How many times can you vote on the online "consultation" on euthanasia by advance request?

One supporter told me that he completed the online "consultation" for euthanasia by advance request more than 20 times.

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

On December 19, 2024 EPC published a Guide to answering the online "consultation" on euthanasia by advance request. EPC created the Guide to answering the online "consultation" since some of the "consultation" questions were a sham with the wording to those questions implying support for euthanasia by advance request.

Today, I was contacted by a supporter who told me that he had completed the online consultation more than 20 times. If he completed it more than 20 times, then others must also have done so.

Obviously, the consultation is more of a sham than first thought.

We are still encouraging our supporters to complete the "National conversation" on advance requests for medical assistance in dying but we recognize that the online consultation results will not be accurate.

The "National conversation" on advance requests for medical assistance in dying is open until February 14, 2025. The online consultation link is found on the Consultation website below the words - Join in. (Consultation Link).

Before completing the online consultation, please read our EPC guide to answering the online consultation. (Link to the EPC consultation guide).

EPC Guide to answering the online "consultation" on euthanasia by advance request.

Before completing the online euthanasia by advance request "consulation" please read our EPC guide to the consultation.

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

Health Canada has opened an online "consultation" on Medical Assistance in Dying (euthanasia) by advance request. When completing the online "consultation" we felt that some of the questions were a sham because the questions imply that you support euthanasia by advance request. This is why EPC created a Guide to completing the online consultation

The "National conversation" on advance requests for medical assistance in dying will be open until February 14, 2025. The online consultation link is found on the Consultation website below the words - Join in: How to participate (Consultation Link).

Before completing the online consultation, please read our EPC guide to answering the online consultation.

Some people suggested that we boycott the "consultation." This is not the first Canadian government consultation that is a sham. EPC has produced a guide for our supporters to answer the online consultation questions.

Euthanasia was originally legalized in Canada under the guise of being limited to mentally competent aduls, who are capable of consenting and who freely "choose." Euthanasia by advanced request undermines these principles.

The first principle for the Euthanasia Prevention Coalition is that we oppose killing people.

Background to the "consultation."

The "consultation" was announced on October 28, 2024 by Health Minister, Mark Holland who was responding to the Québec government instituting euthanasia by advance request starting on October 30, 2024.

The Québec government announced on September 7 that they informed the provincial Crown prosecutor’s office to not prosecute medical practitioners who carry out euthanasia by advance request, so long as the medical practitioner complies with Québec law. The federal law does not permit euthanasia by advance request.

Euthanasia by advance request means that a person, while competent, legally declares their "wish" to be killed and if the person becomes incompetent, the person would then be killed, even though the person is not capable, at that time, of consenting. 

It must be noted that every Canadian province has advanced directive laws. Therefore the federal government is considering an issue that is outside of their jurisdiction.

The "National conversation" on advance requests for medical assistance in dying will be open until February 14, 2025. The online consultation link is found on the Consultation website below the words - Join in: How to participate (Consultation Link).

EPC Guide to answering the online "consultation" questions.

Question 1: To what extent do you support or oppose Canada's current MAiD law pursuant to the above criteria and safeguards?

Response: Strongly oppose.

Question 2: To what extent would you support or oppose adults having the option of making an advanced request for MAiD, in the following situations:

(A) After a diagnosis of a serious and incurable medical condition that will lead to the loss of capacity to make decisions (for example: Alzheimer's Disease, Huntington's disease, Parkinson's disease)?

Response: Strongly oppose.

(B) While living with a medical condition that could lead to a sudden or unexpected loss of capacity to make medical decisions (for example: high blood pressure which could lead to a severe stroke)?

Response: Strongly oppose.

Question 3. What values guide you when thinking about advanced requests for MAiD? Check all that apply.

Response: Sanctity of life and/or Protection of vulnerable people.

Question 4. If the advanced requests for MAiD were permitted, how important would it be as an option for your formal personal health planning needs?

Response: Not at all important.

Question 5. The following considerations have been raised about advance requests. Check any of the considerations below that are a concern to you.

Response: A person could feel pressured by family or others to make an advance request and/or 

A person could make an advance request before knowing how well they might adapt to (or tolerate) their medical condition with appropriate support in the future.

Question 6. Please specify other considerations about advance requests you have without providing personal identifying information (250 word limit). You can state what you want within a 250 word limit.

