Executive Director, Euthanasia Prevention Coalition
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Parliament legalized MAiD in June 2016 and expanded the legisation by passing Bill C-7 in March 2021. Bill C-7 expanded the law in the following way:
The legislation introduced a regime of 2 MAiD pathways. Several safeguards from the initial regime were removed from what was now called “Track 1,” a pathway for which an applicant still has to have an (Reasonably Foreseeable Natural Death) RFND. Bill C-7 added “Track 2,” a new pathway for those with a serious disease, illness, or disability and an irreversible decline of capabilities, but who are not approaching their natural death. This means de facto persons with disabilities. A delayed implementation clause for Track 2 (“sunset clause”) stipulated that those with sole mental disorders would become eligible for MAiD in March 2023.
The Truchon court decision, that led to Bill C-7, and the Supreme Court of Canada Carter decision, that led to the legalization of euthanasia in 2016, did not deal with the issue of euthanasia (MAiD) for mental illness. This is important because the Canadian government now claims that the Carter decision permitted euthanasia for mental illness.
The article discusses the increase in Canadian euthanasia deaths by comparing Canada to California. Canada and California have a similar population and both jurisdictions legalized assisted dying in June 2016. In 2021, Canada had 10,064 reported MAiD deaths and California had 486 reported assisted suicide deaths. Quebec now has the highest euthanasia rate in the world.
They then analyze Canada's experience with euthanasia by examining several categories.
They first analyze Canada's inadequate data collection:
The data are acquired from the MAiD providers via self-reporting. There is no mechanism for objectively, prospectively, or retroactively identifying or uncovering any errors or abuses of the process. Providing assisted suicide and euthanasia outside the parameters of the law remains prohibited. MAiD providers filling out the forms know that any deviation of the key criteria may result in criminal prosecution, making self-declarations of error or deviation unlikely.
Cases of non-compliance have been reported in Québec, Ontario, the Office of Correctional Investigator, and through several news articles. Yet, none of these stories or data appear in Health Canada's Annual reports.
Under the heading, Lack of Oversight, they examine several known cases.
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| Donna Duncan's daughters. |
The researchers then explain the case of Donna Duncan. Here is a link to the story of Donna Duncan's euthanasia death (Article Link).
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The researchers state:
Rather than the government accepting responsibility for setting up procedures for investigation, the Justice Minister stated that oversight must be provided by family members complaining after the fact to initiate disciplinary actions or police investigations. Yet, the experiences of family members who have tried to pursue concerns suggest that cases cannot be transparently reviewed, and health authorities have invoked “best interest exceptions” to rebuff requests for access to medical records.
They show how Canada is Prioritizing access to MAiD over patient safety and needs:
Sathya Dhara Kovac, 44, ended her life through the MAiD program. Kovac lived with a degenerative disease and her condition was worsening, but she wanted to live. However, she lacked the home care resources to do so. “Ultimately it was not a genetic disease that took me out, it was a system,” Kovac wrote in an obituary to loved ones.
The researchers point out that Canada's promotion of MAiD contravenes the Supreme Court of Canada Carter decision:
The Supreme Court’s decision that spurred the partial legalization of MAiD did not create an explicit “right to die with dignity” and left it to the legislature to design a “strict regulatory regime”. Regardless, the decision is being interpreted by many as creating a positive right of access to MAiD, even when other forms of medical care are available and when psychosocial suffering can be ameliorated.
This is an important section of the article. Use this link to read the full article (Article Link).
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| Christine Gauthier |
A military veteran and former Paralympian who has been trying to get a wheelchair ramp installed at her home for the past 5 years testified that she was offered MAiD by her caseworker, and it has been confirmed that at least 4 other veterans were also offered the option of MAID when trying to access resources and care.
The researchers explain:
In Canada, the Canadian Association of MAiD Assessors and Providers (CAMAP) recommends that all those who “might qualify should be offered MAiD” as part of the informed consent process. No other country in the world has normalized assisted suicide or euthanasia in this way as a potential first line therapeutic option to address suffering. Offering MAiD to a patient who has not raised it could be interpreted as an indication that their suffering will likely become intolerable, and that MAiD is the recommended way out, impacting patient hope and resilience.
No other country in the world has normalized euthanasia or assisted suicide as a potential first line therapeutic option.
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The problem of undefined terminology in the legislation:
The language in the Canadian MAiD legislation is imprecise and makes clear determinations and consistent implementation of clinical practice standards for MAiD difficult. Due to the imprecise term, “reasonably foreseeable natural death” (RFND), physicians’ interpretations of eligibility have been challenged in the courts.
They provide the following case as an example:
A man had a small stroke, affecting his balance and swallowing. The prognosis was that this man would be able to eat normally and regain most of his balance. The patient was depressed and isolated due to the COVID-19 outbreak on his ward. He declined all therapy and requested euthanasia. Neither of his MAiD assessors had expertise in stroke recovery. In this acute phase, while struggling with his mood and isolation, and with no therapy to gauge his final level of function, he received MAiD. He had no terminal diagnoses, but due to the fact that he was temporarily slightly undernourished, his MAiD assessors considered him Track 1 eligible.
Track 1 eligible means he could have an immediate death.
Suffering is subjectively defined and can be rooted in psycho-social distress. The euthanasia lobby group Dying with Dignity states that people do not qualify for euthanasia on the basis of inadequate housing, disability supports, or home care. Whereas this statement is true it is also false.
