Québec’s five-year Euthanasia Report (2018-2023) on the situation in end-of-life care.

Amy Hasbrouck

By Amy Hasbrouck
Director: Toujours Vivant - Not Dead Yet,

In April of 2019, Québec’s Commission on end-of-life care (or CSFV for Commission sur les soins de fin de vie) released a report (French only) on the situation of end-of-life care in the province from December, 2015 through March, 2018, which summarized the first two plus years of palliative care, Continuous Palliative Sedation (CPS) and euthanasia. 

You can find my analysis of that report on EPC’s Blog or the website of Toujours Vivant-Not Dead Yet. At the time, I identified several problems with “Palliative and end-of-life care” (PELC) as imagined, organized and provided in Québec. These include:

• People stuck in institutions are requesting and receiving euthanasia, but there’s not enough information to know how many.
• There’s not enough information (I’m detecting a theme here) to know how doctors determine whether a person has capacity to choose euthanasia, or whether the request is voluntary. 
• What information (apart from the person’s or their family’s assurances) do doctors use to determine capacity and voluntariness; 
• Do doctors consider the impact of psychological, social, economic and discrimination-related barriers when determining capacity and voluntariness of the request?
  

• Early identification and referral for palliative care is inadequate. There is not enough data to know how many people who need palliative care aren’t getting it.
• The data are inadequate to establish the timeliness and quality of palliative care services provided, and whether they meet the needs of the person and their loved ones. 
• There is not enough information to explain the wide variation in the number of euthanasia and continuous palliative sedation (CPS) between doctors, hospitals and regions. 
• Six percent of people who received CPS did not have signed consent forms in their files. 
• Six percent of people who received CPS were not getting palliative care; this information is missing on another 11% of those who had CPS. 
• Four percent (66 of 1,498) euthanasia did not conform to the law, either because the person was ineligible, or safeguards were flouted. 
• The medical model adopted by Québec for assisted death is reflected in the location where CPS and euthanasia are administered. Less than 3% of CPS were administered at home, while about 20% of euthanasia were provided in the person’s home. Most occurred in hospitals. 
• The numbers didn’t come out right (discrepancies continue).

On February 24, 2025, Québec’s CSFV released a five-year report, covering the period from April 1, 2018 through March 31, 2023. The report runs 127 pages, not including 30 pages of appendices (featuring statistics describing who did what to whom, when, where, why, and for how long). Suffice it to say that all of the problems I noted in the 2018 report are still featured in the 2023 report (including the numbers not coming out right). This is a lot of information to get through, so I’m going to break it up into shorter, topic-oriented chunks for easier mental digestion. This post will deal with the palliative care findings. I would also recommend a similar article from Vivre dans la dignité/Living with Dignity. All translations are mine in collaboration with Google.

Subsequent articles will focus on Continuous Palliative Sedation, euthanasia, the activities of the Commission, and issues affecting the future of euthanasia in Québec.

Palliative Care

In the 2018 Summary report we identified several problems relating to palliative care. We noted in our webcast that “[t]he Commission admits it doesn’t have data to prove that the gaps in palliative care services observed in a study published in 2000 still exist, but they’re pretty sure that’s the case.” Five years, and multiple plans, studies and consultations later, the Commission still lacks crucial information. The report shows:

• how many people receive palliative and end-of-life care each year
• how many people were getting palliative care when they requested and received euthanasia and CPS, 
• The percentage of people receiving palliative and end-of-life care in various settings.
  

The 2023 report does not show:

• What palliative care services are provided,
• The duration and quality of the services, 
• If the services met the needs of the people receiving them, their families and carers;
  

• How long was the delay between the request for services and when they are provided?
• How many people are eligible for, but did not receive palliative care? 
• What related services (e.g. income supports, housing assistance, self-directed personal assistance or home modifications for accessibility) could decrease the need/demand for euthanasia?

The discussion of palliative care on page 8 of the report shows the continuing ambivalence about who palliative care is meant for. Québec’s statute, health and social service system usually refer to “palliative and end-of-life care” (PELC) together, («soins palliatifs et de fin de vie» or SPFV) rather than palliative care alone. In so doing, Québec expresses a policy-level preference for limiting access to palliative care to people who are dying, thereby ignoring the needs of people with non-terminal disabilities and chronic conditions who could benefit from pain management and other services. Though the five-year report does pay lip service to expanding access to palliative care to people with “chronic illness with a limited prognosis.” Section 3.3 of the report (on pages 13-14) mentions an estimated 40,000 people who might not be getting the PELC they need). It’s not clear whether this group includes people who need pain management or other supports, but whose conditions are not likely to cause death, i.e. disabled people.

The association between palliative care and death may be a factor in a decrease in the number of people receiving palliative care since the 2015-2018 report. On page 44 of the 2018-2023 report, the Commission notes that: “Nearly 68% of people who asked for MAiD were receiving palliative care when they made the request, and 82% received it between the request and administration of MAiD.” This represents a DECREASE from the earlier study, where 80% of those asking to die were receiving palliative care when they made the request, and 89% were getting it when they were euthanized. The reason for the decrease is unclear.

The Québec statute’s end-of-life eligibility requirement was struck down in the Truchon court decision in 2019, yet the expansion of access to death has not been accompanied by greater access to services people need to live. As long as “Palliative and end-of-life care” forces a connection between “life-ending” and pain relief for people with disabilities and chronic conditions, the scope of the services offered will be inadequate to prevent disabled people from being forced to “choose” death.

Problems with inadequate data as to availability and quality of services that were identified in the first summary report (2015-2018) persisted in the new report, due in part to:

• Lack of standardization in codes for palliative care services between facilities (p. 12)
• People who were eligible for, and needed palliative care, but did not receive it, are not counted.
• People who were eligible for, and needed palliative care, received delayed referrals.

“Some experts … expressed concern that difficulties in accessing PELC could prompt some people to request MAiD to relieve suffering that could have been alleviated with [palliative and end of life care]” (p. 13).

Also on page 13, the report points to problems related to palliative care training

• “It appears that providers and care teams working in different care settings are not sufficiently trained to provide quality basic palliative care or to identify early people who could benefit from it.
• “The basic concepts of palliative care taught in professional curricula and continuing education offered in palliative care are insufficient. 
• “The shortage of qualified workers weakens and compromises the provision of quality palliative care and the maintenance of skills in PELC. 
• Psychosocial resources are also insufficient to meet the needs of people and their loved ones for support, assistance and respite. 
• There are no management indicators or standardized tools to assess 
• the quality of care and services in PELC, 
• the response to the needs of people and their loved ones, and 
• to examine the efficiency of the system.

Palliative care provision moved away from the home and toward hospitals, peaking at 38.6% in 2019. Despite the spike in home care during the pandemic (up to 44%, see figure 3.4 on p. 11) there was also an increase in palliative care in nursing homes at that time. Before the pandemic, home-based care was at or below 40%. The remainder was provided in nursing homes and hospice.

Palliative Care

• The Commission doesn’t have the data necessary to say:
• how many people that need palliative care aren’t getting it, or 
• the duration, quality, or suitability of the care.
  

• The report focuses on palliative care as an option only for people at the end of life.
• There’s no discussion of other kinds of support than palliative care to prevent requests for euthanasia; 
• how many people who need SDPA services to live at home aren’t getting them, or 
• For those who are getting in-home supports, the duration, quality, or appropriateness of palliative care.
  

Problems with voluntariness & consent for euthanasia

• We don’t know how doctors decide if a person is subject to abuse, coercion or other “external pressure” to request euthanasia,
• whether psycho-social, economic and discrimination-related factors are taken into account, 
• No information about assessment for coercion and abuse
  

• No information about doctors’ disability bias.

