No Other Options. An exposé on euthanasia in Canada.

"euthanasia seems like the only way out"

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

Alexander Raikin wrote an exposé on the experience with Canada's (MAiD) euthanasia exposé titled No Other Options . His exposé was published in The New Atlantis on December 16. Raikin provides important insights into Canada's experience with euthanasia that should be read by everyone concerned with the issue (Link to the article).

Raikin writes his article as an investigative reporter into Canada's Medical Assistance in Dying (MAiD) law. He begins the article by speaking with Dr Stefanie Green one of Canada's leading euthanasia doctors. Green tells Raikin that:

The procedure, she assures me on our call, is “100 percent effective.” If her patient asks to die, and if her schedule, her ethics, and the law permits it, she will administer a lethal injection.

To create context, Raikin quotes David Lametti, Canada's Justice Minister, who stated:

Supporters insist that this is not state-sanctioned suicide. Rather, it’s a dignified solution for those who no longer wish to suffer from terminal or chronic illness. MAID allows “for compassionate action, while also protecting those who are particularly vulnerable,” claimed David Lametti, the attorney general and minister of justice, in 2021.

Raikin then quotes from Prime Minister Justin Trudeau: 

Prime Minister Justin Trudeau has long promised to strike just this balance. In 2019, while pressing the need to expand access to euthanasia, he assured that people will be able to choose assisted death “in a way that isn’t because you’re not getting the supports and cares that you actually need.”

This is the promise of medical assistance in dying: that vulnerable people who want to die for the wrong reasons will be encouraged to live, as they always have been — while people who want to die for the right reasons will have their autonomous decision upheld. If even a single vulnerable person were pushed into assisted death, it would be a scandal to the system. That is why safeguards were put into place.

Raikin states:

As this article will show, in internal meetings, those close to the system have long talked openly about red flags that many people are choosing euthanasia because they’re not getting the “supports and cares” they need. The physicians in charge of the process not only know that this is happening, but they have discussed it in seminars, collected evidence, and then kept it quiet in public.

The safeguards promised by Trudeau and others to prevent vulnerable people from heading down the road to euthanasia turn out to be vague, pro forma, and easy to get around by doctor-shopping.

The quotes from Lametti and Trudeau are important considering the scandal of euthanasia for people with disabilities because of poverty, an inability to obtain needed medical treatment or care, homelessness, neglect and abandonment.

Raikin then comments on the number of people who have died by euthanasia.

One of the greatest reasons for concern is the sheer scale of Canada’s euthanasia regime. California provides a useful point of comparison: It legalized medically assisted death the same year as Canada, 2016, and it has about the same population, just under forty million. In 2021 in California, 486 people died using the state’s assisted suicide program. In Canada in the same year, 10,064 people used MAID to die.

...But the picture that emerges is not a new flowering of autonomy but the hum of an efficient engine of death.

Raikin's interview with euthanasia provider Stefanie Green continues:

Asked on a call about stories of abuse, she raises her voice and says, “you cannot access MAID in this country because you can’t get housing. That is clickbait. These stories have not been reported fully.”

Raikin reminds us that the Supreme Court of Canada, in the Carter decision that legalized euthanasia wrote that:

“a permissive regime with properly designed and administered safeguards” would be “capable of protecting vulnerable people from abuse and error.”

To add context, Raikin quotes from former Senator James Cowan who said:

“We have four or five years of experience now, and absolutely no indications, that I’m aware of, of alleged misuse or poor decisions,”

Helen Long, the CEO of Dying with Dignity told MacLeans magazine:

arguing that the stories that people “who are not able to access supports like safe and affordable housing are opting to have MAID instead” are “simply not true and there is no evidence that I’m aware of to support those claims.”

Raikin then points out that Green, Cowan and Long are denying what they know to be true. Raikin quotes euthanasia provider Madeline Li who testified to a parliamentary committee that:

...legislated safeguards are “impotent.”

“I believe the Canadian populace and maybe even the legislators are not aware of who has been qualifying for MAID.”

Raikin then proves that the euthanasia lobby are aware that people are dying by euthanasia because of poverty, access to medical treatment and housing. He writes:

The Canadian Association of MAID Assessors and Providers, the leading organization of Canadian euthanasia providers, has sat on credible evidence by its own members that people are being driven to euthanasia by credit card debt, poor housing, and difficulties getting medical care. These are people who do have some sort of medical condition but in many cases are using these conditions to check a box in the approval process, when the relief they are mainly seeking is from other forms of suffering. And the system is doing much more to help them down the path toward death than to protect them as the public was promised.

