Canada's euthanasia law was no slippery slope; it was a cliff.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Yuan Yi Zhu

An article by Yuan Yi Zhu, a Canadian academic, that was published as a Special to the National Post on February 18, 2025 explains that 10 years after the Supreme Court of Canada Carter decision (that legalized assisted death in Canada) that Canada's MAiD law was not a slippery slope; it was a cliff. 

Zhu writes that the Supreme Court of Canada Carter decision claimed that no slippery slop would happen, which is exactly the opposite of what has happened. Zhu wrote:

February marks the 10th anniversary of the Supreme Court of Canada’s decision in Carter v. Canada (Attorney General), in which the court unanimously ruled, against both basic logic and its own precedents, that the right to life, guaranteed by the Constitution, included the right to a state-assisted suicide through what came to be known euphemistically as “Medical Assistance in Dying” (MAiD).

At the time, the court dismissed evidence from other jurisdictions that the legalization of euthanasia inevitably led to its open-ended expansion as well as abuse against the vulnerable. Belgium’s disastrous euthanasia experiment, which saw children and people with psychiatric disorders dying at the hands of doctors, was, the court said, the “product of a very different medico-legal culture…. We should not lightly assume that the regulatory regime will function defectively, nor should we assume that other criminal sanctions against the taking of lives will prove impotent against abuse.” There would be no slippery slope, the court promised us.

Zhu examines his assertions about Canada's euthanasia law.

In 2016, Parliament legalized MAiD for people whose deaths were “reasonably foreseeable.” A short five years later, unnoticed in the midst of the pandemic, Canada’s euthanasia regime was expanded to cover those with chronic conditions whose deaths were not imminent. At the same time, Parliament legalized euthanasia for mental illness alone to come into force in 2023 (it has since been postponed to 2027), making a mockery of our society’s commitment to mental health and suicide prevention.

Christine Gauthier

Zhu examines several of Canada's euthanasia horror stories, such as Paralympian, Chritine Gauthier:

The horror stories Canada’s euthanasia regime has generated — the Paralympian who was offered MAiD by a government employee when she asked for a wheelchair ramp, the disabled woman living on welfare who opted for MAiD because she could not secure adequate housing, the cancer patient who chose to kill himself because he could not access chemotherapy in time — have become so commonplace that they have blunted our sense of decency, of what is the minimum we owe to our fellow citizens. Meekly, we have accepted that such horrors, and many more unreported ones, are part and parcel of Canadian society.

We have no answers to the contradictions raised by the legalization of MAiD. The civil servant who suggested it to Christine Gauthier was fired; but why did she lose her job, when MAiD is healthcare and when Gauthier, who is confined to a wheelchair, is eligible for euthanasia under Canadian law because of her disability? Was she not simply doing her job, providing information to those who may need it?

Zhu then comments on Canada's euthanasia statistics:

When it was introduced, proponents claimed MAiD would only account for a small number of deaths. In 2023, almost one death out of 20 in Canada was due to MAiD. In Quebec, which has adopted the practice more enthusiastically than virtually any other human society, the figure is 7.3 per cent, the highest such figure anywhere in the world. Last year, Quebec unilaterally legalized MAiD by advance directive — which under the Criminal Code is murder. The federal government’s reaction was to hold a series of national roundtables to discuss the idea more.

What about the “regulatory regime” on which the learned judges of the Supreme Court rested their hopes to protect the vulnerable? In Ontario, the chief coroner’s office recorded at least 428 cases of non-compliance with Canadian law by MAiD providers over a five-year period, in what was described as “a pattern of not following legislation, a pattern of not following regulation.” Most cases led to nothing more than an email to the provider; only four cases were referred to professional regulators. Not a single law-breaker was referred to the police.

Jocelyn Downie

To confirm how Canada's euthanasia law is being widely interpreted, Zhu refers to comments by Canada's leading euthanasia academic:

In the words of Jocelyn Downie, who received the Order of Canada for her promotion of MAiD, when doctors or nurse practitioners are assessing a patient’s eligibility for MAiD, “you can ask as many clinicians as you want or need” for a second opinion, allowing them to shop around until they find a colleague who will sign off on a MAiD request. On another occasion, she told medical professionals that, when it came to signing off on MAiD requests, “There is no certainty or unanimity required. There is not perfection required.” Legally, she was right: Canadian law does not require medical professionals to be right when they authorize MAiD for someone; they must merely have reasonable belief. The MAiD assessor does not even need to meet the patient face-to-face: a Zoom meeting is sufficient.

Finally Zhu refers to the role of the courts in Canada's euthanasia horror:

As for the courts, which opened a Pandora’s box, they have largely washed their hands from it all. Last year, an Alberta judge ruled that an autistic woman with no apparent diagnosis of a physical illness could receive MAiD, even though the judge himself did not understand how she came to be approved for MAiD and even though at least one doctor had turned down her request.

Some judges are even proud of the role they played in ushering in MAiD: in 2018, Richard Wagner, the chief justice of Canada, agreed the Carter decision and other rulings of its kind made the Supreme Court, as one Vancouver lawyer had characterized, “the most progressive in the world,” and added that he was “very proud of that.”

A decade on, there was no slippery slope; it was a cliff. 

