Canada's euthanasia lobby is pushing for child euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Kelsi Sheren, on Twitter, commented on the lobbying by euthanasia groups to legalize euthanasia for "mature minors" (children) in Canada.

The response to her social media was phenomenal but it also elicited a response from some euthanasia lobby leaders who accused Sheren of fear mongering and not getting her facts straight.

Sheren responded with a link to a Global news story from February 16, 2023 reporting on the Canadian government Special Joint Committee on Medical Assistance in Dying (AMAD) released a report calling for the expansion of euthanasia (MAiD) to include mature minors.

Euthanasia for "mature minors" (children) is not legal in Canada but the issue of child euthanasia is being promoted by Canada's euthanasia lobby and a federal government committee recommended on February 15, 2023 that euthanasia be extended to "mature minors."

I responded to the February 15, 2023 (AMAD) report by stating:

The report by the Special Joint Committee on Medical Assistance in Dying (AMAD) was tabled in the House of Commons on February 15, 2023 calling for a drastic expansion of euthanasia (MAiD) in Canada. Among the recommendations, the report recommended that euthanasia be expanded to include children "mature minors."

Recommendation 19 in the report stated:

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

This means that parents or guardians may or may not be consulted, in the euthanasia death of a child that is deemed to have decision-making capacity.

To understand Recommendation 19 better we need to go back to the draft policy developed by the Hospital for Sick Children in Toronto on euthanasia for "mature minors" that was published as a report in the Journal of Medical Ethics in September 2018.

• Article: Sick Kids Hospital Toronto will euthanize children with or without parental consent (Link).

Sick Children's hospital draft policy applied the same "ethics" for mature minors to make medical decisions as for making a decision to be killed. 

The draft policy by Toronto's Hospital for Sick Children set out what can be expected if Canada permits euthanasia for children (mature minors).

Children who are deemed, by their physician, as competent to make medical decisions would also be deemed competent to decide, with or without the consent of their parents, to be killed by lethal injection.

The Canadian government report suggested that child euthanasia and euthanasia of incompetent people by advance request be permitted. Both of these issues fundamental change the meaning of consent.

Child euthanasia is wrong, based on the meaning of effective consent.

Euthanasia is wrong because it enables doctors and nurse practitioners to literally kill their patients.

EPC (Election Analysis) Zoom event on Monday May 5.

    Canadian election euthanasia (MAiD) analysis.

Join the EPC (Election Analysis) Zoom event on Monday May 5 at 12 noon (Eastern Time) / 9 am (Pacific Time)

EPC Executive Director, Alex Schadenberg, EPC President, Gordon Friesen and Kelsi Sheren will discuss the Canadian election results and our concerns for the immediate future.

Gordon Friesen

Register for the Zoom Meeting (Registration Link). You will receive the meeting link, after you register.

We will discuss our concern that: 

• euthanasia for mental illness alone is currently scheduled to begin on March 17, 2027. 
• We will also discuss the push to extend the law to include euthanasia by advance request and euthanasia for "mature minors."
• Alex Schadenberg will unveil the latest EPC strategy / campaign.

Register for the Zoom Meeting (Registration Link).
You will receive the meeting link, after you register.

Elections have consequences. Vote for candidates who oppose further expansions to euthanasia.

Alex Schadenberg

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

Elections have consequences.

This is an important election for Canadians who oppose killing people.

Canada's 2023 euthanasia report stated that there were 15,343 reported euthanasia deaths representing 4.7% of all deaths. 

My research uncovering the 2024 Canadian euthanasia data indicates that there were approximately 16,500 reported euthanasia deaths. In Québec, the number of euthanasia deaths increased again. Québec has the highest euthanasia rate in the world.

The Office of the Chief Coroner of Ontario released a report from the Ontario MAiD Death review Committee indicating that there were at least 428 non-compliant Ontario euthanasia deaths from 2018 to 2023.

Recently, Canada's federal government was studying expanding euthanasia to advance requests, meaning, to permit people who state in an advance directive that they would want euthanasia, that the person could be killed if they become incompetent.

Canada's federal government has scheduled to allow euthanasia for mental illness (alone) beginning on March 17, 2027. A report by the Special Joint Committee on Medical Assistance in Dying (AMAD) that was tabled in the House of Commons on February 15, 2023 called for an expansion of euthanasia to include children "mature minors" and patients with mental illnesses and that patients with dementia be permitted to make advance requests for euthanasia.

