Canada's Ministry of Death

The following article has written by Alexander Raikin been reprinted without edits. This article: Canada's Ministry of Death was published by National Review online and will be published in the National Review print edition on February 20, 2023.

Raikin also wrote the article: No Other Options: An exposé on euthanasia in Canada, that was published in the New Atlantis on December 16, 2022.

By Alexander Raikin

It was supposed to be easy. If journalists asked the Honourable David Lametti, Canada’s minister of justice, a difficult question about euthanasia, he simply needed to read his talking points for February 24, 2020. A senior civil servant from his department prepared the lines; the prime minister’s staffers approved them. All that was left was to kill the messenger.

Publicly, Lametti said that the rate of change in public attitudes toward euthanasia had surprised even him. Barely five years earlier, prosecutors had called euthanasia “culpable homicide.” Now the government of Canada calls it “MAiD” — Medical Assistance in Dying, or, in other words, killing as medical treatment. Lametti, standing with other cabinet ministers, was to announce a further expansion of MAiD that, as Bill C-7, would come partially into effect in 2021. This March, the two-year sunset clause in that bill expires and the list of acceptable reasons for MAiD will be expanded once again, this time to mental suffering unaccompanied by physical ailment.

I filed a freedom-of-information request to find out what Lametti knew when he introduced the bill. While Lametti, like other cabinet ministers, was told to stress that there is “a consensus” among the public behind the plan, his own notes belie the point.

Some questions were never meant to be answered. Question 43 in the memo: Why did the government of Canada not appeal a lower-court decision in Truchon v. Canada, which, contrary to the government’s earlier promises, will expand euthanasia to people with essentially any chronic illness or disability? The answer, in its tautological beauty, is that “the Government of Canada announced in October 2019 that it would not appeal.” Want to know — Question 37 — how many euthanasia deaths there have been so far? The answer is that there has been “a consistent and gradual increase” as the practice of euthanasia “gains greater comfort and acceptance by Canadians.” No need to worry about any numbers — more is better anyhow.

But the most notable question was the one that was never asked at the press conference. It clearly was more important, as it was on the second page of the talking points. It was the Canadian equivalent of a jeremiad, accusing the government of forsaking some of the most important documents of civil liberties that a card-carrying member of Justin Trudeau’s Liberal Party could believe in. “Q6: Advocates for persons with disabilities are saying that this Bill violates the equality rights and dignity of persons with disabilities, contrary to the Charter of Rights and Freedoms, the United Nations Convention on the Rights of Persons with Disabilities, and the Liberal Party of Canada’s Disability Equality Statement. Does this Bill put the lives of persons with disabilities at risk as advocates claim?”

The prepared answer was another nonanswer. The government would address “stigma and bias”; it would bring about “a culture change to ensure that the important contributions made to Canada by persons with disabilities are recognized and valued on the [same] basis as those of other Canadians.” What the government would not do is slow down a program that offers suicide-prevention services to most people but assisted suicide and euthanasia only to the disabled, terminally ill or not.

Behind the scenes, even on the day of the cabinet minister’s press conference, bureaucrats from the central agencies who had worked on the memo worried about the toll of the government’s policies. One email talked about how “from a comms perspective, I wonder if it might seem like the increase [in MAiD deaths] is buried if it isn’t there and others will report on it rather than the Govt.” The increase wasn’t included in the accompanying media deck, and the media didn’t report on it, not really.

Since Trudeau was elected in 2015, his government has single-handedly created the largest, most permissive euthanasia program in the world. “You can kinda yell till you’re blue in the face that there are problems, but people aren’t listening,” John Maher, a psychiatrist in Ontario specializing in treatment-resistant mental illnesses, told me. When MAiD was first implemented, in 2016, a CBC article claimed that 90 percent of requests for assisted deaths were being refused in Toronto. But by 2021, only 4 percent of requests were deemed ineligible nationwide. “There isn’t a slippery slope,” said Timothy Stainton, a professor of social work at the University of British Columbia. “This is Mount Everest in a snowstorm.”

