Canada: Women, the lonely, and people with disabilities, at risk to euthanasia

This article was recently published by the Australian Care Alliance.

Article: Health Canada reports 13,241 assisted deaths in 2022 representing 4.1% of all deaths (Link).

In October 2023 the Fourth Annual Report on Medical Assistance in Dying in Canada was published. It stated that there had been 13,241 reported cases of euthanasia and assisted suicide in 2022, bringing the total of such deaths since legalisation to 44,958.

The number of cases each year has more than quadrupled (466%) in 6 years from 2,838 in 2017, the first full year of legalisation, to 13,241 in 2022 with annual increases of 57.8% (2018); 26.4% (2019) 34.2% (2020); 32.4% (2021) and 31.2% (2022).

“Fewer than seven” cases of assisted suicide have occurred each year since 2019. Canadian practice overwhelming uses euthanasia. The 2019 report stated that: “providers are less comfortable with self-administration [assisted suicide] due to concerns around the ability of the patient to effectively self-administer the series of medications, and the complications that may ensue”.

In 2022 euthanasia and assisted suicide accounted for 4.1% of all deaths in Canada. Provincial rates of euthanasia are highest in Quebec - 6.6% in 2022 and British Columbia - 5.5% in 2022.

Underlying conditions

Very limited data is provided on the “main condition” for which euthanasia is performed.

In 2022, for 8.3% of cases the “main condition” is reported as “multiple comorbidities” and a further 14.9% as “other conditions” - that is other than cancer, cardiovascular, respiratory, neurological or organ failure. For these two categories combined, 25% of cases involved “frailty” and 11.9% involved diabetes. Other conditions cited included vision or hearing loss, tendency to falls; and difficulty swallowing. For women these two categories now account for nearly one out of three (29.1%) deaths by euthanasia.

The 2021 report comments “Multiple comorbidities and other conditions encompassed a wide range of diseases or conditions, including frailty, diabetes, arthritis, and osteoporosis”. Note that these are not terminal conditions.

In only 161 cases in 2022 did the clinician administering euthanasia give their specialty as oncology. Additionally, 806 cases involved some consultation with an oncologist. This means that in 2022, at least 7,649 Canadians were euthanized on the basis that they had cancer with no discussion with an oncologist about this course of action. This represents 90.6 % of cases of euthanasia for cancer.

The majority (67.7%) of those administering euthanasia were primarily engaged in family medicine.

The 2022 report notes that the second opinion on eligibility was given by a nurse practitioner in 7.3% of cases.

“Death be reasonably foreseeable” - no longer required

The Canadian law initially required that “death be reasonably foreseeable”. The decision of the Ontario Superior Court of Justice in AB v Attorney General of Canada delivered on 19 June 2017, in paragraph 81, interpreted this requirement as not requiring any connection whatsoever between the underlying conditions for which euthanasia is sought and the reasonable foreseeability of death – which can be based simply on advanced age. The woman in this case was 79 years old.

On 11 September 2019, the Quebec Superior Court, in the case of Truchon c. Procureur général du Canada, invalidated the relevant provisions in the Canadian law which limited euthanasia to cases where “natural death has become reasonably foreseeable” and the Quebec law which required that the person be “at the end of life”. The effect of this decision was suspended for six months.

The Canadian Government introduced Bill C-7 into the House of Commons in February 2020 to give statutory effect to the decision. The Bill became law from 21 March 2021 opening the way for euthanasia to be given to people with chronic, non-terminal conditions, including people with a disability.

463 such cases were reported for 2022. -59% of these involving the euthanasia of a woman whose death was not reasonably foreseeable.

In Ontario in 2022, 121 out of 3934 (3.1%) euthanasia cases involved a person whose natural death was not reasonably foreseeable.

Short time between initial request and euthanasia being performed

Section 241.2 (3) (g) of the Canadian Criminal Code required a physician to “ensure that there are at least 10 clear days between the day on which the request was signed by or on behalf of the person and the day on which the medical assistance in dying is provided or — if they and the other medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the person’s death, or the loss of their capacity to provide informed consent, is imminent — any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstance”.

Of the 7,384 people killed by euthanasia in Canada in 2020 for whom data is available on the length of time between first request and when euthanasia was administered some 34.3% or 2,532 people were euthanased in less than 10 days of first requesting it.

For 905 of these people the only justification given for the haste with which euthanasia was performed was that loss of capacity to consent was imminent. This raises real questions about the validity of the original request. If a person is on the verge of losing capacity what degree of certainty can there be that the person currently has full capacity?

In the period April 2021 to March 2022 in Quebec, 50% of people were euthanized less than 10 days after making a request. However, only 13% of people had a prognosis of less than 2 weeks to live.