Recent articles on this topic:

• Canada euthanasia: Unmasking healthcare and social failures (Link).
• Euthanasia is a national tragedy and it's only getting worse (Link).
• Family sues after British Columbia man dies by euthanasia while on a psychiatric day pass (Link).
• Canada: 13,343 reported euthanasia deaths in 2023 (Link).
• Ontario: At least 428 non-compliant euthanasia deaths (Link).
  

The group that legalized euthanasia in Canada admits that it's being abused.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The National Post published a Special Report by Miranda Schreiber on December 19, 2024 explaining that the group that was behind Canada's euthanasia law is now saying that the euthanasia law is being abused.

A similar article was written by Cameron Henderson and published by The Telegraph on October 26, 2024.

Schreiber explains that the BC Civil Liberties Association, which is the group that carried the Carter case through the British Columbia trial court and then up to the Supreme Court of Canada is warning that euthanasia has become too easy to obtain and the government must enact safeguards. Schreiber reported that:

Liz Hughes, who has served as BCCLA executive director since June 2023, said in a statement to the National Post that the group is “aware of concerning reports of people being offered MAID in circumstances that may not legally qualify, as well as people accessing MAID as a result of intolerable social circumstances.”

Hughes called for government action: “Governments must put in place, actively review, and enforce appropriate safeguards to ensure that people are making this decision freely.”

The BCCLA’s work around MAID has evolved, Hughes said, and the organization “will continue to hold the government accountable.”

Schreiber points out that the BCCLA already agreed in September 2023 that the law was being abused.

In a video shared with the National Post by disability activists, a BCCLA litigation staff lawyer told a Zoom town hall on Sept. 27, 2023, that her work with the association “may very well involve adopting either a modified or a new policy around our position on MAID in light of the fact of, you know, that it’s being abused.”

She said she is “very uncomfortable with our previous work around MAID,” and said staff want to be “making sure people have adequate supports and access to health care and other financial resources.”

Another BCCLA staff member told the town hall “we’ve done an environmental scan, so that was a kind of review of what’s currently happening with MAID in Canada, and it’s very concerning … the whole coercive dynamic that’s inherent with, you know, disabled people and their health-care providers.”

The BCCLA were particularly concerned about euthanasia for prisoners and people with disabilities.

Of particular alarm to the staff members were reports of MAID being used in prisons while incarcerated people were shackled to their beds, the program’s lack of legal oversight, disproportionate representation of impoverished people receiving assisted suicide, and health-care practitioners offering assisted suicide when patients asked for support for living.

Disability activist, Roger Foley, told Schreiber:

In an interview, disability activist Roger Foley said it is significant that these comments come from the civil liberties group that spearheaded the inception of Canada’s MAID program: “BCCLA was the driving force and creator of the legal challenge that decriminalized euthanasia and assisted suicide in Canada,” Foley said.

Schreiber continues by outlining concerns with Canada's euthanasia data:

Health Canada’s Fifth Annual Report on Medical Assistance in Dying in Canada last week revealed that over 15,300 Canadians died by MAID in 2023, representing a 15.8 per cent increase in deaths from the previous year. In 2023, MAID accounted for 4.7 per cent of deaths in Canada.

Quebec accounted for 36.5 per cent of all Canadian MAID deaths in 2023. Quebec’s 5,601 MAID deaths represented 7.2 per cent of the province’s total deaths — about one in every 14. B.C. is not far behind; MAID now represents 6.1 per cent of all deaths in that province.

Health Canada’s report reveals that 47.1 per cent of non-terminally ill Canadians who applied for MAID reported “isolation or loneliness” as one of the causes of their suffering. Just under half of all Canadian MAID cases (terminal and non-terminal) indicate that they want an early death in part lest they become a “perceived burden on family, friends or caregivers.”

Health Canada's Fifth Annual Report released last week revealed that MAiD was responsible for about one in 20 deaths in Canada in 2023, including 622 people who received MAID for a non-terminal illness.

Previous article on this topic:

• The group that orchestrated Canada's euthanasia law admit abuse of the law (Link).

The group that orchestrated Canada's euthanasia law, admits abuse of the law

"In one instance, they spoke of a patient who had been approved for assisted dying on the grounds of suffering from hearing loss."

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

Cameron Henderson reported for The Telegraph on October 26 that the BC Civil Liberties Association (BCCLA) admits that Canada's euthanasia is being abused. It was the BCCLA that carried the Carter case that legalized euthanasia in Canada to the Supreme Court. According to Henderson:

Assisted dying is being abused in Canada with doctors coercing patients into ending their lives, members of the group who helped to legalise it have admitted.

Henderson reports that:

The Telegraph can now reveal that members of the British Columbia Civil liberties Association (BCCLA), the group that spearheaded efforts to legalise assisted dying, have privately raised fears the practice is being “abused”.

Staff members also fear disabled people in Canada are being coerced by doctors into choosing to end their lives.

Henderson's report is published one week after the Chief Coroner of Ontario pubished a review of Ontario's experience with euthanasia which indicated that:

those on lower incomes who were offered the scheme were more likely to opt for it.

Henderson uncovers the information from a leaked footage from a video call last year between BCCLA staff and a Canadian disabled patients’ group.

In the footage a BCCLA employee admits that:

“we are seeing MAiD being abused”.

Henderson further reports that:

In one instance, they spoke of a patient who had been approved for assisted dying on the grounds of suffering from hearing loss.