The daily death toll is staggering, even more so because it is unreported. Every day in Canada, in 2021, more than 27 people died by the hands of their physicians or nurses. It’s double the suicide rate, and there isn’t any sign of its stopping or slowing down. The world’s “euthanasia capital” is no longer Brussels or Amsterdam. It is now Ottawa. Canada euthanizes more people than any other country in the world — and its death toll is growing at a faster rate than that of any other voluntary system of euthanasia anywhere. (So much for Lametti’s description of “gradual increases.”)

To put this in context: When the number of Dutch deaths from euthanasia doubled in six years, a Dutch official in charge of reviewing euthanasia deaths warned that the Dutch model of euthanasia should be avoided. But after Canada’s legalization, the number increased tenfold in six years. At any rate, it will be impossible for any similar Canadian watchdog to warn about Canada. That is because no such watchdogs exist: Unlike in the Netherlands or Belgium, Canada has no mandated review process for potential stories of abuse.

That people with disabilities would be at a unique risk of an early death by MAiD is not an accident, as Lametti’s office knew. In fact, it was predicted well in advance. Before Bill C-7 passed, over 140 disability groups claimed that Trudeau’s plan “put their very lives at risk.” A petition of Indigenous doctors and politicians demanded that it “not be forced on our peoples.” Three United Nations human-rights experts, including the U.N.’s special rapporteur on the rights of persons with disabilities, decried the legislation as riddled with “ableist assumptions about the inherent . . . ‘worth’ of the life of a person with a disability.” “Under no circumstance should the law provide that it could be a well-reasoned decision for a person with a disabling condition who is not dying to terminate their life with the support of the state,” they wrote. Lametti’s response was to talk about stigma.

How did Canadian institutions become so bullish on euthanasia in the face of such opposition? It’s an important question. A simple answer is that Canada’s descent into death-on-demand is because of its supreme court or its culture. But both explanations seem weak.

It is, of course, fair to say that the court has played an outsized role in creating a “right to die.” In 2015 the Supreme Court of Canada, in Carter v. Canada, unanimously overturned nearly a century and a half of common law to strike down the federal prohibition on “physician-assisted death,” declaring it contrary to the “life, liberty, and security of the person” as guaranteed in Section 7 of the Canadian Charter of Rights and Freedoms. But the exact same section of the Charter had been used two decades prior to keep medically assisted suicide illegal in the split supreme-court ruling in Rodriguez v. British Columbia that “human life should not be depreciated by allowing life to be taken,” especially by a physician. Why did an already activist court change its mind? Jocelyn Downie, a law professor who was part of the legal team that argued in the Supreme Court for euthanasia to be decriminalized, told me that she is nonetheless “surprised” at the “massive change” that Canadian society — and the courts — had to accept. It couldn’t have happened any sooner.

The court wasn’t responding to any change in law; it was responding to a perceived change in the mood around assisted suicide — conducting a vibe test for euthanasia. “Despite the Court’s decision in Rodriguez, the debate over physician-assisted dying continued,” the court said, arguing the need for it to revisit its earlier ruling, citing failed parliamentary bills in Canada, “recent reports” by Canadian academics, and a changing “legislative landscape” in other jurisdictions such as Colombia and Luxembourg. But this change in mood, as shown by the examples the court cited (which included no polls or surveys), was not the result of some bottom-up change in society.

The culture argument is lackluster too. Earlier attempts to force Canadians to accept euthanasia or assisted suicide as a form of medical treatment failed rather decisively. As late as 2010, a three-quarters majority of the House of Commons wanted to keep physician-assisted death a criminal offense. No major national party supported legalizing euthanasia, which explains why half a dozen bills to introduce euthanasia between 1991 and 2010 failed to pass.

Canadians outside the legislature were unconvinced, too. It’s one thing to support the idea of assisted suicide in the abstract and another to put it into practice. A national 2010 poll by Environics found that if you asked Canadians whether the government should focus on legalizing euthanasia, improving end-of-life care, or both, the response was overwhelmingly (71 percent) for improving end-of-life care. Only 19 percent said euthanasia and 5 percent said both. Two-thirds of Canadians expressed concerns that the elderly would feel pressured to die because of financial concerns, a fear that is already coming true. Although “MAiD providers,” physicians or nurses who perform euthanasia, have long argued that no one is requesting MAiD because of poverty or lack of medical care, I wrote for the New Atlantis that the situation is common enough that the leading organization of MAiD providers held multiple seminars on it. “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,” admitted Ellen Wiebe, one of the most prolific “MAiD providers” in Canada.

