Québec Medical Group requires physicians and nurse practitioners to refer for euthanasia.

Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

A memorandum from a Québec medical group reminds healthcare professionals of the obligation to leave their conscience "at the door" by referring patients for death by euthanasia (MAiD). The subject line reads "General reminder regarding requests for medical assistance in dying (MAiD)."

 

Canada legalized MAiD in June 2016 by creating an exception in the Criminal Code for homicide (murder).

An association of healthcare professionals in Montreal Québec sent a memorandum as a "general reminder" regarding requests for medical assistance in dying (MAID) to ensure that all healthcare professionals know that they are obligated to refer all patients who request death by euthanasia (MAiD), if the healthcare professional conscientiously object that the request must be sent to the Interdisciplinary Support Group (ISG). The memorandum states:

No healthcare professional can ignore a request for MAID. It is the responsibility of every professional to ensure that such a request is taken care of. As stipulated in sections 26 & 31 of the s-32.0001 - Act respecting end-of life care, any health or social services professional may complete the (contemporary) MAID request form when a person so requests.

Any physician or specialized nurse practitioner who receives a request for an MAID must notify the Interdisciplinary Support Group (ISG) and, if applicable, forward the request form to the ISG when he or she:

• refuses a request (based on the eligibility criteria recognized by the Act);
• refuses to assist a person in formulating an anticipated application (moral or religious conscientious objection) or in withdrawing such an application;
• refuses to carry out the required examination.

The ISG is to provide clinical, administrative and ethical support for end-of-life care. In particular, for the evaluation of a request or the administration of MAID, continuous palliative sedation and in the drafting of an anticipated MAID application (answering questions, coaching and mentoring by experts).

You can contact the MAID and ISG coordinator by e-mail: amm.comtl@ssss.gouv.qc.ca or at: 514-809-6174.

For more information, the CIUSSS intranet is regularly updated https://intranet.comtl.rtss.qc.ca/en/clinicalpractice/palliative-care-and-end-of-life-care/medical-assistance-in-dying-maid.

We remind you that no intimidation of anyone requesting information or an MAID, nor of the professionals involved, will be tolerated. Anyone witnessing such a situation should report it: employees should inform their superior, users and families should contact the Ombudsman.

Thank you for your cooperation,

For people outside of Canada, healthcare is a provincial jurisdiction, therefore each province will have different rules pertaining to referrals for euthanasia. 

 

When reading this memorandum, it is sadly not surprising that Québec has the highest euthanasia rate in the world.

 

More articles on this topic:

• Canada's euthanasia deaths continue to rise with approximately 16,500 euthanasia deaths in 2024 (Link).
• Québec shows the way with euthanasia in Canada (Link).
• Québec approves euthanasia by advance request (Link).

The Health Impacts of Seniors' Loneliness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In the past, The Canadian Association of Retired Persons (CARP) was a strong promoter of Canada's euthanasia law and expansions of that law, but a new CARP initiative tackling Seniors Loneliness is worthwhile. In a recent update on Seniors' Loneliness CARP states:

Social isolation is a serious issue when it comes to seniors and a signal of a dysfunctional society. It’s estimated that almost 30% of Canadian seniors live alone – and without strong community connections, many of these seniors suffer silently from loneliness and depression.

Loneliness can impact physical and mental well-being. Isolation can lead to depression, which in turn can further exacerbate health issues. For example, depression in older adults is tied to a higher risk of cardiac diseases. At the same time, depression reduces an older person’s ability to recover from illness.

Depression is not a typical part of aging. Yet it is estimated that 20% of older adults experience symptoms – like persistent sadness, loss of interest in activities, fatigue, feelings of worthlessness and even suicidal thoughts – and rates increase up to 40% for those in hospitals and long-term care homes.

These numbers are a warning sign of a public health crisis hiding in plain sight. The World Health Organization recently named loneliness a global health priority, urging countries to take action. And the science is clear: chronic isolation is more harmful than smoking 15 cigarettes a day.

While CARP is promoting their initiative to counter Senior's Loneliness, I want to reiterate my support for the Compassionate Community Care charity that also focuses on reducing Seniors' Loneliness.

While CARP has strongly promoted euthanasia (MAiD) in the past, the Euthanasia Prevention Coalition recognizes how loneliness can lead to requests euthanasia. Many people who are living with difficult health conditions also feel lonely, feel hopeless and begin to believe that they have no further reason to live. 

Instead of offering these people death, they should be offered support from a caring community who reasures them that they are important and that they still have a reason to live.

