EPC intervention in euthanasia for mental illness court case.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Euthanasia Prevention Coalition (EPC) needs your financial support (Read).

The legal counsel for the Euthanasia Prevention Coalition (EPC), Hugh Scher, was in a Toronto court on July 21 / 22, 2026 representing EPC in the case concerning Claire Brosseau and Dying with Dignity. 

The Brosseau case is asking the court to legislate from the bench to permit euthanasia for mental illness alone in Canada.

Scher reported that:

Leave to intervene was granted to EPC by order of the court. We prepared a 10 page written legal argument, reviewed the file documents and prepared for oral arguments for July 21 / 22.

The judge hearing the motion was Justice Carissima Mathen. Curiously, she used to be head of litigation for LEAF, the Women's Legal Education and Action Fund. Her background is in constitutional litigation particularly with respect to women's rights.

... At the hearing, she seemed much more interested in taking charge of the application than limiting the scope of her review to the motion for a stay which was the matter properly before her.

Hugh Scher

Scher summarized the EPC position before the court:

In our oral submissions, we focussed on the core requirement of irremediability which was a core principle laid down by the Supreme Court of Canada Carter decision as a criteria to access an assisted death. ...We relied on the significant evidence that suggests that it is impossible to determine if a person with a mental illness only is irremediable.

It is also hard to determine prognosis given the significant changes that occur with mental illness that are often quite fluid. EPC urged the court against finding on the minimal record before it that a stay is appropriate.

We also suggested that the intention of this application was to avoid the change in direction of Parliament, effectively pitting the court against Parliament. ...Parliament has recently, through its parliamentary committee (AMAD) on euthanasia report indicated a desire to be cautious and to defer any further action on euthanasia for mental illness alone.

Scher completed his report by stating:

It remains to be determined what the court will do, particularly given the background of the judge and her possible desire to establish some kind of precendent. That said, the law is currently against granting a stay to grant Brosseau death based on mental illness alone.

EPC has intervened in this case in an attempt to prevent the court from expanding euthanasia by legislating from the bench to allow euthanasia for mental illness alone.

Previous articles about the Brosseau case:

• (EPC) filed to intervene in Euthanasia for mental illness court case (Read). 
• Canadian actress seeking euthanasia for mental illness (Read)

Important insight into decision to reject euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The report of the Special Joint Committee on Medical Assistance in Dying (AMAD): Mental Disorder as the Sole Underlying Medical Condition: A Complex and Challenging Conversation Among Canadians was released on June 17, 2026, which is also the 10th Anniversary of the legalization of euthanasia in Canada.

The AMAD Committee decided that Canada should not implement euthanasia for mental disorders as the sole underlying medical condition on March 17, 2027. The report concluded:

That the Government of Canada amend the Criminal Code to indefinitely exclude persons whose sole underlying medical condition is a mental illness from eligibility for medical assistance in dying.

It is great news that the AMAD Committee decided that Canada should not implement euthanasia for mental illness, but the battle is not over.

Possibly the most interesting parts of the AMAD Committee report were the supplemental reports from the members of the Committee. 

Dr Marcus Powlowski MP

The supplemental report (starting at page 63 of the report) from AMAD Committee Chair, Marcus Powlowski, (Liberal MP from Thunder Bay - Rainy River) and a physician is most interesting. Powlowski's arguements may influence Canada's future euthanasia debates.

Powlowski first examined Canada's Charter of Rights and Freedoms (Charter) with regard to not permitting euthanasia for mental illness alone. he writes:

Unfortunately, the discourse about whether to allow MAiD for mental illness seems to have been largely reduced to the somewhat simplistic question of whether not allowing it is a violation of the Charter. The argument being if we allow MAiD for physical illness, but do not allow it for those with mental illness, we discriminate against those with mental illness (under s.15) and inappropriately restrict their liberty or threaten their security (s.7)...

Powlowski explains his position on Canada's Charter:

I think the courts ought to conclude, as did our committee, that not allowing MAiD for mental illness, until such time as some fundamental concerns are addressed, is a reasonable limitation under s.1. These fundamental concerns are the difficulty/perhaps even impossibility of determining irremediability of mental suffering (a core requirement under the law), and the lack of ability to distinguish suicidality from rational decision making in someone with a mental illness (I will return to this issue, and explain why it is so important, at the end of this submission). Numerous witnesses cited these concerns as reasons why we should decline to expand MAiD to this population.