Palliative care

• Setting where palliative care was provided

2015-2018 - Home 47%, Hospital 31%, Nursing home 13%, Hospice 9%
2018-2023 - Home 42%, Hospital 37%, Nursing home 13%, Hospice 9%

Highlights of 2018-2023 report

• Overall
• Doesn’t give the totals of CPS or MAiD since the program began
  

• Obvious findings:
• The number of euthanasia and CPS are increasing. 
• Some doctors, hospitals, and regions provide more palliative care, CPS, and euthanasia than others. 
• Most of the people who die by euthanasia and CPS are over 60 years old and have cancer.
  

Palliative Care

• Use of SPFV Highlights the forced connection between “life-ending” and pain relief for chronic conditions.
• There are three types of people who could benefit from palliative care 
• People with terminal illness who die 
• People with chronic illness and disabilities who die (40,000) 
• People with chronic illnesses and disabilities who don’t die
  

• Only refers to palliative care at the end of life (SPFV p. 8)
• People with “life-threatening” prognoses (doesn’t count disabled) 
• “Relieve suffering without hastening or delaying death” p. 8
  

• Doesn’t talk about management of chronic pain.

Palliative care

• Disability supports, such as SDPA and access modifications, are not thoroughly discussed.
• Same problems with inadequate data as to availability and quality of services, 
• Problems caused by:
  
• Lack of standardization in codes for palliative care services between facilities (p. 12) 
• People who were eligible for, and needed palliative care, but did not receive it, are not counted. 
• People who were eligible for, and needed palliative care, received delayed referrals. 
• “Some experts and respondents to the questionnaire expressed concern that difficulties in accessing SPFV could prompt some people to request MAiD to relieve suffering that could have been alleviated with SPFV.” (P. 13)
• Especially for people who don’t have cancer.
  

• despite various studies and plans.
• The 2015-2020 Development Plan for Palliative and End-of-Life Care.
  
• The guidelines defined in the report of the national working group for equitable access to quality palliative and end-of-life care.
  
• The priorities and strategic measures presented in the 2020-2025 Action Plan For equitable access to quality palliative and end-of-life care. 
• Spring, 2023 consultation with 15 providers and experts in palliative care.
  

• Access to quality palliative care necessarily requires adequate training of providers. (p. 13)
• It appears that providers and care teams working in different care settings are not sufficiently trained to provide quality basic palliative care or to identify early people who could benefit from it. 
• It appears that providers and care teams working in different care settings are not sufficiently trained to provide quality basic palliative care or to promptly identify people who could benefit from it. 
• The basic concepts of palliative care taught in professional curricula and continuing education offered in palliative care are insufficient. 
• The shortage of qualified workers weakens and compromises the provision of quality palliative care and the maintenance of skills in SPFV. 
• Psycho-social resources are also insufficient to meet the needs for support, assistance and respite of individuals and their loved ones. 
• There are no indicators or standardized tools for assessing: 
• the quality of care and services provided, 
• the satisfaction of those receiving care and their loved ones, and 
• to provide an overview of the efficiency of the system.
  

• Public awareness about palliative care is inadequate
• “The vast majority of Quebecers will be supported at the end of their lives and will receive palliative care. Approximately 3% of them will receive a CPS and 7% MAID as end-of-life care.” For a total of nearly 10% (P. 8)

2015-2018 - Home 47%, Hospital 31%, Nursing home 13%, Hospice 9%

2018-2023 - Home 42%, Hospital 37%, Nursing home 13%, Hospice 9%

• Note decrease in home-based services, increase in hospital-provided services
• Despite home-care spike during the pandemic (fig. 3.4, p. 11) 
• In 2018 and 2019, home-based care was at or below 40%
  

Continuous Palliative Sedation (CPS)

• Of people who received CPS,
• 83% were receiving palliative care 
• 6% were not receiving palliative care 
• In 11% of cases, there was no information about whether they were getting palliative care.
  

• Rate of CPS increased from 1.8% in 2018-9 to 2.5% in 2022-3
• As a proportion of deaths in the province 
• 2015-2018 – low of .89% high of 1.37% 
• 2018-2023 – low of 1.8% high of 2.6%
  

• Consent forms properly filled out
• 94% 2015-2018, 95% 2019-2023. 
• Clarifications (but no numbers) were provided regarding certain cases in which the consent form was not signed, including: 
• the form was attached to the person’s file but was not signed; 
• the form was not attached to the file or to the documents sent to the CMDP, so it is not known whether it was signed; 
• verbal consent from the person or family replaced written consent; 
• for a person unable to consent to care, the form was not signed because the person’s representative was absent, due to special situations, such as the pandemic context.
  

• Psychological / existential distress = 58%;
• Physical pain = 28%; 
• Difficulty breathing = 25%; 
• Delirium and agitation = 20%.

Settings where CPS was administered

2015 - 2018 Home 4%, Hospital 58%, Nursing home 10%, Hospice 27%, Unspecified 1%.

2018 - 2023 Home 3.6%, Hospital 58.9%, Nursing home 9.2%, Hospice 28.3%, Unspecified --

Symptoms that justified CPS than about the kind of suffering that lead to requests for euthanasia:

Psychological or existential distress    2015-18 - 54%, 2019-23 - 59.4%

Intractable, intolerable pain                 2015-18 - 28%, 2019-23 - 32.9%

Progressive, uncontrollable dyspnea  2015-18 - 25%, 2019-23 - 25.5%

Agitated delirium                                    2015-18 - 20%, 2019-23 - 20.5%

Repeated respiratory distress               2015-18 - 16%, 2019-23 - 13.2%

Intractable nausea and vomiting        2015-18 - N/A, 2019-23 - 7.4%

Convulsions                                            2015 - 18 - N/A, 2019-23 - 1.5%

Uncontrolled hemorrage/bleeding    2015-18 - N/A, 2019-23 - 1.5%

Other (includes cachexia, dysphagia, fatigue/frailty)

                                                                   2015-18 - N/A, 2019-23 - 17.9%

Provided consent via approved form 2015-18 - 94%, 2019-23 - 95%

• A minority of CPS and euthanasia were administered in the person’s home.
• Less than 3% of CPS 
• about 20% of euthanasia were provided in the person’s home.
  

MAiD administered

• Total administered 2018 report = 1,632
• Total administered 2023 report = 14,417
• Total of both reports (2015-2023) = 16,049
  

• Four percent (66 of 1,498) euthanasia did not conform to the law
• 11 people were not eligible 
• In 55 cases, doctors failed to comply with safeguards.
  

MAiD not administered

• The data as transmitted by the institutions to the Commission do not allow us to know what is the situation regarding real access to palliative care in the network and the quality of care offered, in particular to know whether needs are actually met and what are the obstacles to accessing quality palliative care in a timely manner. 
• In order to partially fill this information gap, in spring 2023, the Commission consulted organizations and experts involved in the organization and delivery of SPFVs. The analysis of the consultations made it possible to identify a certain number of elements which, beyond the figures, provide a better idea of ​​the current situation of SPFVs and the issues associated with them. These findings were endorsed by the Commission.

- Timely access is still a major issue. Delays and inequity of access exist throughout Quebec. 

- Better access with a view to continuity of care requires better coordination of care and services offered in a given territory, particularly between institutions, palliative care homes, private clinics and volunteer organizations in order to ensure fluidity in the provision of palliative care and to meet the needs that may arise at various stages of the care trajectory. 

- Early screening and referral of people who could benefit from palliative care is a challenge. Indeed, many stakeholders likely to make timely referrals are not adequately trained to identify people who could benefit from palliative care, the relevance of which does not only arise at the end of life, but well before.