On the same call, it was claimed some medical colleges in Canada had been advising against referring to MAiD on patients’ long-form death certificates, in a move which could distort the true numbers of people using it.

Some BCCLA staff members feel very uncomfortable with Canada's euthanasia law. Henderson writes:

One staff member admitted feeling “very uncomfortable” about the group’s previous campaigning on assisted suicide.

Speaking on the call, one of the two current BCCLA employees said: “It is the social and material aspect of [patients] disability and how that isn’t supported and how that’s treated in the community that’s creating intolerable conditions.

“In my view, that’s not proper,” they said, adding that healthcare providers should not raise the subject of MAiD with patients as “it’s far too easy for that to become coercive”.

In a separate voicemail message shared with The Telegraph, another alleged employee voiced regret about the campaigning group’s past agenda and spoke of trying to formulate a new policy that “distances the BCCLA from its past work”.

Henderson reports that the Joseph Arvay, for the BCCLA, argued before the courts in the Carter case that:

the risk of people unnecessarily ending their lives through an assisted dying scheme was negligible.

The euthanasia review from the Chief Coroner of Ontario of the euthanasia law was published last week. Henderson reports:

Yet fast-forward eight years, and the first official report into assisted dying deaths in Ontario, revealed last week by The Telegraph, found vulnerable people faced “potential coercion” and “undue influence” to seek out the practice.

According to the data, disproportionate numbers of people who ended their lives through assisted dying when they were not terminally ill – 29 per cent – came from Ontario’s poorest areas.

That compares with 20 per cent of the province’s general population living in the most deprived communities.

The Telegraph is reporting on Canada's experience with euthanasia as the UK parliament is scheduled to vote on a bill to legalize assisted suicide on November 29.

Canada's Euthanasia lobby launches court case to extend euthanasia to mental illness alone.

Based on the Netherlands where 1.7% of all euthanasia deaths were for mental illness alone, if permitted, there could have been 255 euthanasia deaths for mental illness alone in Canada in 2023.

Alex Schadenberg
Executive Director,
Euthanasia Prevention Coalition

Dying with Dignity, Canada's leading euthanasia lobby group, launched a court case on August 19, 2024 to force Canada to extend euthanasia to mental illness alone. This recent court challenge proves how extreme Canada's euthanasia lobby is and how they have redefined the meaning of the words compassion and equality.

The euthanasia lobby falsely believe that the Supreme Court of Canada, Carter decision (2015), created a right to euthanasia, (which it did not) and that the Carter decision also required Canada to permit euthanasia for mental illness alone (which it did not). 

Stephanie Taylor reported for The Canadian Press that:

An application filed by Dying with Dignity in Ontario Superior Court on Monday argues that it is discriminatory to bar people with mental disorders from being eligible for an assisted death when it is available to people who suffer physically.

The euthanasia lobby has launched a Charter challenge to force Canada to extend euthanasia to people with mental illness alone based on equality. The Dying with Dignity press release states:

The continued exclusion reinforces the stigma and historic prejudice against people with mental illness. It violates section 15 of the Charter by discriminating on the basis of the type of disability experienced. It also violates section 7 of the Charter by denying people with a mental illness the freedom to make fundamental decisions about their body and life; this denial is overbroad. The differential treatment of people whose sole condition is a mental illness minimizes the enduring and intolerable suffering that some individuals experience and undermines their full participation in the range of choices that are available to all other people across Canada.

The Dying with Dignity media release justifies euthanasia for mental illness by stating:

In fact, of the 8,042 assisted deaths in The Netherlands in 2023, 138 (1.7%) were because the primary medical condition was a mental illness.

I have predicted that there were more than 15,000 Canadian assisted deaths in 2023. If Canada approves euthanasia for mental illness alone, based on the Netherlands euthanasia data of 1.7% of all euthanasia deaths were for mental illness alone, there may have been 255 euthanasia deaths (1.7%) for mental illness alone in Canada in 2023.

The reality is that Canadians with mental illness are already being killed by euthanasia, even when their primary purpose for seeking death is a mental illness, so long as the person has a co-morbidity that enables the doctor or nurse practitioner to approve the death.

The issue of euthanasia for mental illness alone has always been part of the euthanasia debate. The original law (Bill C-14) that was passed in June 2016 excluded euthanasia for mental illness alone and it required that a person's "natural death be reasonably foreseeable" (which was not defined). Essentially Bill C-14 required that a person had to have a terminal condition in order to be approved to be killed.

In March 2021, the federal government expanded Canada's euthanasia law by passing Bill C-7. C-7 removed the requirement in the law that a person's "natural death be reasonably foreseeable", it removed the 10-day waiting period for people who were terminally ill, it added a 90-day waiting for people who were not terminally ill and it approved euthanasia for mental illness alone, but added a two year moratorium on euthanasia for mental illness alone to establish guidelines around this new category of killing.

Since then the federal government has twice delayed the implementation of euthanasia for mental illness alone with the most recent legislation (Bill C-62) delaying it until March 17, 2027.

When Canada passed Bill C-7 and eliminated the requirement that a person have a terminal condition to be approved to be killed, the result has been stories of Canadians with disabilities seeking or dying by euthanasia based on poverty, homelessness or an inability to access necessary medical treatments.