The Supreme Court of Canada Carter decision did not obligate the government to permit euthanasia for mental illness alone, but even when interpreted in that manner, I agree with Powlowski that not permitting euthanasia for mental illness is a reasonable limitation.

Powlowski then deals with the question of "readiness" to expand euthanasia to people with a mental illness alone.

In addition, although some, perhaps a majority, of MAiD providers assured us of their readiness to provide MAiD for mental illness, and the adequacy of existing safeguards, we also heard disturbing stories of questionable conduct by some MAiD providers. Given what we heard it is hard not to conclude that some providers take an exceedingly expansive interpretation of what constitutes "serious and incurable illness, disease or disability", what constitutes an "advanced state of irreversible decline in capability"; and what constitutes "enduring physical or psychological suffering that is intolerable". Furthermore, we heard stories of doctors with a seemingly cavalier attitude towards ending a life. 

Although we were assured that mechanisms, such as Colleges of Physicians and Surgeons, would provide adequate safeguards, we were presented with scant, if any, evidence to indicate that such bodies have, as of yet, seriously pursued allegations of misconduct by MAiD providers. This does not mean that colleges have not received complaints or looked into them. As the president of the Nova Scotia College of Physicians and Surgeons pointed out- colleges only publish the reports of hearings when there has been a finding of wrong doing. That being said the paucity of any prosecutions of providers, combined with the suggestion by a number of witnesses that in fact there seems to be a lacunae of law enforcement when it came to MAiD ought to give rise to concern. Several witnesses suggested the criminal system, the medical colleges, and at times government Ministry's responsible for MAiD provision (BC), all allegedly treat enforcement as someone else's responsibility. Given the lack of evidence to the contrary it is frankly difficult to believe that the system is ready to expand.

This may be the most important comment by Powlowski. As the chair of the committee he recognizes that Canada's euthanasia law lacks effective oversight and is saying that expansion to people with mental illness alone would not be safe.

Further to that, his comments are important to the argument by the Euthanasia Prevention Coalition (EPC) that Parliament needs to completely review the law. The evidence suggests that the law lacks oversight, but further to that, the original law required a complete review and that has not happened.

Powlowski then argues that since Canada's law requires a person to have an irremediable medical condition, that the law would need to be amended to approve euthanasia for mental illness alone. He wrote:

But perhaps we will never be ready for MAiD for mental illness as the law is currently written. Numerous very experienced psychiatrists told us of seemingly irremediable cases where for some reason patients, after prolonged periods of seemingly irremediable suffering, the person eventually got better and started to enjoy life again. Furthermore, what evidence there is seems to suggest psychiatrists can not accurately predict who will not get better. 

Perhaps the simplest solution to the legal question is to recognize the requirement of irremediability as being dispositive of the issue. The law as written requires irremediability. If there is really no way to accurately determine irremediability it would seem we would need to change the law if we want to allow for MAiD for mental illness.

Jocelyne Downie

Powlowski suggests that based on irremediability that many euthanasia deaths for physical illness also do not qualify within the law. He writes:

We did, I would acknowledge, hear the argument that perhaps with some physical illness irremediability is not certain either (the argument was most forcibly made by Professor Downie- a law professor not a medical clinician). To the extent that there are such cases I would suggest it would be more appropriate to question whether MAiD is appropriate in any such case where there is uncertainty over the medical prognosis - rather than to accept the conclusion of those practitioners who suggested they were "comfortable" with making a decision about irremediability even if there was inherently some inability to come to that conclusion with reasonable certainty. 

Powlowski then answers the question about the role of parliament and the role of the courts. He writes:

I would suggest the elected legislature is totally justified in drawing a line, in deciding that we are unwilling to support the state enabling physicians to taking the life of someone who, perhaps, would have gotten better. The decision of whether we do so is a moral decision and very much a reflection of what we value as a society. As such it is a decision more appropriately made by those of us who are elected by the members of society, and who are ultimately accountable to the people- at the poll box, rather than the unelected courts.

This is important since Claire Brosseau and the euthanasia lobby are seeking an emergency court decision that would approve Brosseau for death by lethal poison based on mental illness alone. The euthanasia lobby want the court to legislate from the bench by approving that Brosseau be killed. 

EPC is intervening in the Brosseau court case concerning euthanasia for mental illness alone.

