Gabriel Peters: MAiD builds discrimination, not a remedy to it.

The following was published by Gabriel Peters on her substack on April 23, 2026.

 

By Gabriel Peters

Re: Eligibility of Persons Whose Sole Underlying Medical Condition is a Mental Illness

The following is a longer version of my testimony to Special Joint Committee on MAiD. Due to time restrictions I had to edit severely. However the session is an hour long and I had hoped some of the Committee members would use their time to ask me questions. Only one did.

Thank you for the opportunity to provide some brief comments. One of the hats I wear is that I sit as a care partner on the Providence Health Care Psychiatry Lived Experience Research Advisory Committee and I am always struck by the urgency accorded expansion of MAID for mental illness versus that of providing funding for comprehensive mental health care, supports, livable income and housing for those with mental illness.

Injustice can often be measured in time.

Today, I am speaking as co-founder of the Disability Filibuster.

As policy makers I am certain you are aware that neither people nor policies are islands unto themselves. And yet MAID is discussed as if it exists inside a vacuum, free of influence from, or consequence to, society.

In what little time I have I will address a couple of persistent myths that constantly derail and impede rather than build understanding.

Myth One: The reason people oppose expanding MAiD criteria to include mental illness as a sole underlying condition is because they believe mental illness is less real than physical illness and they treat it as less significant and less worthy of support.

False: The division between physical and mental illness is one asserted and maintained by the medical model and the Canadian state. Due to the exclusion of essential elements of mental health care from Canada’s publicly funded and arguably misnamed universal health care system, Canada has a two-tier mental health care system. The average provincial and territorial mental health care funding lags behind that of many peer countries. Proportionally, Canada’s public spending on mental illness is lower than its occurrence among all illnesses. People with mental illness face particular threats to their civil rights. A BC study found that for nearly a third of people with mental illness, their first contact with mental health care involved the police. A situation that the Canadian Mental Health Association attributes to the lack of community services, the limited scope of crisis services, a reduction in hospital beds so that even short stays are only available to those in the most acute crisis. A CMHA fact sheet states: “Police officers are, by default, becoming the first point of access to mental health services for persons with mental illness, earning them the nickname ‘psychiatrists in blue.’” They go on to explain that one of the consequences of this is that “​​public also receives reinforcement for the false perception that mental illness is a crime rather than an illness, and that persons with mental illness are a public danger – a common and erroneous belief which hurts both persons with mental illness and the public.”

Stigma requires power. Without power, stigma is just someone’s bad opinion.

I hope this isn’t too idiomatic a reference, but in terms of the claims asserted by the myth, the call is coming from inside your house, not ours.

As disabled people we understand disability as one large tent. Power divides and builds hierarchies. Justice unites through shared struggle and common goals.

There are differences and these do matter. Where physical disability can be met with a benevolent though also hostile othering that infantalizes, assumes helplessness, denies access and views our bodies with disgust, people with mental illness confront staggeringly pervasive, dehumanizing and isolating stigma and dangerous stereotypes while being simultaneously blamed for their illness and having its existence doubted.

The experience of oppression is not the same but the cause of it is.

And please remember that the majority of disabled people have more than one disability and a combination of both physical and mental illness is not uncommon. So when someone projects this myth onto one of us they are often accusing and pretending to defend the exact same person.

Myth Two: Failing to expand MAID is discrimination.

False: This and other assertions made by proponents of MAiD’s expansion reflect a profound lack of understanding of disability rights, history and what the causes, consequences and solutions to the discrimination and injustice disabled people experience actually are.

This myth exists as part of the hyper-individualization of human rights by neoliberalism. Instead of human rights as integral component for building a better society, your body becomes a container of assets that you manage. Universal human vulnerability is denied and instead treated as a deviance from ‘normal’ so that whatever social institutions and policies do exist, do not reflect the necessary conditions for broad resilience. Disability and illness are interpreted through the lens of self-ownership, (an extension of private property rights) and personal responsibility. That the neoliberal state is generously offering to aid you into the grave – for free – is not a pivot, it’s an unmasking of any pretence left covering Canada’s allegiance to the dictum of Margaret Thatcher: “there is no such thing as a society.”

In a zero-sum society where the state’s responsibility for social welfare of its citizens is eroded, it was almost inevitable that human rights would become a competitive race to the bottom. A throne of nails and a poison drip awaits the victor.

The urge to distinguish oneself as ‘free’ while yoked to neoliberal and eugenic logic leads to absurdly invoking the Charter to demand something simply because someone else has it - even if what that person has is killing them and those around them. MAID is particularly exploitative as it uses the same hierarchy of deservingness as the charity model to suggest you can reverse your way out of pity and ableist oppression, assert your freedom and prove your equality by asking the state to kill you. Surely this committee and the Canadian state is capable of a more sophisticated understanding of discrimination and human rights.

In a forthcoming chapter entitled, The Case Against Legalizing Assisted Death for Psychiatric Disorders,” Trudo Lemmens and Scott Kim demonstrate why parity arguments logically lead to absolute autonomy (death on demand for anyone).

“..the parity argument is difficult to restrain. For instance, it is not clear whether one can

draw a principled line around ‘medical and psychiatric suffering’ so that all other suffering is excluded, if all that matters is some formal criterion of equal treatment. What is unique about medically based suffering (both somatic and mental) that suggests a clear, principled line around it (Braun, 2023; Davis & Mathison, 2020; Kim, 2023)? That is, one could apply the parity principle to whether persons suffering from non-medical causes are being discriminated against. There is a perennial debate in the Netherlands about extending legal EAS [euthanasia, assisted suicide] to, for example, elderly persons who do not have irremediable medical suffering, but who are ‘tired of life’ and would like EAS. What principle would exclude suffering from abject poverty? The logical destination of the parity argument seems to be a pure autonomy-based EAS system.”[i]

This aligns with disability analysis that for years has asked “Why Us?” The actual discrimination exists at the level of deciding that our suffering - and only our suffering - makes us killable. Humans suffer in a myriad of ways and among the worst is feeling helpless while someone you care for is suffering. And those feelings also happen when you are the person who others might be feeling powerless to help. It makes me wonder how much unprocessed grief and feelings of powerlessness lead to a misguided desire to add meaning and purpose by participating in the construction of MAiD. Once you unravel and disentangle your thoughts and definitions of words like dignity from ableism, you are left with the realization that ableism is the only thing defining the perimeters of MAiD.

