" which speaks to the wisdom of appropriately prioritizing minority interests in the public sphere. The centering of a marginal suicidal patient death-wish, however, has nothing in common with such positive examples of minority empowerment as the centering of disabled accessibility requirements in public buildings. Nor can the majority cost of this policy be discounted as a mere passing irritation, born of novelty. The Majority of patients interest and safety are severely compromised by the practices of euthanasia and assisted suicide. There is no legitimate minority claim, therefore, for the centering of assisted death.

Unfortunately, however, the often irrational theater of political compromise (particularly in the face of of actual legalization) has made the frank rejection of assisted suicide, and euthanasia, impossible in many jurisdictions at this time.

It thus becomes imperative to insist on a coherent political understanding of the simple quantitative facts presented here. Typical patients, of the vast non-suicidal majority, should always be served (by default) in Assisted Death-free institutions, by physicians and nurses who can be trusted never to suggest or to collaborate with assisted death in any form.

Only outside of this secure clinical environment might any minority accommodation ever be contemplated, and always limited to a scale which is proportional to real observed demand

The facts and nothing but the facts: demonstrating the marginal presence of patient death-wish

Euthanasia has been practised in the Netherlands and Belgium for over 20 years. It has been practised in the Canadian Province of Quebec for 9 years, and in the whole of that country for a little more than 8 years. We therefore possess an excellent body of data to inform us of the real popular response to assisted death.

We are not talking, here, about democratic support for the hypothetical freedom to choose. We are rather talking about the real instance of choices actually made. For it is to that measure that real policy should coherently respond.

A quick indication of the popularity of assisted death (in any given jurisdiction) may be found in the rate of AD to total deaths. By this measure, the Netherlands and Canada are the most prolific countries in the world having rates of 5.3% and 4.6% respectively. This means that roughly 95% of people (one way or the other) still die a natural death. However, we can't say that all of those people have refused euthanasia, because there are accidental and sudden deaths where that choice is not possible.

In the interests of fairness, therefore, let us examine that category in which the choice of euthanasia is most popular of all, which unsurprisingly concerns the terrifying prospect of terminal cancer. Indeed, on average, for our two countries, cancer causes only 28% of all deaths but results in no less than 60% of all euthanasia. Most interesting, however, is the observation that among all patients in this extreme category, in those two countries possessing the highest acceptance of euthanasia (and where all terminal cancer patients are systematically informed of that option) only 1 in 10 will choose, or consent, to die in that manner.[i]

Hence we are rigorously correct in concluding that the highest participation rate ever recorded, in any medical circumstance, in any jurisdiction --after nearly a quarter century of trial-- is no more than 10%.

To recapitulate

1. The demand for assisted death is a marginal phenomenon arising among a small minority of patients;

2. Considering the proportion of those eligible individuals actually requesting this death it can (and should) be vigorously argued that no practice of assisted death, whatsoever, is reasonably justified;

3. In the real world of political compromise (where assisted death has already been legalized) it must be our task to lobby for the limitation of that practice to a marginal accommodation only, commensurate with the small minority who really desire it.

Above all: we must use these facts to defend our collective interest in maintaining a medical "safe spaces" which is safe for the non-suicidal majority, and thus to reject policies which would threaten that safety by artificially centering objectively marginal suicidal desires.

[i] Note on Canadian and Dutch cancer euthanasia as a fraction of all cancer deaths:

• Canada total deaths: 330,380 total deaths (Link)
• Canada euthanasia deaths: 15,280 (Link)
• Canada total cancer deaths 86,700 Cancer fraction of all deaths .26 (Link)
• Canada euthanasia fraction of all deaths .046 Cancer deaths fraction of all euthanasia deaths .63 (Link) 
• Canada cancer euthanasia fraction of all deaths (.046 x .63) .029 
• Canada euthanasia fraction of all cancer deaths (.029/.26) .11
  