If it wasn’t the courts and it wasn’t the culture, the answer must lie elsewhere. To understand how we really got here, to promoting the assisted deaths of the most vulnerable people in society and calling it progress, it is necessary to look past Lametti’s talk about a supposed “consensus” and see a multimillion-dollar PR campaign to persuade the public and elites to stop worrying and love MAiD.

The signs of its success are visible to the naked eye, often in the quick marginalization of dissenters. Yves Robert, the secretary of the Quebec College of Physicians and a previous supporter of assisted dying, warned in 2017 that euthanasia in Canada was turning into “death à la carte.” The warnings were almost self-evident, because of “the paradoxical discourse [by the media and Parliament] that calls for safeguards to avoid abuse, while asking the doctor to act as if there was no abuse.” “Let us take the time to properly reflect before going further,” Robert urged. “There’s no urgency to die.” But five years later there apparently is.

Now the same Quebec College of Physicians has sent another representative — not Yves Robert — to clamor for Parliament to expand euthanasia still further, this time to minors and even babies less than a year old. Just don’t call it “infanticide,” please. (Inclusion Canada, a leading disability-rights group, said in a response that “this isn’t MAiD, it’s murder.”)

The same push is evident in other medical groups. The Canadian Psychiatric Association, under the presidency of Sonu Gaind in 2015–16, explored the potential impacts of suicide contagion through the legalization of euthanasia. Yet the following leadership squashed any further “evidence-based study” of contagion risks — and then issued a public statement on behalf of the organization saying that it would be “discrimination” if patients who applied for MAiD because of a psychiatric condition were treated any differently from those with a physical illness. But what the leadership believes is not what the group’s members believe. Ontario psychiatrists, according to an internal survey conducted by the Ontario Medical Association Section on Psychiatry, opposed by a nearly three-to-one margin (63 percent to 23 percent) the proposition that “patients with [only] a psychiatric illness . . . should have available the same options regarding MAiD as available to all patients,” without issues of irremediability in mental illness having been examined.

The impact of this pseudo-consensus is evident in news reports: People are getting desensitized. A completely routine caption from a local newspaper last year was “Randy Obenauer, 74, cries as he tries to clean his own catheter.” When Randy’s friend tried to get him help, local health authorities asked him whether Randy was interested in MAiD instead. But the story didn’t go viral. No one was reprimanded for asking such a callous question. Disability groups added another name to their growing “List of Cases of Concern,” and otherwise life went on.

The national media prefer to report, for instance, on how an Ontario police officer donated his lungs from a euthanasia performed at home, a world first, or how a couple married for 73 years could die together through MAiD at home even though only one of them had a terminal illness. The moral nuances were not discussed; the bias was not new. When it came time for the 2015 election, shortly after the Carter decision, the only person with visible disabilities who was chosen by the journalist moderators to ask a question in the election debate between Stephen Harper and Justin Trudeau assumed that a right to die was owed to disabled persons and asked the candidates how their platforms would grant it. This “showed the media complicity” and “the political complicity” in pushing assisted suicide, remarked a matter-of-fact Amy Hasbrouck, the director of Toujours Vivant–Not Dead Yet, a grass-roots disability advocacy group against euthanasia.

International media are not much better. Justin Trudeau’s government is frequently described without any mention of his policy on euthanasia. Until 2021 — years into Canada’s headfirst descent into euthanasia — virtually no major media mentioned MAiD when discussing Trudeau. Instead, the media were seized by “Trudeaumania.” Trudeau was on the cover of Rolling Stone, Attitude (“an international LGBT magazine”), GQ (don’t ask), and even Sky Delta (“Delta Airlines’ popular in-flight magazine”). Just months before Lametti’s press conference, the Atlantic described Trudeau’s government as “the most successful progressive government in the world.”

