Executive Director, Euthanasia Prevention Coalition
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| Alexander Raikin |
The question that Raikin answers concerns the impact of euthanasia on the lives of Canadians with disabilities. The lower court and the Supreme Court of Canada (Carter decision) insisted that legalizing euthanasia would not create a greater risk for people with disabilities. Raikin writes:
In contrast to the insistence of the courts, Raikin explains how legalizing euthanasia has disproportionately affected people with disabilities. Raikin writes:In 2012, Justice Lynn Smith of the British Columbia Supreme Court concluded in Carter v Canada (Attorney General) that an appropriately safeguarded physician-assisted dying program could be adopted in Canada without creating a “heightened risk” or an “inordinate” impact on vulnerable groups, such as persons with disabilities. On appeal, in 2015, the Supreme Court of Canada affirmed Justice Smith’s reasoning, based on the trial judge’s review of evidence from international jurisdictions with assisted dying programs. The Supreme Court upheld the trial judge’s ruling, which struck down the prohibitions against assisted suicide and euthanasia in the Criminal Code, resulting in the decriminalization of assisted dying in Canada.A few years after legalizing euthanasia (Bill C-14) the Truchon decision came down from Justice Baudoin, (Quebec Superior Court) extended euthanasia to people who are not terminally ill based on the Supreme Court Carter decision that assured Canadians that euthanasia would not disproportionately affect people with disabilities.
The national and provincial MAiD data support the findings from chart reviews of MAiD deaths, which is that those who died from MAiD were more likely to have been living with a disability than those who did not die from MAiD, even though both groups had similar medical conditions and experienced diminished capability. In other words, the evidence indicates that MAiD is increasingly driven by disability status, rather than by underlying illness.
Raikin explains the data:
Health Canada’s data demonstrate that people with physical disabilities are overrepresented in MAiD deaths when compared to the expectations established in Carter. From 2019 to 2023, 42 percent of all MAiD deaths involved people who required disability services, including over 1,017 people who required but did not receive these services. During this period, the type of person who was most likely to die from MAiD was one who required disability supports or who had an unknown disability status. Moreover, nationwide in some years, and in Ontario in 2023 (the only data point in Ontario), people with disabilities were the most likely type of person to die from MAiD.The Health Canada report of 2023 indicates that, of those persons with disabilities who did not receive disability supports before their MAiD deaths, in five cases care was not accessible, in 158 cases care was accessible, and in 259 cases it was unknown if care was accessible. These data confirm that MAiD providers in Canada have indeed euthanized disabled patients who needed disability supports and were unable to access them. The data also show that a large number of MAiD deaths occurred even when the provider did not know if disability supports were available, despite the legal requirement to inform MAiD applicants of available disability support services. The adequacy of these disability supports is not assessed, however, in any of these metrics, and therefore these data should be understood as highly limited and partial in regards to gauging access to disability supports.
There is more information in Raikin's research study (Link).
Another question that Raikin investigates is euthanasia for people with mental illness. Euthanasia solely based on mental illness or for non-terminal conditions was already happening before Bill C-7 was passed in March 2021. Raikin explains:
Evidence of overrepresentation of depression in MAiD cases comes from a retrospective chart review of all MAiD requests at a single tertiary care centre in Toronto between June 2016 and April 2019. The review found “high rates of psychiatric comorbidity among requesters of medical assistance in dying,” though unlike in the Ganzini study, most of these requests ended in MAiD. Of the 155 patients requesting, sixty (39 percent) had a documented psychiatric comorbidity (most commonly depression); 117 patients in total received MAiD. Moreover, these sixty patients had a statistically indistinguishable rate of eligibility compared to patients without a psychiatric illness (p=0.363). Compared to the Ganzini findings, patients with a psychiatric comorbidity were much more likely to have requested MAiD than those without a psychiatric comorbidity.
Euthanasia for people who are not terminally ill increased after Bill C-7, which extended euthanasia to people who are not terminally ill, increased. Raikin explains:
As Canada left behind the initial safeguards that restricted MAiD to those who were terminally ill, the number of MAiD deaths of non-terminally ill persons began moving steeply upward. The 2021 expansion to non-terminally ill and disabled persons led to 223 MAiD deaths for non-terminally ill persons in 2021, 463 deaths in 2022, and 622 deaths in 2023. In 2027, Canada will expand MAiD to permit access by reason of mental illness alone, portending further increase in the numbers of non-terminally ill persons seeking state-administered death.