Under the revised law from 21 March 2021 there is no longer any required waiting period for any person whose death is said to be “reasonably foreseeable”. Same day request and lethal injection is acceptable.

In other cases, a 90 day waiting period is specified but if the two assessing practitioners think that loss of decision making capacity is imminent this can be waived entirely.

Advanced directive

Euthanasia can now (since 21 March 2021) be provided on the basis of an advanced directive to persons who have lost decision making capacity. This is not supposed to be done if the person resists or refuses by "words, sounds or gestures".

However, this requirement is undermined by a provision that "involuntary words, sounds or gestures made in response to contact do not constitute a demonstration of refusal or resistance". How do we know they are "involuntary"?

In Ontario in 2022, 190 out of 3934 (4.83%) involved euthanasia of a person who at the time they were killed was incapable of giving consent.

Reasons for requesting euthanasia

The 2022 annual report states that loss of ability to engage in meaningful life activities (86.3%) followed closely by loss of ability to perform activities of daily living (81.9%) were the most common reasons for a euthanasia request.

Inadequate control of pain, or concern about it (59.2%) ranked much lower.

Disturbingly 35.3% reported as a reason for their euthanasia request “Perceived burden on family, friends or caregivers” and 17.1% reported “Isolation or loneliness”.

So in 2022 some 2,294 Canadians were given a lethal injection because they were lonely: Why didn't the doctor or nurse practitioner just have a cup of tea and a chat with them instead of giving them a lethal injection?

For Quebec, between April 2021 and March 2022, 1700 (47%) of people euthanased gave a reason as “Perceived burden on family, friends or caregivers” and 824 (23%) of people reported “isolation or loneliness” as a reason.

Needed disability services and palliative care not provided

In 2022 there were 328 cases where palliative care was not accessible if needed – an increase of 63% from 2021 when cases had already increased by 60% from the 126 cases in 2020.

The 2021 report notes even where palliative care was being accessed or was available “this result does not offer insight into the adequacy or quality of the palliative care services that were available or provided”.

In 2022 there were 568 cases where disability support services were needed but NOT received (up from 332 in 2020 – an increase of 71%). In 2021 this included 12 of the 219 people whose deaths were “not reasonably foreseeable”.

The 2020 report stated that “Disability support services could include but are not limited to assistive technologies, adaptive equipment, rehabilitation services, personal care services and disability based income supplements.” The 2021 report admits that, even for those who were reported as having received disability support services, the data “does not provide insight into the adequacy of the services offered”.

Denied assisted living but offered assisted suicide

Roger Foley, who has a crippling brain disease, has been seeking support to live at home. He is currently in an Ontario hospital that is threatening to start charging him $1,800 a day. The hospital has told Roger that his other option is euthanasia or assisted suicide under Canada’s medical assistance in dying law.

Candice Lewis: pressure for euthanasia based on disability

Candice Lewis (right)

Candice Lewis was a 25 year old Canadian woman who happened to have cerebral palsy.

In September 2016 Candice went to the emergency room at in Newfoundland after having seizures.

The doctor told her she was very sick and likely to die soon. He offered her assisted suicide. The doctor also proposed assisted suicide for Candice to her mother Sheila Elson.

This offer was repeated despite both Candice and her mother making it clear that this was not an option Candice would consider. The doctor told Sheila she was being selfish by not encouraging her daughter to choose assisted suicide.

Candice describes how bad it made her feel that a doctor was offering her assisted suicide.

More than twelve months later Candice had recovered well and her health was much improved. Candice wasn’t having any seizures, was now able to feed herself, walk with assistance, use her iPad. She was more alert, energetic and communicative. She was able to walk down the aisle as a bridesmaid at her sister’s wedding in August 2017. She was doing what she loved most, painting and being with her family.

Candice and her mother Sheila were interviewed by Kevin Dunn, who is produced a film on euthanasia and assisted suicide called Fatal Flaws for the Euthanasia Prevention Coalition. The film of the interview can be viewed here.

Candice has since passed away from natural causes.

There are several take home lessons from Candice’s experience:

• Doctors can get the prognosis wrong. Candice was told she was dying but is flourishing twelve months later. A wrong prognosis can lead to assisted suicide or euthanasia. A life can be thrown away needlessly;
• People with a disability already suffer discrimination in health care. When assisted suicide and euthanasia are legal, people with a disability are more at risk of being offered death as a solution because doctors and others consider that they would be better off dead;
• Once doctors are authorised by the law to provide assisted suicide and euthanasia some of them will feel empowered to offer it to anyone they think would be better off dead. This undermines patients’ trust in doctors and can cause great distress.

A taste for killing?

Of the 1746 physicians and 91 nurse practitioners who euthanased people in 2022, some 336 of them did so 10 times or more – up 29.2% from 260 in 2021. The 91 nurse practitioners killed an average of nearly 14 people each – twice the average for medical practitioners of 7 people each.