- Better information for the general population and health professionals, as well as a better understanding of palliative care, must be on the agenda if we want to improve the supply of palliative care services, access to this care, and its quality. 

 • In the opinion of many, there is very little reliable data on PFS and the available data is fragmentary. There is no universal coding system to accurately identify people who have benefited from PFS. Thus, drawing up an accurate overall picture is difficult. 

 • Although the INSPQ has estimated the number of people who could benefit from palliative care annually, this estimate is very fragmentary, because it does not specify the type and intensity of PFS required. More detailed studies are essential in order to plan the supply of PFS care and services that will meet the needs of Quebecers.

p. 14: “The data as transmitted by the institutions to the Commission do not allow us to know the true degree of access to palliative care in the network and the quality of care offered; in particular to know if the needs are actually met and what are the obstacles to accessing quality palliative care in a timely manner.” Or “do not make it possible to ascertain the true level of access to palliative care in the network or the quality of the care provided, in particular whether needs are effectively met and what the obstacles are to accessing timely, high-quality palliative care.”

• In order to partially fill this information gap, the Commission consulted organizations and experts involved in the organization and delivery of SPFV in the spring of 2023.” The analysis pointed to problems beyond the figures.

- Timely access is still a major issue. Delays and inequity of access exist throughout Quebec.

- Better access with a view to continuity of care requires better coordination of care and services offered in a given territory, particularly between institutions, palliative care homes, private clinics and volunteer organizations in order to ensure fluidity in the provision of palliative care and to meet the needs that may arise at various stages of the care trajectory.

- Early screening and referral of people who could benefit from palliative care is a challenge. Indeed, many stakeholders likely to make timely referrals are not adequately trained to identify people who could benefit from palliative care, the relevance of which does not only arise at the end of life, but well before.

- Better information for the general population and health professionals as well as a better understanding of palliative care must be on the agenda if we want to improve the supply of palliative care services, access to this care and its quality.

• In the opinion of many, there is very little reliable data on PFS and the available data is fragmentary. There is no universal coding system to accurately identify people who have benefited from PFS. Thus, drawing up an accurate overall picture is difficult.

• Although the INSPQ has estimated the number of people who could benefit from palliative care annually, this estimate is very fragmentary, because it does not specify the type and intensity of PFS required. More detailed studies are essential in order to plan the provision of PFS care and services that will meet the needs of Quebecers.

Palliative care before euthanasia p. 44: “Nearly 68% of those who asked for MAiD were receiving palliative care when they made the request and 82% received it between the request and administration of MAiD. These figures are lower than those reported in the Commission’s 2015-2018 triennial report (80% and 89%, respectively).” 

Previous reports by Amy Hasbrouck:

• Québec euthanasia deaths increase by 51% in 2021 - 22 Annual report. A discrepancy of 289 deaths (Link). 
• Québec 2021 Annual euthanasia report. Euthanasia deaths increase by 37%. Unreported deaths continue (Link).

Canada: 15,343 reported euthanasia deaths in 2023

Euthanasia (MAiD) in Canada increased by 15.8% --- 4.7% of all deaths in 2023

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On December 11, 2024, Canada's Ministry of Health released the Fifth Annual Report on Medical Assistance in Dying which indicates that there were 15,343 reported euthanasia deaths representing 4.7% of all deaths in 2023. 

As of December 31, 2023 there have been at least 60,301 euthanasia (MAiD) deaths in Canada since legalization.

On February 6, 2024, after obtaining the euthanasia data from Alberta, Ontario, and Québec, EPC published an article stating that there were approximately 15,300 euthanasia (MAiD) deaths in Canada in 2023.

On July 8, 2024 we published an article with links to the euthanasia data from Alberta, British Columbia, Manitoba, Nova Scotia, Ontario and Québec. We again predicted that there were about 15,300 euthanasia deaths in 2023.

Why did Canada's Ministry of Health wait until December 2024 to release the 2023 euthanasia data when the report essentially concerns numbers and data while lacking information on the actual reason for people wanting to be killed by euthanasia?

Interesting data in the report:

• Of the 15,343 reported euthanasia deaths: 95.9% were Track 1 deaths (the person was deemed to have a terminal condition); 4.1% were Track 2 deaths (the person was deemed to not having a terminal condition).
• People with disabilities accounted for 33.5% of the Track 1 euthanasia deaths and 58.3% of the Track 2 euthanasia deaths. In 2022, 27% of Canadians were people with one or more disabilities. People with disabilities are over-represented in Canada's euthanasia statistics.
• 95.8% of those who died by euthanasia were Caucasian (White) while fewer than 1% were First Nations people. In 2022, 69.8% of Canadians euthanized were Caucasian and 5% were First Nations people.

What is happening in British Columbia, Ontario and Québec?

When analyzing the 5th Annual Report we question, "What makes British Columbia, Ontario and Québec different than the rest of Canada?" In 2023, euthanasia deaths increased by 36.5% in Québec, 30.3% in Ontario, and 18% in British Columbia. When examining the data from the other seven provinces, the next highest rate of increase was Alberta with a 6.4% increase in euthanasia deaths.

Québec has the highest euthanasia rate with 5601 reported euthanasia deaths --- this represents 7.3% of all deaths and 36.5% of all Canadian euthanasia deaths. Canada's 2021 Census indicated that 23% of Canadians live in Québec.

We question the accuracy of the Québec euthanasia data. CBC Radio Canada reported on March 9, 2024 that the Québec government had reported that there were 5,686 reported euthanasia deaths in 2023, but the 5th Annual report states 5,601.

The analysis of the Québec Commission on End-of-Life Care Eighth Annual Report (April 1, 2022 - March 30, 2023) by Amy Hasbrouck indicated that there were 190 euthanasia deaths that may not have been reported by the doctor or nurse practitioner who carried out the death. 190 unreported euthanasia deaths is serious.

Euthanasia for frailty was listed as a reason in 1,392 deaths, representing more than 9% of all euthanasia deaths. In 92 euthanasia deaths, frailty was listed as the only reason.

Euthanasia for chronic pain was listed as a reason in 933 deaths, with 23 of the deaths listing chronic pain as the only reason.

Euthanasia for dementia was listed as a reason in 241 deaths, with 106 of those deaths listing dementia as the only reason.

Similar to other jurisdictions, the reason for seeking euthanasia was highly oriented to the person's social condition. 

• 96% listed "Loss of ability to engage in meaningful activities",
• 87% listed "Loss of ability to perform activities of daily living",
• 70% listed "Loss of dignity",
• 55% listed "Inadequate pain control".

It is important to note that loneliness and isolation was listed in more than 21% of all euthanasia deaths representing more than 3200 people.

People with disabilities should be concerned that more than 50% of those who died identified "loss of independence" and almost 50% listed being a perceived burden on family, friends or care givers.

People with disabilities should be concerned that "other conditions" was the highest identified condition for euthanasia. For people with disabilities, 46.2% of the Track 1 deaths were based on "other conditions" and 62.9% of the Track 2 deaths were based on "other conditions." Other conditions is not further defined and indicates a serious concern with discrimination of people with disabilities.

We recognize another concern related to the difference in income levels for Track 1 and Track 2 euthanasia deaths. People who died by Track 2 euthanasia were more likely to have a lower income than the Track 1 deaths.

More analysis of The Fifth Annual Report needs to be done.  The report includes more information than the previous years reports but it does not examine why people are asking for euthanasia nor does it uncover deaths that may be outside of the parameters of the law.

In October 2024 the Chief Coroner of Ontario released a report from the Ontario MAiD Death Review Committee reporting that between 2018 and 2023 there were euthanasia deaths driven by homelessness, fear and isolation and that poor people are at risk of coercion indicating that Canadians with disabilities are needlessly dying by euthanasia. The data from the Ontario Death Review report indicates that in the reported time period there were at least 428 non-compliant euthanasia deaths and 25% of the euthanasia providers violated the law.