Raikin uncovers a presentation by Althea Gibb-Carsley, a retired care coordinator and social worker of the Vancouver Coastal Health’s assisted dying program. The title of her presentation asked, “What is the role of the MAID assessor when resources are inadequate?”

Gibb-Carsley describes several people who qualified for euthanasia. Mary (55) with fibromyalgia and chronic fatigue who can't afford the food and supplements that would lessen her health issues and identified poverty as driving her to MAiD. Nancy (68) a physician with chronic pain following a car accident who didn't save any money. Greg, 57, a writer who has diabetes, cardiac problems, anxiety and depression, and a history of trauma. Lucy, a 38-year-old trans woman, is an immigrant who has pain, osteoarthritis, depression, and anxiety.

Raikin reports that Gibb-Carsley concludes her presentation by stating:

these patients have “no other options” because of their poverty, their housing situations, their difficulty getting medical care. “I think you will find, and you know already,” she says to her audience of euthanasia providers, that if you want to offer your patients some alternative to MAID, “this will often mean a referral to not very much, and certainly not very fast.” It’s not that they are terminally ill or truly beyond help, but that they can’t get the help they need in the system right now, so euthanasia seems like the only way out.

Raikin then states that it is important what Gibb-Carsley didn't say:

Of Mary, the patient who identified “poverty as the driver of her MAID request,” we do not hear that the system discouraged and denied her application. Of Greg, who the slides say “identified housing as [a] driver” of his euthanasia request, we hear that he is “getting very close to needing to set a date” to be euthanized — and again, not that any effort is being made to stop him. Of Nancy, for whom “uncertain housing is the driver,” we hear of no effort to stop her.

Raikin then explains that people must be protected from abuse.

If the MAID system were working as promised, the presenters should be warning attendees that they must be vigilantly on the lookout for just the kinds of cases described in the seminar, scrupulously ensuring that they are not approved for euthanasia.

Raikin points out that the presenter and the audience understood that these were serious problems, in fact Gibb-Carsley states:

“Our silence is our complicity,”

Raikin shows how they were examining the problem from the wrong point of view. Rather than viewing these issues within the context of changing the implementation of euthanasia they were viewing it within the context of:

an opportunity to highlight the real problem: the inadequacy of the welfare state.

Gibbs-Carsley states that these assessments can be used to leverage the government for improved welfare. She then states:

Your Assessments provide a rare opportunity to hear from the typically disenfranchised patients about their experiences.” The subtext of this sunny euphemism is that giving a voice to the voiceless will, for many, ultimately mean killing them.

The euthanasia assessors are then told that they can withdraw from these cases but they will be obligated to refer those patients to assessors who will be willing.
 

Earlier in the interviews Stefanie Green referred to these stories of abuse as:

“clickbait” that “have not been reported fully.”

Raikin then examines why these deaths are happening in Canada. He writes:

A core reason that Canada’s assisted dying program has grown so much faster than any other program in the world is that it is the most permissive. Eligibility criteria began loose and are rapidly getting looser. You do not need to be terminally ill, only to have a “grievous and irremediable” condition, a standard that is open to significant differences in interpretation. In March 2023, mental illness alone will qualify as an acceptable medical reason to die. And the Quebec College of Physicians now suggests that Parliament expand euthanasia eligibility to minors and even newborns. (Euthanasia for mental illness alone will be delayed).

Raikin then states that the safeguards are clearly not working.

Raikin then interviews Dr Paul Appelbaum, a professor of psychiatry for 40 years, who developed the test to determine mental competency for medical decision making. Appelbaum commented about the test used to assess competency for euthanasia:

“it doesn’t strike me as a particularly well-thought-through evaluation process.” Among other things, “it’s not clear from these forms how an evaluator would decide that a condition is ‘grievous and irremediable,’” he says, quoting one of the key legal criteria.

Moreover, the initial screening questions for depression and anxiety “are not detailed enough to result in a diagnosis, and even if they did, the impact the answers to these questions are supposed to have on the final decision about authorizing MAID is unspoken.”

Dr Mark Komrad, a clinical psychiatrist and ethicist who helped craft the American Psychiatric Association’s statement against euthanasia for patients who are not terminally ill called the evaluation process as: 

“Death by checklist!”