Conclusion

Canada's court ordered experiment with euthanasia is already out of control with significant rates of failure to comply with the legal requirements and processes. No action appears to have been taken in response to identified cases in which euthanasia is performed contrary to the law. People with disabilities are being harassed to choose assisted suicide against their will.

Government of Jersey Assisted Dying report calls for a law with tight restrictions

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I am currently in the UK on a speaking tour and will be speaking in Jersey on Thursday November 9. Today the government of Jersey released its assisted dying ethical review, a report from the Minister for Health and Social Services.

The research for the report is based on three "specialist witnesses" - Professor Richard Huxtable, Professor Trudo Lemmens, and Dr. Alex Mullock.

The Government of Jersey has indicated that they will likely begin the debate on euthanasia and assisted suicide by the end of summer 2024.

The Euthanasia Prevention Coalition opposes euthanasia and assisted suicide because these acts require one group of people (usually physicians) to be involved with killing people.

BBC news reported:

Adults in Jersey seeking AD eligibility fell into one of two categories; those who are "terminally ill", and those with "unbearable suffering".

The experts, after taking many reasons into account, concluded that proposals for AD for those with a terminal illness were "ethically appropriate".

However, they had "serious reservations" about allowing AD for those with "unbearable suffering", deeming the term too vague.

They concluded AD proposals in such circumstances, "are not ethically appropriate."

The experts are correct that the term "unbearable suffering" cannot be defined and approving killing based on "unbearable suffering" will inevitably lead to expansions of the law, the same problem also exists with the term "terminal illness." Some jurisdictions have defined terminal illness as having a six month prognosis, but that is difficult to define.

For instance, an insulin dependent diabetic who decides to stop using insulin will be defined as terminally ill even though that person has a medical condition that is effectively treatable.

The BBC reported that the experts rejected the option of suicide tourism by finding that euthanasia and assisted suicide should only be available to Jersey residents. The experts supported the right for medical professionals to conscientiously object to participating in euthanasia and assisted suicide.

ITV news provided a little more information on the recommendations. ITV news reported:

It says the term "unbearable suffering" is too vague and too open to interpretation - since physical conditions and tolerance of pain can fluctuate over time and can improve with the right treatment.

“Incurability may be hard to define, and ‘intolerability’ will rest on subjective judgements", Professor Huxtable wrote.

The ethical review also suggested that this "route" to assisted dying may undermine the value of disabled people’s lives - and would risk expanding the scope of the law beyond what was intended.

The review panel states: "Incurability may be hard to define, and ‘intolerability’ will rest on subjective judgements, which may mean the patients seek and receive assisted dying without having tried viable options, which doctors may find difficult and which may mean it becomes more difficult to restrict the practice."

Professor Huxtable cites Canada as an example of a "slippery slope" where more and more people may be eligible for assisted dying when there are other treatment options available to them.

The review only supports allowing Jersey residents to end their own lives, to avoid the island becoming a "death tourism" destination.

It asks politicians to consider a minimum term of residency before someone becomes eligible.

It also states more robust testing is needed to determine whether or not someone is cognitively able to make the decision on whether to end their own life.

The review recommends that patients be required to self-administer the drugs to end their lives to protect them and put them in control by confirming it is genuinely their wish.

An appeals process was also suggested, allowing those with a legitimate interest to raise a legal challenge.

Professor Huxtable said this would increase public confidence and address concerns about "medicalising" the issue.

This report is flawed because it examines how to kill rather than if it is ethical to kill people at all. All the ethical reports based on legalizing the killing only debate the question of who we can kill and who should do the killing. Once legalized the question will change to whether it is discriminatory to continue to restrict the killing to certain groups or conditions.

The killing inevitably opens to more conditions for killing and more people who can kill.

Pennsylvania nurse linked to 17 nursing home deaths

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A Pennsylvania nurse proves why you cannot trust every medical professional with your life.

Jon Haworth reported for ABC news on November 3, that:

A former Pennsylvania nurse who, in May, had been accused of killing two patients with doses of insulin, now faces more murder charges. She has confessed to trying to kill 19 additional people at several locations, authorities said Thursday.

Heather Pressdee, 41, is accused of administering excessive amounts of insulin to patients in her care, some of whom were diabetic and required insulin, and some of whom were not, according to the Pennsylvania Attorney General’s Office.

In total, 17 patients died who had been cared for by Pressdee.