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

 

The federal government needs to do a complete review of Canada's experience with euthanasia.

Has Dr Wiebe killed people who did not qualify for euthanasia?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Ellen Wiebe

The question I ask in this article is significant based on the permissive language of the Canadian euthanasia law. 

A British Columbia judge halted the euthanasia death of a woman from Alberta who was scheduled to be euthanized by Dr Ellen Wiebe on Sunday October 27, 2024. (Link to the injunction decision).

The court has a publication ban on this case. The common-law husband is referred to as A.Y. and the woman is referred to as N.B.

1. The case is based on A.Y arguing that N.B. does not qualify to be killed by euthanasia because she does not have an irremediable medical condition.

2. The case suggests that Dr Wiebe inappropriately approved the death of N.B. How many people have been approved for death in a manner that skirts the practice of the law?

3. How many people has Dr Wiebe killed by lethal poison (MAiD) who did not have an irremediable medical condition or fit the criteria of the law?

[Please read my previous article: BC Judge halts euthanasia deaths scheduled by Dr Wiebe (Link).]

This case has not been heard in court. I am quoting from the decision by Justice Simon R Coval who granted a 30-day injunction.

Question 1: Did the woman qualify to be killed by euthanasia in Canada?

A.Y.’s position is that N.B. does not meet the legal criteria for MAID because her condition is one of mental illness or disability, rather than a physical malady, and because it is not an “irremediable” medical condition but in fact one that can be treated in a relatively short period of time.

N.B. had begun to explore MAID in January or February 2024. A.Y.’s evidence is that N.B.’s own doctors in Alberta would not approve it and so she began to search online for doctors who might. She eventually learned of the defendant, Dr. Wiebe, who has a clinic in Vancouver, and she contacted Dr. Wiebe in mid-July.

A.Y. stated that N.B. is living with "akathisia" a condition associated with changing doses of psychotropic or antipsychotic medication. "Akathisia" is a treatable condition but A.Y. states that N.B. was not following the advice of the specialists. A.Y. stated that:

We ([N.B.], Anna Maclnnes and myself) scheduled a second (emergency) consultation with Dr. Horowitz on October 17, where he reiterated his view that she might recover from her akathisia. He again told her to pause her medication tapering and let her body adjust. He said her akathisia might go away in a matter of months. Probably 2 to 6 months. Then, if she followed his advice, she could finish weaning off the drugs without akathisia. Dr. Horowitz appeared surprised that akathisia would justify a MAiD procedure, and gently attempted to discourage [N.B.] from pursuing this goal by suggesting for her to wait another 6 months.

Akathisia has significant chronic side-effects including suicidal ideation, but it is not an irremediable medical condition, which is what the Canadian law requires for MAiD approval.

Question 2: What did Dr Ellen Wiebe do to approve N.B. for death by euthanasia?

N.B. had begun to explore MAID in January or February 2024. A.Y.’s evidence is that N.B.’s own doctors in Alberta would not approve it and so she began to search online for doctors who might. She eventually learned of the defendant, Dr. Wiebe, who has a clinic in Vancouver, and she contacted Dr. Wiebe in mid-July.

To A.Y.’s understanding, N.B. had at least two video calls with Dr. Wiebe in July and August and Dr. Wiebe approved her for MAID at the end of their first call. His evidence is that Dr. Wiebe did not speak directly with N.B.’s doctors, though N.B. provided her with some of her medical records. Dr. Boodhoo has advised A.Y. that his records were not requested for delivery to Dr. Wiebe.

A.Y. saw N.B.’s MAID form, which she submitted on August 30, 2024. The form stated akathisia as her reason for seeking MAID. Because she could not get anyone she knew to witness her form, a volunteer from Dr. Wiebe’s clinic did so for her. A.Y.’s evidence is that, because N.B. did not have a second doctor to provide the requisite second MAID assessment, Dr. Wiebe arranged the second assessor, Dr. Elizabeth Whynot, whom N.B. met in a video call on September 23, 2024.

In October 2024, N.B. had another online appointment with Dr. Wiebe, which A.Y. attended. A.Y.’s evidence about what was said is this:

Sometime in Oct 2024, [N.B.] had another appointment with Dr. Wiebe. I attended that meeting. As I am concerned that akathisia is not an irremediable condition, I asked Dr. Wiebe if she had ever carried out MAiD on someone with akathisia. Dr. Wiebe said that she did not. During the same Zoom session, I also attempted to describe [N.B.] as a person with unresolved mental health problems which were probably not considered during the MAID assessment. Dr. Wiebe responded by stating that diagnosis does not matter, and that only quality of life mattered, and that this was her [N.B.’s] right.

According to the A.Y. affidavit Dr Wiebe approved N.B. for euthanasia even though N.B. does not have an irremediable medical condition. Dr Wiebe was told that N.B.'s "wish to die" may be related to unresolved mental health problems. Dr Wiebe responded to the concern by stating that the:

diagnosis does not matter, and that only quality of life mattered, and that this was her [N.B.’s] right.

Question 3: How many people has Dr Wiebe killed who did not qualify for euthanasia?

I can't answer this question but a full investigation must be done. 

Dr Wiebe has been featured in several articles about Canada's euthanasia law.

Maria Cheng and Angie Wang reported for the Associated Press on October 16, 2024 that Ellen Wiebe stated:

while poverty inevitably exacerbates suffering, improved housing and social situations have never changed a patient’s mind.

“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.’”

In a research article by Alexander Raikin titled: Canada How death care pushed out health care, Raikin reports Dr Wiebe commenting in a MAiD training video in response to a hypothetical question about a person who cannot consent at the point of death but shows signs of resistance. Raikin reports:

The moderator, Ellen Wiebe, is one of Canada’s most prolific “MAID providers” and a leader in the MAID community. On request, she has hastened the deaths of at least 400 people, including some cases that other assessors believed were illegal. She offered an answer: “I’m guessing I would bring in one of their other providers, you know, palliative care or, or whatever, and get them sedated. But what would you say?”

Another article by Alexander Raikin published by The New Atlantic in December, 2022 tells how Ellen Wiebe provided euthanasia to a man who had been rejected for euthanasia in his own city. Raikin reports:

In another CAMAP seminar recording, we learn of a man who was rejected for MAID because, as assessors found, he did not have a serious illness or the “capacity to make informed decisions about his own personal health.” One assessor concluded “it is very clear that he does not qualify.” But Dying with Dignity Canada connected him with Ellen Wiebe, a prominent euthanasia provider and advocate in Vancouver. She assessed him virtually, found him eligible, and found a second assessor to agree. “And he flew all by himself to Vancouver,” she said. “I picked him up at the airport, um, brought him to my clinic and provided for him,” meaning she euthanized him.

Amy Hasbrouck reported in May 2020 on a case of a woman who decided to stop eating and drinking, and was euthanized by Dr Wiebe. Hasbrouck wrote:

In June of 2016, just as medical aid in dying (MAiD) was adopted in Canada, a British Columbia woman known as Ms. S. who had Multiple Sclerosis was evaluated for MAiD by Dr. Ellen Wiebe. According to Jocelyn Downie, Dr. Wiebe concluded that Ms. S. met most of the eligibility criteria (incurable condition, advanced state of decline in capability, and enduring and intolerable suffering) but the doctor did not believe Ms. S. would die “in the foreseeable future,” so she was determined ineligible.

Dr. Wiebe exchanged correspondence with Ms. S. in December of 2016 and January of 2017, to the effect “that the patient’s life expectancy was not short enough to qualify for medical aid in dying.” Then in mid-February of 2017, “Ms. S decided to starve herself to death at home, with the support of palliative-care nursing.”