• Netherlands total deaths 170,100 (Link)
• Netherlands total cancer deaths (2022) 49,790 (Link)
• Netherlands (2023) total euthanasia deaths 9068; cancer euthanasia deaths 5105; (Netherlands euthanasia reports)
• Netherlands cancer fraction of total deaths: (49,790/ 170,100) .29
• Netherlands euthanasia fraction of total deaths: (9068/ 170,100) .053
• Netherlands cancer deaths fraction of total euthanasia deaths: (5105/ 9068) .56 
• Netherlands cancer euthanasia deaths fraction of all deaths (.56 x .053) .03
• Netherlands cancer euthanasia deaths fraction of all cancer deaths (.03/.29) .10
  

Ontario MAiD Death Review stories. Do you have a (MAiD) death story?

Do you have a story about a euthanasia (MAiD) death?

Sharing your story may help prevent other deaths by euthanasia or at least create awareness to alert other families.

To share your story, contact the Euthanasia Prevention Coalition at: info@epcc.ca or 1-877-439-3348.

Why has there been no attempted prosecutions in Ontario?
Why has there been no medical license suspensions? 

Alex Schadenberg

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

The recent Ontario MAiD Death Review that released by the Chief Coroner of Ontario in conjunction with the Review Committee outlines several Ontario euthanasia stories.

According to the Review Committee, these euthanasia stories were not the only stories but they were representative of concerns with the euthanasia deaths in Ontario.

The purpose of this article is to outline the stories in the Ontario MAiD Death Review report and help other people with their concerning euthanasia cases.

Ontario MAiD Death Review Committee report.

Case 1: Complex Medical Condition

Mr. A was a male in his late 40s who experienced suffering and functional decline following three vaccinations for SARS-Cov-2. He received multiple expert consultations, with extensive clinical testing completed without determinate diagnostic results. Amongst his multiple specialists, no unifying diagnosis was confirmed. He had a significant mental health history, including depression and trauma experiences. While navigating his physical symptoms, Mr. A was admitted to hospital with intrusive thoughts of dying. Psychiatrists presented concerns of an adjustment disorder, depression with possible psychotic symptoms, and illness anxiety/somatic symptom disorder. During a second occurrence of suicidal ideation, Mr. A was involuntarily hospitalized. During this hospitalization, post-traumatic stress disorder was thought to be significantly contributing to his symptoms. He received inpatient psychiatric treatment and care through a specialist team. He was also diagnosed with cluster B and C personality traits.

The MAiD assessors opined that the most reasonable diagnosis for Mr. A’s clinical presentation (severe functional decline) was a post-vaccine syndrome, in keeping with chronic fatigue syndrome, also known as myalgic encephalomyelitis.

No pathological findings were found at the time of post-mortem examination. The cause of death following post-mortem examination was provided as post COVID-19 vaccination somatic symptom disorder with post-traumatic stress disorder and depressive disorder.

In this case the person who died by euthanasia had no pathological findings that were found at the time of post-mortem examination. In other words he was otherwise healthy. Whether his health issues were related to psychological issues or some other health concern, Mr. A was killed without having 

Case 2: Concurrent Mental Illnesses

Mr. B was a male in his late 40s. He was diagnosed with longstanding severe gastric and duodenal ulcers with unknown etiology. Mr. B concurrently presented with multiple mental illnesses, namely depression, anxiety, narcissistic personality disorder, and bipolar mood disorder type 2. He had chronic suicidal ideations.

A year prior to the provision of MAiD, Mr. B attempted suicide with a descent from a height. He experienced polytrauma and required extensive medical and surgical management and rehabilitation. Psychiatry was involved in the MAiD assessment process. Mr. B was deemed by psychiatry to be capable of participating in the MAiD process, and the suicide attempt was determined to be a reflection of profound existential suffering. A psychiatrist determined that neither psychiatric illness nor suicidal ideations were facilitating the request for MAiD.

Mr. B may be experiencing suicidal ideation and yet psychiatry found him capable of participating in MAiD and determined that his previous suicide attempt and existential suffering were not leading him to ask for death by MAiD. Since a person with psychiatric concerns can die by euthanasia, in Canada, if they have another health condition, this case shows how it is impossible to determine whether the psychiatric condition is driving the request to die, or not.