According to Haworth, Pennsylvania's Attorney General's Office stated:

"The allegations against Ms. Pressdee are disturbing. It is hard to comprehend how a nurse, trusted to care for her patients, could choose to deliberately and systematically harm them,” said Pennsylvania Attorney General Michelle Henry. "The damage done to the victims and their loved ones cannot be overstated. Every person in a medical or care facility should feel safe and cared for, and my office will work tirelessly to hold the defendant accountable for her crimes and protect care-dependent Pennsylvanians from future harm."

Pressdee has now been charged with 2 counts of first-degree murder, 17 counts of attempted murder and 19 counts of neglect of a care-dependent person.

Haworth reported that The Attorney General's Office stated that:

"The alleged crimes happened while Pressdee was employed as a registered nurse at the following facilities: Concordia at Rebecca Residence; Belair Healthcare and Rehabilitation (Guardian); Quality Life Services Chicora; Premier Armstrong Rehabilitation and Nursing Center; and Sunnyview Rehabilitation and Nursing Center," officials said. "Pressdee typically administered the insulin during overnight shifts when staffing was low and the emergencies would not prompt immediate hospitalization."

The victims ranged in age from 43 to 104.

Similar to the Elizabeth Wettlaufer murders in London and Woodstock, Ontario Canada, the crimes occurred over several years and there was minimal oversight over the medications at the care homes. Similar to the Wetlaufer case, the news article related to the original charges in May 2023 stated that:

The complaint states that Pressdee has an alleged pattern of "being disciplined for abusive behavior towards patients and/or staff" at several other facilities and either resigned from them or was terminated.

Both Wettlaufer and Pressdee received serious complaints against them and were either fired or resigned their positions. But they were still able to find employment as nurses in other facilities.

During the Wettlaufer trial in Canada, I stated that the deaths were only a tip on the iceberg based on the lack of oversight and the vulnerability of those who were killed. My position remains the same. There may be many more murders occurring in care homes throughout Canada and the USA.

Canada's euthanasia law lacks the same type of oversight. In Canada a person is approved to be killed when two doctors or nurse practitioners agree that the person qualifies. The law only requires that the doctors and nurse practitioners be of the opinion that the person meet the criteria of the law. In other words, there is no effective oversight of the law and yet 13,241 Canadians reportedly died by euthanasia in 2022.

An unapologetic recommendation of absolute prohibition on killing: the stopped clock

By Gordon Friesen

President, Euthanasia Prevention Coalition

Gordon Friesen

As Lewis Carroll once pointed out,  a stopped clock is right twice a day. But a clock which loses only one minute in twenty-four hours will be right only once in two years.

Like the stopped clock, the multi-millennial moral precept "Thou shalt not kill", is a simple blunt instrument with no moving parts. Easy to understand. Generally easy in application. Its principal benefit (and over-arching civilizational significance) is that it points clearly to an absolute moral conclusion: killing of any sort (including killing of oneself) is wrong. Full stop.

Unfortunately however, in the complexity of human life, situations necessarily arise, where such invariable conclusions lead to apparent injustice. The idea becomes very appealing, therefore --for legislators as for watchmakers-- to seek ever-more subtle mechanisms, which will enable more finely adapted judgments, in more cases.

But in this pursuit, the watchmaker has a huge advantage over his legislative counterpart: being the fact that he is able to verify the accuracy of his work, through direct observation (of the sun, or other time-reliable phenomena). For the lawmaker, on the other hand, it is the intellectual and spiritual crisis of our time, that there exists no such agreed higher standard, which might allow us to effectively verify, and reset, our moral bearing; and should our complex post-modern legislative construct go slightly out of whack (like the minimally slowing clock), we have no means to verify or correct that fact.

In other words: once simple moral maxims are set aside, subtlety in judgment will be inversely proportional to shared agreement on the justice of those judgments.

Moral simplicity is not always bad

Today, for instance, there is a tendency to examine, not the act, but the intent. In this view, the act of killing, itself, has no moral attribute. Killing may be right or wrong depending on why it is done.

And perhaps that might be true for a perfectly informed, perfectly disinterested, ideal intelligence. But in the real world, such thinking immediately leads to subjectively indulgent attempts, to morally justify acts, which just happen to coincide with the personal interests of the perpetrator.

In a simpler time, on the other hand, it was assumed (however problematically) that there might be exceptions to a rule, without invalidating its core meaning. An aggressor, for example, might be killed in self-defence, but that killing, although understandable, was still considered a regrettable wrong.

This in no way solves the problem of agreeing on which exceptions are legitimate, and in which cases; but it does impose a certain solemnity of deliberation, when compared to the nonchalance of admitting, from the start, that there is nothing intrinsically wrong about killing.

It is a very significant fact, I submit, and too often ignored by clever social theorists, that in spite of our post-modern philosophical malaise, the vast majority of people still instinctively think, feel, and behave in this manner.