Her husband called Dr. Wiebe two weeks later, and Dr. Wiebe visited Ms. S. on March 3. At that time, Dr. Wiebe determined that she met all eligibility criteria, and she was euthanized on March 6, 2017.

Dr Wiebe has a history of controversial euthanasia cases. She is the doctor who entered a Jewish care home to complete a euthanasia death, even though she knew that the Jewish care home had a policy of not permitting euthanasia on the premises.

The Euthanasia Prevention Coalition urges the BC College of Physicians and Surgeons to conduct a complete review of Dr Wiebe's euthanasia practice. If they are unwilling to provide the necessary oversight of the law then the RCMP must be brought in to review the questionable acts of euthanasia performed by Dr Wiebe.

Until an investigation is completed, Dr Wiebe's medical license should be temporarily suspended in order to protect her patients. It is necessary to provide effective oversight of the law and to protect people from doctors, like Ellen Wiebe, who considers "euthanasia to be the best work" she has ever done.

Quebec euthanasia deaths increase in 2023 to the highest euthanasia rate in the world.

2023: Québec had a 17% increase in euthanasia deaths. 7.3% of all deaths were euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

CBC Radio Canada published an article on March 9, 2024 stating that there was a 17% increase in Québec euthanasia deaths with 5,686 reported deaths representing 7.3% of all deaths, which is the highest rate in the world in 2023. The Radio Canada report is based on the Quebec euthanasia deaths between January 1 - December 31, 2023.

I recently wrote an article based on the analysis by Amy Hasbrouck, the leader of Toujour Vivant - Not Dead Yet concerning the inconsistent data published in the The Quebec Commission on End-of-Life Care Annual Reports.

The Quebec Commission on End-of-Life Care Eighth Annual Report indicated that there were 5211 reported euthanasia deaths (April 1, 2022 - March 31, 2023) which was up from 3663 in the previous year (April 1, 2021 - March 31, 2022).

Hasbrouck's analysis of the Eighth annual report found that there were:

• 5,211 euthanasia reported by doctors in declaration forms (§ 3.2 p. 13)
• 5,401 euthanasia reported by hospitals and institutions (table C6 p. 46) 
• 5,208 euthanasia declaration forms received by the Commission (§ 2.1, p. 6)

This means that there was a discrepancy of 190 euthanasia deaths in the Eight Annual Report. Further to that, the Seventh Annual Report had a discrepancy of 289 euthanasia deaths.

In my article I asked the question: How many Quebec euthanasia deaths actually occur?

In early February I wrote an article stating that: There were approximately 16,000 Canadian euthanasia deaths in 2023 and more than 60,000 since legalization I made my prediction based on the euthanasia data from Ontario, Quebec, Alberta and Nova Scotia.

How many Quebec euthanasia deaths actually occur?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alex Schadenberg

In early February I wrote an article stating that: There were approximately 15,300 Canadian euthanasia deaths in 2023 and more than 60,000 since legalization I made my prediction based on the euthanasia data from Ontario, Quebec, Alberta and Nova Scotia. I wrote in my February article:

The Quebec Commission on End-of-Life Care released it's Eighth Annual Report which indicated that there were 5211 reported euthanasia deaths (April 1, 2022 - March 31, 2023) which was up from 3663 in the previous year (April 1, 2021 - March 31, 2022). According to the data there have been 15,997 reported euthanasia deaths from legalization until March 31, 2023 in Quebec.

This represents more than a 42% increase in Québec euthanasia deaths in 2023 representing 6.8% of all Québec deaths, which is the highest in the world.

The report also indicates that from April 1 - June 30, 2023 the number of reported Québec euthanasia deaths increased by another 24%, a slower pace of growth, but substantial considering the massive number of euthanasia deaths.

Amy Hasbrouck

When analyzing the Québec data I noticed some significant concerns. Were there 5211 Quebec euthanasia deaths or were there 5401?

Amy Hasbrouck from Toujours Vivant - Not Dead Yet, provided further analysis of the data found in the Eight Annual Report of the Québec Commission on End-of-Life care. Hasbrouck's indicates the following: 

How many Euthanasia deaths? 

• 5,211 MAiD reported by doctors in declaration forms (§ 3.2 p. 13)
• 5,401 euthanasia reported by hospitals and institutions (table C6 p. 46) 
• 5,208 MAiD declaration forms received by the Commission (§ 2.1, p. 6)
  

Total euthanasia deaths since legalization?

• 15,997 Adjusted MAiD from declaration forms (figure 3.2 p. 13, Row 3) or
• 16,044 (p. 28, “Observations”) 
• 18,532 Total declared by hospitals and institutions. (AR Table C6, QAR stats Row 7) 
  

Non-compliance with the law:

• The Commission concluded that 16 people did not have a serious and incurable illness
• Some people had loss of independence due to aging,
• Others had serious symptoms, but not clear diagnosis,
• Three people had disabilities, but no serious illness, which is a requirement for Québec’s statute 
• One non-compliant because doctor did not get confirmation from a second physician,
• One form was not signed by a health or social service professional,
• Two did not have valid QC health insurance. Since May 2022, the Commission no longer declares as “non-compliant” cases where the health insurance card has expired. This applied to 11 additional cases documented in the 8th annual report.

It must be noted that every year the Québec report admits to cases of non-compliance with the law. None of these cases have resulted in legal or professional actions. In August 2023, Dr. Michel Bureau, the President of the Québec Commission on End-of-Life Care sent a letter to euthanasia doctors urging them to stop abusing the law. In that letter Bureau claimed that there were two to three euthanasia deaths each month that did not fit the criteria of the law.

The 2022 - 2023 report was not the first year with concerns. In fact, all of the reports of the Québec Commission on End-of-Life Care have contained issues.

Hasbrouck reported in her article on the 7th Annual report that:

The seventh annual report from Québec’s Commission on end of life care was filed in Québec’s National Assembly on December 9, 2022. The report covers the 2021-2022 period (April 1, 2021 to March 31, 2022).

The Commission reported 3,663 euthanasia deaths declared by doctors during the fiscal year (p. 13), while the number of euthanasia deaths reported by facilities (3,629) and the Collège des Médecins du Québec (323) totalled 3,952 (p. 25 at note 25); a discrepancy of 289 deaths.

Hasbrouck stated in that article:

In light of the discrepancy (289 deaths) between the number of euthanasia reported in doctors’ declaration forms (3,663) and the facilities’/CMQ reports (3,952), and the unaccounted MAiD requests that didn’t end in euthanasia, (78 people) it’s hard to take seriously the Commission’s claim that 99.6% of euthanasia complied with the requirement of the MAiD law.

Québec is the only Canadian province that has two streams for euthanasia reporting, enabling the uncovering of under-reported euthanasia deaths. Quebec is also the only province that provides information indicating that some of the euthanasia deaths were outside of the law.

It is likely that under-reporting and non-compliance with the law exists in other provinces except that the other provinces don't have a dual reporting system and they are not analyzing the reports to determine if all of the deaths fit the criteria of the law. 

For the sake of brevity, I will provide links to previous articles concerning anomalies from the Québec reports on End-of-Life Care. 

Previous Quebec reports on End-of-Life Care:

• Quebec euthanasia deaths increase by 51% in 2021 - 22 annual report. A discrepancy of 289 deaths (Link).
• Quebec 2020 - 2021 annual euthanasia report. Euthanasia deaths increase by 37% unreported deaths continue (Link).