In every interview that I did with disability advocates or physicians skeptical of euthanasia-on-demand, I asked why they thought euthanasia in Canada had become such an industry. The answer was always the same: “Dying with Dignity Canada,” said one insider who wished not to be named, referring to the largest pro-euthanasia lobbying group, founded in 1980. “I mean, they haven’t come up in all of this, but they’re a very, very powerful, well-funded lobby.”

It was, indeed, Dying with Dignity Canada (DWDC) that created and marketed the public and lobbying campaign for euthanasia, largely through stories of individuals demanding to die. It was highly effective. Whenever parliamentary committees would debate safeguards for MAiD, the organization would arrange for a chosen cadre of individuals to testify in front of the committee; they only needed one activist to balance out the concerns of disability groups, despite the latter’s near-unanimity in opposition to MAiD. Moreover, DWDC could spend millions on promoting a single story online and in the media. There were many groups opposing MAiD, but there was only one national group in support of it. And they were always on script.

Disability advocacy groups couldn’t compete with the slick media campaign featuring almost nothing but white women with terminal illnesses clamoring for suicide (so much for Canadian multiculturalism). It’s the motte-and-bailey rhetorical strategy: Canadians, like Americans, largely support assisted suicide for terminal illnesses, so those were the stories that advocates shared. But the policy of euthanasia was expanding far beyond terminal illnesses: People were dying from hearing or vision loss; treatable illnesses; diabetes or arthritis; loneliness, poverty, old age. Their stories were not told.

Harper Schipper, a professor of medicine at the University of Toronto, told me that after Rodriguez, Death with Dignity Canada was run in a way that was “absolutely brilliant strategically.” He knows this because he believes he was on the receiving end. In the opening session of the Council of Canadian Academies’ panels on MAiD, it was announced that he would chair an important panel. The event was sequestered and barred to the media in order to maintain the integrity of the proceedings; the panelists were told not to reflect on the proceedings publicly until after the panels’ conclusion. But as Schipper’s panel convened the next day, a coordinated campaign created negative publicity about him. Even before his appointment was announced, a “gotcha” article came out impugning Schipper’s objectivity by noting that he had warned that a slippery slope in euthanasia could lead to a replay of Nazi Germany. It was an open secret on who pulled it off.

“I am called out of the meeting,” Schipper recalls, “because Dying with Dignity has found a reporter, a stringer for the Globe and Mail who writes a piece basically saying Dr. Schipper is a shrill opponent of assisted dying. He’s been named chairman of this group. And while we’re not asking him to step down, we asked that he be fair in his chairmanship. And at the same time, two voices pop up in the Commons, making the same kind of comments.” Ultimately, he was forced to resign from his chairmanship

DWDC’s media savvy isn’t a surprise: Its first major donor was a media mogul, Moses Znaimer. In 2008, Znaimer set his sights on seniors. He created a for-profit company, ZoomerMedia, which he used to buy outright the CARP (Canadian Association of Retired Persons) magazine. Then he leveraged this financial partnership into becoming the president of CARP’s board.

The maneuver was strategic. When the longtime executive vice president of CARP, Susan Eng, said that she had a neutral position on euthanasia — neither supporting nor criticizing it — Znaimer fired her. Her replacement was the former CEO of Dying with Dignity Canada. “The only reason he fired me,” Eng has said, “was so that they can put out an official position for CARP saying that they want to insist on assisted dying on demand.” Znaimer also used his position to hire at least four pro-euthanasia lobbyists and arranged a personal meeting with David Lametti to persuade the government to expand assisted suicide further.

In 2010, DWDC raised just $90,000 and, according to a civil discrimination suit, was on a path to bankruptcy. Yet it continued to spend so much on lobbying, public relations, and other forms of activism that in 2015 the Canada Revenue Agency (Canada’s IRS) stripped it of its charity status. DWDC was then revitalized by big donors. A $7.75 million bequest from a supporter who had died through MAiD, and another bequest of $500,000, transformed the organization’s capacities in 2018. It could now do so much more.

