Executive Director, Euthanasia Prevention Coalition
A homeless man refusing long-term care, a woman with severe obesity, an injured worker given meager government assistance, and grieving new widows. All of them requested to be killed under Canada’s euthanasia system, and each sparked private debate among doctors and nurses struggling with the ethics of one of the world’s most permissive laws on the practice, according to an Associated Press investigation.
As Canada pushes to expand euthanasia and more countriesmove to legalize it, health care workers here are grappling with requests from people whose pain might be alleviated by money, adequate housing or social connections. And internal data obtained exclusively by AP from Canada’s most populous province suggest a significant number of people euthanized when they are in unmanageable pain but not about to die live in Ontario’s poorest and most deprived areas.
Some doctors fear moving forward even with cases that meet Canada’s legal requirements, which allow euthanasia for people with “irremediable suffering” from serious but nonfatal medical conditions and disabilities. On private forums, doctors and nurses have expressed deep discomfort with ending the lives of vulnerable people whose deaths were avoidable, according to messages provided to AP by a participant on condition of anonymity due to their confidentiality.
Some of the requests from the forums were approved and acted upon. Others were denied. But the discourse about patients who are poor, disabled or lonely shows a fraught process where medical professionals test the limits of what conditions warrant euthanasia. The controversial cases in the forums have never been disclosed through Canada’s oversight system, even in an anonymized manner.
Euthanasia is becoming the solution to every kind of suffering. The authors reported:
But experts tasked with delivering euthanasia to people who aren’t dying have called it “morally distressing” and say the legal provisions are too vague to be protective, obliging doctors and nurses to at times end the lives of people they believe might otherwise be saved.
“I don’t want (euthanasia) to become the solution to every kind of suffering out there,” a physician wrote to colleagues on one of the private forums.
When euthanasia was legalized, doctors and nurse practitioners set up email discussion groups as confidential forums to discuss potentially troubling cases, with limited patient details for privacy. They’re now run by the Canadian Association of MAiD Assessors and Providers.One of the forum participants shared dozens of messages with the AP reporters.
Association President Dr. Konia Trouton told AP via email that providing euthanasia for vulnerability or financial reasons alone is “completely forbidden.” Trouton said doctors and nurse practitioners consult with one another on the forums “to gain insights and learn from the experiences of others.”
A middle-aged worker whose ankle and back injuries made him unable to resume his previous job told his doctor that the government’s measly support was “leaving (him) with no choice but to pursue MAiD.” His doctor told forum participants the patient met legal criteria, with severe pain, strained social relationships and inability to work. Others agreed and assured the doctor the man was clearly in pain. But the doctor was hesitant because the man cited reduced government payments as a key factor.The reporters learned that euthanasia deaths are more prevalent among people with disabilities.
Cases of homelessness appear regularly and spark some of the most heated debate.
One doctor wrote that although his patient had a serious lung disease, his suffering was “mostly because he is homeless, in debt and cannot tolerate the idea of (long-term care) of any kind.” A respondent questioned whether the fear of living in the nursing home was truly intolerable. Another said the prospect of “looking at the wall or ceiling waiting to be fed … to have diapers changed” was sufficiently painful.
The man was eventually euthanized.
One provider said any suggestion they should provide patients with better housing options before offering euthanasia “seems simply unrealistic and hence, cruel,” amid a national housing crisis.
Physicians said keeping their opinions out of assessments was difficult — and painful, given patients’ emotions and desperation.
Critics have long warned that Canada’s policies have led to euthanasia among disadvantaged people whose deaths weren’t imminent. Despite publicized cases of people asking to be killed because of insufficient support, government officials have largely refuted the idea that socially disadvantaged people are being euthanized.The article states that Canadian officials have examined some of the worrisome cases. The authors report:
But in Ontario, more than three quarters of people euthanized when their death wasn’t imminent required disability support before their death in 2023, according to data from a slideshow presentation by the province’s chief coroner, shared with AP by both a researcher and a doctor on condition of anonymity due to its sensitive nature.
A document from the Ministry of the Solicitor General in Ontario sent to all euthanasia providers in the province in May noted two cases of “lessons learned” in nonterminal cases. The document was shared with AP by a doctor on condition of anonymity because it wasn’t authorized for release.The authors uncovered several other cases that were debated in the forum.
In one, a 74-year-old patient who’d suffered high blood pressure, a stroke and blindness, among other difficulties, was increasingly dependent on their spouse and “expressed their interest in MAiD to their family physician, due to their vision impairment and loss of hope for improvement of their vision and quality of life.”
The report cited three instances where legally mandated safeguards were not met. Among them: No assessor or expert versed in the nonterminal condition was involved, and efforts to discuss alternatives to death were “limited.”
The report also said the procedure was scheduled “based on the spouse’s preference of timing.” Officials questioned whether “the patient’s death was genuinely voluntary and free of coercion.” Independent legal experts said those breaches could constitute violations of criminal law.
Some of that reflection is happening in the confidential providers’ forums.
They’ve debated whether it’s valid to euthanize people for obesity in several cases. One woman with severe obesity described herself as a “useless body taking up space” — she’d lost interest in activities, became socially withdrawn and said she had “no purpose,” according to the doctor who reviewed her case. Another physician reasoned that euthanasia was warranted because obesity is “a medical condition which is indeed grievous and irremediable.”
When a health worker inquired whether anyone had euthanized patients for blindness, one provider reported four such cases. In one, they said, an elderly man who saw “only shadows” was his wife’s caregiver when he requested euthanasia; he wanted her to die with him. The couple had several appointments with an assessor before the wife “finally agreed” to be killed, the provider said. She died unexpectedly just days before the scheduled euthanasia.
Providers on the forum were divided over ending the lives of people in mourning. One case involved a woman in her 80s who required dialysis and lost her husband, sibling and cat in a six-week period. Her assessor said her suffering and request to die were tied to her husband’s death rather than any medical conditions.
Some doctors said because she lost her husband — the protective factor that would make the other losses and suffering bearable — she qualified. Others recommended grief counseling instead.
A provider referenced a similar case, in which a widow requested euthanasia within weeks of her husband’s death: “Her whole life system crashed. I felt much ease in providing for her and had no pushback from the coroner.”
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| Ellen Wiebe |
while poverty inevitably exacerbates suffering, improved housing and social situations have never changed a patient’s mind.The authors conclude the article by stating:
“The idea that because I’m disabled, I should lose my rights that undisabled people have is outrageous,” said Wiebe, who suffers from heart disease and uses a wheelchair.
She predicted legal consequences if officials introduce more safeguards for euthanasia: “We’ll just be back in court with somebody saying, ‘You interfered with my basic human rights.’”
On euthanasia forums, doctors and nurses continue to struggle with cases of patients who aren’t fatally ill, lamenting that Canada’s health and social services can seem woefully inadequate.
“I have great discomfort with the idea of MAiD being driven by social circumstances,” one provider said. “I don’t have a good solution to social deprivation either, so I feel pretty useless when I receive requests like this.”
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