Contact the Compassionate Community Care charity (CCC) to join the Visitor Training program or become trained to provide advocacy for your family members or people who you know. CCC also provides a calling service for contacting lonely seniors who simply need someone to talk to or someone to listen.

Physicians group urges New York Governor to veto assisted suicide bill.

Dear Governor Hochul,

My name is Dr Sharon Quick and I am President of Physicians for Compassionate Care Education Foundation (PCCEF), an organization without religious or political affiliation that advocates for the vulnerable at end of life. I have expertise in pediatric anesthesia, critical care, and medical ethics. We oppose A 136. Please veto this poorly constructed bill.

Summary: A 136, like other medically-assisted suicide laws, inevitably violates (rather than upholds) patient autonomy; creates (based on subjective, often inaccurate, criteria) a class of marginalized patients with the disability of terminal illness from whom the standard of medical care can be withheld; allows lethal drugs to unnecessarily substitute for good palliative care and pain control; disproportionately preys on those with mental health problems and disabilities; and destroys the foundation of medical ethics, creating distrust among patients and the health care profession. In addition, A 136 is the most radical policy in the country because it has no waiting period for obtaining lethal drugs. It also has no residency requirement which could turn New York into an international assisted suicide tourism destination for one-stop lethal drug prescriptions. Will New York citizens have to pay for funerals and/or transport of bodies back to their home states and countries? The bill makes no provision for the fact that out-of-state citizens or non-citizens may be pressured to take lethal drugs immediately and they are not required to make funeral and burial arrangements.

1. Pain should never be a reason to seek lethal drugs. Complaints of excessive symptoms indicate doctors lack palliative care knowledge, such as when to refer to pain management specialists. Lethal drugs should never be a solution for lack of education. In addition, those in significant pain lack capacity to consent for lethal drugs. Instead, improve palliative care access and expertise, which has been assessed as likely insufficient to meet the needs of New York.1 There is evidence that minorities, the uninsured, those on Medicaid, and those living in disadvantaged communities may encounter barriers to receiving palliative care.2 It would be a tragedy for these under served populations if this legislation made lethal prescriptions more accessible than palliative care.

2. This bill has no waiting period to obtain lethal drugs; no other law is so rash. Immediate death does not give adequate time for appropriate discussion and interventions for vulnerable patients who make rash decisions out of fear, depression, embarrassment, subtle pressure by a tired caregiver who makes them feel like a burden, or other reversible or transient concerns. Such patients often change their minds and no longer want to hasten death.

3. Physicians may be wrong about a patient’s prognosis, and they often miss depression and compromised decision-making capacity. Patients in WA and OR have died up to 5 years beyond their original “terminal” diagnosis and receipt of lethal drugs. Neither mental health status nor capacity are required to be assessed immediately before a patient ingests lethal drugs, which could be years after initial assessment; there is no guarantee that patients are not compromised at that time.

4. Lethal drugs are not a proportionate means of achieving palliative care goals but devalue vulnerable patients in a way that violates the very goals palliative care aims to achieve. Assisted suicide is abandonment, not health care, and is not part of palliative medicine. Lethal cocktails are bitter-tasting, sometimes mouth-burning liquids, and patients must ice their mouths with popsicles and take anti-emetics just to get them down. Risks include nausea, vomiting, aspiration, seizures, and not dying. Palliative care can do far better.

5. Lethal drug prescriptions undermine autonomy and discriminate against the disability community. Requests for lethal drugs are not primarily for pain but because of depression and/or psychological responses to disabilities developed during terminal illness--which is itself a disability by both social security and ADA criteria. This bill grants new choices and power to doctors, not patients, allowing them to treat patients unequally, subjectively placing them into either (1) a protected group (getting standard mental health care) or (2) a marginalized group with the disability of terminal illness (who can be abandoned to lethal drugs). This discriminates against the disability community and undermines autonomy by violating equality of persons. New York does not need a two-tiered health system that devalues those with the disability of terminal illness.

6. The slippery slope is real. Patients with depression and those with non-terminal diagnoses of anorexia, hernia, arthritis, and “medical complications” have received lethal drugs. Hundreds of doctors’ and patients’ consent forms are missing in Washington and Colorado.

a. In 2023, Oregonian Cody Sontag decided to avoid advanced dementia by killing herself via voluntarily stopping eating and drinking (called VSED). An Oregon doctor declared her “terminally ill” due to dehydration from VSED. He waived the waiting period, prescribed lethal drugs immediately, and Cody died from them.(3) Dehydration is not “incurable” or “irreversible,” as legally required. How many others with non-terminal diagnoses have used VSED to access lethal drugs? No one—least of all physicians whom the vulnerable must be able to trust—should be granted god-like powers to decide which disabilities make life worthless, prey on those who lack capacity, and assist with termination of those so judged.