Disability analysis has evolved from its early focus on individual rights, independence and integration into existing systems. Breaking free of the medical and charity model and the explosion of knowledge that followed the freeing of many, (though not all), from institutions, led to the realization that the tools we were using were pre-coded to build ableism not dismantle it. As Jean-Sebastian Beaudry, Canada Research Chair in Health, Inclusion and Policy at McGill Law School explains, “Disability justice…requires the dismantling of the multifaceted ableist ideology that pervades the very tools used to achieve justice, and disguises policy shortcomings as unavoidable economic or biological necessities.” [ii]

MAiD is built discrimination, not a remedy to it. The Canadian state decided no dignity is possible for someone who is disabled and, as consolation prize, branded a lethal injection from a state-sanctioned provider “dignified” declaring, “There’s your human rights!”. Conveniently, this aligns with the commodification of human rights. A new revenue stream was created for some but, overall, killing us is vastly cheaper than building the necessary infrastructure and policy to make a dignified life plausible.

The reasoning behind this myth is akin to suggesting that ugly laws were discriminatory not because they banned visibly disabled people from public space but because they didn’t ban all disabled people from public space.

Those presenting the astroturf-autonomy of “access” to death to an actual-autonomy-deprived population are certainly making a choice to do so. But why?

At least one study found that support for euthanasia on the basis of mental illness was positively correlated with stigma towards people with mental illness. Not only the opposite of what one would expect if the myth were true but suggests that those spreading this myth may be projecting their own beliefs onto us.

The co-opting or, at best, outdated and incorrect understanding of disability rights invoked in the name of support for MAiD is made possible by the absence of disabled knowledge and understanding. The mythmaking - or some would call it misinformation – reflects broader epistemic injustice that has remained largely unchallenged and become more entrenched and fictitious as a result of MAID.

MAiD is discrimination not a solution to it. It must be repealed not expanded.


[i] Scott Kim & Trudo Lemmens, The Case Against Legalizing Assisted Death for Psychiatric Disorders

(Forthcoming in Matthé Scholten, Kelso Cratsley, and Tania Gerkel, eds., Mental Health Ethics:

Current Controversies and Emerging Debates (Oxford University Press))

[ii] Jonas-Sebastien Beaudry Ableism’s new clothes: Achievements and challenges for disability rights in Canada

University of Toronto Law Journal 2024 74:1, 1-40

Academia Routinely Dehumanizes Disabled People

Meghan Schrader

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

I love a good philosophical discussion, but I am frustrated that academia has treated disabled human beings as walking moral conundrums instead of people. 

I think Alexander Raikin put this problem well when he posted on X,

“For all the talk about ‘cancel culture,’ if you're an academic, you can say whatever you want about people with disabilities. You can say that their lives aren't valuable, that being dead is an improvement. You won't be penalized for these views—it'll help you get published.”

Exactly. This pattern is a personal beserk button.

Now I come to my most recent foray into academia, a commentary I was invited to write for a prestigious academic journal’s special issue on “MAiD” and disability. I was told that the paper was enthusiastically accepted and later asked to make various adjustments. 

For nine months I worked diligently to carefully and open mindedly address each point, with input from the person who had asked me to write the commentary. Up to when I submitted the manuscript incorporating the second round of feedback, publication appeared likely.

But then I received notice that the editors didn’t want my commentary after all. 

On some level, I have to suck it up. Article rejections are part of academia. Nevertheless I think it’s worthwhile to examine the editors’ assertion that the final outcome occurred solely because editing my writing did not result in “changes to the style to better match the style of the other manuscripts in the special issue and the style of manuscripts in the journal in general” and had nothing to do with publication bias. 

I think the feedback I received complicates that conclusion. Regardless of their intent, the editors seemed to want me to use language and make statements that favor the “MAiD” movement’s ideology.

I know that this perception is influenced by my personal biases, but the second round of feedback I received strikes me as possibly being an example of the longstanding pattern of some powerful “MAiD” supporters being insincere when they say that they want to “have a discussion” about  “death with dignity.” They want a discussion, but only one where their ideology is cast in the best possible light and opponents are expected to make concessions that sanitize horrible bigotry. 

For instance, during the second round of feedback the lead editors wanted me to address disabled people who want “MAiD.” All I could offer was a more detailed version of the argument that I made in the first draft of the commentary and on this blog: I empathize with disabled people who would like to “use MAiD,” but the disabled proponents are in the minority and I think it’s common sense that their suicidal ideation/desire for autonomy should not be able to turn the rest of the disabled community into a killable caste. 

The editors also seemed to want me to make statements that I worried would imply that the disabled community is evenly divided on the issue of “MAiD,” which is one of the “MAiD” movement’s favorite canards. The  majority of the disability community opposes “MAiD” and has for decades. So, in addition providing an intersectional analysis of disabled people who do want “MAiD,” I added contextualized quotes from other, more accomplished disability justice opponents of “MAiD,” to establish that while not every disabled person opposes “MAiD,” my perspective is not unique, either. 