On March 21, 2025 the Convention on the Rights of Persons with Disabilities Committee report urged Canada's federal government to:

Repeal Track 2 Medical Assistance in Dying (MAiD), including the 2027 commencement of Track 2 MAiD for persons whose “sole underlying medical condition is a mental illness”;

Not support proposals for the expansion of MAiD to include “mature minors” and through advance requests;

Elections have consequences. 

I urge you vote for candidates or a government that will oppose further expansions to killing. 

We cannot afford another euthanasia expansionist government.

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

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

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

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

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

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

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

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

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

Medical assistance in dying and advance directives

Ruth Enns (disability rights leader and author)

Advance directives (AD) seduce us into believing that we can order up a beautifully scripted death like a latte-to-go.

However, in the July/August 2012 edition of Gray Matters, Jerome Groopman MD and Pamela Hartzband MD cited Muriel Gillick, MD, a geriatrician at Harvard Medical School and a researcher in end-of-life care, saying that “‘… the consensus … is that the directives have been a resounding failure.’” Nevertheless we are now to believe that we should be able to circumvent current euthanasia/ MAID restrictions by signing an AD even after a dementia diagnosis.

Groopman and Hartzband said the signatories “… cannot accurately imagine what they will want and how much they can endure in a condition they have not experienced.”

Caregivers tend to believe they know what care recipients experience, not understanding that their experience is of caregiving, not of receiving care. They can’t understand the recipient’s perspective any more than men who used to think they spoke for the women in their lives.

Secondly, many people change their minds after signing such a document. Would the authority figures interpreting the directive allow a change of mind or assume it is a product of the disease or disability, not to be taken seriously?

According to Richard Weikart, author of Unnatural Death: Medicine’s Descent from Healing to Killing, the first case of a physician being prosecuted in the Netherlands after euthanasia was legalized in 2001 involved a woman with an AD requesting euthanasia in the event of dementia.

But when her fears materialized, she changed her mind, rejecting the fatal injection three times. The doctor drugged her coffee. Still she struggled. Family members then restrained her to facilitate the euthanasia. Four years later, the doctor was acquitted.

In Canada, despite 428 breaches of current euthanasia/ MAID law in Ontario alone, no one has been prosecuted.

A third reason ADs don’t work is that the prevailing narrative views “disabled” people as lives not worth living.

In an American survey reported in Health Affairs in February 2021, more than 80 per cent of U.S. physicians perceived significantly disabled people’s lives as diminished, “… an attitude that may contribute to health-care disparities among people with disability.”

However, Lisa I. Iezzoni, a health-care policy researcher at Harvard-affiliated Massachusetts General Hospital told the Atlanta Journal-Constitution “Studies of people with disability show that most don’t view their lives as tragic … and view their lives as good quality.”

But wouldn’t authority figures interpret an AD in the light of the ableist narrative reflected in the survey?

Current legislation targets people with disabilities. If the euthanasia/MAID practitioner sees disabled people as having low “quality of life,” wouldn’t that person be inclined, consciously or unconsciously, to interpret an AD differently than the signatory intended?

Since the majority of non-disabled Canadians perceive the ableist narrative as truth, anything else will be and is ignored.

Would any other marginalized group face the same legal discrimination?

A fourth strike against ADs is our current stressed health-care system. What about the interpreter’s level of fatigue, social and other pressures? Fatigue and stress make most of us less tolerant than stress-free environments.

A fifth strike, as Groopman and Hartzband said, is that ADs “cannot encompass every possible clinical scenario.”

A sixth strike is that interpreters, usually medical practitioners, may well be strangers relying on maybe a cursory examination and other people’s notes in the signatory’s medical chart. Wouldn’t a lack of familiarity with the person tilt interpretation toward prevailing biases?

A seventh strike asks: is the euthanasia/MAID provider qualified or willing to assess the reasons prompting the request?

For example, is Dr. Ellen Wiebe in B.C., an enthusiastic and vocal member of the euthanasia/ MAID advocacy organization, Dying With Dignity, qualified to assess the person’s mental health?

Does she bother addressing social and economic pressures?

She has said she determines the person’s eligibility on her assessment of their “quality of life” rather than medical assessments. “Quality of life” is a vague catch-all phrase encompassing anything from economics to end-of-life distress.