While the true number of socially vulnerable persons choosing to die through MAiD in Canada is unknowable without a rigorous review process, the current data paint a dismal image (figure 4). The expectation that most patients who feel themselves a burden to others would be prevented from accessing MAiD did not materialize in Canada—and even the initial optimistic data from Oregon (on which Carter was based) have degraded over time.
According to MAiD providers in 2023, the suffering of almost half their MAiD recipients included the perception of being a burden on others, 10 percent more than the previous year. Because of the nature of the reporting mechanism, we do not know whether this suffering primarily drove the request or was but one contributing factor. Yet federal data reveal that, according to MAiD providers, more than 38 percent of their patients who received MAiD from 2019 to 2023 voiced concerns that they felt like a burden. Such data imply that Canadian physicians are not reluctant to provide MAiD for suffering that includes social vulnerability.
The concern around euthanasia for loneliness is important. Raikin reports that 22% of all euthanasia deaths in 2023 were related to loneliness:
In 2023, however, MAiD providers reported to Health Canada that 22 percent of their patients chose death because of “isolation and loneliness,” up by 5 percent over the previous year. This is a marked increase, but despite the public nature of these data, it does not appear to elicit concern from Health Canada or other government entities.
These data suggest that not only do MAiD providers know that their patients perceive themselves to be a burden or socially isolated but that these same providers may believe these factors are not an obstacle for MAiD access and are potentially even qualifying reasons for MAiD. Notably, clinicians in charge of Vancouver Coastal Health’s assisted-dying team have told patients with chronic pain conditions that choosing to die from MAiD because of feeling like a burden to loved ones can be considered an “expression of love.” While social isolation is not a medical reason for requesting MAiD, the data indicate that it is an important factor within MAiD requests.
Euthanasia for people who cannot consent is legal, happening and increasing. Raikin explains:
Canada has already expanded MAiD to include patients unable to consent to MAiD at the time of their death, through the 2021 provision for a waiver of final consent. In Quebec, the provincial government has now gone much further, having sent an order barring prosecutors from launching criminal investigations into physicians who violate the criminal law by administering euthanasia to patients who have made an advance request for MAiD. The “slippery slope” warning that was rejected in Carter has proved prescient.
Health Canada’s annual reports also show that MAiD deaths of persons with dementia have increased dramatically in Canada. The number of MAiD deaths with a neurological condition as a qualifying factor has more than tripled in number from 2019 to 2023, and increased from 10.4 percent to 14.9 percent of all MAiD deaths.96 In 2022, dementia deaths were 9 percent of neurological MAiD deaths or 150 cases. In 2023, the number of MAiD deaths of persons with dementia increased to 241, which included 106 deaths in which dementia was the sole underlying condition.
Raikin's study to proves that outcome of legalizing euthanasia contrasts greatly with the position of the Supreme Court of Canada (Carter decision) and the lower court decision by Justice Lynn Smith. This is an important study because it begins to create the evidence that will be necessary for overturning Carter but it also undermines the acceptance of Carter in other jurisdictions.
Raikin concludes:
The data are clear: Since MAiD eligibility has become increasingly broad in Canada, it has increasingly and disproportionately affected Canadians with disabilities.
This report compared MAiD’s impact on people living with disabilities with the findings made by Justice Smith in Carter and upheld by the Supreme Court. Further analysis of the disproportionate impact of MAiD on seniors, the poor, and other vulnerable groups also warrants attention, but is beyond the scope of this report.
This report’s findings are contrary to the assumptions by Canadian courts and the claims frequently made by cabinet ministers and Parliament. It corroborates, instead, concerns shared previously and repeatedly by disability activists and groups, including testimony ultimately rejected by the Supreme Court in Carter.
The death of disabled persons is not a rare or incidental effect of Canada’s legalized euthanasia program; instead, disability is a remarkably common characteristic among those who access MAiD. The average natural life expectancy of MAiD patients belies the claim that assisted suicide is restricted to those whose death is “imminent,” and MAiD’s reach is not limited to those who are terminally ill. Those seeking MAiD do not encounter a consistently “rigorous standard of scrutiny” that prevents most requests from ending in death. Specialist screenings for depression do not appear to have materialized, even at the very start of the MAiD program. Persons with neurological conditions are seeking death in high numbers compared to the expectations established in Carter. And the socially isolated, far from being protected, are instead being approved for MAiD at high—and increasing—rates.
Previous articles concerning research by Alexander Raikin (Articles Link).
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