Similar to Canadians with disabilities, Canadians living with mental illness are also more likely to live in poverty or homeless and they often have difficulties accessing necessary medical treatments. In some communities, a person with mental illness will wait more than 90 days to be seen by a mental health specialist, and yet the law permits euthanasia for non-terminally ill people with a 90-day waiting period.

This is the second Charter challenge launched by Dying with Dignity. On June 17, 2024 Dying with Dignity launched a Charter challenge to force all medical institutions to provide euthanasia.

The Dying with Dignity lawsuit proves how extreme that the euthanasia lobby in Canada has become.

The Euthanasia Prevention Coalition will seek to intervene in this court case.

Important articles on this topic: 

• Euthanasia Prevention Coalition says that the expansion of euthanasia to include mental illness should be scrapped (Link).
• Treat people with mental health problems, don't kill them (Link).
• Provincial Health Ministers urge the Federal government to indefinitely pause euthanasia for mental illness alone (Link).
• Euthanasia for those with mental illness should not be on the table (Link).
• Euthanasia for mental illness should never come to pass (Link). 
• Canada's euthanasia law. We've already gone too far. (Link). 
• Canada has revealed the horror of assisted dying (Link). 
• Canada must put the brakes on euthanasia for mental illness (Link).
• Don't abandon people to death by euthanasia (MAiD) (Link)
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The Rise of Euthanasia in Canada: From Exceptional to Routine.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Canada had approximately 15,280 euthanasia deaths in 2023 (Article Link).

I would like to thank Alexander Raikin for his research report on the Rise of Euthanasia in Canada that was produced for and published by Cardus.

In one week there have been three exceptional studies on Canada's euthanasia program published from different perspectives. I hope that the interest in Canada's euthanasia law will lead to changes and a social shift towards rejecting the killing of people by lethal poison.

The first study was a landmark study by Chelsea Roff and Catherine Cook-Cottone on Assisted Death and Eating Disorders. (Link 2).

The second was a research study by Professor Christopher Lyon that asked the question: Does Canada's euthanasia law enable healthcare serial killers?

This third study, by Alexander Raikin, examines the change in the attitude towards euthanasia in Canada under the title: The Rise of Euthanasia.

The Rise of Euthanasia in Canada: From Exceptional to Routine.

Alexander Raikin

The key points by Raikin are:

• The number of Canadians dying prematurely by “medical assistance in dying” (MAiD) has risen thirteenfold since legalization. In 2016, the number of people dying in this way was 1,018. In 2022, the last year for which data are available, the number was 13,241.
• MAiD in Canada is the world’s fastest-growing assisted-dying program.
• MAiD is now tied with cerebrovascular diseases as the fifth leading cause of death in Canada. Only deaths from cancer, heart disease, COVID-19, and accidents exceed the number of deaths from MAiD.
• Assisted dying was not meant to become a routine way of dying. Court rulings stressed that it be a “stringently limited, carefully monitored system of exceptions.” Then Minister of Justice and Attorney General Jody Wilson-Raybould agreed: “We do not wish to promote premature death as a solution to all medical suffering.” The Canadian Medical Association likewise stated that MAiD was intended for rare situations.
• MAiD assessors and providers do not treat it as a last resort. The percentage of MAiD requests that are denied continues to decline (currently it is 3.5 percent). MAiD requests can be assessed and provided in a single day.
• Government departments and agencies continue to state that Canada’s MAiD experience is similar to that of other jurisdictions, that the rate of increase is expected, and that the growth is gradual. The data contradict these statements.
• Health Canada has dramatically underestimated what a “steady state” of MAiD deaths would look like and how quickly Canada would reach the 4 percent threshold of total deaths. This threshold was reached in 2022, eleven years ahead of what Health Canada predicted only months earlier, and double its prediction just four years earlier.
• Despite the importance of accurate vital statistics, some provinces’ death records do not record MAiD as a cause of death, instead recording the underlying condition that led to the MAiD request and subsequent death. Further, Health Canada reports on the number of MAiD deaths, but Statistics Canada does not consider MAiD a cause of death. These inconsistencies in reporting have an impact on research about MAiD and about causes of death more generally.
• The systematic underestimation of MAiD in government statements and reporting is a serious impediment to understanding the scale of MAiD’s normalization in Canada and its abnormality with regard to other countries where some form of assisted dying is permitted.
• For policymakers and the public to properly understand the Canadian reality, it is essential that government agencies collect consistent data and issue correct statements.

Euthanasia was sold to Canadians as a "last resort" but in fact it has been normalized as "medical treatment." The number of Canadian euthanasia deaths has far exceeded the projected numbers and euthanasia has been falsely asserted to be a "right" in Canada.

Canada's Troubling Normalization of Euthanasia as Health Care: Part 1: There is NO CONSTITUTIONAL RIGHT to euthanasia (MAiD) in Canada

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Trudo Lemmens

The American Journal of Bioethics published on October 25, 2023 an excellent article by Professor Trudo Lemmens entitled: When Death Becomes Therapy: Canada's Troubling Normalization of Health Care Provider Ending of Life. Trudo Lemmens, is Professor and Scholl Chair in Health Law and Policy at the University of Toronto. (Link to the article).

I have decided to comment on this article by separating the main topics to enable it to be fully appreciated. 

