Heart-wrenching lessons from Canada's euthanasia regime.

This article was published in the Scotland Herald on November 12, 2024 titled: Heart-wrenching lessons from Canada's Assisted Dying regime.

By Dr Ramona Coelho

Twenty years ago, just out of medical school, I couldn’t have imagined that vulnerable patients might one day feel their suffering was so poorly dealt with that they'd ask their doctor to end their lives. Since our country, Canada, legalised Medical Assistance in Dying (MAiD) in 2016, we have seen over 60,000 MAiD deaths by 2023, with exponential yearly growth rates. Quebec’s recent report reveals that their MAiD annual death rate has surpassed 7%, and they can’t even assess the quality of palliative care provided.

The Canada I grew up in valued dignity and protected the vulnerable. Now, inadequate care and weak safeguards are pushing Canadians with disabilities toward assisted death. A recent report from an Ontario government committee I sit on confirms the warnings of Canadian and United Nations human rights experts: people are choosing death because they lack essential supports and services.

Take the report’s review of a man in his 40s with inflammatory bowel disease. Isolated, unemployed, and struggling with mental illness and addiction, he depended on family for housing and financial support.

Rather than receiving care for his mental health, a psychiatrist asked if he knew about MAiD. In the end, a MAiD provider personally drove him to the location where he ended his life — without input from his family, despite their deep concerns. Canada claims to have a social and health safety net, but in his case, was he not pushed toward death?

There are countless other stories like his — stories revealed in reports, the media, and those that I now frequently encounter first hand. Every time I hear them, I’m reminded that what was meant to be an exceptional option has come at an unacceptable cost.

I see patients who are trapped in a system that doesn’t care enough for them. For many, MAiD is the only “compassionate” option when palliative care, mental health support, and basic social services are inaccessible.

These stories are heart-wrenching, and they are far from rare. The report reviews the case of a woman with multiple chemical sensitivities who applied for MAiD because she couldn’t find housing that met her medical needs. She didn’t want to die — she wanted to live in a way that felt safe and supported. But when faced with few options, death seemed to be the only choice.

I care for many elderly and disabled patients, those battling loneliness, isolation, and the quiet anguish of feeling like a burden due to societal neglect. In Canada, MAiD is routinely raised to the elderly and disabled as a care option — sometimes even before palliative care is explored.

I recall a conversation with a man who felt he was no longer needed, that his family would be better off financially if he chose MAiD. I’ve also seen families pressuring elderly relatives, concerned about the financial burden of supporting them. It breaks my heart that, in Canada today, death can seem easier to arrange than creating a safe supportive community where everyone feels valued and connected.

As I prepare to testify in Scotland, I think of the patients I’ve seen swept along by a system that no longer protects them.

In 2016, MAiD was meant for those at the end of life, with reassurances that it would never be offered as a "solution" for social suffering. But those promises have crumbled, replaced by an increasing push for accessibility.

Today, in Ontario, most patients choosing MAiD who are not dying come from marginalised, poor backgrounds. They are younger, with a higher percentage being women (61%). These groups are more vulnerable, often suffering from social deprivation that could be treated with the right support, yet MAiD is offered as a quicker option than suicide prevention and care.

Worryingly, MAiD recipients often lack adequate mental health and disability supports. In Ontario, only 8.6% of those not dying who chose MAiD were offered housing support, and only 6% were offered income support. Those not dying but accessing MAiD are less likely to list an immediate family member as their next of kin — often naming a friend, lawyer, or healthcare provider instead, signalling a stark lack of social support.

The situation continues to worsen. When life’s difficulties become unbearable, MAiD is now presented as an answer, rather than addressing the root causes of despair. How have we, as a society, reached a point where death can sometimes be offered more easily and as a less costly solution than investing in social and mental health services, things that make life worthwhile?

Individual autonomy has been used as an argument to blow open access to MAiD. Mental illness as a sole medical condition to access MAiD will be allowed in 2027, and federal consultations about MAiD advance directives are currently underway.

Quebec has taken matters further, breaking the criminal code by allowing advance directives for MAiD, simply requesting non-prosecution for offenders. Our federal joint parliamentary committee on MAiD has recommended MAiD for children deemed capable of making their own healthcare decisions.

Look at Canada today and ask if this is the reality you want for your own people. Our experiences show that the road to legalising assisted dying is a slippery one. It starts with promises of compassion that have led to a system where some patients feel pushed toward death. This is the opposite of autonomy and choice – it is desperation and structural coercion to die. I would not wish this reality upon any nation.

If Scotland truly wants to offer compassion, it should strengthen palliative care and provide social support that help people live with dignity. Compassion is not offering death to those who feel like burdens or are lonely (which are highly cited reasons for choosing MAiD in Canada) — it’s lifting that burden by creating a society where people feel valued, and every person feels supported and safe.

Previous articles by Dr Ramona Coelho.

• Canadians with disabilities are needlessly dying by euthanasia (Link).
• Canada's assisted dying regime should not be expanded to include children (Link).
• Euthanasia for those with mental illness should not be on the table (Link).

Dr Ramona Coelho is a family physician whose practice largely serves marginalised persons in London, Ontario. She is a senior fellow at the Macdonald-Laurier Institute and co-editor of the upcoming book Unravelling MAID in Canada: Euthanasia and Assisted Suicide as Medical Care. She presented evidence to Holyrood on Liam McArthur MSP's Assisted Dying for Terminally Ill Adults (Scotland) Bill.