Response: Alex Schadenberg suggests using some of the following: 

When euthanasia (MAiD) was legalized, Canadians were told that the law would be limited to: competent adults who are capable to consent and freely choose. 

Euthanasia by advance request undermines these principles. Even though a person makes an advance request, the person when killed by euthanasia is not a competent adult, is not capable of consenting and cannot freely choose. Therefore, euthanasia by advance request is technically euthanasia without consent.

Once a person becomes incompetent, they are not legally able to change their mind, meaning that some other person will have the right to decide when the person dies, even when that person is happy with life.

If euthanasia by advance request is approved, the law will discriminate against incompetent people who did not make an advanced request. The law will be challenged and it will be argued that the person didn't make an advance request based on timing (the option didn't exist yet) or lack of knowledge that it was possible to make an advance request. 

Once killing incompetent people is viewed as "compassionate" it will be considered cruel to not kill an incompetent person who is deemed to be suffering, because the person didn't make an advance request.

Advanced directives are also provincial not federal jurisdiction.

The next questions are problematic since they infer that you support euthanasia by advance request.

Question 7. Please rate the importance for you of the following potential conditions as safeguards when a person is developing their advance request.

A person must wait for a minimum period of time following their diagnosis of a capacity limiting illness before they can make an advanced request?

Response: Prefer not to say.

The person who makes the request must validate it periodically (such as every five years) and can withdraw and modify it at any time while they still have decision making capacity.

Response: Prefer not to say.

Question 8. Please rate the importance for you of the following potential conditions of safeguards when the individual is assessed for MAiD and MAiD is provided based on advanced request.

There must be a minimum assessment period during which the health care providers must evaluate and confirm the patient is demonstrating the conditions described in their advance request on a recurring basis and that they otherwise meet the eligibility requirement for MAiD.

Response: Prefer not to say.

Any provision of MAiD based on an advanced request must be provided in accordance with standards developed for health care professionals. (Ridiculous question)

Response: Prefer not to say.

Health care providers must be trained on the assessment and provision of MAiD based on an advance request. 

(This is not helpful since the euthanasia doctors group - CAMAP - provides the training).

Response: Prefer not to say.

The advance request must be made using a government designated form, must be notorized or witnessed, and recorded in a person's medical record or a registry.

Response: Prefer not to say.

The person must be provided personal care planning by a healthcare professional or their team, including information on living with a capacity-limiting disease as well as available care and supports, as part of preparing an advanced request.

Response: Prefer not to say.

The person making the advance request must do so voluntarily and with the assistance of a health care professional who has received training related to the appropriate development of advance requests. (This is not helpful considering CAMAP will provide the training).

Response: Prefer not to say.

Question 9: Do you have any comments about other potential conditions and safeguards you think are needed for advanced request? To protect your confidentiality, please do not provide information that could be used to identify yourself or others (250 word limit).

Response: Alex Schadenberg responded in this manner.

Euthanasia by advance request should never be considered an option. The very premise of allowing euthanasia is that the person be a competent adult who is capable of consenting and freely "choosing." Euthanasia by advance request undermines any and all potential "safeguards" and opens the door to euthanasia of people who are incompetent and have not consented.

It is impossible to separate an act of killing an incompetent person for reasons of compassion, because the person indicated, out of fear or other situational reasons, that the person wanted to be killed under these circumstances. Euthanasia by advance request requires another person to decide when this person should be killed, knowing that the person is not competent to make the decision for themselves.

We shouldn't even be discussing this issue.

Advanced directives are also under provincial not federal jurisdiction.

Question 10: In addition to no longer having capacity to make decisions, do you think a person should be demonstrating another serious physical or psychological limitation (such as loss of ability to communicate or loss of ability to perform activities of daily living, like eating or dressing) in order to be eligible to receive MAiD based on their advance request?

Response: Prefer not to say.

Question 11: After a person has lost capacity to make decisions, should a person other than the person who made the advance request (such as a member of the family) have the authority to withdraw or modify the person's advance request. (Precendent would require an advanced directive, if specific, to be followed).

Response: Prefer not to say.

Question 12: Consider a person who no longer has the capacity to make decisions and meets all of the conditions outlined in their advance request that describe enduring and intolerable suffering and advance decline in capability, and yet they appear to be content. Select the statement that best describes what you think should happen next:

(You may think that the second answer is best except that the second answer requires the person to be reassessed at a later time for the purpose of killing.)

Response: Prefer not to say.