Powlowski made many more important comments but his closing argument is important:

In recommending that we not extend MAiD to those with mental illness we are not suggesting embarking on a new path of prohibiting suicide, or further trying to limit people's autonomy. We are suggesting the state decline to provide assistance to people with mental illness ending their lives and decline to allow medical professionals to actively do it for them.

EPC opposes killing people but we are not limiting a persons autonomy but rather we oppose the state giving doctors and nurse practitioners the right in law to kill people. When a doctor or a nurse pracitioner kills you, it is not about autonomy, it is about someone else killing you.

The EPC presentation to the AMAD Committee on May 5 urged Parliament to do a complete review of the euthanasia law, which was actually part of the original euthanasia law that was implemented in June 2016. I stated:

...Parliament needs to examine how the current law has led to outcomes like the death of Kiano Vafaeian (26) died by MAiD in Vancouver on December 30, 2025. Parliament needs to completely review the euthanasia law.

More broadly, Canada’s assisted dying law is vague. While Health Canada provides guidance, the legal framework allows for wide interpretation and it lacks effective oversight.

Because of time constraints, I will highlight one key issue.

Sections 241 (3) and 241 (3.1) of Canada's Criminal Code states that medical practitioners or nurse practitioners are required only to be “of the opinion” that the eligibility criteria are met. That, in practice, makes accountability extremely difficult, even impossible to prosecute a medical or nurse practitioner in Canada, even when the MAiD death is clearly wrong or deeply disturbing.

The MDRC reports and cases that have already been submitted to you speak to that reality.

Canada should not be considering the expansion of the euthanasia law to include people with mental illness alone but rather Parliament needs to fully review the law.

In April 2026, Canada surpassed 100,000 euthanasia deaths since legalization. Many of these deaths have been controversial and were outside the intent of the law.

EPC urges the government to consider the many stories associated with our euthanasia law that have been publicized world-wide and recognize that the law needs to be reviewed.

We look forward to presenting to the AMAD Committee when they provide a complete review of Canada's euthanasia law.

Canadians with disabilities are disproportionately dying by MAiD.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alexander Raikin

Alexander Raikin is a visiting fellow in Bioethics at the Ethics and Public Policy Center. Raikin, who has been published by multiple journals and news agencies. Raikin published this research article examining how Canada's euthanasia law violates the Carter Supreme Court decision which led to the legalization of euthanasia in Canada. (Link to this research article)

The question that Raikin answers concerns the impact of euthanasia on the lives of Canadians with disabilities. The lower court and the Supreme Court of Canada (Carter decision) insisted that legalizing euthanasia would not create a greater risk for people with disabilities. Raikin writes: 

In 2012, Justice Lynn Smith of the British Columbia Supreme Court concluded in Carter v Canada (Attorney General) that an appropriately safeguarded physician-assisted dying program could be adopted in Canada without creating a “heightened risk” or an “inordinate” impact on vulnerable groups, such as persons with disabilities. On appeal, in 2015, the Supreme Court of Canada affirmed Justice Smith’s reasoning, based on the trial judge’s review of evidence from international jurisdictions with assisted dying programs. The Supreme Court upheld the trial judge’s ruling, which struck down the prohibitions against assisted suicide and euthanasia in the Criminal Code, resulting in the decriminalization of assisted dying in Canada.

A few years after legalizing euthanasia (Bill C-14) the Truchon decision came down from Justice Baudoin, (Quebec Superior Court) extended euthanasia to people who are not terminally ill based on the Supreme Court Carter decision that assured Canadians that euthanasia would not disproportionately affect people with disabilities.

In contrast to the insistence of the courts, Raikin explains how legalizing euthanasia has disproportionately affected people with disabilities. Raikin writes:

The national and provincial MAiD data support the findings from chart reviews of MAiD deaths, which is that those who died from MAiD were more likely to have been living with a disability than those who did not die from MAiD, even though both groups had similar medical conditions and experienced diminished capability. In other words, the evidence indicates that MAiD is increasingly driven by disability status, rather than by underlying illness.

Raikin explains the data:

Health Canada’s data demonstrate that people with physical disabilities are overrepresented in MAiD deaths when compared to the expectations established in Carter. From 2019 to 2023, 42 percent of all MAiD deaths involved people who required disability services, including over 1,017 people who required but did not receive these services. During this period, the type of person who was most likely to die from MAiD was one who required disability supports or who had an unknown disability status. Moreover, nationwide in some years, and in Ontario in 2023 (the only data point in Ontario), people with disabilities were the most likely type of person to die from MAiD.