Advocates of assisted death are therefore faced with a strong social discomfort before the facts of suicide, and homicide. And to the extent that relativist arguments have proved insufficient to counter this bias, they have undertaken to perpetrate a direct assault on the foundations of common language, and understanding.

When killing is not killing

With astounding simplicity it is declared (and in my country, decreed, with the full force of parliamentary power) that euthanasia is a positive "good".  And since "killing" is universally considered to be "bad" (regardless of intent), it therefore follows (by definition) that euthanasia (although technically identical in every respect) is not killing.

There may be a small satisfaction in remarking the complete rational bankruptcy of such a position --similar to that of a small child who covers his own eyes in order to become invisible-- but that satisfaction in no way compensates for the vandalism incurred.

Most importantly, as with our touchingly deluded child, wilfully ignoring the basic facts of assisted death --whether assisted suicide or euthanasia-- does not make the deeper social implications of those practices go away.

Examining our three options, side by side...

First of all, the absolute prohibition of homicide (including the killing of oneself) implies an affirmation that life must be protected. This shared conviction offers the greatest support, both internal and social, for all those who are struggling on the cusp of existential despair. It does not make the universal relief of suffering any more immediately possible, but it does imply a constant civilizational effort (and hence a reliably constant progress) towards that goal.

Secondly, The simple social permission of suicide, including assisted suicide, is postulated upon the idea that for some people, in some circumstances, life is simply not worth living. But from this first theoretically admitted exception, the practical bar of application is arbitrarily lowered, through a general liberty of autonomous subjective choice. In the end, therefore, the threshold of "intolerable suffering" is set by the most marginal suicidal wish among us. And the despair, of that one, is allowed to justify and to nourish the despair, of all others.

In third place, the justification of assisted death as a positive medical benefit (objectively appropriate for the treatment of suffering in defined clinical situations), leads directly to a pseudo-scientific crusade, aimed at the elimination of all defective (suffering) life. For in the Canadian view, deaths by euthanasia (in keeping with the Greek etymology) are literally "good" deaths. And the promotion of such deaths thus becomes, itself, a worthy goal.

Furthermore, since death is now embraced as a simple and infallible cure, there will quite naturally be less perceived urgency, in any other relief of present suffering, or in any committed social effort to improve the means of that relief.

And again, since both the social acceptance of suicide, and that of euthanasia, imply that there is no intrinsic value in preventing death, these phenomena are rooted in a philosophy which is optimally suited to validate suicidal desire and despair; and to validate the self-perception of those few who --for whatever reason-- abandon themselves to those forces.

The "stopped clock" of the absolute prohibition of homicide, on the other hand, is optimally suited to socially sustain the efforts of that majority who will ultimately choose to survive. And since it is these survivors (and perhaps their descendants) who alone intend to live, in the future world governed by present policy, it is my belief, that their interest should be given far greater weight, than that of their more ambivalent counterparts.

The best choice: simple prohibition

Clearly there is no easy solution. We must weigh the scale of comparative harms.

Is it really so egregious, that a few people be asked to live a little longer, in order to unambiguously protect the lives of those --much more numerous-- who do not wish to die or be killed?

To conclude, it is my sincere belief that jurisdictions studying the assisted death question need not allow themselves to fall into the trap of that curious (but uncommitted) potential customer, who has allowed the clever salesman to impose a choice between the red one, and the blue one.

On the contrary, there is no urgent necessity to make any choice at all. The current, time-tested, absolute prohibition of homicide (including assistance to suicide) carries much less social hazard than either the Canadian, or the Swiss model, of assisted death.

Gordon Friesen, Montreal

1. "The two clocks", from Further Nonsense Verse and Prose, Lewis Carroll, posthumous, 1926   https://archive.org/details/further-nonsense-verse-and-prose/page/90/mode/2up   accessed Nov 5, 2023

Globe and Mail editorial urges federal government to withdraw euthanasia for mental illness

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Globe and Mail editorial from November 4 urges the federal government of Canada to withdraw the expansion of euthanasia for mental illness.

The editorial comments on the 2022 Health Canada euthanasia report indicated that 13,241 people reportedly died by euthanasia in Canada, with Quebec having the highest euthanasia report in the world. The editorial quotes Quebec officials who are concerned that euthanasia is no longer a "last resort."

Dr. K Sonu Gaind

The editorial quotes Dr. K Sonu Gaind, Chief of Psychiatry at Sunnybrook Health Sciences Centre in Toronto, who consistently states that there is "absolutely no consensus" as to what constitutes an irremediable medical condition when it comes to patients with mental illness. This is important because the law requires that a person only be approved for euthanasia if they have an irremediable medical condition. 

The editorial states:

However, Canada's framework for approving a medically assisted death for someone suffering from a mental illness does not require that a trained psychiatrist make an evaluation. Instead, doctors (with some expertise) are expected to make a case-by-case detemination. even when those with decades of experience are flummoxed.