Question 13: How important would it be to have the same minimum eligibility criteria and safeguards permitting advance requests for MAiD apply across every province and territory in Canada? (This is a provincial jurisdiction)

Response: Not at all important.

The consultation ends with a series of demographic questions.

Why is euthanasia (MAiD) by advance request more egregious?

Alex Schadenberg
Executive Director
Euthanasia Prevention Coalition

Health Canada has opened an online "consultation" on Medical Assistance in Dying (euthanasia) by advance request. When completing the online "consultation" we felt that some of the questions were a sham because they imply that you support euthanasia by advance request. This is why EPC created a Guide to completing the online consultation (Link to the EPC Guide).

The "National conversation" on advance requests for medical assistance in dying will be open until February 14, 2025. The online consultation link is found on the Consultation website below the words - Join in: How to participate (Consultation Link).

Before completing the online consultation, please read the EPC guide to answering the online consultation (Link to the EPC guide).

The first principle for the Euthanasia Prevention Coalition is that we oppose killing people. So why is euthanasia by advance request more egregious?

Euthanasia was originally legalized in Canada under the guise of being limited to mentally competent adults, who are capable of consenting and who freely "choose." Euthanasia by advanced request undermines these principles.

Euthanasia by advance request means that a person, while competent, legally declares their "wish" to be killed, and if the person becomes incompetent, the person would then be killed, even though the person is not capable, at that time, of consenting. Therefore euthanasia by advance request is technically euthanasia without consent.

Once a person becomes incompetent, they are not legally able to change their mind, meaning that some other person will have the right to decide when the person dies, even if that person is happy with life.

If euthanasia by advance request is approved, the law will discriminate against incompetent people who did not make an advance request. The law will be challenged and it will be argued that the person didn't make the advance request based on timing (the option didn't exist yet) or lack of knowledge that it was possible to make an advance request.

Once killing incompetent people is viewed as "compassionate" it will be considered cruel not to kill an incompetent person who is deemed to be suffering, because the person didn't make an advance request.

Every Canadian province has advanced directive laws. Therefore the federal government is debating an issue that is outside of their jurisdiction.

The "National conversation" on advance requests for medical assistance in dying will be open until February 14, 2025. The online consultation link is found on the Consultation website below the words - Join in: How to participate (Consultation Link).

Before completing the online consultation, please read our EPC guide to answering the online consultation (Link to the EPC guide).

Government report recommends euthanasia for children and euthanasia by advanced directive.

By James Schadenberg

A report by the Special Joint Committee on Medical Assistance in Dying (AMAD) was tabled in the House of Commons on February 15 calling for a drastic expansion of euthanasia  (MAiD) in Canada. The report recommends that children "mature minors" and patients with mental illnesses should be eligible for euthanasia and that patients with illnesses such as dementia should be permitted to make advanced requests by advanced directives for euthanasia. The report, Medical Assistance in Dying in Canada: Choices for Canadians, can be viewed here: (Link).

Sign our petition: No to child euthanasia in Canada (Link)

The report was supported by Liberal, NDP and Bloc-Quebecois members of the committee. The report gave 23 recommendations for actions by the government regarding euthanasia. 

• The majority of Canadians oppose euthanasia for mental health (Link).

Recommendation 13 involved euthanasia for mental illness alone. The report suggests that prior to the legalization of MAiD for mental illness, AMAD should re-convene to ensure its "safe and adequate application":

Recommendation 13 

That, five months prior to the coming into force of eligibility for MAID where a mental disorder is the sole underlying medical condition, a Special Joint Committee on Medical Assistance in Dying be re-established by the House of Commons and the Senate in order to verify the degree of preparedness attained for a safe and adequate application of MAID (in MD-SUMC situations). Following this assessment, the Special Joint Committee will make its final recommendation to the House of Commons and the Senate.

Recommendations 14 - 20 all involve the exapansion of euthanasia in Canada to children (or as referred to in the report as "mature minors"):

Recommendation 14

That the Government of Canada undertake consultations with minors on the topic of MAID, including minors with terminal illnesses, minors with disabilities, minors in the child welfare system and Indigenous minors, within five years of the tabling of this report.

Recommendation 15

That the Government of Canada provide funding through Health Canada and other relevant departments for research into the views and experiences of minors with respect to MAID, including minors with terminal illnesses, minors with disabilities, minors in the child welfare system and Indigenous minors, to be completed within five years of the tabling of this report.