Lemmens begins his article by commenting on a research article by Daryll Pullman who compared Canada's euthanasia law to California's assisted suicide law:

Undeniably, a strikingly higher number of people die with direct health care provider involvement in Canada’s euthanasia regime, euphemistically termed “Medical Assistance in Dying” [MAiD], than under a California-style assisted suicide system. Daryl Pullman (2023) rightly identifies several key reasons: the fact that in about all cases it involves a lethal injection by health care providers, rather than assisted-suicide with self-administration of medication; the law’s vague and broadly interpreted access criteria; “acquiescence and [...] indifference of federal and provincial authorities, the courts, and medical associations”; and, briefly mentioned, the failure to treat ending of life as a last resort (Pullman 2023). Particularly the last points are worth exploring further since they are likely among the key reasons why Canada’s regime results in substantially higher percentages of euthanasia deaths even when compared to the few other liberal euthanasia regimes, and with an accumulation of reports of arguably troubling practices. These points are also connected to the law’s origin in constitutional litigation, which has had a remarkable impact on the Canadian debate and policy.

Lemmens discusses how Canada passed its law after a Supreme Court decision, and then expanded it after a Québec lower court decision that was not appealed by the federal government:

Indeed, the Supreme Court’s Carter decision did not create an unrestricted constitutional right to physician-ending-of-life but only invited parliament to legalize some form of “physician assisted dying” (Grant 2023; Lemmens, Kim, and Kurz 2019). It issued broad parameters for law reform, tied its reasons to the “circumstances of the case” (a case of a patient approaching her death) and confirmed the role of the criminal law in protecting life. Yet despite the case’s limitations, advocates for broad legalization, advisory committees in which the latter often received influential positions, health professional organizations, and media commentators, quickly embraced a rhetoric of a “constitutional right to MAiD,” focusing largely on access and expansion (Gaind et al.2022).

The parameters of the law are still a matter of interpretation. Lemmens comments on the Truchon court case:

The Quebec Truchon judgment mentioned by Pullman, which declared the safeguard of the restriction to end-of-life unconstitutional, was a trial court decision that was not binding on higher courts and outside Quebec (Lemmens and Jacobs 2019; Grant 2023). Yet, the federal government invoked the decision, disingenuously claiming its hands were tied, to push for expansion of MAiD, including for mental illness (Lemmens 2023a).
 
The decision not to appeal the Truchon decision, which was publicly announced in the midst of a federal election in Quebec, a province in which the expansion of MAiD appeared very popular, seems an example of instrumental political use of a judicial process. How the government subsequently failed to consult with disabled persons, Indigenous communities, and others particularly affected (the former in fact explicitly treated as intended “beneficiaries” of an expanded MAiD law), by invoking court-imposed urgency; and then pushed through a new law, in the midst of the pandemic, and against the explicit objection of nearly all disability advocacy organizations,various Indigenous organizations, and international human rights rapporteurs and experts; and how, contrary to its initial endorsement of evidence-informed prudence, it ended up including MAiD for sole reasons of mental illness (Gaind et al.2022), will remain a stain on Canada’s human rights record. Commentators have rightly argued that the expanded MAiD law is discriminatory, since it deprives disabled persons who are not approaching their natural death from the same protection against premature death that others continue to receive (Grant 2023; Lemmens and Jacobs 2019). Indeed, facilitating the death of others, even when they consent, remains criminally prohibited, and others continue to be protected by suicide prevention policies. But even merely procedurally, it is hard to think of a more explicit ignoring of “nothing about us without us,” a participatory principle reflected in the United Nations Convention on the Rights of Persons with Disabilities.

Lemmens states that by:

Invoking a seemingly unrestricted constitutional right to MAiD, or perhaps intimidated by the perception of its existence, not only many politicians and MAiD advocates, but also health care providers and health profession organizations largely stopped engaging meaningfully with evidence-informed clinical, ethical, and policy arguments about potential benefits and harms of expanding MAiD. The parroting of rights rhetoric, with frequent references to “discrimination,” distorted the Canadian debate. Proportionality review embedded in constitutional or human rights-analysis must be informed by evidence-informed clinical, policy and ethical arguments. Yet, in Canada, rights rhetoric largely replaced evidence-informed debate.

Lemmens provides a thorough explanation of how Canada went from legalizing euthanasia and assisted suicide to it becoming a "right" to die (which does not exist).

By claiming that there is a "constitutional right" to be killed, the Canadian debate turned from debating the issue openly to the implementation of wider and wider access to killing.

There is no legal right to euthanasia for people with mental illness in Canada.

This is a reprint of a letter written by Trudo Lemmens and co-signed by 30 Canadian legal professors and sent to the Prime Minister and key cabinet ministers.