The Health Canada report of 2023 indicates that, of those persons with disabilities who did not receive disability supports before their MAiD deaths, in five cases care was not accessible, in 158 cases care was accessible, and in 259 cases it was unknown if care was accessible. These data confirm that MAiD providers in Canada have indeed euthanized disabled patients who needed disability supports and were unable to access them. The data also show that a large number of MAiD deaths occurred even when the provider did not know if disability supports were available, despite the legal requirement to inform MAiD applicants of available disability support services. The adequacy of these disability supports is not assessed, however, in any of these metrics, and therefore these data should be understood as highly limited and partial in regards to gauging access to disability supports.

There is more information in Raikin's research study (Link).

Another question that Raikin investigates is euthanasia for people with mental illness. Euthanasia solely based on mental illness or for non-terminal conditions was already happening before Bill C-7 was passed in March 2021. Raikin explains:

Evidence of overrepresentation of depression in MAiD cases comes from a retrospective chart review of all MAiD requests at a single tertiary care centre in Toronto between June 2016 and April 2019. The review found “high rates of psychiatric comorbidity among requesters of medical assistance in dying,” though unlike in the Ganzini study, most of these requests ended in MAiD. Of the 155 patients requesting, sixty (39 percent) had a documented psychiatric comorbidity (most commonly depression); 117 patients in total received MAiD. Moreover, these sixty patients had a statistically indistinguishable rate of eligibility compared to patients without a psychiatric illness (p=0.363). Compared to the Ganzini findings, patients with a psychiatric comorbidity were much more likely to have requested MAiD than those without a psychiatric comorbidity.

Euthanasia for people who are not terminally ill increased after Bill C-7, which extended euthanasia to people who are not terminally ill, increased. Raikin explains: 

As Canada left behind the initial safeguards that restricted MAiD to those who were terminally ill, the number of MAiD deaths of non-terminally ill persons began moving steeply upward. The 2021 expansion to non-terminally ill and disabled persons led to 223 MAiD deaths for non-terminally ill persons in 2021, 463 deaths in 2022, and 622 deaths in 2023. In 2027, Canada will expand MAiD to permit access by reason of mental illness alone, portending further increase in the numbers of non-terminally ill persons seeking state-administered death.

Among other issues, Raikin examined the data concerning euthanasia based on "feeling like a burden." Raikin writes:

While the true number of socially vulnerable persons choosing to die through MAiD in Canada is unknowable without a rigorous review process, the current data paint a dismal image (figure 4). The expectation that most patients who feel themselves a burden to others would be prevented from accessing MAiD did not materialize in Canada—and even the initial optimistic data from Oregon (on which Carter was based) have degraded over time.

According to MAiD providers in 2023, the suffering of almost half their MAiD recipients included the perception of being a burden on others, 10 percent more than the previous year. Because of the nature of the reporting mechanism, we do not know whether this suffering primarily drove the request or was but one contributing factor. Yet federal data reveal that, according to MAiD providers, more than 38 percent of their patients who received MAiD from 2019 to 2023 voiced concerns that they felt like a burden. Such data imply that Canadian physicians are not reluctant to provide MAiD for suffering that includes social vulnerability.

The concern around euthanasia for loneliness is important. Raikin reports that 22% of all euthanasia deaths in 2023 were related to loneliness:

In 2023, however, MAiD providers reported to Health Canada that 22 percent of their patients chose death because of “isolation and loneliness,” up by 5 percent over the previous year. This is a marked increase, but despite the public nature of these data, it does not appear to elicit concern from Health Canada or other government entities.

These data suggest that not only do MAiD providers know that their patients perceive themselves to be a burden or socially isolated but that these same providers may believe these factors are not an obstacle for MAiD access and are potentially even qualifying reasons for MAiD. Notably, clinicians in charge of Vancouver Coastal Health’s assisted-dying team have told patients with chronic pain conditions that choosing to die from MAiD because of feeling like a burden to loved ones can be considered an “expression of love.” While social isolation is not a medical reason for requesting MAiD, the data indicate that it is an important factor within MAiD requests.