Canadian Health Authority promotes euthanasia to pensioners.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Fraser Health, a healthcare authority in British Columbia Canada, has been sending a slideshow promoting euthanasia to pensioners. Will Potter, reporting for the Daily Mail on July 1, obtained a copy of the slideshow promoting assisted death, that was sent to healthy pensioners. Potter reported:

The slideshow included advice on 'expressions of wanting to die', noting that it can be used to 'promote a sense of control'. Terminally ill patients are also seemingly offered the chance to die within 'a day'.

Potter explains that British Columbia had a 24% increase in euthanasia deaths in 2022 resulting in 2515 euthanasia deaths. Euthanasia has grown exponentially since March 2021 when Canada expanded the law to permit euthanasia for people who are not terminally ill. Potter explains

This was detailed in the slideshow allegedly sent by Fraser last week, which revealed its 'track system' included two options for when death is either 'reasonably foreseeable' or 'not reasonably foreseeable'.

For those whose death is 'not reasonably foreseeable', the healthcare provider said patients go through just 90 days of assessments. While symptoms that fall under the option were named as chronic pain and fibromyalgia, the Canadian government has announced plans to allow people to die under the practice solely due to mental illness by March 2024.

Potter reported that the slideshow was sent to people in the Fraser Health region as part of a pension package. Potter explains that a Canadian parliamentary committee has recently advocated for the expansion of euthanasia to children.

Amy Hasbrouck from Not Dead Yet commented to Potter on child euthanasia.

'I think it's horrible,' said Amy Hasbrouck, who campaigns against MAiD for the group Not Dead Yet.

'Teenagers are not in a good position to judge whether to commit suicide or not. Any teenagers with a disability, who's constantly told their life is useless and pitiful, will be depressed, and of course they're going to want to die.'

Christine Gauthier

Potter commented on the death of Donna Duncan (61) who died by euthanasia in October 2021 after experiencing mental health difficulties related to a concussion she experienced from a car accident in February 2020.

Potter then commented on Canadian military veteran Christine Gauthier:

In December, this was thrust into the spotlight when retired Army Corporal Christine Gauthier, a former Paralympian, was offered euthanasia by the Canadian government when she complained about delays to having a wheelchair lift installed in her home.

After years of frustrating delays in getting the home lift, Gauthier says a caseworker told her: 'Madam, if you are really so desperate, we can give you medical assistance in dying now.'

Alan Nichols died in the Fraser Health Region in August 2019. Alan was depressed and living with suicidal ideation. His request to be killed was taken as a request for euthanasia. Instead of being treated for suicidal ideation, as he had received in previous experiences with suicidal ideation, but rather he was approved for and died by euthanasia, even though his family begged the doctors who approved his death to re-assess him.

Canada's Ministry of Death

The following article has written by Alexander Raikin been reprinted without edits. This article: Canada's Ministry of Death was published by National Review online and will be published in the National Review print edition on February 20, 2023.

Raikin also wrote the article: No Other Options: An exposé on euthanasia in Canada, that was published in the New Atlantis on December 16, 2022.

By Alexander Raikin

It was supposed to be easy. If journalists asked the Honourable David Lametti, Canada’s minister of justice, a difficult question about euthanasia, he simply needed to read his talking points for February 24, 2020. A senior civil servant from his department prepared the lines; the prime minister’s staffers approved them. All that was left was to kill the messenger.

Publicly, Lametti said that the rate of change in public attitudes toward euthanasia had surprised even him. Barely five years earlier, prosecutors had called euthanasia “culpable homicide.” Now the government of Canada calls it “MAiD” — Medical Assistance in Dying, or, in other words, killing as medical treatment. Lametti, standing with other cabinet ministers, was to announce a further expansion of MAiD that, as Bill C-7, would come partially into effect in 2021. This March, the two-year sunset clause in that bill expires and the list of acceptable reasons for MAiD will be expanded once again, this time to mental suffering unaccompanied by physical ailment.

I filed a freedom-of-information request to find out what Lametti knew when he introduced the bill. While Lametti, like other cabinet ministers, was told to stress that there is “a consensus” among the public behind the plan, his own notes belie the point.

Some questions were never meant to be answered. Question 43 in the memo: Why did the government of Canada not appeal a lower-court decision in Truchon v. Canada, which, contrary to the government’s earlier promises, will expand euthanasia to people with essentially any chronic illness or disability? The answer, in its tautological beauty, is that “the Government of Canada announced in October 2019 that it would not appeal.” Want to know — Question 37 — how many euthanasia deaths there have been so far? The answer is that there has been “a consistent and gradual increase” as the practice of euthanasia “gains greater comfort and acceptance by Canadians.” No need to worry about any numbers — more is better anyhow.

But the most notable question was the one that was never asked at the press conference. It clearly was more important, as it was on the second page of the talking points. It was the Canadian equivalent of a jeremiad, accusing the government of forsaking some of the most important documents of civil liberties that a card-carrying member of Justin Trudeau’s Liberal Party could believe in. “Q6: Advocates for persons with disabilities are saying that this Bill violates the equality rights and dignity of persons with disabilities, contrary to the Charter of Rights and Freedoms, the United Nations Convention on the Rights of Persons with Disabilities, and the Liberal Party of Canada’s Disability Equality Statement. Does this Bill put the lives of persons with disabilities at risk as advocates claim?”

The prepared answer was another nonanswer. The government would address “stigma and bias”; it would bring about “a culture change to ensure that the important contributions made to Canada by persons with disabilities are recognized and valued on the [same] basis as those of other Canadians.” What the government would not do is slow down a program that offers suicide-prevention services to most people but assisted suicide and euthanasia only to the disabled, terminally ill or not.

Behind the scenes, even on the day of the cabinet minister’s press conference, bureaucrats from the central agencies who had worked on the memo worried about the toll of the government’s policies. One email talked about how “from a comms perspective, I wonder if it might seem like the increase [in MAiD deaths] is buried if it isn’t there and others will report on it rather than the Govt.” The increase wasn’t included in the accompanying media deck, and the media didn’t report on it, not really.

Since Trudeau was elected in 2015, his government has single-handedly created the largest, most permissive euthanasia program in the world. “You can kinda yell till you’re blue in the face that there are problems, but people aren’t listening,” John Maher, a psychiatrist in Ontario specializing in treatment-resistant mental illnesses, told me. When MAiD was first implemented, in 2016, a CBC article claimed that 90 percent of requests for assisted deaths were being refused in Toronto. But by 2021, only 4 percent of requests were deemed ineligible nationwide. “There isn’t a slippery slope,” said Timothy Stainton, a professor of social work at the University of British Columbia. “This is Mount Everest in a snowstorm.”

The daily death toll is staggering, even more so because it is unreported. Every day in Canada, in 2021, more than 27 people died by the hands of their physicians or nurses. It’s double the suicide rate, and there isn’t any sign of its stopping or slowing down. The world’s “euthanasia capital” is no longer Brussels or Amsterdam. It is now Ottawa. Canada euthanizes more people than any other country in the world — and its death toll is growing at a faster rate than that of any other voluntary system of euthanasia anywhere. (So much for Lametti’s description of “gradual increases.”)

To put this in context: When the number of Dutch deaths from euthanasia doubled in six years, a Dutch official in charge of reviewing euthanasia deaths warned that the Dutch model of euthanasia should be avoided. But after Canada’s legalization, the number increased tenfold in six years. At any rate, it will be impossible for any similar Canadian watchdog to warn about Canada. That is because no such watchdogs exist: Unlike in the Netherlands or Belgium, Canada has no mandated review process for potential stories of abuse.