Thursday, February 2, 2023

Justice Minister David Lametti announced today the introduction of a bill which would delay by one year, until March 2024, the scheduled implementation of MAID for sole reasons of mental illness. Until today, the federal government had repeatedly suggested it was bound by 'the courts' to expand MAID and to make MAID also available for persons whose sole underlying medical condition is mental illness. Minister Lametti even stated in an interview for a recent investigative documentary of CBC's The Fifth Estate, which revealed troubling components of the current MAID practice, that the Supreme Court had recognized 'a right to suicide' and that MAID was a 'species of suicide'. He made similar statements in an interview for a podcast with Althia Raj of the Toronto Star. With some colleagues of other law faculties, we drafted a letter to Prime Minister Trudeau, Ministers Lametti, Duclos, Qualtrough and Bennett, to challenge this problematic and in our view unfounded rhetoric of 'our hands are tied by the courts'. We urge the government to take the time "to conduct a serious, inclusive, and evidence-based re-evaluation of the appropriateness of expanding MAiD" and "to suspend this implementation."  In one day, the letter was signed by 28 law professors of the Universities of British Columbia, Dalhousie, Manitoba, Montreal New Brunswick, Ottawa, York (Osgoode Hall Law School), Thompson River, Toronto and Windsor. Colleagues can contact me to have their names added. The original letter went out with the first 25 signatories below. 

Here is the letter: 

The Right Honourable Justin Trudeau, Prime Minister of Canada; The Honourable David Lametti, Minister of Justice and Attorney General of Canada; The Honourable Jean-Yves Duclos, Minister of Health; The Honourable Carla Qualtrough, Minister of Employment, Workforce Development and Disability Inclusion; The Honourable Carolyn Bennett, Minister of Mental Health and Addictions

February 1, 2023 

Re: Legal Claims about the Need for Legalizing MAiD for Persons Whose Sole Underlying Medical Condition is Mental Illness

Dear Prime Minister, dear Ministers Lametti, Duclos, Qualtrough and Bennett,

We write as law professors to contest the assertion of the Liberal government that legalizing MAiD for reasons of mental illness has been mandated by our courts.  While we welcome the federal government’s announcement to halt the implementation of the legislative sunset clause, we are concerned about statements that this is only a delay, and is not treated as an opportunity to conduct a serious, inclusive, and evidence-based re-evaluation of the appropriateness of expanding MAiD.

We disagree as law professors that providing access to MAiD for persons whose sole underlying medical condition is mental illness is constitutionally required, and that Carter v Canada AG[1] created or confirmed a constitutional right to suicide, as Minister Lametti has repeatedly stated. Our Supreme Court has never confirmed that there is a broad constitutional right to obtain help with suicide via health-care provider ending-of-life.

It suffices here to point to some key elements to challenge the claim that there is a clear constitutional duty to create access to MAiD for persons whose sole underlying condition is mental illness. First, the Supreme Court explicitly stated in Carter, after hearing evidence from allegedly problematic euthanasia cases in Belgium, that “euthanasia for minors or persons with psychiatric disorders or minor medical conditions” would “not fall within the parameters suggested in these reasons”.[2] The Court further emphasized that “[t]he scope of [its] declaration is intended to respond to the factual circumstances in this case” and that it made “no pronouncement on other situations where physician-assisted dying may be sought.”[3]        

Carter did not involve plaintiffs with mental illness, but with terminal neurogenerative diseases. The trial court in Carter further explicitly stated that it is “problematic to conflate decision-making by grievously and irremediably ill persons about the timing of their deaths, with decision-making about suicide by persons who are mentally ill or whose thinking processes are affected by substance abuse, trauma or other such factors.”[4]  

Second, while the Alberta Court of Appeal decision in Canada (A.G.) v E.F.,[5] and the Quebec Superior Court decision in Truchon v Canada AG,[6] interpreted Carter as not excluding (MAiD for) mental illness, they did not rule on the constitutionality of a legislative exemption for mental illness. Moreover, these decisions are not binding in other provinces, and were not appealed to the Supreme Court of Canada or the Quebec Court of Appeal respectively. In E.F., the Alberta Court of Appeal further explicitly stated: “Issues that might arise regarding the interpretation and constitutionality of eventual legislation should obviously wait until the legislation has been enacted.”  The case can therefore hardly be invoked as a precedent confirming the constitutional need to legalize MAiD for mental illness.

With respect to the Truchon decision, the plaintiffs were not requesting MAiD based on mental illness, and any comments by the trial judge about MAiD for sole reasons of mental illness should be considered obiter dicta. We note that Minister Lametti’s decision as Attorney General not to appeal Truchon and to simply amend the legislation was unprecedented.

In the absence of binding precedent, it is premature to argue that the Charter requires access to MAiD for persons whose sole underlying medical condition is mental illness. It is in our view also reckless to suggest that a constitutional right to MAiD should and would be recognized by our Supreme Court when there has been no meaningful review of the evidence suggesting that psychiatrists can predict for whom mental illness will be irremediable, the impact on suicide prevention, the impact on the health care and lived experience of persons experiencing mental illness, and the challenge of balancing access to MAiD with the protection of the life of those who are otherwise not approaching their natural death. In fact, there is for that reason on the contrary a strong argument to be made that the Charter requires adequate and equal protection against premature death of all persons with disabilities. This is what about all Canadian disability organizations have argued.

For all these reasons, we strongly object to suggestions that MAiD for mental illness needs to be made available as a matter of constitutional right, and support a suspension and review, not just a delay, of further expansion of MAiD.