Recommendation 16

That the Government of Canada amend the eligibility criteria for MAID set out in the Criminal Code to include minors deemed to have the requisite decision-making capacity upon assessment.

Recommendation 17

That the Government of Canada restrict MAID for mature minors to those whose natural death is reasonably foreseeable.

Recommendation 18

That the Government of Canada work with provinces, territories and First Nations, Inuit and Métis communities and organizations to establish standards for assessing the capacity of mature minors seeking MAID.

Recommendation 19

That the Government of Canada establish a requirement that, where appropriate, the parents or guardians of a mature minor be consulted in the course of the assessment process for MAID, but that the will of a minor who is found to have the requisite decision-making capacity ultimately take priority.

Recommendation 20

That the Government of Canada appoint an independent expert panel to evaluate the Criminal Code provisions relating to MAID for mature minors within five years of the day on which those provisions receive Royal Assent, and that the panel report their findings to Parliament.

• Why euthanasia for children "mature minors" is wrong (Link).

Recommendations 21 - 23 all call for permitting advance requests for euthanasia for those with dementia and other incurable illnesses. This would mean that patients can be killed through euthanasia after they've lost the capacity to consent to it:

Recommendation 21

That the Government of Canada amend the Criminal Code to allow for advance requests following a diagnosis of a serious and incurable medical condition disease, or disorder leading to incapacity.

Recommendation 22

That the Government of Canada work with provinces and territories, regulatory authorities, provincial and territorial law societies and stakeholders to adopt the necessary safeguards for advance requests.

Recommendation 23

That the Government of Canada work with the provinces and territories and regulatory authorities to develop a framework for interprovincial recognition of advance requests.

The report also included a dissenting opinion by members of the committee from the Conservative Party. In it, the Conservative members of the committee express their disapproval for the hasty and reckless way that the government has moved to expand Canada's MAiD regime, though they are divided on whether to allow advanced requests. They claim the government refused to put "evidence ahead of ideology" when they moved to expand MAiD for situations where mental illness is the sole underlying medical condition without first determining whether it could be implemented safely. 

The Conservative members dissenting report did not approve child euthanasia, claiming "it would be irresponsible for the Liberal government to move ahead with any expansion of MAID for mature minors" and that "Conservatives do not support MAID for mature minors at this time".

The dissenting report concluded with the following statement:

The Liberals’ rushed and reckless approach to Canada’s MAID regime has put the lives of vulnerable Canadians at risk. We caution the Liberal government against repeating the mistakes they made concerning MAID MD-SUMC. MAID policy must be grounded in evidence, consultation with impacted groups, and with serious consideration given to protecting the vulnerable.

The recommendations being put forth by AMAD would give Canada the most permissive euthanasia law in the world. Given the current state of Canada, where vulnerable people continue to be pressured to euthanasia on a frequent basis, it is inappropriate for the government to consider these radical expansions to the euthanasia law. There should instead be a greater focus on how governments in Canada can help people who may be feeling that their life is not worth living.

The Euthanasia Prevention Coalition submitted a brief to AMAD in early 2022, which expressed the dangers of Canada's current MAiD regime, and the dangers of expanding it to allow for advance directives and child euthanasia. This brief can be viewed here: (Link).

Further reading:

• Euthanasia by Advanced Directive - A recipe for abuse (Link).
• Responding to the Special Joint Committee on Medical Assistance in Dying (Link).

Canada's medical assistance in dying (MAiD) law is the most permissive euthanasia legislation in the world.

Dr Ramona Coelho is a family physician in London, Ontario, whose practice includes caring for marginalized patients and those living with mental illness and disabilities. In her article, Coelho explains how Canada's euthanasia law has become the most permissive regime in the world. Her article was published by the London Free Press on July 9, 2022.

Canada’s medical assistance in dying (MAiD) law is the most permissive euthanasia and assisted-suicide legislation in the world. The United Nations special rapporteur on the rights of persons with disabilities, the UN independent expert on the enjoyment of all human rights by older persons, and the UN special rapporteur on extreme poverty and human rights have all warned our Canadian government that our MAiD law will lead to human rights violations.

Still, the federal special joint committee on MAiD is studying and making recommendations to the government on expanding the system that was created in 2016 and further enlarged in 2021.