Case 3: Chronic Pain & Adjustment Disorder

Mr. C was an older male in his 80s, who experienced chronic back pain (15 years) due to spinal stenosis and post-surgical adhesive arachnoiditis. He was followed by a specialist pain clinic. Mr. C was also diagnosed by a psychiatrist with an adjustment disorder leading up to his request for MAiD. He declined further pharmacological interventions for same. The psychiatrist determined that this approach was in-keeping with an informed decision. Mr. C’s adjustment disorder was mainly influenced by irremediable chronic pain, and less likely to be responsive to pharmacologic intervention.

Mr. C needed support related to his adjustment disorder and he required relief from chronic pain. Some members of the Ontario MAiD Death Review Committee suggested that a 90-day waiting period was insufficient in this case because Mr. C needed a time to adjust to his condition. Mr. C did not need to be killed.

Case 4: Social Vulnerability

Mr. A was a male in his 40s with inflammatory bowel disease. He received extensive treatment for this illness. It was reported that partly due to the course of his illness, Mr. A did not have an active social network: he could not maintain employment, he found personal relationships difficult to sustain, and he was dependent on family for housing and financial support. As a result, Mr. A lived with reduced social supports. He had declined multiple social support programs and psychosocial services.

Mr. A had a history of mental illness, previous episodes of suicidality, and on-going alcohol and opioid misuse. He lost his driver’s license secondary to his addictions. During a psychiatry assessment, the psychiatrist asked him if he was aware of MAiD and presented information on the option. While Mr. A was believed to have maintained decisional capability, his substance use was not explored in the MAiD assessments, and he was not offered addiction treatments.

During the MAiD process, there was no documented input from Mr. A’s family, nor a statement about why there was no engagement with family. The MAiD provider documented that the family had concerns about his request for MAiD.

The MAiD provider personally transported Mr. A in their vehicle to an external location for the provision of MAiD.

The MAiD Death Review Committee expressed concerns related to Mr. A and his lack of social connections, his family not supporting the death decision and his addiction and mental health problems.

Mr. A was killed without being offered an alternative to live. Even the fact that the MAiD provider gave Mr. A a ride to his death opens the question as to whether Mr. A was killed due to his request or based on the MAiD providers convictions.

Case 5: Housing Vulnerability

Ms. B was a female in her 50s with multiple chemical sensitivity syndrome (MCSS). She had a history of psychiatric hospital care for depression, anxiety, suicidality, and post-traumatic stress disorder, related to childhood trauma.

Ms. B had difficulty securing housing that met her medical needs. After years of attempts to secure appropriate housing, the Human Rights Tribunal issued a ruling to allocate funds to renovate her apartment. These renovations did not satisfactorily address her MCSS symptoms. A remaining option presented was to live in a small hypoallergenic space (i.e., a bubble). As a result of her housing situation and conditions, necessary to address her MCSS, Ms. B experienced social isolation, which greatly contributed to her suffering and request for MAiD.

It is safe to conclude that Ms. B is dead because she was not provided suitable housing. Housing is a serious problem in Ontario but in this case the lack of affordable suitable housing resulted in the death of Ms. B.

Case 6: Disability

Mr. C was a male in his 40s living with quadriplegia following a motor vehicle collision. The COVID-19 pandemic may have contributed to vulnerability in his medical journey (e.g., social isolation). Mr. C received rehabilitation without physical or functional gains. Due to his complex medical conditions, returning home with supports was not feasible.

The MAiD assessors considered his death non-reasonably foreseeable, thereby proceeding with Track 2 safeguards. However, one of the MAiD assessors considered the 90-day assessment period to be a “waiting period” and documented the possibility of “reducing the timeline should his natural death become reasonably foreseeable” (e.g., untreated septicemia).

Mr. C was separated from his family while receiving on-going complex continuing care. He was distressed about perceived limits of maintaining an ongoing relationship with his young children. Mr. C was a member of a racialized and religious community, with associated challenges with acceptance of MAiD.