There is a concern that people with neurological conditions who are unable to consent would be killed by euthanasia. The Carter court case suggested that this problem could be avoided in Canada. 

Euthanasia for people who cannot consent is legal, happening and increasing. Raikin explains:

Canada has already expanded MAiD to include patients unable to consent to MAiD at the time of their death, through the 2021 provision for a waiver of final consent. In Quebec, the provincial government has now gone much further, having sent an order barring prosecutors from launching criminal investigations into physicians who violate the criminal law by administering euthanasia to patients who have made an advance request for MAiD. The “slippery slope” warning that was rejected in Carter has proved prescient.

Health Canada’s annual reports also show that MAiD deaths of persons with dementia have increased dramatically in Canada. The number of MAiD deaths with a neurological condition as a qualifying factor has more than tripled in number from 2019 to 2023, and increased from 10.4 percent to 14.9 percent of all MAiD deaths.96 In 2022, dementia deaths were 9 percent of neurological MAiD deaths or 150 cases. In 2023, the number of MAiD deaths of persons with dementia increased to 241, which included 106 deaths in which dementia was the sole underlying condition.

Raikin's study to proves that outcome of legalizing euthanasia contrasts greatly with the position of the Supreme Court of Canada (Carter decision) and the lower court decision by Justice Lynn Smith. This is an important study because it begins to create the evidence that will be necessary for overturning Carter but it also undermines the acceptance of Carter in other jurisdictions.

Raikin concludes: 

The data are clear: Since MAiD eligibility has become increasingly broad in Canada, it has increasingly and disproportionately affected Canadians with disabilities.

This report compared MAiD’s impact on people living with disabilities with the findings made by Justice Smith in Carter and upheld by the Supreme Court. Further analysis of the disproportionate impact of MAiD on seniors, the poor, and other vulnerable groups also warrants attention, but is beyond the scope of this report.

This report’s findings are contrary to the assumptions by Canadian courts and the claims frequently made by cabinet ministers and Parliament. It corroborates, instead, concerns shared previously and repeatedly by disability activists and groups, including testimony ultimately rejected by the Supreme Court in Carter.

The death of disabled persons is not a rare or incidental effect of Canada’s legalized euthanasia program; instead, disability is a remarkably common characteristic among those who access MAiD. The average natural life expectancy of MAiD patients belies the claim that assisted suicide is restricted to those whose death is “imminent,” and MAiD’s reach is not limited to those who are terminally ill. Those seeking MAiD do not encounter a consistently “rigorous standard of scrutiny” that prevents most requests from ending in death. Specialist screenings for depression do not appear to have materialized, even at the very start of the MAiD program. Persons with neurological conditions are seeking death in high numbers compared to the expectations established in Carter. And the socially isolated, far from being protected, are instead being approved for MAiD at high—and increasing—rates.

Previous articles concerning research by Alexander Raikin (Articles Link).

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 slope 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).
  

Insight into The Cautionary Tale of Canada's Euthanasia Regime

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alexander Raikin

On October 9, 2024, The European Conservative published an interview by Jonathon Van Maren with Alexander Raikin. Raikin has recently published a research article titled: The Rise of Euthanasia in Canada: From Exceptional to Routine.

First question: In your view, why did Canada’s euthanasia regime go off the rails much sooner than other jurisdictions that have legalized euthanasia/assisted suicide? Raikin Responds:

The premise of your question is interesting. When the Supreme Court of Canada decriminalized euthanasia, it was based on the argument of a right to life—that those who would die from euthanasia would have otherwise died from suicide. It was a lesser evil. Yet every day in 2022, on average, Canadian physicians and nurses ended the lives of more than 36 people. It is now quadruple the official suicide rate.

In an ordinary country, in an ordinary time, this would be considered a national crisis: a royal commission would be called and weekly press conferences by worried government officials would dominate the news cycle, especially if the victims were all people with disabilities and the elderly. Instead, we now have cognitive dissonance of a national variety. News media credulously write about the horror of a Canadian man selling suicide kits online—and then report almost monthly on how a state-sanctioned, state-funded, and state-administered death from euthanasia is “beautiful.” Or how the lethal injection of prisoners in the U.S. is cruel and unusual, unless a prisoner denied for parole in Canada asks for a lethal injection instead.

This dissonance is reflected in what our public healthcare system funds. The median wait time for a CT scan in Canada was 66 days in 2023. A government-funded suicide, meanwhile? Only 11 days in 2022. I don’t know any elective medical procedure in Canada that is as rushed as euthanasia.