Raikin continues by writing:

when I asked Stefanie Green how she decides whether a patient with a mental health condition has the competence to choose euthanasia, she said that she makes a judgment call about whether a patient has an “active” or “stable” case of mental illness. For “active” cases, she will consult a specialist; for “stable” cases, she proceeds on her own. Green is not a psychiatrist, so I asked Appelbaum about her framework. “It’s not a distinction that makes any sense to me,” he says.

Raikin points out that the law allows any doctor or nurse practitioner to assess someone for euthanasia without requiring further training.

Raikin then writes about how easy it is to die by euthanasia in Canada. He begins by pointing out that if an assessor rejects someone for euthanasia that all they need to do is go to another assessor. Raikin explains:

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.

Jocelyn Downie states in a seminar that you can ask as many assessors as you want or need disagreement doesn't mean you must stop.

Jocelyn Downie

Downie stated in euthanasia seminars that:

“There is no certainty or unanimity required. There is not perfection required,” says Downie. The result: There are many paths available to reach the end, and you only need to find one. The system makes it easy to die.

When asked by email how these statements reconcile with safeguard reassurances that have been offered to the public, Downie responded:

“This is an inaccurate characterization of what I said and did at the two seminars.” She did not specify the nature of the inaccuracy.)

The fact is that the rules surrounding euthanasia are subjective and enforcement of the procedure is lax. Nancy Hansen, the Director of the Disability Studies program at the University of Manitoba, told Raikin that in effect:

“there’s no consequences for non-compliance” with the law.

When asked for her response to her earlier comment, Weibe said:

“It is rare for assessors to have patients who have unmet needs, but it does happen. Usually these unmet needs are around loneliness and poverty. As all Canadians have rights to an assisted death, people who are lonely or poor also have those rights.”

Raikin continues his exposé by writing about Les Landry and Rosina Kamis.

Landry, was a truck driver who had a reaction to anesthesia in 2009, which led to his disability. When Landry was turning 65 he requested euthanasia based on poverty. Landry told Raikin:

“I turned 65 [and] lost all m[y] disabilities benefits and now a senior in poverty. I am not going to live my life like this.” On December 2, Les received his first approval for euthanasia. He is now waiting for the second and final approval. And he says he will doctor-shop until he gets it.

Rosina Kamis (41) requested euthanasia because she was in constant pain from her fibromyalgia, had chronic leukemia and a myriad of other mental and physical illnesses. But there was much more to her story. Raikin did an investigation and learned:

Oftentimes, Rosina was hungry. The artificial light in her room would make her migraines worse. It was loneliness driving her to MAID, that she “must suffer alone” with her service dog — which she could “easily lose,” as her landlord was trying to evict her and she had nowhere else to go. It was that she didn’t want her physicians to harm her by changing her pain medication, as they sometimes did. It was that she was “scared” of being institutionalized; that what she needed to live was not what she could reasonably expect to get; and that others would benefit from her death because MAID “is the best solution for all.” Her choices seemed slim. When her fingers hurt, she couldn’t make food. She would post a video of herself going to bed, in her dark room, hungry and crying.

Rankin then states:

Rosina showed one face of her suffering to the MAID system, and another to her confidants. To the latter, the reasons she gave for really wanting to die were not physical suffering. “Please keep all this secret while I am still alive because … the suffering I experience is mental suffering, not physical,” Rosina wrote in a message apparently intended for her powers of attorney. “I think if more people cared about me, I might be able to handle the suffering caused by my physical illnesses alone.” To her two dozen subscribers on YouTube, she said, “Sometimes all the pain will go away just by having another human being here.”

Raikin explains:

Rosina was approved, and specifically asked to die on the date of her ex-husband’s birthday. Rosina died in her shared basement apartment on September 26, 2021, after a doctor gave her a lethal injection.

Raikin further assesses the reality of euthanasia in Canada. He writes:

Whatever your view on euthanasia, stories like Les’s and Rosina’s are not entirely straightforward. In many cases it is hard to sort out the tangle of internal and external reasons someone might make a voluntary request to die. But that is precisely the problem. Canadians were promised a system that would distinguish a rational choice to die from a desperate cry for help. But in stories like Les’s, Rosina’s, and so many others, that distinction breaks down.