Mr. C is the prime example on how one's disability can lead to their death by euthanasia. Mr. C needed an adjustment period to come to accept his new life with a disability. It is normal for an able-bodied person to grieve and feel that their life lacks meaning and hope after a serious accident that led to a serious disability.

Further to that Mr. C was living with social isolation since he was now separated from his family. If care-givers provided him the opportunity to re-intergrate into his family/home and/or provided a positive peer support to encourage him to adjust to his disability, then he would likely be alive today.

Mr. C. didn't need death, he needed an opportunity to live.

It is important to restate that the six cases that were outlined in the Ontario MAiD Death Review Committee Report were representative of cases, not the only cases. 

These cases were based on six areas of concern: Complex Medical Condition, Concurrent Mental Illnesses, Chronic Pain & Adjustment Disorder, Social Vulnerability, Housing Vulnerability, Disability.

Some of these themes were present within more than one of the cases, especially concerns around disability, mental health (psychiatric conditions) and social vulnerability.

The greatest question related to these cases is: Why has there been no attempted prosecutions in Ontario and/or why has there been no medical license suspensions?

These cases have been discussed after the person died. Clearly there is a problem with the death approval system. 

The Euthanasia Prevention Coalition opposes euthanasia and assisted suicide because these acts result in the killing of a person. The current approval system enables two doctors or nurse practitioners to approve a death and carry out the killing. There is no committee or “third-party” to ensure that there is effective oversight before a person is killed. You can’t bring any of the 6 people featured in these case back from the dead.

Do you have a story about a euthanasia (MAiD) death? Sharing your story may help prevent other deaths by euthanasia or at least create awareness to alert other families.

To share your story, contact the Euthanasia Prevention Coalition at: info@epcc.ca or 1-877-439-3348.

The Ontario MAiD Death Review report has three parts (Part 3) (Part 2) (Part 1). 

Canadian government will discuss euthanasia by advanced request.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Canadian government website - Medical Assistance in Dying: National conversation on advanced requests (Link).

The Canadian government will launch a consultation on expanding Canada's (MAiD) euthanasia law to permit euthanasia by advanced request. 

David Baxter reported for the Associated Press on October 28 that Canada's Health Minister, Mark Holland, made the announcement on October 28.

Baxter explained that the Québec government announced that, starting on October 30, they will permit advanced requests for euthanasia to enable people with dementia or Alzheimer's disease to request euthanasia while the person is still competent. Euthanasia by advanced request is not permitted in Canada's euthanasia law.

Health Minister Mark Holland

Baxter reported Holland as stating:

“What we’re saying very clearly is that this is an incredibly difficult issue, that we need to take the time to have a national conversation that includes our provincial and territorial colleagues, that where these lines are drawn and whether or not the system is ready is a very important step,” Holland said at a press conference on Parliament Hill on Monday.

“This continues to be illegal in this country, that if you act on an advance request, the Criminal Code is very clear that that is not legal.”

The Quebéc government announced on September 7 that they had asked the provincial Crown prosecutor’s office to not pursue charges against doctors as long as they comply with the provincial law. Euthanasia by advanced request changes the requirement of consent.

Canada's euthanasia law requires that a person be capable of consenting to euthanasia when the doctors or nurse practitioners approve the death. The Québec government will enable someone to state, in advance, their wish to die and then it would be legally carried out at a later date, even if the person has become incompetent.

Canadians with disabilities are needlessly dying by euthanasia.

"A lack of proper care and inadequate safeguards are driving some Canadians with disabilities to choose assisted death."

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Ramona Coelho

Dr Ramona Coelho was published by the Globe and Mail on October 28.

Coelho is a family physician whose practice serves marginalized persons in London, Ontario. She is a senior fellow at the Macdonald-Laurier Institute and co-editor of the upcoming book Unravelling MAID in Canada: Euthanasia and Assisted Suicide as Medical Care. Coelho is also a member of the Ontario MAiD Death Review committee that recently released it's report outlining the experience in Ontario with legalized euthanasia.

