Executive Director, Euthanasia Prevention Coalition.
Canada's 2021 euthanasia report indicated that there were 10,064 reported euthanasia deaths in 2021 representing 3.3% of all deaths, which was up from 2.5% in 2020. The data indicates a big difference in the percentage of euthanasia deaths between provinces with euthanasia representing 4.8% of all deaths in British Columbia and 4.7% of all deaths in Quebec.
Sharon Kirkey wrote an article for the National Post on November 2 that partially explains why euthanasia deaths have increased so quickly in Canada. Kirkey reports that unlike other jurisdictions, doctors in Canada are introducing the option of euthanasia rather than waiting for patients to bring it up. Kirkey wrote:
In most jurisdictions in the world with legalized euthanasia, doctors are explicitly prohibited, or strongly discouraged from raising assisted dying with a patient.University of Toronto ethicist, Kerry Bowman tells Kirkey that this is an ethical problem. Kirkey reports:
The request must come from the person.
But a guidance document produced by Canada’s providers of medically assisted death states that doctors have a professional obligation to bring up MAID as an option, when it’s “medically relevant” and the person is likely eligible, as part of the informed consent process.
But some ethicists argue that introducing death as a “treatment option,” without the person suggesting it first, is seriously problematic, especially within the expanding realm of MAID, and that people could be unduly influenced to choose to have their life intentionally ended, given the power dynamics of the doctor-patient relationship.Kirkey explains that The Canadian Association of MAiD Assessors and Providers (CAMAP) published a euthanasia guide in 2019 that opened the issue of doctors offering euthanasia rather than waiting for a patient request. CAMAP’s vice president, Dr. Konia Trouton told Kirkey:
“Some people, no matter how well-handled your conversation, may infer that it’s essentially a suggestion,” said University of Toronto bioethicist Kerry Bowman.
“They would also definitely infer that they have the strong potential to meet eligibility criteria, or you wouldn’t be offering it.”
Canada’s assisted dying law states that no health-care professional commits an offence “if they provide information to a person on the lawful provision of medical assistance in dying.” Canada’s MAID providers and assessors said that there is also no provision in the law that prohibits clinicians from initiating the discussion and raising the possibility of MAID.
While it is absolutely illegal to counsel someone to die by suicide, to “counsel,” from a doctor-patient perspective, means to “inform and discuss,” the group’s guidance reads.
“The clinical perspective of the meaning of the word ‘counsel’ has no bearing on the legal meaning.”
The case of a Veterans Affairs caseworker who reportedly suggested to a combat veteran with PTSD that MAID was a better option than “blowing your brains out against the wall” drew outrage.Bowman is also concerned about doctors offering euthanasia to a patient who is struggling to pay their rent. Kirkey writes:
“We don’t know how that conversation played out,” Bowman said. “But I suspect what is happening across the country is that some people are bringing it up regularly and some people aren’t.”
The expansion of MAID to those not at imminent risk of dying adds another layer of complexity and debate, he said. “I also see it as very problematic when we bring (MAID) up to people who can’t pay the rent, or people who are living with disability who don’t have adequate access to the things that they need,” Bowman said.
“You have a person who is severely depressed where the nature of the illness is often accompanied by a desire to die. The person takes a step to go and see a mental health counsellor to get help, and is being told, as part of the informed consent procedure, we can have treatment a, b, c or MAID.”Lemmens told Kirkey that doctors who introduce the topic of euthanasia to patients is unique to Canada. Kirkey reports:
In Canada, in contrast to just about all other jurisdictions, MAID is no longer seen as an exceptional procedure, Lemmens said.
“The fact that this has been presented as, ‘This has to be on the table because it’s part of informed consent,’ reflects, overall, an attitude that has developed in the Canadian context,” he said. “It’s being sold as a normal medical practice.”
In New Zealand and Victoria, Australia, two jurisdictions where assisted dying for the terminally ill was recently legalized, doctors are explicitly prohibited from bringing it up. While it’s not explicitly prohibited in Belgium and the Netherlands, “it is generally not considered appropriate,” Leemens said, especially outside the end-of-life context.As I stated at the beginning of the article, one of the reasons that euthanasia in Canada has expanded so quickly is that doctors are introducing the topic of MAiD and not waiting for a patient to request it.
“The emphasis is on how the request must come from the patient.”
More articles on this topic:
- Canada releases 2021 euthanasia report. More than 10,000 reported deaths (Link).
- Canadian veteran who was urged to seek (MAiD) euthanasia was not the only one (Link).
- Another case of euthanasia for disability and poverty (Link).