Canada is, of course, not the only jurisdiction with horror stories of what happens when we selectively decriminalize murder and assisted suicide by physicians and nurses. Every jurisdiction that has legalized permissive euthanasia or assisted suicide has seen wrongful deaths that shouldn’t have happened. It is as true in the Netherlands and Belgium as it is in Switzerland or Oregon. I could spend the rest of my life counting these cases: consider, for instance, the dozens of reported cases of euthanasia based on autism or an eating disorder that sparked some worldwide interest. The Swiss Medical Association had to issue a statement that suicide “for healthy persons is not medically and ethically justifiable.” Yet, even in a limited assisted suicide program which requires a terminal diagnosis with less than six months of natural life, we have seen the same excesses. In Washington state, according to the physicians responsible for ending their patients’ lives, 10% of all assisted suicides in 2022 were because their patients were concerned with “financial implications of treatment.” Not one media account reported on it.

But Canada surpasses all these jurisdictions, at least in how quickly we’ve seen the same stories. It was in the first hundred cases of euthanasia in Ontario, for instance, that we saw anorexia as a qualifying condition for euthanasia. Not a single newspaper reported on that either. There is no innate reason for why Canada’s euthanasia program has turned to be such a catastrophic failure in terms of human rights, especially for the people that the Supreme Court of Canada described as “vulnerable persons” who must be protected. On paper, Canada should have one of the strictest euthanasia programs in the world: the eligibility criteria and the safeguards are written as exemptions—in the Criminal Code—from homicide and aiding suicide. If a physician or a nurse practitioner breaks any provision, they would not be protected by these exemptions and could therefore face up to 14 years in prison. That hasn’t happened.

I have some speculations about why Canada’s euthanasia program has turned into a global canary in the coal mine for permissive euthanasia. It’s not because physicians or nurses in Canada are any more diabolical than in other jurisdictions—the vast majority have no interest in killing their patients, even as it becomes a surefire route for a promotion and a leadership position. The irony, of course, is that the exact physicians you don’t want to be involved in ending their patients’ lives are those who are most interested to do so.

I think the more likely reason is because of how Canada was forced to decriminalize euthanasia by the courts. Leon Kass warned that a ‘right to die’ invariably becomes a ‘duty to die.’ Once the Supreme Court of Canada enshrined this right much more forcefully than in other jurisdictions, the Criminal Code protections became moot—the relationship between physicians and their patients were ruptured. If it is a legal right to die, then there is no purpose for anyone else to be involved in this decision, even if it is a cop or a judge. No one else is in that room. It means that a physician and a nurse—who self-selected to reject their roles as healers—can break as many rules as they want, or pressure their patients to die from euthanasia.

It’s not a direct pressure, of course. It is more subtle: if you are suffering, why not be treated by this painless, ‘100% effective’ medical treatment? You are dying anyhow, even if it is a year or four decades from now, and other medical treatments are months away. Why not die? You feel in any rate like a burden to society, to your family, and to me, your caregiver. That is not a hypothetical: according to ‘MAID providers’ (their preferred description), over a third of their patients expressed that as at least one of their reasons to die.

Question 2: Your reporting has uncovered many disturbing aspects of Canada’s MAID system. What are some aspects of the way MAID has been implemented that would (or should) shock people?

Let’s start with something I found today. The Government of Canada created a website to tell physicians and nurse practitioners how to interpret its euthanasia legislation. It states, quite clearly, “Provinces and territories may create further policies and standards with respect to MAID. However, they cannot permit actions that the Criminal Code prohibits.”

Later this month, Quebec is set to unilaterally permit actions that the Criminal Code prohibits—it will allow people to sign an “advanced directive” for a clinician to end their life in the future when they lack the capacity to consent to their death. Let’s be clear what this means: physicians will have to approach a person with dementia, confused and unaware of what is happening, possibly emotional, and then restrain them and end their life. What if these patients changed their mind, maybe regained lucidity for a time, or learned to live a meaningful life with their condition? It wouldn’t matter. It is a murder warrant. One doesn’t have to go as far to read John Locke to know the virtue of why common law has made it so that no one can consent to their own death or harm. The idea that this can ever be made ‘safe’ is wrong.