The researchers refer to the story of Sophia:
A national CTV News story recounted how “Sophia” was unable to secure affordable housing compatible with her chemical sensitivities. She chose MAiD because she could not find a healthy and affordable place to live given her meager disability support income, and prior to her death by MAiD recorded a video where she stated “the government sees me as expendable trash”
People are qualifying for euthanasia based on their medical condition, but they are requesting euthanasia based on their social condition. The researchers explain the problem of how assessments are done:
To qualify for MAiD, 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 for further validation or requirement for clinicians to agree that there are no other options to address the suffering.
No standard treatments have been tried first or even been available to qualify for euthanasia:
In Belgium and the Netherlands, 2 other jurisdictions that allow euthanasia outside the end-of-life context, before euthanasia can be provided the physicians must agree that there are no further medical or social support options that can relieve a patient’s suffering. In Canada, patients are required to be advised of treatment options that may exist. For Track 2 cases, physicians have to verify that patients considered all other options, but it is left unclear what “considered” really means. There is no requirement that standard best-practice treatments have been appropriately attempted, or even that they are accessible. Tragically, some people are choosing to die while on wait lists for potentially effective treatment or because they are refused care.
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| Jennyfer Hatch |
A short film, titled “All is Beauty,” along with its advertising trailers, was promoted by Simons (an upscale department store in Canada). In the series, a young woman is encircled by people on a beach, in a candle-lit forest, and in other settings that depict a romantic and lovely tableau of her final days before MAiD. “Even now, as I seek help to end my life, … there is still so much beauty,” says Jennyfer Hatch. However, a national news agency has revealed that Jennyfer was the same woman who spoke up earlier (under a pseudonym) about her difficulties accessing treatment, prompting her to seek MAiD as a last-ditch effort for access to palliative care. Hatch died by MAiD in October 2022 at age 37. She was unsuccessful in her attempts to receive other care.
The issue of Suicide contagion:
We have long known that publicized suicides can lead to more people choosing suicide. Well-known is how suicide rates went up when Robin Williams completed suicide. This can also be seen in suicide clustering among Indigenous youth where 1 suicide can set off a series of suicides in a community. As well, literature has shown that increased exposure to lethal means increases rates of suicide.
Canada's Justice Minister stated that legalizing euthanasia is a more humane way to die than suicide. The researchers respond:
In reality, the evidence from reviews does not support the hypothesis that introducing MAiD reduces rates of (non-assisted) suicide. Further, data on suicide rates would not factor in people who may have been ambivalent and would never have attempted or completed suicide, but who chose to receive MAiD following social normalization of assisted suicide. In our view, the Justice Minister should be concerned about suicide contagion rather than normalizing what he acknowledges MAiD to be: “a species of suicide”.
MAiD in Canada is a Human rights outcry:
Three United Nations human rights experts, over a 100 Canadian disability and social justice organizations, Indigenous advocacy groups, and hundreds of medical and legal experts have argued that Canada’s euthanasia and assisted suicide laws put the lives of marginalized and vulnerable Canadians at risk.
Criticism is growing as an increasing number of media reports regarding worrisome MAiD stories are emerging in the Canadian press. Yet, those who support the expansion of MAiD tend to reject the claim that social service failures can create and sustain the predicaments that can make death an attractive choice.
Dr. Stefanie Green, President of CAMAP admits, “Our health system is woefully inadequate in serving our population with these resources.” Even so, she adds, “I do not think we can hold these patients hostage”. She seemingly condones the use of MAiD despite the lack of political will to provide necessary psychosocial supports. Bioethicists supporting MAiD expansion have argued that limiting MAiD for reasons of psychosocial suffering “would translate into removing the agency of decisionally capable patients without offering them a way out of their predicament” and have remarkably claimed that providing MAiD in response to social suffering caused by “unjust social circumstances” is a form of “harm reduction”. This is particularly troubling considering that harm reduction strategies precisely aim at saving lives. In addition to distorting the concept of “harm reduction,” from an equity and diversity point of view, the claim reflects a perspective based on privilege. This wrongly suggests MAiD is supporting the autonomy of marginalized people who are rather being driven to death by poverty and lack of care, despite knowing how to address poverty and improve care. Dr. Ellen Wiebe, a prolific MAiD provider (430 people as of May 2022) has said she will provide MAiD while people are on waitlists for medical treatment.
They are concerned about the expansion of MAiD to those for the sole reason of mental illness. Euthanasia for the sole reason of mental illness was originally scheduled to be implemented by March 2023 but has been delayed until March 2024. They write:
Therefore, patients with mental illness, a population known for a high prevalence of psychosocial suffering, will be wrongly informed, during periods of despair and hopelessness, that their conditions are “irremediable” and will not improve, despite this being impossible to predict. In response to concerns that irremediability of any individual’s mental illness could never be predicted (a legal requirement to provide MAiD for mental illness in Canada), Dr. Justine Dembo, a MAiD activist and psychiatrist who sat on the 2022 federal panel on MAiD for mental illness, suggested she would simply advise the patient of the uncertainty that they could recover so they could make their own “informed decision” to receive MAiD, despite the fact that legal reporting forms require indicating that the medical condition is irremediable.
On top of offering MAiD under false pretenses for mental illness, equally concerning is the fact that in the few European countries that provide euthanasia for mental illness, the majority of those requesting it are women and marginalized individuals disproportionately seeking relief from suffering, not from their mental illnesses per se, but because of marginalization, including unresolved social and economic suffering and loneliness, all of which are remediable problems.
The researchers then ask the question, "What is next?"
A parliamentary committee released a report supporting euthanasia for "mature minors" and euthanasia by advanced directive. Quebec's Bill 11 expanded euthanasia by obliging all palliative care homes to provide MAiD and allows for MAiD by advance request for situations of dementia.
The researchers don't offer the reader signs of hope. They recognize the political pressure for further expansions of euthanasia.
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