One of the editors suggested that I call Peter Singer’s assertion that raping some disabled people is acceptable “controversial.” I think they were ok with my proposed substitution of “callous,” but why has academia conditioned people to suggest adjectives like “controversial” when discussing raping disabled persons? The consensus among ethical people in our culture is that rape is abhorrent, not “controversial.” I think referring to the rape of a disabled person as  “controversial” reinforces our culture’s pattern of treating the horrible abuse of disabled persons as if it weren’t necessarily wrong, even if that wasn’t the editor’s intent. 

In addition to seemingly wanting me to imply that the disabled community is evenly divided on the issue of “MAiD” and refer to the rape of disabled people as “controversial,” the editors wanted me to say that killing disabled children with “MAiD” was hateful “in my opinion.” I added the phrase “in my opinion,”  but I also added contextualized quotes from other, more accomplished disability rights advocates who concur with that assessment. I worried that otherwise my commentary might suggest that my perspective on killing disabled children is unique and that such killings are something that 21st century people should agree to disagree about. 

That concession isn’t appropriate for a personal commentary. I’m a disabled disability justice advocate. Therefore I think that disabled people’s dignity demands that if a policy of killing  able-bodied children from other disenfranchised groups is considered hateful, killing disabled children be regarded as hateful.

Even if bias was not the intent, I am nonplussed by the sanitizing language the journal editors asked me to use in my discussion of raping and killing. I think academic and political debate is usually a very good thing, but there are limits to what responsible people should concede. 

Richard John Neuhaus remarked, “Thousands of medical ethicists and bioethicists, as they are called, professionally guide the unthinkable on its passage through the debatable on its way to becoming the justifiable until it is finally established as the unexceptionable.” 

Yes. So I did everything I could to respond eruditely  to my reviewer’s feedback without becoming part of that process. I am sorry that my commentary was not published by the prestigious journal, but at least I didn’t have to say that raping disabled people is “controversial” or that killing disabled children is only hateful “in my opinion.”

Academia’s insistence on treating disabled people like walking thought experiments is obnoxious;  rhetoric that promotes raping and killing disabled people is oppressive. However limited my own influence may be, that’s why I’ve written blogs and X threads that say, “Oh, you want to have a nice, polite discussion about killing disabled people, eh? Here’s a picture of your book in a toilet!” 

Disabled people aren’t “porn” for scholars’ intellectual vulgarity sessions. We are not obliged to accept abuse from academics who wish to debate the merits of raping and killing us at conferences in posh hotels. Not using disabled people’s personhood as an intellectual plaything is one of the least things society could do for people with disabilities.  

Author Note 1: For an incisive, more comprehensive commentary on resisting the “MAiD” movement’s framing in discussions about assisted suicide and eugenics, please read disability policy analyst Gabrielle Peters’s article “Acceding To MAiD Proponent’s Framing Excludes Abolition As a Potential Solution” in the American Journal of Bioethics. 

Author Note 2: For clarification of what I mean when I say that Peter Singer said that raping some disabled people is acceptable, read this blog post.

Canada is euthanizing its poor and disabled.

Euthanasia for poverty is horrifying, profane, the outcome of a failed social welfare system and it is indefensible. 

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

David Moscrop wrote an excellent article that was published by Jacobin Magazine on May 2, 2024. Jacobin is an ideologically left magazine, which is concerned about Canada killing people with disabilities and the poor by euthanasia, known as MAiD. The article begins with this quote:

Canada boasts one of the world’s highest assisted-death rates, supposedly enabling the terminally ill to die with dignity. However, this suicide program increasingly resembles a dystopian replacement for care services, exchanging social welfare for euthanasia.

Normand Meunier

Moscrop tells the story of Normand Meunier, the quadriplegic man in Québec who died by euthanasia after suffering from horrific neglect. Moscrop writes:

For want of a mattress, a man is dead. That’s the story, in sum, of a quadriplegic man who chose to end his life in January through medically assisted death. Normand Meunier’s story, as reported by the CBC, began with a visit to a Quebec hospital due to a respiratory virus. Meunier subsequently developed a painful bedsore after being left without access to a mattress to accommodate his needs. Thereafter, he applied to Canada’s Medical Assistance in Dying (MAiD) program.

As Rachel Watts writes in her report, Meunier spent ninety-five hours on a stretcher in the emergency room — just hours short of four days. The bedsore he developed “eventually worsened to the point where bone and muscle were exposed and visible — making his recovery and prognosis bleak.” The man who “didn’t want to be a burden” chose to die at home. An internal investigation into the matter is underway.

I find it interesting that the article states that Meunier chose to die by euthanasia when in fact he was put into an untenable situation. Moscrop then reinforces the concerns of the disability community:

Disability and other advocates have been warning us for years that MAiD puts people at risk. They warned that the risk of people choosing death — because it’s easier than fighting to survive in a system that impoverishes people, and disproportionately does so to those who are disabled — is real. Underinvestment in medical care will push people up to and beyond the brink, which means some will choose to die instead of “burden” their loved ones or society at large. They were right.

Moscrop comments on how euthanasia is the outcome of a failed social welfare state:

A libertarian ethos partially underwrote the fact that not many people blinked when MAiD was initially rolled out. Taking a more expansive view of rights, many of those not swayed by rote libertarianism were convinced that concerns over bodily autonomy and compassion were reason enough to adopt MAiD. However, in the absence of a robust welfare state, and in the face of structural poverty and discrimination, particularly toward disabled people, there is no world in which the MAiD program can be understood to be “progressive.”

Indeed, last year, Jeremy Appel argued that MAiD was “beginning to look like a dystopian end run around the cost of providing social welfare.” Initially supportive, he changed his mind on MAiD as he considered that the decisions people make are not strictly speaking individual but are instead collectively shaped and sometimes “the product of social circumstances, which are outside of their control.” When we don’t care for one another, what do we end up with?