As of March 2023 she had “helped” 431 people into the nearest hearse and faces no legal consequences, although she is getting pushback from her own clinic and others.

But what then? How are these directives to be used? As a yes-no shortcut for medical end-oflife decision-making? As legal protection for the interpreters?

Instead of ensuring choice, doesn’t signing ADs actually abdicate choice? Who is really empowered by such directives? The signatory or the interpreter? Are they not simply a manifestation of ableism?

If ADs don’t deliver on their promises for anyone, how can they deliver those promises for those diagnosed with dementia? Doesn’t that make vulnerable people even more vulnerable?

Groopman and Hartzband said, “… there are no shortcuts around emotionally charged and time-consuming conversations that involve patients, families and physicians.”

But who has time, resources and patience for such conversations these days?

Ruth Enns writes from Winnipeg.

Euthanasia (MAiD) by advance request is euthanasia without consent.

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

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

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

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

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

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

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

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

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

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

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

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

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

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

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

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

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

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

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

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

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

Background to the "consultation."

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

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

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

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

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

EPC Guide to answering the online "consultation" questions.

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

Response: Strongly oppose.

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

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

Response: Strongly oppose.

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

Response: Strongly oppose.

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

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

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

Response: Not at all important.

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

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

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

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

Response: Alex Schadenberg suggests using some of the following: 

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

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

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

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

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

Advanced directives are also provincial not federal jurisdiction.

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

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

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

Response: Prefer not to say.

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

Response: Prefer not to say.

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

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

Response: Prefer not to say.

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

Response: Prefer not to say.

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

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

Response: Prefer not to say.

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

Response: Prefer not to say.

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

Response: Prefer not to say.

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

Response: Prefer not to say.

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

Response: Alex Schadenberg responded in this manner.

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

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

We shouldn't even be discussing this issue.

Advanced directives are also under provincial not federal jurisdiction.

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

Response: Prefer not to say.

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

Response: Prefer not to say.

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

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

Response: Prefer not to say.

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

Response: Not at all important.

The consultation ends with a series of demographic questions.

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

Alex Schadenberg
Executive Director
Euthanasia Prevention Coalition

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

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

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

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

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

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

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

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

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

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

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

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

Canadian government will discuss euthanasia by advanced request.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Canadian government website - Medical Assistance in Dying: National conversation on advanced requests (Link).

The Canadian government will launch a consultation on expanding Canada's (MAiD) euthanasia law to permit euthanasia by advanced request. 

David Baxter reported for the Associated Press on October 28 that Canada's Health Minister, Mark Holland, made the announcement on October 28.

Baxter explained that the Québec government announced that, starting on October 30, they will permit advanced requests for euthanasia to enable people with dementia or Alzheimer's disease to request euthanasia while the person is still competent. Euthanasia by advanced request is not permitted in Canada's euthanasia law.

Health Minister Mark Holland

Baxter reported Holland as stating:

“What we’re saying very clearly is that this is an incredibly difficult issue, that we need to take the time to have a national conversation that includes our provincial and territorial colleagues, that where these lines are drawn and whether or not the system is ready is a very important step,” Holland said at a press conference on Parliament Hill on Monday.

“This continues to be illegal in this country, that if you act on an advance request, the Criminal Code is very clear that that is not legal.”

The Quebéc government announced on September 7 that they had asked the provincial Crown prosecutor’s office to not pursue charges against doctors as long as they comply with the provincial law. Euthanasia by advanced request changes the requirement of consent.

Canada's euthanasia law requires that a person be capable of consenting to euthanasia when the doctors or nurse practitioners approve the death. The Québec government will enable someone to state, in advance, their wish to die and then it would be legally carried out at a later date, even if the person has become incompetent.

Québec approved euthanasia by advanced request (starting October 30, 2024)

Euthanasia by advanced request is euthanasia for incompetent people.

Alex Schadenberg

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Shuyee Lee and Kwabena Oduro reported for CBC news that Québec's Justice Minister, Simon Jolin-Barrette has asked the Crown's Prosecution Office to not lay charges when a doctor or nurse practitioner kill an incompetent patient who made an advanced request for death, based on the euthanasia law.

Justice Minister, Jolin-Barrette asked the Crown Prosecution Office to not lay charges in these deaths because Criminal law is a federal jurisdiction. Even though Canada's federal government has radically promoted euthanasia, they have not approved euthanasia by advanced request.