A delay until March is not enough; Ottawa needs to withdraw it's amendments that include mental illness in the law for MAiD. There are too many uncertainties, most crucially the inability to determine who is suffering from a truly irremediable mental disease and who will recover given enough time, treatment and hope.

Previous articles from K Sonu Gaind (Articles Link).

HOPE Ireland Conference - Saturday November 11, 2023

Register for the HOPE IRELAND Conference on Saturday November 11, 2023. (Registration Link)

We are very pleased to announce that our Living and Dying with Dignity Conference will take place at the Dublin Chamber of Commerce on Clare Street on Saturday 11th November from (11 am until 3 pm). (Information Link)

Speakers will include:

• Alex Schadenberg
• Professor Des O'Neill
• Dr. Miriam Colleran
• Dr. Gordon MacDonald

Alex Schadenberg

The event will be headlined by Alex Schadenberg.

Alex is one of the world’s premier opponents of euthanasia and assisted suicide. He is the co-founder and executive director of the Euthanasia Prevention Coalition, founded in 1998 and based in Canada.

Des O'Neill is Professor of Medical Gerontology in Trinity College Dublin. He was the first medical director of the Alzheimer Society of Ireland.

Dr. Miriam Colleran is Consultant in Palliative Medicine in Naas General Hospital.

Dr. Gordon MacDonald

Dr. Gordon MacDonald is Chief Executive of Care Not Killing, an Alliance of organisations that oppose assisted suicide and euthanasia.

Seating is limited, if you wish to attend the event please take a moment to register instantly today using the button below. (Registration Link).

Kind Regards,
Siobhán Traynor

Canada’s Assisted Death Rates a concern for America?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Last week, I was interviewed by Maggie Hroncich concerning Canada's 2022 euthanasia data (and Canada's experience with euthanasia) and the possible affect on the USA. Hroncich's article was published by the New York Sun on Friday October 27. 

Hronich reports:

As backers of assisted suicide push to expand legalization in the United States, new numbers from Canada’s government show euthanasia is now the fifth-leading cause of death in the country.

A stunning 4 percent of the country’s deaths last year were due to assisted suicide. More than 13,000 patients died by it in 2022 — a 31 percent spike from the previous year. The country’s deaths by euthanasia now number nearly 45,000 since legalization in 2016, almost as many as have died from Covid in Canada.

In fact, Canada's euthanasia deaths have surpassed the number of Covid deaths. The 2022 report stated that there were 13,241 reported assisted deaths in 2022 and 44,958 reported assisted deaths (legalization until December 31, 2022). According to Health Canada there are 54,738 people who have died from Covid in Canada. Since December 31, 2022 there has likely been more than 12,000 assisted deaths in Canada, meaning Canada has likely had approximately 57,000 assisted deaths since legalization.

Hroncich continues:

Canada’s skyrocketing death numbers are raising concerns about American efforts to further legalize assisted suicide.

Some advocacy groups say expanding euthanasia for mentally ill or disabled patients prevents discrimination, while others warn the expanded legalization will lead to a culture of death that allows drug-addicted patients to be assisted in killing themselves, even though they are not sober or able to give their consent.

Alex Schadenberg speaking

Hroncich then reports:

Groups that are advocating for more legal assisted suicide in America should learn from and be wary of Canada’s death rates, a top Canadian euthanasia expert warns.

“You don’t want to legalize this because you can’t keep the door shut,” the Euthanasia Prevention Coalition’s executive director, Alex Schadenberg, tells the Sun.

“Some people say, ‘Well, we can have a little bit of this.’ That’s what they argued in Canada too,” he says. Euthanasia advocates say they’re providing a social good by ending suffering, he says.

“But in the end, it can’t be controlled,” Mr. Schadenberg adds. “If it’s okay for me to kill you or to kill somebody, then these safeguards become seen as a hindrance,” he says, and advocates begin a political push to remove barriers.

I explain that the argument by the euthanasia lobby to expand Canada's law is that it is discrimination to require people to be terminally ill; they then argue that it is discrimination to prevent euthanasia for people with mental illnesses alone.

Hroncich then gets to the reason for her interview concerning the US assisted suicide trends:

Although euthanasia is currently less accessible in America than in Canada, California had a 63 percent increase in assisted suicide last year.

“It’s actually a trend that we’re seeing everywhere,” Mr. Schadenberg adds. “And there’s nothing saying there won’t be another big bump this year in California and in other states.”

Oregon removed its waiting period in 2019, Mr. Schadenberg notes, and Oregon and Vermont removed residency requirements, leading to “suicide tourism,” as residents travel from out of state to die, the Sun has reported.