“I’ve come to realize,” wrote Appel, “that euthanasia in Canada represents the cynical endgame of social provisioning with the brutal logic of late-stage capitalism — we’ll starve you of the funding you need to live a dignified life [. . .] and if you don’t like it, why don’t you just kill yourself?”

Moscrop then comments on that euthanasia for psychiatric reasons has been delayed in Canada based on the lack of mental health care. He refers to the reality as grotesque and writes that this is the stuff of nightmarish science fiction. Moscrop comments on the broken social welfare system in Canada.

In Canada’s most populous province, Ontario, a recipient of disability support receives about $1,300 a month — a pittance they’re meant to stretch to cover food, shelter, and other basic needs. Ontario Works — the province’s welfare program — pays a current maximum of $733 a month. Meanwhile, rental costs for a one bedroom apartment routinely push toward an average of $2,000 a month in many cities. In April, in Toronto, a one bedroom apartment averaged almost $2,500 a month.

Moscrop challenges a statement by euthanasia activists James Downer and Susan MacDonald who stated:

[d]espite fears that availability of MAiD for people with terminal illness would lead to requests for MAiD driven by socioeconomic deprivation or poor service availability (e.g., palliative care), available evidence consistently indicates that MAiD is most commonly received by people of high socioeconomic status and lower support needs, and those with high involvement of palliative care.

Moscrop replies:

By their own admission, the data on this matter is imperfect. But even if it were, the fact that “most” patients who choose MAiD are better off socioeconomically is beside the point. Some are not — and those “some” are important. That includes a man living with Amyotrophic Lateral Sclerosis who, in 2019, chose medically assisted death because he couldn’t find adequate medical care that would also allow him to be with his son. It also includes a man whose application listed only “hearing loss,” and whose brother says he was “basically put to death.” This story came a year after experts raised the concern that the country’s MAiD regime was in violation of the Universal Declaration of Human Rights.

In 2022, Global News said the quiet part out loud: poverty is driving disabled Canadians to consider MAiD. Those “some” who are driven to assisted death because of poverty or an inability to access adequate care deserve to live with dignity and with the resources they need to live as they wish. They should never, ever feel the pressure to choose to die because our social welfare institutions are starved and our health care system has been vandalized through years of austerity and poor management.

Moscrop then states that Canada has the resources to prevent endemic poverty and provide adequate care, that poor people being euthanized by the state is profane.

Trudo Lemmens

Moscrop then refers to a recent article by professor Trudo Lemmens who is a critic of Canada's euthanasia law.

In a February piece for the Globe and Mail, University of Toronto law professor Trudo Lemmens wrote, “The results of our MAiD regime’s promotion of access to death as a benefit, and the trivialization of death as a harm to be protected against, are increasingly clear.” In critiquing MAiD’s second track, which allows physician-assisted death for those who do not face “a reasonably foreseeable death,” Lemmens points out that within two years of its adoption, “‘track two’ MAiD providers had ended already the lives of close to seven hundred disabled people, most of whom likely had years of life left.”

In raising concerns about expanding MAiD to cover mental illness, Lemmens added that “there are growing concerns that inadequate social and mental health care, and a failure to provide housing supports, push people to request MAiD,” noting that “[a]dding mental illness as a basis for MAiD will only increase the number of people exposed to higher risks of premature death.”

Gabrielle Peters

Moscrop continues by referring to a commentary from disability leader Gabrielle Peters.

In 2021, Gabrielle Peters warned in Maclean’s that extending MAiD to cover those who weren’t facing an immediately foreseeable death was “dangerous, unsettling and deeply flawed.” She traced the various ways in which a broader MAiD law could lead to people choosing to die in the face of austerity, adding an intersectional lens that is often missing from our discussions and debates over the issue.

She warned that we were failing to consider “how poverty and racism intersect with disability to create greater risk of harm, more institutional bias and barriers, additional layers of othering and dehumanization, and fewer resources for addressing any of these.” And now here we are. We should have listened more carefully.

Moscrop ends his article by suggesting that euthanasia may be OK based on personal choice but it is indefensible when it is based on poverty.

While MAiD may be defensible as a means for individuals to exercise personal choice in how they live and how they die when facing illness and pain, it is plainly indefensible when state-induced austerity and mismanagement leads to people choosing to end their lives that have been made unnecessarily miserable. In short, we are killing people for being poor and disabled, which is horrifying.

It thus falls to proponents of MAiD to show how such deaths can be avoided, just as it falls to policymakers to build or rebuild institutions that ensure no one ever opts to end their life for lack of resources or support, which we could provide in abundance if we choose to.

I agree with most of Moscrop's comments but I disagree with his statement that euthanasia is possibly defensible as a means of individuals exercising personal choice. Even though people with disabilities experience social devaluation in Canada, they may be still exercising personal choice when they ask to be killed.

The problem with modern writers is that they miss the fact that euthanasia is about killing people. Even if Canada had a greater level of equality, there would be people who ask to be killed based on their poverty or their concerns about homelessness.

The real concern is that Canada has given medical professionals the right in law to kill their patients. This is about people killing people.

Nonetheless Moscrop is right that euthanasia based on poverty or disability is rarely based on personal choice and autonomy, it is horrifying, it is profane, it is the outcome of a failed social welfare system and it is indefensible.

People need health care free from MAiD (euthanasia).

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Gabrielle Peters

I was going through my emails and found this excellent article that was published on April 26 in Policy Options by Gabrielle Peters, a disabled writer, policy analyst and the co-founder of Disability Filibuster. X: @mssinenomine

Peters is writing from a disability perspective as to why we need MAiD free health care options in Canada. Peters explains:

Some health-care providers see MAiD-free spaces as working environments that allow them to respect their conscience and adhere to their professional understanding of doing no harm.