7. There is no mechanism to enforce the law or detect abuse, which is perhaps why no sanctions have been reported. The design of this bill, like other assisted suicide laws, is a set-up for undetected elder abuse, coercion, or murder, given neither capacity re-evaluation nor the presence a neutral party are required when patients ingest lethal drugs (sometimes weeks, months, or years after initial evaluation).

8. Doctors often devalue those with disabilities. Protect the medical profession from acting on that bias by not granting them power to assist the suicides of patients disabled by terminal illness—especially a bill that has no more oversight than Oregon, where physicians are not disciplined for ending the lives of those with non-terminal illness (like Cody).

9. Protect the medical profession from distrust, both between patients and their doctors and among doctors. Patients in the northwest who are opposed to assisted suicide now have legitimate fears that doctors might overlook depression or compromised capacity, devalue them, and prescribe lethal drugs if they request hastened death while depressed or in a moment of vulnerable weakness. A death request is often a plea for help, and people often change their minds about hastening death with time, treatment, and support. Dr. Bentz lost trust in colleagues after referring a patient to an oncologist who, over Dr. Bentz’ objections, gave lethal drugs to his patient instead of treating his depression.

10. This bill contains potential conscience violations for physicians and health care employers:

a. Requires falsifying the death certificate, naming the underlying disease as the cause, rather than the actual cause of death—lethal drugs (p. 12, lines 12-14)

b. It is unclear whether an objecting health care employer can prohibit physician employees from providing information about lethal drug provision or referring patients for them, or whether objecting physicians could be forced to inform or refer for this process, both of which would violate their conscience for participation in an unethical practice that is not medical care.

11. Finally, participants do not need to be New York residents, which may allow persons out-of-state (or country) to obtain lethal drugs. These patients may not receive adequate evaluation, especially of capacity and lack of coercion, by New York physicians who may not know them well. Non-residents would be pressured to take the lethal drugs immediately in New York to avoid legal complications from ingestion in their home state/country, when many patients hold on to the drugs for weeks, months, and even years, and some never take them. New York may become an international assisted suicide tourism destination.

Please veto A 136. I am happy to answer any questions you may have.

Sincerely,
Sharon Quick, MD, MA (Bioethics)
President, Physicians for Compassionate Care Education Foundation (PCCEF)

P.O. Box 7122 Bonney Lake WA 98491 Tel: 253-501-7011 or info@pccef.org, www.pccef.org

1. CAPC. Palliative Care in New York. 2025. (Link)
2. Chambers B. How to Increase Awareness and Reduce Gaps in Palliative Care for MinoritiesJuly 9, 2020. (Link) (accessed 9-22-2024).
3. Pope TM, Brodoff L. Medical aid in dying to avoid late-stage dementia. Journal of the American Geriatrics Society 2024: 1-7. (Link).

The legalization of assisted suicide is not “inevitable.”

Meghan Schrader

By Meghan Schrader

Meghan is an instructor at E4 - University of Texas (Austin) and an EPC-USA board member.

Unfortunately, New York’s senate has voted to legalize assisted suicide, and the bill now goes to the governor’s desk. In order to ask the governor to veto the legislation, contact her. If you live in New York and can get to the capital building, please consider paying the governor’s office a visit to explain why assisted suicide will exacerbate the world’s pattern of systemic ableism.

With regard to that pattern, it’s not shocking that New York legislators would ignore the disabled community’s opposition to this policy. Despite New York’s protestations of progressivism, the state has not been particularly kind to its disabled community: the governor calling home care services a “racket,” the governor giving a speech in which the only time she mentioned disabled people was to promote increased institutionalization to stop gun violence, Andrew Cuomo allowing Covid 19 to run rampant through nursing home facilities, New York candidate Andrew Yang suggesting institutionalizing people with psychiatric disabilities so they do no harm property values, and the subway system being largely inaccessible to disabled people. In 2021 the director of New York’s ACLU delusionally said that her organization had been advocating for disabled people “for decades,” even though NYCLU’s webpage of disability rights commentary goes back only to 2020; three of the commentaries being about how wonderful “MAiD” is for the disabled community. NYCLU apparently does not care about the input from disability rights groups that really have been advocating for disability rights for decades; the national ACLU did not create a disability rights division until 2012, ninety two years after the organization was founded. So, if you are a disabled New Yorker who gets institutionalized, or your disability can become terminal without the correct support and people around you pressure you to die by assisted suicide don’t worry, the ACLU will be there for you in nine decades.