Hroncich discusses more of the data from the interview:

In nearly 500 cases — 3.5 percent of Canada’s assisted suicide deaths — the patient was not terminally ill or did not have a reasonably foreseeable death. A recent Canadian conference concluded that people with drug addiction should be eligible for euthanasia since addiction is a mental illness.

It’s “really problematic” to let someone consent to end their life in the midst of a chronic drug addiction, Mr. Schadenberg says. “They have serious addiction problems, so they’d have serious incapabilities or problems with consenting, not knowing the reality of their health condition.”

Only 28 percent of Canadians support euthanasia solely for mental health conditions, according to Canadian polling data. Death With Dignity, which describes itself as “a national leader in end-of-life advocacy and policy reform,” was unable to immediately comment.

People need to understand that euthanasia was sold to Canadians as being an option for the few. But in a very short time it has moved from the few people who are nearing death to people who are not nearing death and in March of 2024 it will include people who are not dying and nearing death, but possibly living with treatable mental illnesses.

Once killing is seen as a solution for some circumstances, it will naturally expand to include others.

Twenty five years of the ‘Oregon model’ of assisted suicide: the data is not reassuring

This article was published by the British Medical Journal of Medical Ethics on October 27, 2023.

By David Jones

On 27 October 1997, ‘physician-assisted suicide became a legal medical option for terminally ill Oregonians’. There are now 25 years of reports on the implementation of the Death With Dignity (DWD) Act. These give some insight into how the practice has changed since it was first introduced. The reports are all available online and an article has just been published analysing all 25 years. What do these reports show?

First and most obviously there has been a dramatic increase in numbers from 16 in 1998 to 278 in 2022. At the same time, the proportion referred for psychiatric evaluation prior to assisted suicide has dropped from 31.3% to 1.1%.

The 25-year review also highlights changes in the drugs used and in the rate of complications. Between 2010 and 2022 complications were reported on average in 11% of cases. In 2022, reported complications fell to 6%. Unfortunately this is not so reassuring as it seems, as an increasing percentage of data on complications is missing. In 2022 there was no data on complications for 74% of cases.

The reports also show shifts in the reasons given for seeking assisted death, with more citing the fear of being a burden and more citing financial concerns. The figures vary from year to year but in both cases the trend is clear. The increasing number of people seeking death because they feel they are a burden to others does not speak well of changes in social attitudes in Oregon since the DWD Act came into force.

Another shift evident in these reports relates to language. The first sentence of the first report refers to ‘physician assisted suicide’. This phrase is used in the first line of every report until the ninth report for 2006. This change in language was not associated with any change in practice in Oregon but it may have reflected political efforts in other States to pass similar laws. After 9 years Oregon was still the only State in the United States to have legalised physician assisted suicide. This political motivation is acknowledged by the philosopher Gerald Dworkin, an advocate of such laws: ‘the use of the term “Physician-assisted suicide” is now politically incorrect, for tactical reasons. I understand that the popular prejudice against suicide makes it more difficult to rally support for the bills I favor.’

The term ‘assisted suicide’ nevertheless remains the ordinary term in Europe and was used by Margo MacDonald MSP for the Assisted Suicide (Scotland) Bill she introduced in November 2013. That bill, which was rejected by the Scottish Parliament, was largely based on Oregon’s DWD Act. In 2017, the American Association of Suicidology adopted a statement opposing the characterising of assisted deaths as ‘suicide’. However, in March this year that statement was quietly ‘retired’, a move welcomed by some disability groups. The language of physician assisted suicide remains in use by the American Medical Association. It also has the advantage of distinguishing self-administration of lethal drugs (assisted suicide) from administration by doctors (euthanasia).

If political debates outside Oregon influenced its shift in use of language, they may also account for the recent expansion of the DWD Act. Before 2016 there were only three States with such legislation (Oregon, Washington, Vermont) and one where assisted suicide was legal through case law (Montana). However, by 2021 there were ten jurisdictions with statute laws plus Montana where assisted suicide remained legal by case law. It is remarkable that, before 2019 neither Oregon nor any other jurisdiction in the United States had amended their law on physician assisted suicide. However, in the four years since 2020, there have been seven amendments to such laws across five states: in Oregon in 2020 and 2023; in Vermont 2022, and 2023; in California in 2022; in Washington in 2023; and in Hawaii in 2023 and an amendment has been introduced in New Jersey. This amounts to six out of the ten jurisdictions with such legislation. All these changes expand access, for example, waive waiting times, allow nurses to prescribe the lethal medication, or drop residency requirements. Until 2019 it had been possible to argue that there was ‘no evidence of a “slippery slope”’ because ‘The Oregon law has remained unchanged since 1997’. This is no longer true. In recent years there has been a wave of expansion of such laws and further expansion is surely to be expected.

