Ontario Coroner's euthanasia report: Poor at risk of coercion.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Ontario MAiD Death Review report has three parts (Part 3) (Part 2) (Part 1).

Janet Eastman has written an excellent commentary on the report of the Ontario Chief Coroner concerning the experience with euthanasia in Ontario, Canada's largest province. Eastman's article was published in The Telegraph on October 17, 2024. 

Eastman focuses on the Coroner's report in relation to the upcoming assisted dying debate in the UK. Eastman writes:

Assisted dying is used by patients in Canada because they are poor and lack housing, a major report has found.

The first official report into assisted dying deaths in Ontario, which has been obtained by the Telegraph, found vulnerable people face “potential coercion” or “undue influence” to seek out the practice.

Sixteen experts across medicine, nursing and law identified people whose lives may have been wrongly terminated at the hands of the state, where the action is called Medical Assistance in Dying (MAiD).

It comes after Kim Leadbeater, the Labour MP, introduced her private member’s Bill to legalise the practice for terminally ill patients on Wednesday, saying it “contains robust protections”.

Eastman then explains some of the concerning stories from the Ontario Coroner's report:

In one example identified in the report, a MAiD practitioner drove a 40-year-old addict to his death after his psychiatrist suggested assisted dying as an option.

Using their own car to drive the patient to an external location to die by assisted dying “may have created pressure, and gave rise to a perception of hastening a person towards death”, the report found.

On another occasion, a man in his forties who had been “involuntarily hospitalised” on mental health grounds died by assisted dying after he became convinced he had been injured by the Covid-19 vaccination. A post-mortem later found “no pathological findings”.

Elsewhere in the report, one man who had tried to jump to his death the previous year, who presented with stomach ulcers, narcissistic personality disorder and chronic suicidal ideation, was allowed to die.

Eastman reports that: One of the doctors on the committee warned that “the UK should not assume it will manage this better or avoid potential pitfalls”

Eastman then interview Dr Ramona Coelho who is one of the members of the Coroner's committee and a family medicine practitioner based on London Ontario who said:

“With the legalisation of MAiD, real lives are at stake and the dangers of a slippery slope are very real.”

“When Canada legalised assisted suicide and euthanasia under MAiD in 2016, Canadians believed it was intended to be a rare, last-resort measure, reserved for consenting adults enduring intolerable suffering at the end of life.

“However, lobbying efforts have steadily pushed for broader access and eligibility.”

 Coehlo offers a warning to British legislators:

“British legislators have to consider how easily assisted dying can be expanded, how easily abuses can go undetected.”

Eastman outlines more concerns from the report:

The MAiD Death Review Committee member said: “This worrisome finding suggests that MAiD could be the option of least resistance and be used to end lives when social policies have failed them.”

A 50-year-old depressed woman, dubbed Ms B, was allowed an assisted death because the state could not find housing that “satisfactorily” addressed the symptoms of her multiple chemical sensitivity syndrome (MCSS) in one case.

“As a result of her housing situation and conditions, necessary to address her MCS, Ms B experienced social isolation, which greatly contributed to her suffering and request for MAiD,” it said.

Some committee members “cautioned that a social issue – housing – was at the forefront of this request, not in keeping with a medical condition”. They felt that “MAiD is not a solution for all society and policy failures, furthering social injustices”.

The report also raised concerns about the case of 40-year-old addict with inflammatory bowel disease who died by assisted dying after “a psychiatrist asked him if he was aware of MAiD and presented information on the option”.

Evidence also suggested that Canadian patients could be incentivised to refuse medical treatment and make themselves more ill in order to access the practice.

Dr Coelho emphasized the case of a quadriplegic patient:

Dr Coelho pointed to a case in which a quadriplegic patient was told by one MAiD examiner that the 90-day assessment period prior to his assisted death could be “reduced” if he developed “untreated septicemia”, leading him to refuse treatment.

Eastman interviewed Kim Leadbeater (MP) and Lord Falconer who argued that, if legalized, British assisted suicide legislation will not be extended. But Alex Ruck Keene KC, the leading capacity barrister in the UK disagreed

Alex Ruck Keene KC, the leading capacity barrister, disagreed and said: 

it would be “quite possible to see how the courts would be willing to entertain discrimination-based challenges to the limits she said will be in the legislation because it will not be a question of whether assisted dying should be legal, which the courts have said is for Parliament, but rather to whom it should be available.”

Once legalized, assisted dying legislation will inevitably be extended. If legalized, the debate about whether it's OK to kill ends with a new debate beginning that concerns whether the restrictions are justified and equitable. Further to that, a new debate begins concerning who can kill and for what reasons.