But if New York’s governor does sign its assisted suicide bill, I don’t see why New York has to doom the rest of the country. I think some opponents are likely feeling demoralized by the fear that assisted suicide being legalized in New York means it will inevitably be legalized throughout the country. If we give up and let the proponents just march in wherever they feel like it, sure, but there’s no reason why we have to do that.

It is sad that the proponents may achieve a victory in New York, but there would still be 38 states that have not legalized assisted suicide. Despite the movement of SB138 in New York, the anti assisted suicide movement still has important tools at its disposal. There is still the United Spinal lawsuit in California, and I think we have a good chance at succeeding if we can get SCOTUS to take the case.

The American Association of Suicidology’s 2023 “retirement” of its 2017 “MAiD is not suicide” statement is a huge win for us. The American Medical Association’s reaffirmation of its opposition to assisted suicide is another significant victory.

So, don’t throw in the towel. The legalization of assisted suicide is not “inevitable.” Re-double the time you spend on the issue. Look for ways in which such policies can be corrected. And this is one of the most important things I can reiterate: make sure members of the anti assisted suicide movement are working together to ensure disabled people everywhere have the support we need to flourish: a strong social support system, excellent mental health services, a good education, accessible employment, etc. These things provide a bulwark against the ableist degradation that leads to suicide, both assisted an unassisted.

Two personal stories regarding MAID

The following true story was sent to our EPC "Story Contest", from a reader who wishes to remain anonymous. We will refer to her only as Barbara.

Please visit our "contributor info" (Link). "recent stories" (Link). and "story index" (Link). 

We would be thrilled to receive your own story at: story@epcc.ca

All written formats are welcome, especially short video's.

Two personal stories regarding MAID (euthanasia)

I am sharing a recent experience my husband had in a hospital in Alberta. It is not to point a finger at the doctor treating him because he respects and admires her. It is instead to put a spotlight on what the official government narrative is regarding MAiD, how it is supposed to be administered, and what is in reality happening to vulnerable individuals who seek treatment at a hospital. (Not all individuals, but enough to raise an alarm.) 

On Wednesday, May 7, 2025, he was admitted to the hospital with a suspected pulmonary embolism. It was diagnosed and he was receiving treatment (blood thinners and morphine). On Saturday, his doctor came into his room (I was not with him at the time) and said to him, “I am embarrassed to ask you this question, but I am required by federal mandate to ask people over the age of 65: Do you want to end this?” (He’s 67) with MGUS, a pre-cancerous condition. He immediately replied that he did not, and she said that she wouldn’t have accepted his answer anyway. He called me surprised and shocked and relayed his experience to me. 

I would have thought that perhaps he was confused because of the morphine, if it were not for an experience a dear friend of mine had three years ago when she was dealing with Stage 4 breast cancer. She fainted while she and her husband were out and he rushed her to the hospital in Calgary. When she awoke, she was in a hospital bed. Confused, she asked the nurse where she was. The nurse explained that she was in the hospital awaiting MAID. She asked what that was and when it was explained to her, she was outraged. She said she would never, ever request such a thing. When she chastised her husband for letting her be in that position, he was chagrined and said that when they brought her in, they asked her if she wanted it and she had agreed.

Both of these experiences suggest that MAID is being raised not in response to the patient’s request, but rather based on age or the medical team’s assessment of quality of life. This is frightening. 

I believe that these two stories are not isolated. I fear many other seniors and vulnerable patients are being approached in similar ways and may not have the ability or presence of mind to respond confidently or resist. It makes me wonder if a hospitalized person needs the 24 hour presence of an advocate to prevent them from being pressured to take MAiD. The narrative seems to have gone from a terminal person asking for MAiD to doctors asking if the person wants MAiD when they are in a vulnerable position. My prediction is that it will soon shift to pressure on people to do the right thing by ending their suffering. (Similar to Trudeau asking retired people to give up their homes for younger people).

I share these testimonies with you in hopes that your organization can bring further attention to this disturbing trend and advocate for:

• Transparency in how MAID is being introduced in hospital settings,
• Clear, age-neutral policies regarding end-of-life conversations,
• Stronger safeguards against miscommunication, pressure, or consent violations
  

I am grateful that there are organizations like yours who advocate for the vulnerable sector among us.

Barbara

Healing Retreats: For those grieving a loss to euthanasia (MAiD).

You're Invited to Healing Retreats for Those Grieving a Loss to Euthanasia

"People were healing, and we could feel it. So thankful..." — Retreat participant

Have you lost someone you love to euthanasia (MAiD)?