This increase in the number of States with assisted suicide and increase in number of deaths has also allowed more data on the secondary impact of legislation. In 2015 there were some indications of an association between legalisation of physician assisted suicide in the United States and increases in unassisted suicide. However, the association was not statistically significant once linear trends were included. In contrast, US data analysed in 2022 by two different methods showed a statistically significant increase in unassisted suicide after physician assisted suicide was introduced. Association does not, of course, demonstrate causation, but neither is such an association grounds for reassurance.

We now have twenty five years of data from Oregon and data from an increasing number of other States with similar laws. However, the more we know, the less reassuring the ‘Oregon model’ of assisted suicide seems to be.

David Jones is the Director, Anscombe Bioethics Centre, Professor of Bioethics; St Mary’s University, Twickenham; Fellow, Blackfriars Hall, University of Oxford 

Record numbers of Canadian euthanasia deaths.

This article was published by Mercatornet on November 3, 2023.

Michael Cook

By Michael Cook

In 2022, 13,241 Canadians died through Medical Assistance in Dying (MAID) – 4.1% of all deaths. 

• Health Canada reports 13,241 assisted deaths in 2022 representing 4.1% of all deaths (Link).

The advance of MAID has been astonishing. Since euthanasia and assisted suicide were legalised in 2016, there have been 44,958 MAID deaths. About one Canadian in 25 dies after a lethal injection. It took Belgium and the Netherland about 20 years to reach this level of normalised euthanasia – it has taken Canada only seven years.

Bioethics commentator Wesley J. Smith noted in a column in the National Review that: 

“If the same percentage of people were killed by doctors in the USA as are in Canada, that would amount to about 140,000 homicides annually. That’s about as many people as live in cities such as Waco, Texas, or Fullerton, Calif.”

Canada’s Minister of Health, Mark Holland, said in a preface the 2022 statistics that: 

“we continue to advance core principles of safety, accessibility, and the protection of persons who may be vulnerable, throughout the MAID system.”

What he fails to do is set an upper limit on euthanasia deaths. How many is too many for Canadian supporters of MAID? Will it level off at 10%? At 15%? At 25%? Next year could see a big jump in MAID deaths, as euthanasia for mental illness will become available. Will the next step be involuntary euthanasia for people with dementia?

Here are some of the highlights of the Ministry’s fourth annual report. 

• The number of MAID cases grew by 31.2% over 2021.
  
• More males (51.4%) than females (48.6%) received MAID.
• The average age of individuals at the time MAID was provided in 2022 was 77.0 years. Only a small percentage was between 18-45 (1.3%) and 46-55 (3.2%).
• Cancer (63.0%) is the most cited underlying medical condition for MAID, followed by cardiovascular conditions (18.8%), other conditions (14.9%), respiratory conditions (13.2%) and neurological conditions (12.6%).
• MAID for patients whose deaths are not reasonably foreseeable was only legalised in 2021. In 2022, 3.5% of the total number of MAID deaths (463 individuals), were individuals whose natural deaths were not reasonably foreseeable. This is an increase from 2.2% in 2021. The most cited underlying medical condition for this population was neurological (50.0%), followed by other conditions (37.1%), and multiple comorbidities (23.5%).
• In 2022, the most commonly cited sources of suffering by individuals requesting MAID were the loss of ability to engage in meaningful activities (86.3%), followed by loss of ability to perform activities of daily living (81.9%) and inadequate control of pain, or concern about controlling pain (59.2%).
• The number of MAID providers is growing. During 2022 there were 1,837, up 19.1% from 2021. 95.0% of all MAID practitioners were physicians, while 5.0% were nurse practitioners. However, the number of nurses providing MAID is growing. Nurse practitioners performed 9.4% of all MAID procedures, up from 8.4% in 2021 and from 7.0% in 2019. 
• As MAID becomes socially normalised, doctors are doing them more frequently. In 2022, the average number of MAID provisions per practitioner was 7.2, compared to 6.5 (2021), 5.8 (2020) and 5.1 (2019).

Recent stories on Canada's euthanasia law:

• Euthanasia for drug addicts is an outcome of euthanasia for mental illness (Link).
• MAiDhouse kills 125 people in 2022 (Link).
• Canada's MAiD program has gone mad (Link).
• Has Canada's euthanasia law has gone too far (Link).

November 18 - Montréal event: Let's protect people with mental health problems

Let's protect people with mental health problems

Speakers to be announced.

Save the Date: 

Saturday, November 18, 2023
Time: 2 pm - 4 pm 

Location: Parc Place du Canada (Across from Canada Place) 1010 Rue De la Gauchetière O, Montréal, QC

For more information: Dr. Paul Saba: pauljsaba@gmail.com