Disabled patients, however, have expressed different reasons for wanting MAiD-free health-care settings.

Peters continues:

To start with, we should have the right to receive medical care in places and from people who do not contemplate or participate in killing disabled people as part of a care plan.

Who wants to look up at a doctor from a hospital bed and wonder if they have just deliberately ended the life of someone with a similar condition? Or to overhear conversations in hallways, waiting rooms, nursing stations or on the other side of a curtain, about how a lethal injection preserved a relative’s dignity before she – gasp – became incontinent, like me.

Peters explains that faith based facilities (for now) are the only MAiD-free spaces. She then comments on the reality of ableism:

Many disabled people can remember a time in their lives when they would or could have agreed to MAiD had it been suggested to them. The reason for this unfortunate common bond is ableism.

A brief and widely adopted definition of ableism Fiona Kumari Campbell explains it as “a network of beliefs, processes and practices that produces a particular kind of self and body…that is projected as perfect and species-typical, and therefore essential and fully human.”

As a result, disability “is cast as a diminished state of being human.” It is a short journey from believing disability makes you less human to thinking that it is better to be dead than disabled.

Ableism in Canada is structural, codified, and acts as the rebar in our economy, politics, and culture. It defines and designs access to resources, services, public space, education, housing, health and health care, employment, and fundamental human rights.

Ableism affects how others perceive and treat us and how we perceive ourselves and our experiences. In this way ableism informs how our suffering is interpreted, making causal links that are not supported by evidence.

Peters then quotes from Professor Heidi Janz who commented on medical ableism:

Medical ableism is often presented as “common sense” instead of bias, University of Alberta professor Heidi Janz says. Part of what allows it to remain unexamined is it exists within a larger contested framework referred to as the medical model of disability. In this model, disability is defined as deficiency, tragedy, and the opposite of health. Suffering is assumed and, because disability is understood entirely as a problem with an individual’s body, knowledge, power, and authority are placed within the medical field.

The result of this is our entire humanity is compressed into our diagnoses. There is no examination of the inherent political oppression or the bias in treatment because the medical model assumes the inequity disabled people experience is a logical result of being disabled.

This also incidentally is one of the many reasons MAiD assessors are ill-equipped to identify social suffering and solutions.

Peters writes about how health-care professionals have power over people with disabilities since the doctor are often the gate-keeper to the services and that people need. Peters continues:

That signature is shaped by their perception of us, which is shaped by how well we align with their judgment of us as a “good patient.” In recent years, medicine has moved away from the use of the word compliant to describe whether patients follow medical advice. Now they talk about adherence. But whichever word they use, the power imbalance remains, and patients and family are hesitant to ask questions or raise concerns. As well, in most interactions, patients have just 11 seconds to speak before a physician interrupts them, research has shown.

Physicians conflate disability with suffering. Some bioethicists have likened disabled people to “happy slaves” for daring to suggest that disability is not a synonym for misery. Physicians consistently rate disabled people’s quality of life lower than disabled people themselves do. This is called the disability paradox.

Peters then explains why the euthanasia lobby have had such influence:

The deluge of emotionally charged MAiD coverage is driven primarily by stories crafted or at least aided by the public relations and lobby efforts by proponents. As part of its recent campaign, Dying with Dignity, a national organization that campaigns for the expansion and liberalization of MAiD, emailed supporters urging them to submit opinion pieces to media organizations and offered the help of its communications team.

The CEO of Dying with Dignity has met with senators and members of Parliament in official lobbying capacity 41 times in the last 12 months. The charity also employs lobbyists at Blackbird Communications.

In a public-relations war, money can create even more imbalance than it does in a courtroom.

Peters explains her concerns with suicide contagion.

But much of the media coverage of MAiD runs counter to the World Health Organization’s guidelines for responsible reporting on suicide. The WHO warns against spreading suicide contagion through prominent placement of stories about suicide, by normalizing it or presenting it as a constructive solution to problems, and by explicitly describing the method used.

Perhaps a lot of the coverage of MAiD ignores contagion protocols because MAiD is a euphemism for assisted suicide or euthanasia.

Peters then comments on the concept of the "forced transfer":

A former executive director of Dying with Dignity said in a 2019 statement of claim that it was her “creative-thinking” that is responsible for the “ground-breaking” term. The statement was part of an Ontario lawsuit in which the public-relations value of the term was highlighted, noting it has been adopted “nationally and internationally by academics, clinicians, lawyers, and others in the right to die movement.”

Patients are transferred every day to access care, equipment or expertise that is not available where they are.

And it is striking that the term “forced transfer” is selectively applied to MAiD and not, for example, patients forced to move to long-term care facilities not of their choosing, on threat of being billed $400/day by the government if they refuse.

Peters comments on the reality of her deterioration of care.

In 2009, before MAiD was legalized, I was living in North Vancouver. Since the onset of my rare neuromuscular disease several years prior I had been seen by an assortment of specialists at three different hospitals. Approximately two years of that time was spent in search of diagnosis for the multiple and worsening symptoms. At first, I thought I was just run down following a virus, but a turning point was when I had to be helped out of the community centre pool by a lifeguard because I couldn’t catch my breath a quarter of the way into my first lap. Over time, I transitioned from trail runner to using a cane, then walker and eventually a wheelchair. Simultaneously I transformed from being perceived as normal but sick to disabled and “unfixable” – and fat because of the corticosteroids.

No longer able to work and unable to access benefits due to eligibility criteria that declared me a dependent of the boyfriend I had been living with, my economic situation deteriorated.