Many people are not aware that Canada has two euthanasia laws, the federal law and the Québec law. On June 7, 2023; the Québec National Assembly passed Bill 11 which expanded their euthanasia law by:

• creating an obligation for palliative care homes to offer MAID (in 6 months);
• offering MAID in cases of serious physical disability* (in 9 months); 
• offering MAID by advance request* (in a maximum of 24 months).

Québec Justice Minister, Jolin-Barrette decided to institute euthanasia by advanced request on October 30, 2024. 

The controversy related to the first provision of Bill 11, that being the obligation for palliative care homes to offer MAiD erupted in December 2023.

On December 2, 2023 I published an article about the St Raphael Palliative Care Home and Day Centre, that was founded by the Archdiocese of Montréal, being forced to provide euthanasia. On February 6, 2024 I published an article that the Archdiocese of Montréal was suing the Québec government to prevent euthanasia at St Raphael Palliative Care Home and Day Centre.

Quebec already has the highest euthanasia rate in the world.

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

There are many controversial stories including people in Québec being pressured to "seek" death by euthanasia. Some of the recent stories include:

Katrine Desautels reported for the The Canadian Press on August 14, 2024 that Sébastien Verret (44) is seeking a death by (MAiD) euthanasia based on long covid.

Matt Gilmour reported for CTV news Montreal on July 5, 2024 that Tracy Polewczuk, a woman who lives with Spina Bifida, on two separate occasions was urged to request euthanasia by a medical professional without initiating the request.

Rachel Watts reported for CBC News on April 12, 2024 that a quadriplegic man, Normand Meunier (66) "chose" to die by (MAiD) after developing a severe bedsore at a hospital in Saint-Jérôme, Québec. Meunier experienced a tragic spinal chord injury in 2022.

Private Members Bill would allow euthanasia by advanced request.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Sylvie Bérubé BQ MP (Abitibi—Baie-James—Nunavik—Eeyou) is sponsoring Bill C-390 which would expand Canada's euthanasia law.

Sylvie Bérubé BQ MP and Luc Thériault BQ MP (Montcalm) held a press conference on May 22 to announce that they have introduced Bill C-390 to expand Canada's (MAiD) euthanasia law to, among other areas, permit euthanasia by advanced request.

Bill C-390 would expand Canada's euthanasia law by adding to each section of the law - the words:

"or an applicable provincial framework."

In June 2023 Québec expanded their provincial euthanasia law by passing Bill 11  expanding euthanasia in Québec by:

• creating an obligation for palliative care homes to offer MAID;
• offering MAID in cases of serious physical disability;
• offering MAID by advance request*

Amending Canada's federal euthanasia law based on Bill C-390 would expand euthanasia enabling it to be decided by an advanced request, by causing federal legislation to be changed when a Province changes it's provincial legislation.

The federal report by the Special Joint Committee on Medical Assistance in Dying (AMAD) that was tabled in the House of Commons on February 15, 2023 called for an expansion of euthanasia (MAiD) in Canada. The report recommended that children "mature minors" and patients with mental illnesses be eligible for euthanasia and that patients with illnesses such as dementia be permitted to make advanced requests by advanced directives for euthanasia.

Euthanasia (killing) is bad enough, but killing by advanced request changes the nature of consent, meaning, someone can be killed without a clear and present consent. When consent becomes secondary, it changes the question of who can be killed by lethal injection.

Provincial governments have the ability to amend the practise of euthanasia in their jurisdiction. Bill C-390 would allow provinces, such as Québec, to change their provincial law with it resulting in an immediate change to the federal law.

Reaction to the Bloc Québécois federal euthanasia bill

The Boundary of incapacity: must not be crossed. (Link to the original release)

Montreal, May 23, 2024 – The Bloc Québécois announced today that it will table a Federal Bill that “would allow advance requests for medical assistance in dying (MAiD) for people suffering from neurodegenerative disorders such as Dementia."

This was presented during a Press Conference in Ottawa, in collaboration of a Coalition made up of the Quebec Association for the Right to Die with Dignity (Association Québécoise pour le droit de mourir dans la dignité, AQDMD), the Quebec Bar (Barreau du Québec), the Chambre des notaires du Quebec (CNQ), the College of Physicians of Quebec (CMQ), the Order of Nurses of Quebec (OIIQ), the Order of Pharmacists of Quebec (OPQ) as well as the Order of Social Workers and Marriage and Family Therapists of Quebec (OTSTCFQ) (see their press release in French) + Dying with Dignity Canada.