Canada has another pro-dying group, one specifically geared to physicians: CAMAP, the Canadian Association of MAiD Assessors and Providers. Its purpose, its president Stefanie Green told me, is to be “the support for people that do the work.” I’ve written before in the New Atlantis on how CAMAP has kept hidden from the public and the Parliament stories of MAiD’s being offered as an alternative to poverty and inferior medical care. We know little about CAMAP except that it was founded shortly after the Carter decision. In 2021, CAMAP became a registered charity, revealing some curiosities in its financing. Unlike most charities, it spent $0 on fundraising, yet it had an astonishing $780,000 in near-liquid capital in the bank. Where did this money come from? It’s unclear. But much of CAMAP’s resources, training briefs, and studies show that its activities are funded by Dying with Dignity Canada.

Sometimes CAMAP crosses the line into activism. Green told me (and Parliament) that her organization does not advocate for any position on MAiD, but rather that CAMAP impartially reports what is happening on “the front line” to interested parties. But in a seminar, Aaron McKim, a MAiD provider in Newfoundland, hinted at actions that MAiD providers take to counteract other professional associations. “Our nursing association and social-work association have both put out practice advisories that their members aren’t really supposed to even bring up MAiD unless the patient specifically asks about it,” said McKim in a CAMAP seminar on “lack of resources” in May 2021. “And so we’re, we’re trying to kind of figure out ways to counteract that.”

“It’s clear that people associated with Dying with Dignity have been unusually influential in the policy-making in Canada related to [MAiD],” Trudo Lemmens, a law professor from the University of Toronto, told me. “It contrasts sharply with how disability-rights organizations and Indigenous organizations have been ignored in this debate.” Heidi Janz, a disability scholar and activist, said in an email interview with me that “proponents of the so-called ‘right to die’ and the federal Liberals — who are often one and the same — have consistently framed the expansion of eligibility for MAiD as advancing the autonomy rights of people with disabilities, but this claim is blatantly false.”

Lobbying records indicate that Lemmens and Janz are right. Dying with Dignity Canada has met ten times with staffers for the Ministry of Justice, including once with David Lametti himself. Every senator but one that their lobbyists spoke to was appointed by Justin Trudeau. Every vote to pass and then amend MAiD succeeded because of Liberal members. There are no records that David Lametti met with any lobbyists from disability groups.

The connection between DWDC and the Liberal Party is now even familial. James Cowan, the former leader of the Independent Liberal senators who made possible the passage of the first MAiD legislation in the Canadian senate, is now in political retirement as chairman of the board of DWDC. His daughter is Suzanne Cowan, the president of the Liberal Party.

In sum, euthanasia advocates dominated the political and media conversation and have finally come to control the expert panels and their power of imprimatur. The experts now chosen are able de facto to shape euthanasia policy as they wish while giving the Trudeau government a veneer of supposed scientific legitimacy (as if medical expertise were sufficient to resolve what is at root an ethical question). The most recent example was the expert panel formed to study safeguards for euthanasia in cases of mental illness. The panel reported that current safeguards around MAiD work well and recommended no additions. Unsurprisingly, the chairperson of that panel was an enthusiastic MAiD supporter and others had already argued for the expansion of MAiD to mental illnesses. Two board members resigned in protest, but the needed conclusion was reached.

It has been a proven strategy from the beginning of the euthanasia boom. When the Royal Society of Canada issued a report in 2011 on “end-of-life decision-making,” the chosen “expert panel” included only supporters of euthanasia. It wasn’t even subtle: The chairman publicly wrote his thoughts on the topic beforehand, while two other commissioners had published books that argued for the legalization of permissive euthanasia. The panel of course reached the desired conclusion. It was even more unsubtle that the panel thanked Peter Singer for editing the philosophical section that justified euthanasia. (Singer is a philosopher who argued in Practical Ethics [1979] that it is moral to kill “defective infants.”) When the time came for the Supreme Court to revisit the legality of euthanasia in 2015, it cited this report as proof that Western mores around death were changing.

At some point, historians or judges will lay blame for all the lives thrown away. Many major institutions in Canada will bear responsibility: the Supreme Court for failing to abide by its precedent in Rodriguez protecting the right to life; political leaders, for failing to safeguard the same right; the medical system, for failing to see people with disabilities as people with lives worth living; and the media, for failing to cover the debate with objectivity. What they should not blame is “a consensus.” There never was one.