Here are some recent examples of MAiD abuses under the current law, based on information provided by doctors, a patient and family members:

A man was admitted to hospital after suffering a small stroke affecting his balance and swallowing. He was feeling down and isolated due to a COVID-19 outbreak on his ward. The stroke neurologist anticipated he would be able to eat normally and regain most of his balance. Psychiatry diagnosed an adjustment disorder but noted his prognosis was very good. The patient then requested MAiD. Neither of his MAiD assessors had expertise in stroke rehabilitation and recovery. Because he was temporarily eating less, the MAiD assessors decided he could die right away instead of waiting the required 90 days for those living with disabilities despite having no terminal comorbidities. He received MAiD the following week. This man died alone and depressed and before he had tried proper therapy or reached maximal recovery.

A 71-year-old widower was admitted to a Southwestern Ontario hospital after a fall. His family says during his admission he contracted an infectious diarrheal illness. He was humiliated by staff for the smell of his room, his family said. He developed new shortness of breath that was not comprehensively assessed. In this context, a hospital team member suggested he would qualify for MAiD. The team said he had end-stage chronic obstructive pulmonary disease and it was terminal. The patient was surprised by the diagnosis but trusted the team. Within 48 hours of his first assessment, he received a medically assisted death. Post-mortem testing showed he did not have end-stage COPD. His family doctor, when notified of his death, also stated he did not have end-stage COPD, but the team had failed to contact her when they were assessing his history.

Was MAiD raised as an option because the man’s admission was taking too long or his room smelled or because he was a victim of ageism? Did he choose death because his treating team made him feel horrible or he made his decision based on inaccurate information? His family believes this is the case. There is no safeguard in the legislation that protects marginalized Canadians (victims of ageism, racism, or ableism) from MAiD being raised as a “treatment option.”

CTV ran a W5 story showing a man’s MAiD provision and a patient let me know the story was very appealing, and MAiD would be a good option for her. This patient is in her midlife and has a recent onset mild spinal cord injury of which she hasn’t had time to adjust, receive any peer support or proper symptom control. She would prefer to die than be poor and she is aware the government won’t provide what she needs to live with her new disability.

The legislation is written such that she can access MAiD before she can get better, heal to the extent she can, and adjust. Also troubling, the government has not considered the well-documented phenomenon that messaging promoting suicide increases rates of suicide. Have we considered how MAiD offered by the government might affect a person’s decision to choose death?

Despite these cases and numerous others in the media spotlight that should make us pause and consider the evidence, some are pushing for MAiD expansion. The federal expert panel on MAiD for mental illness has recommended mental illness be grafted onto the MAiD framework without any legislative changes in March 2023.

Troublingly, Canadian bioethicist Udo Schuklenk dismisses concerns that suffering caused by societal injustice could lead to choosing death. Schuklenk claims that limiting MAiD for psycho-social suffering “would translate into removing the agency of decisionally capable patients without offering them a way out of their predicament.”

Schuklenk speaks of agency but shows no consideration for how societal structures, such as governments, create and sustain the predicaments that can make death an attractive choice for those who would have instead benefitted from greater resources and care.

Dr. Jeff Kirby, a member of the expert panel on MAiD for mental illness, writes that he had to resign before the report was published as the recommendations were “soft” and “inadequate.” He also states there were procedural issues, including the discouragement of members bringing forward relevant matters for deliberation and a lack of reporting transparency.

Ellen Cohen, representing a national mental health advocacy organization, also resigned giving equal concerns. Canada should be extremely cautious about recommendations that come from an expert panel where two of 12 appointed members resigned in good conscience.

Canada’s MAiD law currently allows suicide facilitation for persons with disabilities and is on track to expand in March 2023 to those living with mental illness. The first report of the federal special joint committee on MAiD suggests it will not only ignore all the problems caused by MAiD but also further entrench and expand MAiD in Canada.

Previous articles by Dr Ramona Coelho:

• Offering euthanasia to a suicidal person leads to premature deaths (Link).
• Why euthanasia for children is wrong (Link).
• Profound social change with euthanasia for mental illness (Link).
• Why expanding access to medical assistance in dying keeps us up at night (Link).

Why euthanasia for children "mature minors" is wrong.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

• Sign the Petition: No to child euthanasia (Link).

Dr Ramona Coelho

Dr Ramona Coelho, a family physician in London Ontario and the Hon Graydon Nicholas, a member of the Wolastoqiyik Nation and a former Lieutenant Governor of New Brunswick wrote an insightful opinion article that was published in the Ottawa Citizen on May 11, 2022 on the issue of euthansia for children.