Given the tone of the Press Conference, which was very critical of the Liberal government, this maneuver has little chance of finding an attentive ear.

A thorough review is required before expanding access to medical assistance in dying by advance request. Crossing the boundary of incapacity and contemporaneous consent to administer MAiD would have serious and unprecedented consequences.

Here is an excerpt from the Brief from Living with Dignity presented last year during the examination (in Quebec) of Bill 11, An Act to amend the Act respecting end-of-life care and other legislative provisions:

The limits of advanced and substituted consent, the numerous practical issues concerning the administration of MAiD, the possible conflicts of interest (numerous cases of abuse and neglect of elderly individuals) and the major impacts of this new access on a network of already fragile geriatric care, strongly questions the merits of this expansion which we also consider to be marked by ableism.

It is important to remember that the opponents of this expansion were not invited to testify in a parliamentary committee concerning Bill 11 last year at the National Assembly of Quebec.

Webinar by Professor Theo Boer

To reflect on the issue of advance directives, the citizen network Living with Dignity invites interested people to follow a webinar organized by Doctors Say No International. At 4 p.m. (Montreal time), Friday, May 24, Professor Theo Boer, Professor of Health Ethics (PThUniversiteit Groningen, Netherlands) will present (in English) during this webinar on Assisted dying and its impact on culture: 40 years of Dutch experience with euthanasia.

Zoom link (password: 089934).

Holland is the only country in the world that allows the death of a person by advanced request when they are Incapable of decision-making and conscious (Belgium only allows it when a person is Incapable and unconscious). Professor Boer's contributions in French during the International Meeting on the End-of-Life are now also available in print (in French), as are those of all the speakers at this gathering held in Paris on February 28, 2024.

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Jasmin Lemieux-Lefebvre
Coordinator
Living with Dignity citizen network
info@vivredignite.org
438-931-1233

A nurses story: Euthanasia (MAiD) death was not dignified.

This story was sent to the Euthanasia Prevention Coalition by a nurse who wanted to remain anonymous. The nurse changed all names to ensure the privacy rights of those involved. -Alex Schadenberg.

They say euthanasia is a compassionate, dignified way to die. They say everyone should have the option, and that a life with suffering is not a life worth living. But that's not what I've seen. I know Medical Aid in Dying (MAID) to be messier and more distressing than anyone cares to talk about. I have seen the ripple effects of euthanasia, and the complexity it adds to grief. I want people to know the impact MAID has on healthcare professionals. I am a palliative care nurse, and this is my side of the story.

One shift I worked with a patient named Laura who was scheduled to be euthanized later that day. Laura had a terminal metastatic breast cancer diagnosis, but with no exceptionally challenging symptoms that I could observe. However, she told me she was tired of living, and the thought of living longer scared her more than dying. Laura had picked out music to play in the background while she died, and had chosen which loved ones she wanted by her side. It was planned for 6 pm. She was alert and oriented, and had signed a waiver saying that if for whatever reason she was no longer judged to be of sound mind at the time of the MAID provision, she could be euthanized anyways. She thought she had complete control. Just a few hours before 6 pm Laura had a completely unexpected grand mal seizure. She wouldn't stop seizing and required large doses of a sedating anticonvulsant. The time of the provision came, and she was confused and groggy from the sedating medication, and unable to properly confirm she wanted the euthanasia, or say goodbye to her family members. She tried to speak but no one could understand what she was saying. Laura was euthanized at 6 pm, according to the waiver she had signed. This was what she had requested, but the family came out of her room shaking, with eyes wide. They cried, and kept saying it should have never happened that way. They had no closure. There was no dignified, peaceful ending. Just their loved one, killed in the middle of trying to say something.

This was a horrible death. If Laura had chosen to die naturally, maybe she would have lived two more weeks. Maybe she would've needed more sedatives, and spent more time sleeping. But we would've kept her comfortable. Her family could've been by her side and treasured any awake moments and words she had to give. As her nurse I would've battled any restlessness, worked to prevent any seizures, noticed a furrowed brow and given pain medication. I could've explained the dying process to Laura's family, spoken about the changes we were seeing in breathing, in circulation, and slowly walked alongside them in their grief as she grew closer to death. Instead her death was sudden, and traumatic, and the family went home right after without anyone to support them through the process.