Soon, my care changed, too. Nurses stopped complimenting me on my shoes, asking about my work, and telling me not to give up. The new answer to every question was a shrug and “you’re disabled.” It took three trips to two different hospitals and a tense standoff to finally be diagnosed and treated for deep-vein thrombosis and a pulmonary embolism following an intravenous immunoglobulin treatment (IVIG).

Meanwhile my condition created a smorgasbord of symptoms and managing one would sometimes worsen or create another. There were complications, “atypical presentations,” systemic infections, superbugs, and an ever-growing list of prescriptions sometimes accompanied by allergic reactions and serious side effects. I was a “high-cost health-care user.” The term is used to describe the five per cent of health-care users who are said to account for nearly two-thirds of health-care costs.

I sensed a growing defeatism among those providing me with care. But I was certain that the danger was at least partially a result of the health-care system’s siloed and almost exclusive focus on the latest acute crisis made worse by under-funding and embedded bias.

Peters explains her experience with treatment and care at St Paul's hospital in Vancouver that led to her improved health. There was a hospital employee who pressured her to accept non-treatment as a "treatment" proposal but after dealing with that employee she did find good care at St. Paul's. She then writes:

Many, if not most, disabled people would prefer the additional option of secular MAiD-free spaces. But Catherine Frazee, whose quote starts this article, has articulated the view of a great many disabled people who fervently want safety from MAiD.

Affirming support for the belief of “better dead than disabled” in health care is dangerous and cruel. Canada has made disabled people a killable class, and hardly anyone has considered the impact this would have on us. This country must maintain MAiD-free health-care spaces.

More articles concerning Gabrielle Peters:

• Disability activists pushing back against euthanasia (Link).
• Canada is not as advertised. MAiD is eugenics (Link).
• Canada. How death care is pushing out healthcare (Link).

Canada: How Death Care is pushing out Health Care

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alexander Raikin has written another excellent exposé on Canada's euthanasia regime published in the National Review on September 14, 2023 entitled: How Death Care pushed out Health Care. 

Raikin's previous article: No other options: An exposé on euthanasia in Canada, published by the New Atlantis on December 16, 2022, provides important insights into Canada's euthanasia law.

Raikin focuses on proceedings from the Canadian Association of MAiD Assessors and Providers (CAMAP), training seminars and interviews with patients and doctors concerning death 'care'. 

CAMAP is an independent organization funded by Canada's federal government to train doctors and nurse practitioners on how to euthanize (kill) patients (MAiD).

A panel at the CAMAP training seminar explained how "strict" the law is:

On the same day that a patient enters into an optional written agreement with only one of his or her two MAID assessors — even if it is unsigned, without any witnesses, and with no family members having been informed — the clinician can administer the lethal injection without asking for the final consent of the patient.

Quoting from a CAMAP training seminar, Raikin writes:

"Next question is from Debbie," the moderator of a discussion on medical decision-making capacity said to her fellow physicians. “How would folks interpret someone who has lost capacity with a waiver in place and is now delirious, shouting, pulling their arm away as one tries to insert the IV to provide MAID?”

The question is important because the patient is clearly unable to consent and is showing signs of resisting. 

The Moderator, Dr Ellen Wiebe, possibly Canada's most prolific euthanasia doctor, responds to the question by stating:

“I’m guessing I would bring in one of their other providers, you know, palliative care or, or whatever, and get them sedated. But what would you say?”

First to speak is Jim MacLean, who claims that he has performed more than 75 “provisions” since MAID expanded to include non-dying patients. “I don’t think I have any great thoughts on this one.” Wiebe laughed. “Everyone’s different. I mean, you try to deal with the situation. Calm the room down. See what you can achieve through conversation and calmness.”

Chantal Perrot is the co-chairman of a clinician advisory council for Canada’s largest pro-MAID lobby group. She described herself to a parliamentary committee as someone who has “cared for hundreds of patients . . . as they navigated the MAID process.” Responding to Wiebe, she said, “That’s a question. If they’re sedated, then have we sedated them into being accepting of MAID? You know, that’s a whole other question.”

Kevin Reel, a senior ethicist at Sunnybrook Hospital in Toronto and former president of the Canadian Bioethics Society, answers in part with another question: “If what we’re doing by trying to honour the waiver is reducing distress for the patient and also for maybe even the family around them, would it be acceptable to do something similarly covert to keep them from reacting in that way?”

Reel continues, “That might be a way around it, but — ” before being interrupted by MacLean, whose new answer takes the question from the hypothetical to the actual and clarifies what he meant by “conversation and calmness”: “One waiver I did use, the patient was a little agitated. So we did give her some subcutaneous hydromorphone” — an opiate ordinarily used for acute-pain control instead of sedation — “before I did the MAID, did the provision. So we did, we did use it in that situation and it was very helpful.”

“Good,” the moderator says, before moving on to the next question. 

No one on the panel or audience objects.

Raikin explains:

The asterisk in the law is that the agreement is in place only as long as the patient “does not demonstrate, by words, sounds or gestures, refusal,” or “resistance to its administration.” If this demonstration is “involuntary” and “made in response to contact,” the death of the patient may still proceed. But consent is a spectrum, and patients with delirium can flicker between having capacity and not; patients can also change their minds about dying at the hands of their physician or nurse.

The recording from an October 2021 training session documents the use of sedation to obtain consent. 

Raikin explains the importance of the use of sedation to obtain consent for death:

At the core of death care is the presumption that safeguards work and that consent, the most important safeguard, prevents death care from slipping into rampant homicide or suicide contagion. Instead, it is turning into the end of medicine.

Raikin provides examples of the use of sedation to gain consent for death:

In Belgium last year, after a lethal injection failed to kill a 36-year-old woman with terminal cancer, the presiding physician smothered her with a pillow. In New Zealand and Canada, suicidal patients seeking medical care for suicide prevention were prompted to consider assisted suicide instead.