They begin by explaining that the government's Special Joint Committee on Medical Assistance in Dying (MAiD), is currently meeting and, among other issues, is considering MAiD for children. Briefs can be submitted to the committee until May 30.

Graydon Nicholas

Coelho and Nicholas express their concern with the current problems with euthanasia in Canada and state that the Special Joint Committee should be examining the problems not expanding access to the MAiD regime in Canada. They write:

In an increasing number of reported cases, MAiD is taking the place of medical treatment and government assistance for those with social, economic and psychiatric issues. An example is the case of Alan Nichols, who had recurrent episodes of depression. Nichols was picked up by the RCMP and admitted to hospital under the Mental Health Act. While in hospital, he received MAiD — to the utter dismay of his family, who wished he had received medical care instead. Similarly, a recent CTV story recounted how “Sophia,” unable to find affordable housing compatible with her chemical sensitivities, chose MAiD.

How can we keep MAiD from being used as a tool to absolve governments of their obligation to provide for those living in poverty, with disability, or with mental illness their equal rights as citizens to health, economic security, and life? That is the question the Special Joint Committee should be considering. But instead, expanding MAiD for children is on the agenda.

Coelho and Nicholas ask the question: What are the dangers with expanding euthanasia to children? They respond:

One is teenager suicide contagion. There is evidence that messages that promote suicide, and knowing someone who has engaged in self-harm or suicide, both raise the risk of teenage suicide contagion. Indigenous youth are particularly at risk because of an already high suicide rate resulting from longstanding injustice. Indigenous stakeholders have repeatedly demanded support from the federal government for the implementation of suicide prevention and mental wellness strategies in their communities. These demands have not been adequately met and in many cases, ignored, while the federal government instead focuses on making suicide access easier for youth, including Indigenous youth.

Coelho and Nicholas complete their article by stating:

The Council of Canadian Academies Expert Working Group on MAiD for Mature Minors notes that there is a lack of evidence on how MAiD for children will affect families. It noted there is no robust evidence that captures the voices of youth on this matter including views of minors with disabilities, Indigenous youth, and/or those in the child welfare system. It cites a paucity of international evidence on which to draw conclusions as well.

Given the lack of evidence to support safe practice and risk of suicide contagion in teenagers, and the gravity of MAiD as an option, a valid question is: why the rush to make MAiD available for children?

More articles on this topic:

• Responding to the Special Joint Committee on Medical Assistance in Dying (Link)
• Sign the Petition: No to child euthanasia (Link).

No clear guidelines in report concerning MAiD (euthanasia) for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Final Report of the Expert Panel on MAiD and Mental Illness was submitted to Canada's Minister of Health, Jean-Yves Duclos and Justice Minsiter, David Lametti on May 6, 2022.

Similar to previous "expert" reports the Expert Panel offers recommendations but few clear guidelines.

Canada legalized euthanasia and assisted suicide under the term Medical Aid in Dying (MAiD) when the government passed Bill C-14 in June 2016. Previous to that, the Supreme Court of Canada struck down protections in Canadian law that prohibited euthanasia and assisted suicide in its Carter decision and euthanasia became legal in Québec in December 2015 with the implementation of Bill 52.

In March 2021, the Canadian govenment passed Bill C-7 which expanded the MAiD law by permitting euthanasia for people who are not dying, by eliminating the 10 day waiting period for people who are terminally ill, by permitting euthanasia for incompetent people who were previously approved for MAiD and at the last minute, Bill C-7 was amended to permit euthanasia for people with mental illness.

When passing Bill C-7 the government acknowledged that euthanasia for mental illness was different than other forms of MAiD, so they stated that their would be a two year moratorium on MAiD for mental illness providing time to develop guidelines around the killing. I believe the two-year moratorium is unenforceable making euthanasia for mental illness legal already.

The Euthanasia Prevention Coalition opposes MAiD. We oppose giving doctors and nurses the right in law to kill people. But considering that the recommentations from the "Expert" Panel on MAiD and Mental Illness concern guidelines for killing people with mental illness, one would think that the guidelines would offer fixed rules and yet the 19 recommendations for implementing MAiD for mental illness, lack clarity on key recommendations.

For instance, recommendation 2 concerning: Establishing Incurability, states

MAiD assessors should establish incurability with reference to treatment attempts made up to that point, outcomes of those treatments, and severity and duration of illness, disease or disability.

It is not possible to provide fixed rules for how many treatment attempts, how many kinds of treatments, and over what period of time as this will vary according to the nature and severity of medical conditions the person has and their overall health status. This must be assessed on a case-by-case basis.