Yet the truth of the matter is that Canada has already and quietly allowed a version of this. For National Review, I wrote a cover story last year about how Canada removed the requirement for final consent before a death from euthanasia, if a patient enters in a written agreement with one of their two MAID assessors. The form doesn’t need to be signed, and no one else needs to know about it. The exception is that, if a patient shows any verbal or physical signs of “refusal or resistance” to their death, then the euthanasia cannot proceed. MAID providers found and laughed about a loophole instead: they first sedated the patient who “is now delirious, shouting, pulling their arm away as one tries to insert the IV to provide MAID.” There can be no resistance for euthanasia if the patient is first sedated. These physicians then discussed with a bioethicist on the value of having this procedure potentially done away from the family of the deceased, because it would otherwise be distressful.

There are too many stories of abuse in Canada’s MAID program. I wrote about a suicide attempt that failed and then was ‘completed’ through MAID, even though a prominent supporter of MAID believed that it was potentially illegal. I’m writing a story right now on the Criminal Code violations of MAID. But these concerns were known virtually from the beginning of Canada’s euthanasia program. The Office of the Correctional Investigator said, in 2019, “There is no legal or administrative mechanism for ensuring accountability or transparency for MAiD in federal corrections.” Nothing was done. Yet think about what this statement means. It means that the MAID process, in itself, has no legal or administrative mechanisms to keep even the most watched people in our society safe. The federal government has explicitly excluded itself from any oversight role for a policy it created and a criminal law that it is meant to enforce.

Question 3: In your view, why have so many non-religious voices—suicide prevention advocates and disability rights activists—been ignored by the government and groups like Dying With Dignity?

Well, that the government ignores certain groups is not exactly controversial. But I think these groups are ignored not just because they lack a large lobbying purse or political power.

My theory—and I would prefer if I were wrong—is because these non-religious groups sound too much like religious groups. They both rely on an unprovable and therefore uncontestable notion of equality. Your next question asks me about my views on the lawsuit filed by disability organizations in Canada, which claims that Canada’s euthanasia program for people with disabilities who are not terminally ill is discriminatory and unconstitutional. I was listening to their first press conference last week. Heather Walkus, the National Chairperson of the Council of Canadians with Disabilities, Canada’s oldest disability organization, said at the press conference that “CCD will always fight for life.” Fight for life? In 2024? When was the last time that you heard those words from any Canadian or American NGO, let alone a progressive organization—or a religious group nationally in Canada?

Suicide prevention advocates, mental health professionals, disability rights activists: virtually all of them are opposed to the idea that certain lives are less worthy of living. The corollary is that each life has an inherent dignity by virtue of being alive. Call it anti-ableism or a culture of life, imago Dei or article 10 of the Convention on the Rights of Persons with Disabilities. We either believe that disabilities do not make a person less worthy of dignity and life, no matter how severe or life-altering, or we do not. Either we believe that human life is sacrosanct, or else that it is disposable.

A government that decriminalizes suicide and murder for only some people is fundamentally unjust. If it is true, as argued Lord Rabbi Immanuel Jakobovits, the late chief rabbi of the United Kingdom, “The value of human life is infinite and beyond measure,” then it logically means that “Any part of life—even if only an hour or a second—is of precisely the same worth as seventy years of it, just as any fraction of infinity, being indivisible, remains infinite.” That certainly doesn’t mean that a person who is dying and in pain must suffer: we have developed, even if we don’t fund it adequately, the most advanced form of palliative care, and dual intent for palliative medicine to treat suffering that shortens life is almost universally accepted in medicine and among faith groups. But to cross that line, to treat a patient’s suffering by ending the patient, is the difference between healthcare and deathcare.

I spoke to someone whose sister died from MAID. She had a non-terminal illness, and should therefore not have been eligible for MAID, at least according to the law at the time (in 2021, Canada expanded euthanasia to non-terminal illnesses and disabilities). He told me that, if his sister would have been on the side of a bridge, he wouldn’t have pushed her. But her MAID assessor believed otherwise. His sister couldn’t find a medical treatment option for her in Canada—besides euthanasia.

Question 4: What is your view of the Charter of Rights and Freedoms challenge filed in Ontario Superior Court by a coalition of disability groups and two affected individuals?