In the Netherlands, a similar story of a physician sedating her patient into accepting euthanasia led to the first criminal trial of a euthanasia physician. She was acquitted. The judges said, “We believe that given the deeply demented condition of the patient the doctor did not need to verify her wish for euthanasia,” even though the patient repeatedly attempted to fight off her physician.

I have written previously about how a failed suicide attempt in Canada was completed through euthanasia, despite concerns of illegality by physicians involved with CAMAP, an organization that has held internal seminars on patients requesting euthanasia because of poverty, lack of medical care, homelessness, and credit-card debt.

Raikin quotes Michel Bureau, head of the Commission sur les soins de fin de vie (Commission on end-of-life care), the independent monitoring agency for MAID in Quebec who told the Canadian Press news agency this summer:

“We’re now no longer dealing with an exceptional treatment, but a treatment that is very frequent.”

In every jurisdiction that has legalized assisted suicide, the number of deaths have ballooned and "safeguards" have been rescinded. Raikin writes:

In California, the number of assisted suicides last year increased by more than 63 percent. In Canada, the number of deaths by euthanasia is on track to increase more than 13-fold in just the first seven years of the practice’s legalization. Belgium has seen a more than twelvefold increase since 2003. In Switzerland, which legalized assisted suicide in 1941, the number of such suicides has doubled every five years since 1999.

Raikin gives examples of deaths that are outside of the law:

A sibling found out that his brother’s MAID paperwork in British Columbia listed only “hearing loss” as his qualifying condition. In the Netherlands, dozens of patients qualified for euthanasia only because of autism. In Canada, “advanced age” helps qualify patients to die, even though Quebec cautions that to rely on it as the sole criterion is illegal. Young patients have died through euthanasia in Belgium for a range of reasons, including a botched sex change, sexual exploitation by a psychiatrist, unresolved post-traumatic stress disorder after a terrorist attack, and again, this time in twins, hearing loss.

Last year the Swiss Medical Association saw a need to issue a statement reminding physicians, for the first time, that “assisted suicide for healthy persons is not medically and ethically justifiable.” The agency responsible for monitoring assisted suicides in Quebec issued a similar reminder over the summer.

Raikin quotes bioethicist Leon Kass, who warns that if the value of a human being is considered subjective, invariably the right to die metamorphoses into the duty to die.

Raikin explains the planning and goals of CAMAP:

In 2018, at CAMAP’s annual conference, the leading death-care practitioners gamed out their plan. It was nothing short of prescient. Many speakers, such as the CEO of Dying with Dignity, stressed that MAID is a “political issue” and that it would require “the political will to speak out against Catholic institutions around MAID.” Moreover, as some panelists insisted, it was important for practitioners to “recognize the harm to vulnerable populations that comes with the assertion of freedom of religion.”

 In comparison, MAID was “sacred.” One speaker implored non-MAID clinicians “to keep the spirit of MAID intact.”

Just two years into Canada’s euthanasia experiment, physicians were busy laying plans for how to expand euthanasia to children, especially Indigenous children, since they “are considered wise because they are closest to the ancestors.”

Raikin explains how CAMAP promotes euthanasia for poverty:

Senior CAMAP leadership has repeatedly denied that patients are receiving euthanasia primarily because of poverty. Yet in 2018, it devoted an entire panel to “providing MAID to vulnerable, Indigenous, homeless, and frail elderly populations.” Panelists described how they could “help to empower vulnerable populations” by helping “patients fight for options that would allow them to have access to MAID” — in other words, to help find “what supports” patients might need to die instead of to live.

“I have a First Nation patient who meets all the criteria for MAID, but much of their suffering is due to a life lived in poverty,” one panelist said. “If I could change their social determinants of health, their situation might improve.” Even a hypothetical example of a patient with “fixed delusions that are causing him severe suffering” was deemed potentially eligible because “it doesn’t matter what he wants [MAID] for.”

Stefanie Green, the leader of  CAMAP, advocated that opposition by hospices to euthanasia will be overcome. Raikin quotes Green as stating:

“Over time, perhaps ten years from now, I think this conversation will happen again. If we push it now too hard and too fast, I think that will put more wedges in.”

CAMAP’s strategy has already succeeded. In 2017, Vancouver Island had a Catholic hospital and four hospice beds. Now as a consequence of a public campaign by death-care advocates, there are no remaining “MAID-free” spaces on the island.

In 2021, Vancouver Island had the highest euthanasia rate in Canada. 

Raikin discusses the cases of several Catholic hospitals that have been taken over by the Australian government in order to provide access to death services. 

Raikin writes of the doctors who object to euthanasia and are being forced out of medicine:

Helen Lord, one of the nine palliative specialists in Tasmania, retired once                "death care" began.

“I know I actually can’t kill someone, I can’t do it.  

“I said I’m not going to have any part of this. It’s not medicine. It’s just not what we do. . . . Half of the people who came into [my] palliative care were scared that they were going to be euthanized.”

When Lord spoke out against euthanasia she was accused of being a right-wing Evangelical, which she is not. Lord does believe that "life is precious" and "time is precious."

Félix Pageau, a geriatrician practicing in Quebec, testified to a national parliamentary committee in Ottawa that in his opinion as a physician, based on research, Canada was not ready to expand MAID to advanced dementia. For this, he said, a colleague in his home hospital “filed a complaint to the Collège des médecins” saying he “lied” to the committee. The Collège decided to “open an inquiry, even though they don’t have jurisdiction over testimony at the federal [level] or in the Parliament.” The investigation became an ordeal — and an expensive one, since Pageau needed to hire a lawyer. Pageau in his parliamentary testimony was exercising his free-speech rights. Eventually, the Collège ruled that it did not have jurisdiction, but the point was made.