It wasn't just the family traumatized by this death. For every MAID provision, a nurse is in the room, along with the MAID provider injecting the lethal medication. As a conscientious objector to euthanasia, I did not have to be in the room as it happened. Instead, my coworker volunteered. After Laura's life was ended, this coworker sped out of the room shaking and crying, distressed in a way no natural death of a patient has ever affected her. I know multiple other nurses who have been through the same experience. Although they had no religious or moral objections to MAID, after witnessing it first hand they swore to never be in the room again while it happened. They were deeply unsettled, and their conscience told them what they couldn't admit to themselves: the intentional ending of a life is wrong, no matter the circumstances.

The ripple effects of Laura being euthanized carried on, beyond her family, beyond the staff, to other patients on the palliative unit. Mark, who had the unfortunate position of a bed in the hallway, expressed to me, "I saw something today that I am not okay with, and I just have to bring it up". Mark carried on to tell me he saw Laura go by in her wheelchair, talking with a visitor as she went into her room. Later, Mark observed staff and family members going in, and then witnessed the family coming out weeping. He reported seeing a stretcher leave the room, with a black cover overtop, and realized Laura had died. Mark watched her family crying, and it brought up memories of his own wife dying. He was horrified that one moment Laura was up and talking, and the next she had died. He admitted to feeling scared he would die suddenly, too. I hadn't said a word about Laura due to confidentiality, but as a patient in the hallway Mark was able to observe and hear a lot of things. He and Laura were both mobile, and over the past few days they had spoken in the patient lounge on occasion. Her death brought up many complex emotions and distress for Mark, and I felt torn on how to support him.

For myself, Laura's death was exceptionally hard to deal with. Before she died, it was difficult to interact with her in a normal way. I kept watching the clock, and counting down the days, hours and minutes till her scheduled death. I had an awkward moment of bringing in the scheduled laxative she got each morning along with her other medications, to which she responded, "really? I'm dying today, does it matter if I'm constipated?". Every interaction I had with her I felt the weight of her impending death, I wanted to scream out "don't do it! Your life has value!". But instead I bit my tongue and supported her, and then went home morally distressed, wondering if I had spoken my mind, would it have made a difference? I wanted to rip up the waiver she had signed, and plead with the doctor injecting her lethal dose not to do it. After she died and my shift was over, I went home feeling profoundly sad, and helpless at how the situation played out.

The goal of palliative care is to alleviate suffering and support patients and families until natural death, neither hastening nor prolonging death. I am upset that in Laura’s case, we had to betray our own philosophy. When euthanasia was first legalized in Canada, palliative units and hospices were exempt from having to provide MAID on site, for good reason. The whole unit feels the impact when death is chosen before it’s time. Perhaps for staff who see natural death on a regular basis, we feel the impact even more than others. We see the contrast, we know a natural death doesn’t have to be scary or painful. If a patient like Laura has a grand mal seizure, we are skilled at adapting to changing circumstances to keep her comfortable. Letting death happen at its natural hour gives families the chance to bond, and soak in every last moment loved ones have to give. Patients may think that choosing MAID relieves their family of the burden of waiting for their death, or seeing suffering. But in reality it steals time and closure, and replaces a natural process with an unsettling ending. From what I have seen, loved ones of euthanized patients appear to struggle more in their grief than loved ones of patients who die naturally.

A story like Laura’s showcases a reality of euthanasia not often spoken about. And even though this was just one example, it is not an isolated incident. There are many more stories I could’ve shared, and the impacts of euthanasia are felt far and wide with each and every case - even the ones that go as planned. My hope in telling this story is that eyes will be opened to the horrifying reality of euthanasia, and perhaps hearts and minds will be changed as well. I am a palliative care nurse, and this is my side of the story.

Canada's euthanasia system abandons people in need under the guise of autonomy.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Diana Duong and Lauren Vogel wrote a commentary on Canada's current (MAiD) euthanasia law that was published in the Canadian Medical Association Journal on April 3, 2023. They write:

Canada is on track to have one of the world’s most expansive assisted dying programs, but concerns about safeguards and clinical standards persist.

More than 31 000 people (as of December 31, 2021) have received medical assistance in dying (MAiD) in Canada since the service became legal in 2016, with the number of recipients growing steadily each year.

