Normalizing Death as “Treatment” in Canada: Whose Suicides do we Prevent, and Whose do we Abet?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The recent edition of the World Medical Association Journal (WMAJ) features an article titled: Normalizing Death as “Treatment” in Canada: Whose Suicides do we Prevent, and Whose do we Abet? The article is written by: Ramona Coelho, Trudo Lemmens, Sonu Gaind and John Maher.

Normalizing Death as “Treatment” in Canada: Whose Suicides do we Prevent, and Whose do we Abet? (Link)

The WMAJ has world-wide readership and significance. I encourage everyone to read this article but there are several key points that I am sharing in this article. The writers argue that with the passing of Bill C-7, Canadians should change the term Medical Assistance in Dying (MAiD) to Medically Administered Death (MAD).

Dr Ramona Coelho

MAD is available to Canadians even when that person is unable to attain needed treatment or services to live. The writers state:

As a result, there is a remarkable situation in Canada that MAD is fully funded and broadly accessible, and available for disabled Canadians who are otherwise not dying. At the same time, access to adequate health care and social support is not guaranteed and, in many instances, not given the same priority. In fact, although basic health care services are publicly funded, there is no positive right to health care in Canada ... Palliative care, most speciality chronic care, disability and community support services are inadequately funded, and in chronically short supply.

... Canada’s federal parliament and government have aggressively promoted access to MAD and imposed this as a practice that provinces have to implement and fund, but they have failed to do the same for timely and adequate access to many other components of health care and social support.

Trudo Lemmens

Canada has created a two tier law whereby people who are determined to be dying can be killed immediately but those who are not dying can be approved with a 90 day waiting period. The writers explain how someone is approved for death:

In order to qualify for MAD, a patient must be in a situation of irreversible decline of capability, and experience intolerable psychological or physical suffering. These terms are not further defined by the legislation, and suffering is treated as purely subjective. If the patient says their suffering is intolerable, there is no requirement or provision for further validation by clinicians, as there is in Belgium and the Netherlands, where physicians at least have to agree with the patient.

Patients need to be informed about alternative options to MAD, and physicians have to ensure that patients ‘considered’ all these. However, there is no legal requirement that the other means of alleviating suffering be accessible to the patient, nor is there any requirement that standard best-practice treatments have been appropriately attempted prior to providing death by MAD. In Belgium and the Netherlands, two other jurisdictions that allow state-sanctioned euthanasia or assisted suicide outside the end-of-life context, physicians need to agree that there are no further medical or social support options that can relieve patients’ suffering. Canada thus has now arguably the most wide-open state-facilitated suicide process in the world, which can be subjectively driven by patients declaring intolerable suffering during periods of despair. To reiterate this point: MAD can be provided despite lack of access to care and resources that could remediate symptoms, or if the patient refuses to try standard treatments in the depth of their despair, despite scientific literature demonstrating that this treatment would overwhelmingly lead to adjustment and recovery.

Dr Sonu Gaind

The writers then comment on the 90 day waiting period for euthanasia in the context of the wait times for patient care in many parts of Canada.

With the dangers of such broad and imprecise legislation, access to medical and social care in Canada is often not timely, which directly fosters and compounds patient suffering and desperation. For example, the average wait time to be treated by a psychiatrist can exceed six times the 90-day waiting period to access a lethal injection. That is to say, a person seeking treatment from a psychiatrist and also asking for death, could be given access to death long before they get appropriate treatment. Some MAD proponents have even suggested that being on such a waiting list for a long time should qualify someone for MAD. The wait times for many other specialized health care and social support services, including specialized pain clinics, specialized long-term care homes, community-based housing, and disability benefits, far exceed the 90-day assessment period.

Dr John Maher

The writers continue by commenting on the specific concerns for people with disabilities who often live in poverty or have difficulty obtaining timely medical treatment. Sadly, many people with disabilities find that they need to fight to receive the care that they need. Further to that the writers comment on the concerns around people who have acquired a disability, expecially since many people will consider dying by euthanasia before they have had a chance to adjust to their new reality.

The writers also comment on the concern with people who are living with suicidal ideation. Considering the lack of definition within Canada's euthanasia law, many of these people will be given euthanasia rather than treatment and hope in living.

In their conclusions the writers comment on the report from Canada's parliamentary budget officer explaining the healthcare cost savings that will be associated with the expansion of euthanasia. (Link to article on healthcare savings). The writers then conclude:

The legalizing of MAiD, or MAD, has been claimed to offer ‘choice’ to Canadians, despite the known gaps in our health care system that fail to provide medical care or community support to the chronically ill, the disabled, and the mentally ill. Particularly, the expansion of MAD provides the illusion of choice, while in reality it pushes the most vulnerable and marginalized Canadians towards choosing an enticed death instead of allowing them a meaningful and fulfilled life.

With the recent expansion of MAD, Canadians with disabilities are deprived of an equal protection against premature death and suicide, which others continue to receive. Canadians are increasingly opting to receive medical state-funded death, not because they no longer want to live, but because our society has failed them.

As I stated earlier, everyone should read this article. Unlike many journal articles this one is written in a manner that can be understood. Normalizing Death as “Treatment” in Canada: Whose Suicides do we Prevent, and Whose do we Abet? (Link).