The Panel is of the view that the requester and assessors must come to a shared understanding that the person has a serious and incurable illness, disease or disability. As with many chronic conditions, the incurability of a mental disorder cannot be established in the absence of multiple attempts at interventions with therapeutic aims.

Incurability is a requirement in Canada's MAiD law, and yet the Expert Panel has stated that it is not possible to provide fixed rules concerning treatment.

In the Netherlands, a person requesting euthanasia for mental illness must be willing to try effective treatment. This is not an onerous request considering that the person is requesting to be killed.

Similarly, the Expert Panel deals with recommendation 3 concerning: Establishing Irreversibility in the same manner. It states:

MAiD assessors should establish irreversibility with reference to interventions tried that are designed to improve function, including: recognized rehabilitative and supportive measures that have been tried up to that point, outcomes of those interventions, and the duration of decline.

It is not possible to provide fixed rules for how many attempts at interventions, how many types of interventions, and over how much time, as this will vary according to a requester’s baseline function as well as life goals. Therefore, this must be assessed on a case-by-case basis.

The Panel is of the view that the requester and assessors must come to a shared understanding that the person is in an advanced state of irreversible decline in capability.

Once again, Canada's MAiD law requires that the person's condition be irreversible and yet the Expert Panel states that it is not possible to provide fixed rules.

I am concerned that the current Special Joint Committee on Medical Assistance in Dying will also follow the same direction of this Expert Panel, by offering recommendations but few clear lines.

The Special Joint Committee on Medical Assistance in Dying (AMAD) is composed of Senators and MPs who are to study and make recommendations concerning:

1. MAiD for mature minors,
2. Advance directives for MAiD,
3. Regulations for Psychiatric MAiD once the C7 sunset clause is lifted March 2023,
4. The state of palliative care in Canada (was required as part of the 5 year review after C-14 but never completed),
5. Protections for persons with disabilities.

The mandate of the Special Joint Committee appears oriented to expanding MAiD in Canada.

The Expert Panel made some good recommendations, such as suggesting that assessments be done by independent experts, increasing the reporting requirements, providing income or housing support where necessary, having consultations with First Nations, Métis, and Inuit peoples, nonetheless, some of these recommendations are too little or too late a response.

People have been lethally injected for loneliness, depression, poverty, chemical sensitivities, fear of isolation and more.

The Expert Panel appears to be attempting to improve Canada's MAiD law while in reality the fundamental recommendations include no fixed rules.

Remember, the law only requires that a physician or nurse be of the opinion that the person fits the criteria of the law. Therefore, the Report of the Expert Panel on MAiD for Mental illness does not provide any assurances that people who are living with suicidal ideation will not die by euthanasia.

Sadly, Canada legalized euthanasia by giving doctors and nurses the right in law to kill their patients. It only requires that the assessors and the practitioner who lethally injects their patient be only of the opinion that the person, who they killed fit the criteria of the law.

Canada has now expanded the killing to people with mental illness alone and this "Expert Panel" suggests that the killing be done without clear rules.

When will people wake up and realize that killing people is not a solution?

More articles on this topic:

• The truly awful cost of Canada's assisted death program (Link).
• Abbotsford police investigating euthanasia death (Link).
• Euthanasia for mental illness. Killing people without a certain prognosis (Link)
• Profound social change with euthanasia for mental illness (Link).
• Article supporting euthanasia for mental illness provides excellent argument against euthanasia (Link).
• New euthanasia rules put psychiatrists into an impossible position (Link).
• The complexity of assessing mental health and capacity (Link).

Responding to the Special Joint Committee on Medical Assistance in Dying.

The Committee has extended the time frame for receiving submissions to May 30, 2022.

We need your comments to be heard by the members of the Committee. The Committee is accepting submissions of no more than 1000 words.

Send submissions to the commitee by E-mail: AMAD@parl.gc.ca or Fax: 613-947-3089 

When Canada legalized MAiD (euthanasia) the legislation (Bill C-14) required that a five year review be conducted starting in June 2020. The federal government decided to expand the legislation (Bill C-7), before reviewing the law. After passing Bill C-7 the government established a committee for the review.

