Ontario Doctor experiences abuse with MAiD (euthanasia) law.

By Taylor Hyatt and Amy Hasbrouck
Tourjours Vivant - Not Dead Yet

Taylor Hyatt

Recently, Taylor Hyatt attended a conference for medical students, where a few lectures on euthanasia were presented. 

Taylor was moved by the talk given by Dr. David D’Souza, a chronic pain specialist in Toronto. His talk focused on eligibility for euthanasia, and he included the stories of three people considering euthanasia whom he had seen in his practice. Dr. D’Souza expressed concern that the safeguards around euthanasia eligibility were being flouted in all three cases.

The first case happened when visiting a nursing home where Dr. D’Souza met an elderly lady with dementia. Her condition had progressed “to the point where she [couldn’t] recognize her own family and [had limited] communication abilities.” Her family asked to meet with the doctor, and requested that she be euthanized. They brought a will that she had written 10 years before, while in the early stages of her dementia, which stated that she would want to be euthanized. Dr. D’Souza told the family that she was not a candidate for euthanasia. According to the eligibility criteria, the person must request MAiD themselves; no one can do it on their behalf. He also told them the law requires the person be able to give consent at the time of the procedure, which she was not competent to do. Dr. D’Souza also pointed out that, “she may have sufficient quality of life that she still enjoys.”

The second incident took place “shortly after euthanasia was legalized” in 2016. A middle-aged man who spent two months on a waiting list for palliative care, came to Dr. D’Souza. He was a wheelchair user and amputee, and he was on dialysis. The man only had his wife for support, and had “[decided] to discontinue dialysis completely.” By the time the man saw Dr. D’Souza, he hadn’t had dialysis for over three weeks, and so had “nausea, fatigue…uncontrolled pain, [and] shortness of breath.” He also reported a “low mood” along with feelings of hopelessness. The man had submitted a request for euthanasia.

His first words to the doctor were “Are you here to relieve my pain? Are you here to relieve my suffering?” Dr. D’Souza said yes. Then the man asked him whether he was “here to end my life.” Upon hearing “no,” he asked “Why not? Isn’t that part of your job? I heard about this MAID thing on TV … isn’t that what you do?” Dr. D’Souza provided palliative care for him, who then withdrew his MAiD request. Dr. D’Souza reported that “although he chose to decline further dialysis sessions, he later died peacefully and comfortably, and of natural causes, with the assistance of genuine palliative care.”

The last case is about a man in his 70's who was concerned about hardness in his abdomen. Early tests suggested gastrointestinal cancer as a possible cause. The first thing he said after receiving these test results was “I want to be euthanized.” Dr. D’Souza “tried to steer the conversation in a different direction and said to him ‘you don't qualify for that. You don’t even have a diagnosis. Let’s first figure out the diagnosis and we can talk about all that later.’” He was then sent for the scan. 

A few weeks later, Dr. D’Souza received a report from the hospital: the patient had gone there the day after his initial appointment and “demanded to be euthanized.” He was admitted to the hospital, but “refused further testing;” he also turned down meetings with a surgeon, oncologist, and psychiatrist. Instead, he met with the euthanasia team, including a nurse practitioner and a physician. They determined that he met the eligibility requirements for MAiD. 

Dr. D’Souza visited him on the day he was euthanized. Dr. D’Souza recalled that “he was in no apparent pain [or] distress. He was smiling. He was excited for the big event, and so was his family. His family was surrounding him and they had dressed him up in a very nice suit, and they were very, very excited. He told me he wanted to have a dignified death” not caused by unknown and unpredictable factors.

Dr. D’Souza pointed out eligibiity criteria that were were disregarded and safeguards that were overlooked when the request for euthanasia was approved:

• First, the person must “have a serious and incurable illness, disease, or disability.” He did not have a definitive diagnosis. “He refused investigations and specialist assessments; therefore, he did not know if he had an incurable illness.”
• Next, the person must “be in an advanced state of irreversible decline.” Not knowing his condition, it was impossible to know whether it was in decline. Even if further tests confirmed that he had cancer, his prognosis “would depend on a number of [factors, including] the primary source of cancer, presence of metastases, [and] type of tumour. These factors would then [suggest treatment] options, such as chemotherapy and/or surgery.”
• The person must also have “physical or psychological suffering that is intolerable to them.” The MAID team reported “that he was in no pain, but he was deemed to be in intolerable suffering.”

Dr. D’Souza also mentioned that he did not see a psychiatrist, so it is impossible to know whether emotional issues may have played a role in his decision to request euthanasia. Asking to die while refusing to obtain an accurate diagnosis suggests an impulsive and emotional choice, or that he was already prone to suicidal feelings. The doctor also believed the 10-day waiting period is arbitrary and inadequate. He doesn’t know “any physician who has been able to completely cure anxiety or depression in 10 days.”

These potential violations were discovered by someone with extensive experience in the medical field and knowledge of the Canadian euthanasia program, who took the time to share his insights. These case histories give us a glimpse into how the MAiD program works on the ground. Multiply Dr. D’Souza’s experience by the number of practitioners performing MAiD, and a frightening picture emerges. It also raises troubling questions: 

• Was man's euthanasia seen as compliant with the law upon review by the designated authorities? 
• How many ineligible people are being euthanized when MAiD evaluation teams don’t completely grasp or strictly apply the eligibility criteria and safeguards?

If this isn’t a slippery slope, what is?