We invite you to a gentle, supportive space for healing and reflection. Our upcoming retreats offer a time to gather with others who share this unique and often deeply personal grief. Together, we will engage in guided sharing, a pastoral talk, a memorial service, and a shared meal.

Two retreat dates and locations are available in 2025: Sunday, July 27 | 2:00 – 7:30 p.m.
St. Mary of Egypt Refuge
206 Barry Rd, Madoc, Ontario

Wednesday, November 19 | Evening
St. John the Compassionate Mission
155 Broadview Ave, Toronto, ON

Registration is done through St. Mary’s Refuge. A brief form will ask for some background information to help us ensure this retreat is right for you and to better support your healing. Please feel free to share only what you are comfortable disclosing. All responses are confidential.

We are here to walk with you, at your own pace, toward healing and hope.

Register: http://www.compassionatecommunitycare.org/euthanasia-healing-retreats

Warmly,

Compassionate Community Care

Euthanasia Prevention Coalition

The moral cowardice of Compassion & Choices.

Meghan Schrader

By Meghan Schrader

Meghan is an instructor at E4 - University of Texas (Austin) and an EPC-USA board member.

Before getting to the main point of this post, I want to acknowledge the tragic passing of my colleague and friend Stephen Mendelsohn, who died instantly when he was struck by a car on June 1st. In my time with Stephen, I enjoyed hearing about his devout Jewish faith and his references to concepts like “tikkun olam,” or “repairing the world.” In addition to being a kind and honorable person, Stephen was the EPC-USA's primary researcher who kept us apprised of the assisted suicide movement’s activities across the country. The anti assisted suicide and disability rights movements are much poorer without him. I’m sorry, Stephen. May you rest in eternal peace.

Stephen Mendelsohn

One of the things I liked most about interacting with Stephen was that as a fellow autistic person, Stephen had a similarly blunt way of communicating his thoughts. It was a refreshing opportunity for camaraderie. In honor of Stephen, I won’t mince words when I talk about the ableist moral cowardice expressed in “A Patient-Directed Approach: How the U.S. Model of Medical Aid in Dying Balances Compassion with Safeguards” by upper middle class, able-bodied Compassion and Choice’s leaders Kevin Diaz and Bernadette Nunley. In the piece contrasting Canada’s “MAiD” program with their policy goals, they assert:

“This commentary does not dispute nor confirm the facts or interpretations of Canadian law referenced in the article. Instead, it highlights key aspects of the U.S. legal framework, exploring its effectiveness and the principles that distinguish it from the Canadian model. Any comparisons are intended for context and insight, not to assert superiority or to question the legitimacy of the Canadian approach.”

Ie, “Hey, everyone, murdering disabled people is a matter that we should all agree to disagree about!”

I’m sorry, no deal. I’m all for not making prejudiced judgments about, say, people who need to use EBT benefits or who immigrated from a different country, but forcing disabled people of all backgrounds to live in an environment where the government, medical system, media and members of the general populace function as death pushers is not the same thing.

The moral relativity expressed in the aforementioned essay reflects and reinforces the same callousness demonstrated by Canadian Senator Stan Kutcher during Canada’s “Track 2 MAiD” hearings, when he snidely dismissed Canadian disability rights advocates’s attempts to save disabled people’s lives as “moral panic.”

Well, suggesting “MAiD” to someone who has called a suicide hotline, as my friend “Amy” experienced, is a crime against humanity. It’s evil to subject members of a marginalized group to horrible oppression and then take that to the lowest common denominator by offering them to “choice” to be killed.

When I was helping “Amy,” I sent Amy a box of things that had helped me when I was depressed. When I mailed the box, I had the sense that I was sending humanitarian aid to someone being persecuted by a government, because I totally was.

The ethical equivocation in Diaz and Nunley’s paper is nice for them, I’m sure, as they sip cocktails at their organization’s posh lobby events. But, that kind of ethical cowardice is not nice for the disabled community.

The expedient moral relativism expressed by C&C’s leaders about Canada's Track 2 MAiD is an extreme consequence of the world’s pattern of neutrality towards systemic ableism. It’s because of this longstanding apathy towards disability justice that people support incentivizing disabled people to die by suicide in the first place. If a society routinely persecutes and dehumanizes a marginalized group, then it becomes easier for members of that society to tolerate killing members of that group.

Compassion and Choices’ leadership apparently does not comprehend how predatory it is for a person who is functionally an Angel of Death serial killer to look into the eyes of a viciously subjugated person and suggest that they let themselves be killed. And that does not reflect well on the organization’s agenda.