This is particularly true in cases where a patient seeking euthanasia has a history of depression. As the psychiatrist Paul Appelbaum told me: “People with depression can be extremely rational in explaining the reasons for the decisions that they’re making. And what is most difficult is to separate the effect of the depression on that decision from what their underlying non-depressed motivations might be.”

Raikin explains that the law requires that a person have an “incurable” and “irremediable” medical condition. Even the euthanasia lobby knows that this is often not the case. Raikin states:

According to an internal study of MAID assessments, presented to CAMAP in 2022, of 54 patients who were not terminally ill, two-thirds had concurrent mental illness. A fifth of the patients had difficulty finding “appropriate” treatment. And, most disturbingly, over a third of patients were “not offered appropriate / available treatments.”

Raikin refers to euthanasia doctor, Ellen Wiebe as an example.

Ellen Wiebe, the poster child for Canadian medical death — in 2016 Maclean’s covered her as a visionary. She has since become one of the most prolific MAID providers, having personally euthanized over 400 patients. In testimony to a parliamentary committee, Wiebe said that she would consider a patient on a five-year waitlist for an effective treatment to have “irremediable suffering.”

Elsewhere, in a public talk, Wiebe described a recent procedure she performed, saying, “It was a beautiful death.” And she admitted that the real difficulty is not protecting the vulnerable from abuse: “Angry family members are our greatest risk,” she says, and laughs.

Even the Simons euthanasia commercial, All Is Beauty, featured a woman who didn't want to die. Raikin explains:

an ad video by the Canadian fashion company La Maison Simons, titled “All Is Beauty,” went viral online. It told the story of Jennyfer Hatch, a 37-year-old-woman with Ehlers-Danlos syndrome who had chosen euthanasia. Slickly produced, the video showed slow-motion images of people gathered on beaches. At one point it describes “the most beautiful exit,” apparently referring to MAID. Hatch was euthanized the day before the campaign launched. She had told friends and interviewers that she wanted to live, but couldn’t afford it.

Raikin suggests that the tide is turning with relation to euthanasia and quotes from disability scholar Catherine Frazee who says:

has observed patients who become fixated on MAID, who under different circumstances, before MAID was a part of our culture, would have carried on living through difficult times, or who would have pursued treatment options with a reasonable chance of success even though doing so would be temporarily unpleasant or uncomfortable. Many people who are not at risk of suicide are nevertheless at risk of MAID, especially so because it has been so quickly embraced as an honourable, “dignified,” idyllic form of death.

Amy Hasbrouck, a disability advocate told Raikin:

MAID is a way to “get rid of disabled people.” It’s an extreme view. Yet it is possible to imagine a euthanasia system that is set up without that intention, even one that is nominally set up to protect the vulnerable — and yet that, step by step, becomes indistinguishable from a system deliberately designed to usher them to their deaths.

Euthanasia doctor Madeline Li told a Parliamentary Committee that:

“I’ve certainly had cases where I felt compelled to provide MAID against my better clinical judgment because the law did not adequately protect.”

While psychiatrist John Maher, editor of the Journal of Ethics in Mental Health, who told a Parliament committee that:

he has patients who could get better but “are now refusing effective treatment to make themselves eligible for MAID.”

Raikin ends his exposé by stating:

From Rosina, Les, Mary, Nancy, Greg, Lucy, and so many others across Canada, what we hear are the cries of people in despair asking for help. Just a few years ago they would have been textbook candidates for what a just society would say: Your life has value. In Canada today they hear something else: Your death will be beautiful.

Links to more stories of the euthanasia experience in Canada:

• Toronto Star: We need to put the brakes on euthanasia (Link).
• Globe and Mail: No to euthanasia for mental disorders (Link).
  
• Veterans affairs worker advocates euthanasia for PTSD (Link).
• Canadian man claims that he was pressured to request euthanasia (Link).
  
• Why did they kill my brother (Link).
  
• Manitoba woman died by euthanasia based on inadequate home care (Link).
• Quebec man seeks euthanasia based on changes to home care (Link). 
• Alberta man requests euthanasia based on poverty (Link).
• Ontario man approved for euthanasia because he can't get medical treatment (Link).
• Shopping for doctor death in Canada (Link).
• Gwen is seeking euthanasia because she can't access medical treatment (Link).
• Euthanasia for disability and poverty (Link).
• Euthanasia for Long Covid and poverty (Link).
• Canada's MAiD law is the most permissive in the world. (Link).