That people with disabilities would be at a unique risk of an early death by MAiD is not an accident, as Lametti’s office knew. In fact, it was predicted well in advance. Before Bill C-7 passed, over 140 disability groups claimed that Trudeau’s plan “put their very lives at risk.” A petition of Indigenous doctors and politicians demanded that it “not be forced on our peoples.” Three United Nations human-rights experts, including the U.N.’s special rapporteur on the rights of persons with disabilities, decried the legislation as riddled with “ableist assumptions about the inherent . . . ‘worth’ of the life of a person with a disability.” “Under no circumstance should the law provide that it could be a well-reasoned decision for a person with a disabling condition who is not dying to terminate their life with the support of the state,” they wrote. Lametti’s response was to talk about stigma.

How did Canadian institutions become so bullish on euthanasia in the face of such opposition? It’s an important question. A simple answer is that Canada’s descent into death-on-demand is because of its supreme court or its culture. But both explanations seem weak.

It is, of course, fair to say that the court has played an outsized role in creating a “right to die.” In 2015 the Supreme Court of Canada, in Carter v. Canada, unanimously overturned nearly a century and a half of common law to strike down the federal prohibition on “physician-assisted death,” declaring it contrary to the “life, liberty, and security of the person” as guaranteed in Section 7 of the Canadian Charter of Rights and Freedoms. But the exact same section of the Charter had been used two decades prior to keep medically assisted suicide illegal in the split supreme-court ruling in Rodriguez v. British Columbia that “human life should not be depreciated by allowing life to be taken,” especially by a physician. Why did an already activist court change its mind? Jocelyn Downie, a law professor who was part of the legal team that argued in the Supreme Court for euthanasia to be decriminalized, told me that she is nonetheless “surprised” at the “massive change” that Canadian society — and the courts — had to accept. It couldn’t have happened any sooner.

The court wasn’t responding to any change in law; it was responding to a perceived change in the mood around assisted suicide — conducting a vibe test for euthanasia. “Despite the Court’s decision in Rodriguez, the debate over physician-assisted dying continued,” the court said, arguing the need for it to revisit its earlier ruling, citing failed parliamentary bills in Canada, “recent reports” by Canadian academics, and a changing “legislative landscape” in other jurisdictions such as Colombia and Luxembourg. But this change in mood, as shown by the examples the court cited (which included no polls or surveys), was not the result of some bottom-up change in society.

The culture argument is lackluster too. Earlier attempts to force Canadians to accept euthanasia or assisted suicide as a form of medical treatment failed rather decisively. As late as 2010, a three-quarters majority of the House of Commons wanted to keep physician-assisted death a criminal offense. No major national party supported legalizing euthanasia, which explains why half a dozen bills to introduce euthanasia between 1991 and 2010 failed to pass.

Canadians outside the legislature were unconvinced, too. It’s one thing to support the idea of assisted suicide in the abstract and another to put it into practice. A national 2010 poll by Environics found that if you asked Canadians whether the government should focus on legalizing euthanasia, improving end-of-life care, or both, the response was overwhelmingly (71 percent) for improving end-of-life care. Only 19 percent said euthanasia and 5 percent said both. Two-thirds of Canadians expressed concerns that the elderly would feel pressured to die because of financial concerns, a fear that is already coming true. Although “MAiD providers,” physicians or nurses who perform euthanasia, have long argued that no one is requesting MAiD because of poverty or lack of medical care, I wrote for the New Atlantis that the situation is common enough that the leading organization of MAiD providers held multiple seminars on it. “It is rare for assessors to have patients who have unmet needs, but it does happen. Usually these unmet needs are around loneliness and poverty,” admitted Ellen Wiebe, one of the most prolific “MAiD providers” in Canada.

If it wasn’t the courts and it wasn’t the culture, the answer must lie elsewhere. To understand how we really got here, to promoting the assisted deaths of the most vulnerable people in society and calling it progress, it is necessary to look past Lametti’s talk about a supposed “consensus” and see a multimillion-dollar PR campaign to persuade the public and elites to stop worrying and love MAiD.

The signs of its success are visible to the naked eye, often in the quick marginalization of dissenters. Yves Robert, the secretary of the Quebec College of Physicians and a previous supporter of assisted dying, warned in 2017 that euthanasia in Canada was turning into “death à la carte.” The warnings were almost self-evident, because of “the paradoxical discourse [by the media and Parliament] that calls for safeguards to avoid abuse, while asking the doctor to act as if there was no abuse.” “Let us take the time to properly reflect before going further,” Robert urged. “There’s no urgency to die.” But five years later there apparently is.

Now the same Quebec College of Physicians has sent another representative — not Yves Robert — to clamor for Parliament to expand euthanasia still further, this time to minors and even babies less than a year old. Just don’t call it “infanticide,” please. (Inclusion Canada, a leading disability-rights group, said in a response that “this isn’t MAiD, it’s murder.”)

The same push is evident in other medical groups. The Canadian Psychiatric Association, under the presidency of Sonu Gaind in 2015–16, explored the potential impacts of suicide contagion through the legalization of euthanasia. Yet the following leadership squashed any further “evidence-based study” of contagion risks — and then issued a public statement on behalf of the organization saying that it would be “discrimination” if patients who applied for MAiD because of a psychiatric condition were treated any differently from those with a physical illness. But what the leadership believes is not what the group’s members believe. Ontario psychiatrists, according to an internal survey conducted by the Ontario Medical Association Section on Psychiatry, opposed by a nearly three-to-one margin (63 percent to 23 percent) the proposition that “patients with [only] a psychiatric illness . . . should have available the same options regarding MAiD as available to all patients,” without issues of irremediability in mental illness having been examined.

The impact of this pseudo-consensus is evident in news reports: People are getting desensitized. A completely routine caption from a local newspaper last year was “Randy Obenauer, 74, cries as he tries to clean his own catheter.” When Randy’s friend tried to get him help, local health authorities asked him whether Randy was interested in MAiD instead. But the story didn’t go viral. No one was reprimanded for asking such a callous question. Disability groups added another name to their growing “List of Cases of Concern,” and otherwise life went on.

The national media prefer to report, for instance, on how an Ontario police officer donated his lungs from a euthanasia performed at home, a world first, or how a couple married for 73 years could die together through MAiD at home even though only one of them had a terminal illness. The moral nuances were not discussed; the bias was not new. When it came time for the 2015 election, shortly after the Carter decision, the only person with visible disabilities who was chosen by the journalist moderators to ask a question in the election debate between Stephen Harper and Justin Trudeau assumed that a right to die was owed to disabled persons and asked the candidates how their platforms would grant it. This “showed the media complicity” and “the political complicity” in pushing assisted suicide, remarked a matter-of-fact Amy Hasbrouck, the director of Toujours Vivant–Not Dead Yet, a grass-roots disability advocacy group against euthanasia.

International media are not much better. Justin Trudeau’s government is frequently described without any mention of his policy on euthanasia. Until 2021 — years into Canada’s headfirst descent into euthanasia — virtually no major media mentioned MAiD when discussing Trudeau. Instead, the media were seized by “Trudeaumania.” Trudeau was on the cover of Rolling Stone, Attitude (“an international LGBT magazine”), GQ (don’t ask), and even Sky Delta (“Delta Airlines’ popular in-flight magazine”). Just months before Lametti’s press conference, the Atlantic described Trudeau’s government as “the most successful progressive government in the world.”

In every interview that I did with disability advocates or physicians skeptical of euthanasia-on-demand, I asked why they thought euthanasia in Canada had become such an industry. The answer was always the same: “Dying with Dignity Canada,” said one insider who wished not to be named, referring to the largest pro-euthanasia lobbying group, founded in 1980. “I mean, they haven’t come up in all of this, but they’re a very, very powerful, well-funded lobby.”