Coelho states in her article in the Globe and Mail:

A lack of proper care and inadequate safeguards are driving some Canadians with disabilities to choose assisted death. This is just one of the disturbing findings revealed by a report released earlier this month by the MAID Death Review Committee, which was launched in January by the Chief Coroner of Ontario.

As a member of the committee, I am dismayed to confirm the validity of repeated warnings from the Canadian Human Rights Commission (CHRC) that some Canadians with disabilities are opting for medical assistance in dying because they lack access to essential supports and health services.

The MDRC report also underscores a troubling trend: some MAID providers may end the lives of Canadians with disabilities without fully exploring other care options, considering the effects of non-medical factors influencing requests for death, or questioning whether MAID should even be an option. The law must change to prevent these needless deaths.

The federal government legalized MAID in 2016 as a last resort for suffering individuals facing a “reasonably foreseeable death,” now called “track one″ deaths. It expanded that in 2021 to include Canadians with disabilities who are not dying but are “suffering intolerably” and “in an advanced state of irreversible decline of capability,” or “track two″ deaths. Of the 4,644 MAID deaths recorded in 2023, 116 were track two.

We found that track-two patients tend to come from a younger cohort, with the majority falling between ages 18 and 59. Alarmingly, out of all 116 such deaths, 61 per cent were female. Research shows that twice as many women attempt suicide, but then benefit from suicide prevention and do not reattempt. Individuals who chose a track-two death were also more likely to reside in areas with higher levels of marginalization.

Worryingly, the report also suggests that MAID recipients lacked adequate mental health and disability supports before ending their lives. Only 8.6 per cent of Canadians who chose track-two deaths were first offered housing support, and 6 per cent were offered income support.

The case reviews are telling. In one situation, a man with inflammatory bowel disease was informed about MAID – an example of potential undue influence. Although the man also struggled with untreated addictions, social isolation, and mental health issues, those appear to have been largely overlooked, as were his family’s concerns. In another case, a woman with multiple chemical sensitivities opted for MAID due to suffering caused by isolation and her housing situation.

As a physician serving marginalized patients for 17 years, I have seen how a lack of care, discrimination and social isolation can deepen despair. In contrast, supportive care can ease wishes for death and lead to healing – even if it requires significant effort and time.

The vague language used in MAID legislation only exacerbates the situation. Terms like “reasonably foreseeable death,” “intolerable suffering,” and “irreversible decline” remain largely ambiguous, making their use as eligibility criteria worrisome. Patients are legally entitled to refuse treatment options (they can decline, or services might simply be inaccessible) before opting to end their lives, but clinicians only need to inform patients that treatments exist; they do not have to provide access to treatments and social support. These factors highlight the risk of abuse in the process.

Medicine has developed standards of care designed to protect patients, and these standards should apply equally to MAID. To suggest that eligibility should be decided on a case-by-case basis, as expansionists have repeatedly argued, is an irresponsible approach. In Canada, some doctors have deemed patients eligible for MAID due to suffering exacerbated by long wait times for care. Meanwhile, the Canadian Association of MAID Assessors and Providers is offering clinicians guidance on how to convert track-two MAID requests into track-one cases, facilitating a quicker MAID death.

But since health conditions can improve and suffering can be alleviated through care and support, it is crucial to emphasize the need for better care and to address issues like housing, addictions, and palliative care for those in terminal situations.

By offering Canadians with disability easy access to MAID, physicians are reinforcing ableism – the belief that disabled lives are less valuable. Many in the disability community strongly opposed MAID’s legalization – including a coalition of disability groups that has launched a Charter challenge against track-two deaths, alleging that MAID for people with disabilities violates their equality and security rights – but Ottawa has largely dismissed their concerns.

Moving forward, we must actively listen to the disability community in these conversations. It’s a matter of life or death.

The Ontario MAiD Death Review report has three parts (Part 3) (Part 2) (Part 1).