Yours sincerely,

Trudo Lemmens Professor and Scholl Chair in Health Law and Policy, Faculty of Law, University of Toronto; Isabel Grant, Professor, Peter A. Allard School of Law, University of British Columbia;  H. Archibald Kaiser, Professor, Faculty of Law and Department of Psychiatry, Faculty of Medicine, Dalhousie University; Mary Shariff, Associate Professor, Faculty of Law, University of Manitoba; Elizabeth Sheehy, Professor Emeritus, Faculty of Law, University of Ottawa; C. Tess Sheldon, Assistant Professor, Faculty of Law, University of Windsor; Roxanne Mykitiuk, Professor, Osgoode Hall Law School, York University; Kerri Froc, Associate Professor, Faculty of Law, University of New Brunswick; Brandon Trask, Assistant Professor, Faculty of Law, University of Manitoba; Michelle Gallant, Professor, Faculty of Law, University of Manitoba; Geoffrey Sigalet, Assistant Professor, Centre for Constitutional and Legal Studies, University of British Columbia Okanagan; Brian Bird, Assistant Professor, Peter A. Allard School of Law, University of British Columbia; Janine Benedet KC, Professor, Peter A. Allard School of Law, University of British Columbia; Bill A. Bogart, Distinguished University Professor and Professor of Law (Emeritus), Faculty of Law, University of Windsor; Darcy MacPherson, Professor, Faculty of Law, University of Manitoba; Sophia Moreau, Professor of Law and Philosophy, Faculty of Law, University of Toronto; Richard Moon, Distinguished University Professor, Faculty of Law, University of Windsor; Ravi Malhotra, Professor, Faculty of Law, Common Law Section, University of Ottawa; Alan Brudner, Albert Abel Professor of Law Emeritus, Faculty of Law, University of Toronto; Lynda Collins, Professor, Faculty of Law, University of Ottawa; Mohammad Fadal, Professor, Faculty of Law, University of Toronto; Pascale Chapdelaine, Associate Professor, Faculty of Law, University of Windsor; Karine Millaire, Professeure Adjointe, Faculté de droit, Université de Montréal; Patrick Garon-Sayegh, Professeur Adjoint, Faculté de droit, Université de Montréal; Audrey Macklin, Professor and Rebecca Cook Chair in Human Rights Law, Faculty of Law, University of Toronto; Bruce B. Ryder, Associate Professor, Director Clinical Legal Education, Osgoode Hall Law School, York University; Jeffrey G. MacIntosh, Professor, Faculty of Law, University of Toronto; Martha Shaffer, Professor, Faculty of Law, University of Toronto; Natasha Bakht, Professor and Shirley Greenberg Chair for Women and the Legal Profession, Faculty of Law, University of Ottawa; Debra M. Haak, Assistant Professor, Faculty of Law, Queen's University; Ruby Dhand, Professor, Faculty of Law, Thompson River University; Neil Seeman, Senior Fellow, Dalla Lana School of Public Health, University of Toronto.

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[1] Carter v Canada (Attorney General), 2015 SCC 5

[2] Ibid. at para 111.

[3] Ibid. at para 127.

[4] Carter v Canada, 2012 BCSC 886 at para 814

[5] Canada (Attorney General) v EF, 2016 ABCA 155

[6] Truchon c Procureur Général du Canada, 2019 QCCS 3792

Canada’s Euthanasia (MAiD) law is the most permissive in the world. How did this happen?

Alex Schadenberg

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In 2015 the Supreme Court of Canada struck down Canada’s laws that protected people from euthanasia and assisted suicide. The case, known as the Carter case, was based on Kay Carter (89), who was not terminally ill but lived with spinal stenosis and died by assisted suicide in Switzerland, and Gloria Taylor, who lived with ALS.

At that time I wrote how the Supreme Court of Canada's decision was irresponsible and dangerous, but the Supreme Court did state that the federal government was to create a “carefully-designed system” with “stringent limits that are scrupulously monitored and enforced.” Clearly, the government ignored that requirement.

In 2016, while the federal government was debating euthanasia Bill C-14, there were many attempts to amend the bill or to define the language in the bill to fulfill the requirement of the Carter decision. The problem with Bill C-14 was evident, the bill gave doctors and nurse practitioners the right in law to cause the death of their patients, without defining the terminology within the law.

For instance, Bill C-14 stated that euthanasia would be restricted to people “whose natural death was deemed reasonably foreseeable.” The government claimed that this phrase would limit euthanasia to terminally ill people but because the phrase was not defined it created confusion.

Based on a lack of definition I predicted that the euthanasia law would expand based on the practise and the law would be interpreted in an expansive manner.

Soon after the passing of Bill C-14 a couple of people with disabilities launched court challenges to the legal requirement that that their “natural death must be deemed reasonably foreseeable.” They argued that it was discrimination to deny euthanasia to someone who is suffering but not terminally ill.

Even though the interpretation of “reasonably foreseeable” had expanded beyond its original interpretation, in September 2019, a Québec lower court struck down the requirement that a person’s death must be “reasonably foreseeable” in the Truchon decision. Even though this was a lower court decision, the federal government did not appeal the decision, thus expanding euthanasia to people who are not terminally ill.

The original law required that a person must have an “irremediable medical condition” combined with that their “natural death being reasonably foreseeable.” By removing the reasonably foreseeable death requirement, euthanasia became available to nearly anyone with a disability or chronic condition.