The Special Joint Committee on Medical Assistance in Dying (AMAD) was reconvened on April 8, 2022, where Senators and MPs were given five topics related to MAiD in Canada. The topics of study are:

• MAiD for mature minors,
• Advance directives for MAiD,
• Regulations for Psychiatric MAiD once the C7 sunset clause is lifted March 2023,
  
• The state of palliative care in Canada (was required as part of the 5 year review after C-14 but never completed),
• Protections for persons with disabilities.
  

You will notice that a "review of the law" seems to have been lost as the government appears to be planning for further expansions of MAiD.

We need your comments to be heard by the members of the Committee. The Committee is accepting submissions of no more than 1000 words.

The Euthanasia Prevention Coalition is writing a submission for the committee. Your comments are also important to the committee.

For those who have a personal experience or story please submit it to the Committee at: E-mail: AMAD@parl.gc.ca or Fax: 613-947-3089 

You can also email your submission directly to the Members of Parliament and Senators that are on the committee. (Link to Committee members).

The government continues to ignore the commitment of having a full review of the law while pushing further expansions, but your voice can and needs to be heard.

Assisted suicide must not be confused with palliative care.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr. Ebru Kaya is an associate professor of medicine and the president of the Canadian Society of Palliative Care Physicians (CSPCP) and Dr. Leonie Herx is division chair and associate professor of palliative medicine at Queen’s University and a past president of the CSPCP wrote an opinion article that was published by the Globe and Mail on May 9, titled: Assisted dying must not be confused with palliative care.

The context for the article is the government committee that is examining the expansion of MAID to children (mature minors) and incompetent people who requested death in their advanced directive. Kaya and Herx continue:

While access to MAID is guaranteed in Canada, access to palliative care and other supports, including home and disability services, are not – and worse, MAID is being provided at the expense of already limited palliative care resources. No one should feel compelled to choose an early death because of inadequate care. Tragically, too many physicians know of patients who opted for MAID due to lack of adequate palliative home-care resources to remain in their homes or communities.

Palliative care is a vital service, with clear economic, health and social benefits. It provides medical assistance in living (MAIL) through early identification and impeccable assessment and management of pain and other symptoms – physical, emotional, social and spiritual – that enhance quality of life, reduce depression and anxiety, reduce caregiver distress and may even help people live longer; it does not hasten death, nor does it end life. The National Framework on Palliative Care received unanimous support by parliamentarians in 2018. Yet palliative care has not received the necessary investments and attention to make it a reality for Canadians.

They explain that Canadians lack the necessary information to seek palliative care, rather than MAID but then MAID is now being integrated with palliative care. They write:

Moreover, many palliative care services have had to integrate MAID into their programs in order to continue to receive provincial or federal funding, even though they are fundamentally different. As a result, already scarce resources – including hospice and palliative care unit beds, as well as skilled nurses and doctors – have been diverted to support MAID services.

Palliative care must remain separate from MAID to avoid the risk of confusion between the two. This is especially important for communities that have an underlying distrust of the health care system who decline palliative care because they confuse it with MAID. This does not preclude people who contemplate, request or opt for MAID from receiving palliative care – but in order to make informed choices, patients and family caregivers need to know what palliative care actually has to offer.

They then point out how MAID is an act that is used by the privileged:

As a person approaches the end of his or her life, the inevitable physical decline is viewed in Western European culture as undignified, full of suffering, and a burden on caregivers. However, this belief is not shared by all cultures. Indeed, it should be noted that white, well-educated and wealthy Canadians have led the advocacy for legalization and expansion of MAID; it is not, however, this demographic that bears the pressures to choose MAID due to lack of access to palliative care and other supports needed to live. The government focus on MAID thus disproportionately benefits the already privileged, while continuing to underserve the rest of our society who might not have the same values or advantages.

They conclude that MAID should not be associated or confused with palliative care.

Canadian legislation positioned palliative care as a safeguard to address suffering that might otherwise lead to MAID, and it has led to a tension between MAID and palliative care. As a result, physicians and organizations such as the Canadian Society of Palliative Care Physicians are seen as opposing MAID or obstructing access to MAID when they advocate for palliative care to address suffering.

The expansion of MAID should not be considered without first addressing fundamental problems of inadequate access to care and resources. The expectation that MAID and MAIL can develop in parallel is a fantasy – and the most vulnerable among us risk paying the price.

Thank you Dr's Kaya and Herx for once again defending the proper use of palliative care.

More articles on this topic:

• The Delta Hospice Society continues to fight for safe places to die (Link).
•  Study shows negative impact of MAiD on palliative care in Canada (Link).