They offer old statistics since the federal government hasn't published the 2022 euthanasia data. They then comment on the expanding eligibility for euthanasia:

Canada currently allows MAiD for capable, consenting adults suffering from “grievous and irremediable” conditions, excluding mental illness as a sole underlying condition.

Approvals for MAiD follow two tracks, with expedited access for people whose natural death is foreseeable and a 90-day waiting period for other recipients.

People with mental illness as their sole underlying condition were supposed to gain access to MAiD under the second track this spring. However, the federal government recently postponed that expansion to March 2024.

They comment on the report from Canada's special joint committee on MAiD:

Canada’s special joint committee on MAiD issued a report in February this year recommending the government expand the service to people with mental illness and mature minors, and via advance requests so that people can receive MAiD if they become incapacitated.

The cross-party committee of MPs and senators heard from close to 150 expert witnesses and received more than 350 briefs and other correspondence during six months of consultations in 2022. However, their recommendations were not unanimous, with Conservative members dissenting.

They then comment on MAiD for mental illness:

A recent poll by Angus Reid found that although six in 10 Canadians support MAiD in its current form, only one in three support allowing people to seek MAiD purely based on mental illness.

Uncertainties persist about how to assess if a person with mental illness is capable of consenting, how to distinguish between MAiD requests and suicidal thoughts requiring treatment, and how to determine if the suffering caused by psychiatric disorders is truly irremediable.

However, the special joint committee noted that these challenges aren’t unique to providing MAiD to people with mental disorders or universal to MAiD requests related to mental illness.

Psychiatric MAiD remains rare in other countries that allow it, accounting for 1%–2% of assisted deaths, according to Tyler Black of the University of British Columbia. In the Netherlands, for example, adults have an 8% lifetime risk of suicidal thoughts, yet just 0.0004% receive psychiatric MAiD annually.

“There is simply no credible foundation for the fear that allowing MAiD for psychiatric conditions would create a flood of deaths in Canada,” Black stated.

Whether or not there is a flood of deaths based on MAiD for psychiatric conditions Black clearly misses the point. 

• How can a person be approved to be killed when their condition may be the cause of their suicidal ideation? 
• How can a psychiatrist determine that a person with psychiatric conditions has an irremediable medical condition, meaning he or she will not recover? 
• And how can a person be approved for death for psychiatric reasons when the treatment that they need is both difficult to obtain and might require several different therapies before success is attained?

They then state that the Canadian government remains committed to implementing euthanasia for mental illness:

Even so, the special joint committee raised concerns that “there has not been sufficient time to develop standards of practice” for providing MAiD to people with mental conditions. As such, they recommended the government reconvene the committee later in 2023 to “verify the degree of preparedness” before the law changes in 2024.

The government has appointed an expert group to create MAiD practice standards and is supporting the development of an accredited training curriculum for clinicians by the end of the year.

They then comment on the variation in the interpretation of the euthanasia law.

There is still a lot of variability in the clinical interpretation of MAiD laws, said Madeline Li, a cancer psychiatrist and former head of University Health Network’s MAiD program.

Because the law focuses primarily on patient autonomy, there isn’t much room for clinical judgment, which has led some MAiD providers to approach assessments in a checklist fashion, Li said. “We say, ‘Let’s figure out if you can have it,’ but we don’t back up and say, ‘Let’s talk about whether you’re making the right decision for you.’”

Li recalls the moral distress she felt providing MAiD to a young man with a highly treatable cancer. Seven other clinicians had been uncomfortable with the man’s request, but because he refused treatment, his condition was technically irremediable and thus eligible for MAiD.

“I gave MAiD against my clinical judgment because I will always do what’s in the best interest of a patient if they have made a clear and reasoned decision,” Li said. However, she described feeling “stuck” because, unlike other countries, Canada doesn’t require patients to try alternatives to MAiD — only to consider them seriously.

Moreover, Li said, the law doesn’t require clinicians to meaningfully discuss a patient’s desire for death or the societal factors that may contribute to their request. Practice guidelines and training can emphasize the importance of these discussions, but unless they’re enshrined in law, they’re ultimately optional.

Madeline Li brings up some very important points. Canadians are not required to attempt effective treatment before being killed by euthanasia. A study of people with lung cancer showed that some people were died by euthanasia without first confirming their diagnosis and without attempting effective treatment. Therefore people who have a condition that may be cured are dying by euthanasia.