It was, indeed, Dying with Dignity Canada (DWDC) that created and marketed the public and lobbying campaign for euthanasia, largely through stories of individuals demanding to die. It was highly effective. Whenever parliamentary committees would debate safeguards for MAiD, the organization would arrange for a chosen cadre of individuals to testify in front of the committee; they only needed one activist to balance out the concerns of disability groups, despite the latter’s near-unanimity in opposition to MAiD. Moreover, DWDC could spend millions on promoting a single story online and in the media. There were many groups opposing MAiD, but there was only one national group in support of it. And they were always on script.

Disability advocacy groups couldn’t compete with the slick media campaign featuring almost nothing but white women with terminal illnesses clamoring for suicide (so much for Canadian multiculturalism). It’s the motte-and-bailey rhetorical strategy: Canadians, like Americans, largely support assisted suicide for terminal illnesses, so those were the stories that advocates shared. But the policy of euthanasia was expanding far beyond terminal illnesses: People were dying from hearing or vision loss; treatable illnesses; diabetes or arthritis; loneliness, poverty, old age. Their stories were not told.

Harper Schipper, a professor of medicine at the University of Toronto, told me that after Rodriguez, Death with Dignity Canada was run in a way that was “absolutely brilliant strategically.” He knows this because he believes he was on the receiving end. In the opening session of the Council of Canadian Academies’ panels on MAiD, it was announced that he would chair an important panel. The event was sequestered and barred to the media in order to maintain the integrity of the proceedings; the panelists were told not to reflect on the proceedings publicly until after the panels’ conclusion. But as Schipper’s panel convened the next day, a coordinated campaign created negative publicity about him. Even before his appointment was announced, a “gotcha” article came out impugning Schipper’s objectivity by noting that he had warned that a slippery slope in euthanasia could lead to a replay of Nazi Germany. It was an open secret on who pulled it off.

“I am called out of the meeting,” Schipper recalls, “because Dying with Dignity has found a reporter, a stringer for the Globe and Mail who writes a piece basically saying Dr. Schipper is a shrill opponent of assisted dying. He’s been named chairman of this group. And while we’re not asking him to step down, we asked that he be fair in his chairmanship. And at the same time, two voices pop up in the Commons, making the same kind of comments.” Ultimately, he was forced to resign from his chairmanship

DWDC’s media savvy isn’t a surprise: Its first major donor was a media mogul, Moses Znaimer. In 2008, Znaimer set his sights on seniors. He created a for-profit company, ZoomerMedia, which he used to buy outright the CARP (Canadian Association of Retired Persons) magazine. Then he leveraged this financial partnership into becoming the president of CARP’s board.

The maneuver was strategic. When the longtime executive vice president of CARP, Susan Eng, said that she had a neutral position on euthanasia — neither supporting nor criticizing it — Znaimer fired her. Her replacement was the former CEO of Dying with Dignity Canada. “The only reason he fired me,” Eng has said, “was so that they can put out an official position for CARP saying that they want to insist on assisted dying on demand.” Znaimer also used his position to hire at least four pro-euthanasia lobbyists and arranged a personal meeting with David Lametti to persuade the government to expand assisted suicide further.

In 2010, DWDC raised just $90,000 and, according to a civil discrimination suit, was on a path to bankruptcy. Yet it continued to spend so much on lobbying, public relations, and other forms of activism that in 2015 the Canada Revenue Agency (Canada’s IRS) stripped it of its charity status. DWDC was then revitalized by big donors. A $7.75 million bequest from a supporter who had died through MAiD, and another bequest of $500,000, transformed the organization’s capacities in 2018. It could now do so much more.

Canada has another pro-dying group, one specifically geared to physicians: CAMAP, the Canadian Association of MAiD Assessors and Providers. Its purpose, its president Stefanie Green told me, is to be “the support for people that do the work.” I’ve written before in the New Atlantis on how CAMAP has kept hidden from the public and the Parliament stories of MAiD’s being offered as an alternative to poverty and inferior medical care. We know little about CAMAP except that it was founded shortly after the Carter decision. In 2021, CAMAP became a registered charity, revealing some curiosities in its financing. Unlike most charities, it spent $0 on fundraising, yet it had an astonishing $780,000 in near-liquid capital in the bank. Where did this money come from? It’s unclear. But much of CAMAP’s resources, training briefs, and studies show that its activities are funded by Dying with Dignity Canada.

Sometimes CAMAP crosses the line into activism. Green told me (and Parliament) that her organization does not advocate for any position on MAiD, but rather that CAMAP impartially reports what is happening on “the front line” to interested parties. But in a seminar, Aaron McKim, a MAiD provider in Newfoundland, hinted at actions that MAiD providers take to counteract other professional associations. “Our nursing association and social-work association have both put out practice advisories that their members aren’t really supposed to even bring up MAiD unless the patient specifically asks about it,” said McKim in a CAMAP seminar on “lack of resources” in May 2021. “And so we’re, we’re trying to kind of figure out ways to counteract that.”

“It’s clear that people associated with Dying with Dignity have been unusually influential in the policy-making in Canada related to [MAiD],” Trudo Lemmens, a law professor from the University of Toronto, told me. “It contrasts sharply with how disability-rights organizations and Indigenous organizations have been ignored in this debate.” Heidi Janz, a disability scholar and activist, said in an email interview with me that “proponents of the so-called ‘right to die’ and the federal Liberals — who are often one and the same — have consistently framed the expansion of eligibility for MAiD as advancing the autonomy rights of people with disabilities, but this claim is blatantly false.”

Lobbying records indicate that Lemmens and Janz are right. Dying with Dignity Canada has met ten times with staffers for the Ministry of Justice, including once with David Lametti himself. Every senator but one that their lobbyists spoke to was appointed by Justin Trudeau. Every vote to pass and then amend MAiD succeeded because of Liberal members. There are no records that David Lametti met with any lobbyists from disability groups.

The connection between DWDC and the Liberal Party is now even familial. James Cowan, the former leader of the Independent Liberal senators who made possible the passage of the first MAiD legislation in the Canadian senate, is now in political retirement as chairman of the board of DWDC. His daughter is Suzanne Cowan, the president of the Liberal Party.

In sum, euthanasia advocates dominated the political and media conversation and have finally come to control the expert panels and their power of imprimatur. The experts now chosen are able de facto to shape euthanasia policy as they wish while giving the Trudeau government a veneer of supposed scientific legitimacy (as if medical expertise were sufficient to resolve what is at root an ethical question). The most recent example was the expert panel formed to study safeguards for euthanasia in cases of mental illness. The panel reported that current safeguards around MAiD work well and recommended no additions. Unsurprisingly, the chairperson of that panel was an enthusiastic MAiD supporter and others had already argued for the expansion of MAiD to mental illnesses. Two board members resigned in protest, but the needed conclusion was reached.

It has been a proven strategy from the beginning of the euthanasia boom. When the Royal Society of Canada issued a report in 2011 on “end-of-life decision-making,” the chosen “expert panel” included only supporters of euthanasia. It wasn’t even subtle: The chairman publicly wrote his thoughts on the topic beforehand, while two other commissioners had published books that argued for the legalization of permissive euthanasia. The panel of course reached the desired conclusion. It was even more unsubtle that the panel thanked Peter Singer for editing the philosophical section that justified euthanasia. (Singer is a philosopher who argued in Practical Ethics [1979] that it is moral to kill “defective infants.”) When the time came for the Supreme Court to revisit the legality of euthanasia in 2015, it cited this report as proof that Western mores around death were changing.

At some point, historians or judges will lay blame for all the lives thrown away. Many major institutions in Canada will bear responsibility: the Supreme Court for failing to abide by its precedent in Rodriguez protecting the right to life; political leaders, for failing to safeguard the same right; the medical system, for failing to see people with disabilities as people with lives worth living; and the media, for failing to cover the debate with objectivity. What they should not blame is “a consensus.” There never was one.