It is the start of litigation. It won’t be the end. If a law values some lives as less worthy of living than other lives—be it on the basis of disability, age, or identity—then that law is unjust. There’s a joke in Futurama of a suicide pod in the future where you must pay a nickel. It’s not a joke in Canada. When I lived in Canada, I needed to pay for my drug prescriptions. But MAID is free, always free. The financial and moral costs are paid for by society.

At this point, we need to put some limits on MAID legislation. Even by disability organizations simply launching a lawsuit, it is enough to say to people with disabilities across Canada that they matter, that their lives are worth living, and that simply having a disability is no good reason for suicide. It was a message that, a decade ago, healthcare practitioners used to say to their patients. Now it is disability organizations that are quite literally collecting names of their dead.

Question 5: How do you see this debate unfolding over the next several years? Can the expansion of the euthanasia regime be stopped?

The year is 1919. A group of scientists and physicians claim that using the scientific method and a rational approach, physicians can objectively decide which people would benefit from sterilization and which would not. About a dozen and a half states in the U.S. enacted this practice against the consent of the individual.

In Canada, it is 1928. Despite eugenics originating in the United Kingdom, the only part of the British Empire that legalized forced sterilization was in Canada. In Alberta, where most of these procedures happened, it was at first voluntary and in front of a four-member panel with at least two physicians. Then, in 1937, consent was no longer required.

The arguments for eugenic sterilization and euthanasia are surprisingly similar, partly because, as Ian Dowbiggin demonstrated in his book A Merciful End, these arguments were made by the same people. In both cases, it was pushed through by physicians who believed they were acting in their patients’ interest. In both cases, an objective rubric was meant to apply to decide which patients would be suitable for treatment and which would not. In both cases, it was supported by large majorities and the cultural elite—for a time.

As a society, we haven’t gotten over the role of eugenics. As long as we treat disabilities as a fate worse than death, we remain in the grasps of this dying ideology. Today, even bringing up eugenics in the context of permissive euthanasia is seen to be impolite (and a cancellable offense, as Dr. Harvey Schipper found when he was forced to step aside from a working group on advance requests—the same issue that Quebec is sliding into this month).

Yet eugenics is a dying ideology, at least outside of X. Those who effectively support it are forced to argue for it indirectly. As one prominent bioethicist and supporter of euthanasia suggested, we need infanticide because some babies become disabled through birth. It is a horrific opinion, one that, as G.K. Chesterton described in his Eugenics and Other Evils, could only be sustained through “terrorism by tenth-rate professors.”

We do not need to vacillate on what is right and wrong. Everyone has a right to life, and the experiment in saving life through legalizing some suicides has been an unequivocal disaster. In a generation, or maybe sooner, we will be speaking of euthanasia the same way that we speak of forced sterilization.

Rosina Kamis

Question 6: In your reporting, what story or stories have stuck with you the most?

Every few months, I think about Rosina Kamis. For my reporting in The New Atlantis, through the executor of her estate, I went through her entire email account and her Google Drive. “I think if more people cared about me,” she wrote in an email, “I might be able to handle the suffering caused by my physical illnesses alone.” To her two dozen subscribers on YouTube, she said, “Sometimes all the pain will go away just by having another human being here.” Even without a terminal illness, she was instead given a state-administered euthanasia—the exact condition that disability organizations in Canada are currently contesting.

The other story that struck me the most is how ghoulish proponents of euthanasia have been in promoting euthanasia for Indigenous people. Indigenous Disability Canada is one of the parties in the Track 2 lawsuit, and I hope they will include some of the evidence that I wrote about in National Review. At the 2018 annual convention for the Canadian Association of MAID Assessors and Providers, just two years after legalization of MAID, the physicians and nurses tasked with euthanasia advocated expanding MAID to Indigenous children “because they’re closest to the ancestors.” Even then, MAID providers were surprisingly tolerant of euthanizing “a First Nation patient” whose suffering was exasperated “due to a life lived in poverty.” These MAID providers then suggested that “as soon as a patient tells me their suffering is enough, whether I like it, that is their situation and their context.” Note the answer: try to get their basic needs met, try to fix the system, but above all else, don’t forget to kill a patient suffering from poverty. It’s the only right thing to do, at least in Canada.

Alexander Raikin has been covering Canada’s euthanasia regime for years and has consistently broken stories that other journalists missed (or ignored). His work on euthanasia and assisted suicide has been cited by The Atlantic and the New York Times and has been featured in cover stories for National Review and The New Atlantis.