The authors then comment on some "wrongful" deaths by euthanasia.

Canada has already seen cases of people seeking MAiD owing to a lack of disability support, inadequate housing, or fears of homelessness. Meanwhile, at least four veterans have reported feeling pressured to consider MAiD by a federal caseworker who has since left their position.

“We have learned that as you expand MAiD… it switches from being initially something that was compassionate relief for end-of-life suffering to facilitating suicide for ending life suffering, and that’s very different,” says Sonu Gaind, chief of psychiatry at Humber River Hospital and a professor at the University of Toronto’s Temerty Faculty of Medicine.

They then quote Jocelyn Downie who stated that extending euthanasia to people with psychiatric conditions, alone, was not an extension of the law but a recognition that the Carter Supreme Court decision already granted it.

Downie is the most pro-euthanasia academic in Canada and is wrong about Carter. Carter approved euthanasia for physical and psychological suffering, but not for psychological suffering alone.

The authors then outline the issue of euthanasia for "mature minors."

Looking beyond competent adults, the special joint committee recommended the government allow MAiD for minors with terminal illnesses who are deemed capable of making the decision, with no minimum age limit.

Very few jurisdictions allow MAiD for minors, with the Netherlands allowing access for those aged 12 and older and Belgium setting no minimum age so long as the child has the capacity to make the decision.

Some witnesses pointed out that minors in Canada already make decisions about withholding or ceasing treatment, even when those decisions may hasten death, while others felt the decision to seek MAiD was too weighty for minors to make.

It is true that "mature minors" have the right to make medical decisions for themselves, but it is also recognized that the nature of their consent is different than the consent offered by a fully competent adult.

The authors then outline the issue of euthanasia by advanced request.

Under Canada’s current MAiD laws, people with a terminal illness who have arranged for MAiD on a particular day but become incapacitated beforehand can still receive the procedure if they don’t demonstrate refusal or resistance.

However, the special joint committee heard that this puts pressure on people to arrange MAiD sooner than later, and MAiD providers remain hesitant to administer the procedure without explicit consent.

The committee recommended the government allow people diagnosed with serious and incurable conditions leading to incapacity to make advance requests setting out the conditions under which they would want to receive MAiD.

While the committee noted strong support for the measure, some witnesses raised concerns about difficulties interpreting advance requests and the potential for coercion and abuse.

Among other safeguards, witnesses emphasized the importance of periodically reaffirming advance requests for MAiD, sharing the documents with family and health providers, and including clear, observable criteria for triggering the request, such as being bedridden or unable to eat.

Similar to the issue of "mature minors" euthanasia based on an advanced request can't assure that the person hasn't changed their mind, and furthermore, a person who has become incompetent has no legal ability to change their mind. Euthanasia by advanced request changes the nature of consent and opens the door to euthanasia without consent.

The authors complete their article by commenting on Bill 11 in Quebec.

The committee also recommended that legislators look to Quebec’s experience for guidance. The province recently tabled legislation to allow people with serious and incurable illnesses to make advance requests for MAiD.

Under Bill 11, advance requests for MAiD must be free and informed, notarized in the presence of witnesses, and clearly describe the level of suffering a person deems intolerable. Capable patients can withdraw their requests at any time, and two professionals must sign off before an incapacitated person receives MAiD per an advance request.

The bill would also require palliative care hospices to offer MAiD, as some hospice patients are forced to take ambulances to other facilities to receive the procedure.

Quebec Bill 11 will permit euthanasia by advanced request and it will force palliative care and hospices to participate in euthanasia, against the conscientious objections of the staff or the facility.

Canada is heading into the abyss of unabatted killing. As Madeline Li admits, the decisions to kill or not to kill are based on patient autonomy. When euthanasia for mental illness alone is added to the acceptable criteria, it will mean that people with suicidal ideation, related to their treatable mental condition, will be able to die by euthanasia. Further to that, in our current situation, people are dying by euthanasia even though their medical condition might have an effective treatment, since the law does not require a person to first attempt treatment. Finally, we already have people with disabilities, and others, who are seeking euthanasia based on issues related to poverty, homelessness and an inability to receive effective medical treatment.

Sadly Canada's euthanasia law abandons those in need under the guise of autonomy.