The federal government “codified” the Truchon decision into the law by passing Bill C-7 in March 2021. Bill C-7 removed from the original law that death must be “reasonable foreseeable” but C-7 also eliminated the 10-day waiting period for people who are terminally ill, it created a 90-day waiting period for those who are not dying and it permitted euthanasia for people with mentally illness. The government declared a two-year moratorium on euthanasia for mental illness, meaning that on March 17, 2023 euthanasia for mental illness could begin. On December 15, 2022 the federal government announced that they will delay the implementation of euthanasia for mental illness alone.

During the C-7 debate, the disability community were adamant that, if passed, it would lead to people with disabilities dying by euthanasia for social reasons. Due to a lack of definition in the law, they predicted that almost everyone with a disability would qualify for death yet the reason people would ask for death may be related to poverty, an inability to receive medical treatment and other social concerns.

Canada has the most permissive law.

In April, 2022; CTV news story reported on a euthanasia death in February 2022 of a 51-year-old woman who had multiple chemical sensitivities (MCS). According to Favaro, the woman was not terminally ill but living with a chronic condition that made her highly sensitive to chemicals and environmental allergies. I stated that this story represented the ultimate form of abandonment whereby this woman was killed not because of an “irremediable medical condition” but because she couldn't afford appropriate housing.

Soon after CTV news reported on a 31-year-old woman with MCS who was also approved to be killed by euthanasia. These reports of euthanasia for MCS created awareness that euthanasia was becoming a “treatment” for people with disabilities who were living with poverty or issues related to housing or other social conditions. The good news was that this story resulted in a GoFundMe campaign that raised money to enable this woman to afford a clean place to live.

Donna Duncan's daughters

CTV news also reported that the euthanasia death of Donna Duncan was being investigated by the Abbotsford police. Duncan (61) was diagnosed with a concussion after a car accident in February 2020. Due to Covid restrictions, Duncan was unable to access medical treatment or rehabilitation. The concussion symptoms led to other health problems as well as deep depression. Duncan was assessed, approved and then died by euthanasia even though her condition was treatable.

After these stories were published, other stories began to be featured by reporters. There have been several stories concerning people who were approved for euthanasia but were unable to access medical treatment. Some of these people with disabilities required treatment for their symptoms and found that getting approved to be killed was easier than accessing treatment. 

Canada had now become the most permissive jurisdiction in the world for euthanasia and the world began to wonder why Canada is euthanizing the poor.

Another powerful story was the Canadian veteran who was seeking treatment for PTSD and a Veteran’s Affairs worker told him that he should apply for “MAiD.” When this story was reported, the Ministry of Veteran’s Affairs stated that it had only happened once. Since then it has been reported that several veterans died by euthanasia and at least 6 veterans were told to apply for “MAiD.”

There was the story of a disabled man who was seeking death by euthanasia to avoid homelessness. He was unable to find a new place to live after the building he was living in was sold. This man relied on a disability benefit and he was unable to find an affordable place to live. He said that he would rather die than become homeless. Thankfully a GoFundMe campaign raised enough money to enable him to find a place to live.

Alan Nichols with his brother

A woman with disabilities died by euthanasia based on inadequate home care, a 23-year-old with diabetes was approved for euthanasia, and the story of Alan Nichols keeps coming back as his family wonders why they killed their brother.

To make matters worse, the Quebec College of Physicians are now urging the federal government to legalize euthanasia for newborns, otherwise known as infanticide.

In a few short years Canada went from legalizing euthanasia for terminal illness, then extending it to people with chronic conditions and disabilities and Canada is now considering euthanasia from "mature minors," newborns, people with dementia and more.

There is only one clear line in the sand, that being, is it acceptable for one group of people to kill other people. By legalizing euthanasia, Canadian doctors and nurse practitioners gained the right in law to kill their patients. Once Canada decided that it was acceptable to kill, the only remaining questions are who can be killed and for what reasons. 

Further reading:

• Supreme Court of Canada Assisted Suicide decision is irresponsible and dangerous (Link).
• Quebec Court expands euthanasia law by striking down the terminal illness requirement. (Link).
• Canada passes Bill C-7 allowing euthanasia for mental illness (Link).
• Canada's law will provide not prevent suicide for some psychiatric patients (Link).
• Euthanasia for mental illness. Killing people with an uncertain prognosis (Link).
• Abbotsford police investigating euthanasia death (Link).
• Canada is not as advertised. Euthanasia is eugenics (Link).
• Canada's euthanasia law is the most permissive in the world (Link).
• (MAiD) euthanasia for disability and poverty (Link).
• (MAiD) euthanasia for mental illness and poverty (Link).
• Veterans affairs worker advocates euthanasia for PTSD (Link).\
• Abandoning people. Canada's broadening euthanasia laws (Link).
• Mother wants to stop 23-year-old son from dying by euthanasia (Link).
• Bereaved mother speaks out against euthanasia (Link).
• Woman died by euthanasia because of inadequate home care (Link).
• Infant euthanasia proposed by Quebec College of Physicians (Link).
• How poverty not pain is driving people with disabilities to euthanasia (Link).
• Ontario man seeks euthanasia to avoid homelessness (Link).
• Why did they kill my brother? (Link).
• Canada's doctors offer euthanasia before receiving a request (Link).
• Food bank clients asking for euthanasia based on poverty (Link).
• No other options. An expose on euthanasia in Canada (Link).
• Poverty and euthanasia creates public interest but euthanasia is abhorent on its own (Link).