Raikin continues:

Another physician, a former director of a palliative clinic in Canada, told me, “I had to leave a job that I loved” because “the MAID situation” made it “just too difficult to practice medicine here.” After she spoke up publicly to urge that MAID and palliative care be separate, she was constantly harassed; her email was flooded with dozens of gory images. Another palliative-care physician told me that he started his own small clinic rather than stay at the hospital where he practiced. “Physicians that go against the narrative are sanctioned,” he said. “They’re marginalized. It’s hard. It’s risky.”

Dr David D’Souza and Dr Mark D'Souza are physicians in Ontario:

“I think already there’s a lot of abuse going on, and I’m seeing it in my own practice,” including when families pressure loved ones to die so that estates or insurance payouts become available sooner. “It’s making me think twice about whether I should be continuing in geriatric care.” His brother, Mark, also a physician, left palliative care entirely. “We’re literally doing harm even though it’s under the guise of compassion,” Mark said.

Raikin states: 

The effect of legalizing death care is not just the hostile takeover of medicine. It hurts those who are the most vulnerable, those who want not to die but to be helped to live.

Gabrielle Peters, a disabled writer and policy analyst in Canada, told Raikin that it is essential that there are MAiD free places in Canadian healthcare. Raikin interviewed Rachel, who lives with chronic pain, PTSD and depression.

Rachel, a woman with a condition that causes chronic pain, told me about the difficulties of the past year. “Every day was really hard to stay alive,” she told me. “I really felt like I was dead.” She also suffers from major depression and has a history of PTSD from childhood abuse. “If I said that I wanted to die or that I couldn’t hack it anymore” when she spoke with health-care practitioners before MAID was legalized, “I was met with, ‘Here’s some coping skills and let’s talk about it,’ and various forms of therapy and resources being brought to bear.”

Once her condition qualified for MAID, in 2021, she began to notice a trend. “I would call the crisis line, the suicide crisis line. Many of these mental-health professionals, their advice would be to go look up Dying with Dignity’s website.” She tried to get help for thoughts of suicide, and instead she was being offered advice for how to die from assisted suicide.

“I have been afraid, you know, over this last couple of years to go to just my local hospital, because I was afraid that if any doctor either brought up MAID themselves or met my kind of ambivalent desire for MAID, all I needed was a push and I would be dead right now.”

Rachel found help at the Centre for Addiction and Mental Health (CAMH), Canada’s largest mental-health teaching hospital, located in Toronto. 

Raikin writes:

Its policy is that no CAMH clinicians can provide MAID on site. She felt that she had found a MAID-free space that could treat her illnesses. (CAMH is yet to release a statement on whether its MAID policy will change when, in six months, MAID will be expanded to include mental illnesses.)

Rachel decided to risk everything. With her meager savings from her disability benefits, she purchased a one-way, long-distance bus ticket, not knowing whether she would be admitted to the hospital or instead end up homeless.
“I literally just presented myself at the CAMH ER,” she said. “Part of the reason I felt safe to go to CAMH is just because I knew that they do not endorse MAID for mental illness. They’re pretty strict on that.” In a sense, Rachel lucked out. Despite the usual long wait times at Canadian emergency rooms, especially for psychiatric illnesses, her poor condition meant that her case was triaged to the front of the queue. She soon discovered how MAID was viewed by doctors at the center. “On the psych ward at CAMH, my psychiatrist was terrified — terrified,” Rachel said, carefully enunciating every syllable, “that I would talk about MAID on the floor with the other patients. She was terrified of suicide contagion.”

Over the span of weeks, Rachel began to recover. She was finally put on a new form of pain control; her depression improved. But the most important change at CAMH was that, finally, she felt listened to. “Sometimes, all you need is someone to come alongside you. And just help you cope through the everyday,” she said. “Whether it’s a doctor or just the person who is walking alongside me while I’m in a lot of pain. It may not change how much pain I actually have. But it sure makes a big difference to how much I suffer from that pain.”

Rachel is now happily back home. “I have no intention of using MAID. I have 100 percent turned away from it. Only because I had health care. All I needed was health care and pain care.”

Raikin recounts his previous article about Rosina Kamis, who died by euthanasia and her friend James, who has a similar medical situation:

In the first story that I wrote about death care, “No Other Options,” published in the New Atlantis, I wrote about Rosina Kamis, a 41-year-old Toronto woman with fibromyalgia. She chose to die from MAID in part because of her inability to access proper medical care. Before she died, she entrusted her friend James, a former neighbor, to represent her as her power of medical attorney; since her physicians weren’t listening to her, she wanted to see if someone else who has fibromyalgia, as James does, could get her the medical care that she needed. Despite his efforts, James couldn’t help her — and now, after her death, he can’t get the help that he needs. He messaged me months after our first conversation to tell me that he now sees his own future in what happened to Rosina.

James told me that he is living with the specter of an imminent administered death, like Rosina’s. He could decide to stop fighting for the care he needs, too. It seems inevitable. “I’m going to take it one day. That’s how it feels to me. I don’t like that, but to me, the way things are going, this society is really sending us disabled people a message,” James said. “We got that message even before MAID. But now it’s codified into law and there’s these processes and resources to expedite it.”

“I have diagnosed mental-health conditions and I can’t get treatment. I need therapy. My doctor asked me the other day, What do I need? I need therapy. I need a long-term relationship with someone. And she told me, she said, That’s impossible.” Instead, he was sent YouTube videos on how to do stretches. He chuckles.

“I need actual health care,” James said. Eventually, he tells me, he’ll get death care instead.

CAMAP, which sells itself as the experts on MAiD in Canada, received $3.3 million from the Canadian government to develop a curriculum for MAiD clinicians.

Thank you Alexander Raikin for your research and your continued advocacy for health care not death 'care'.