Canadians are being swept mercilessly into a death trap by Liberal government legislation, passed in June 2016, which allows physician-assisted suicide. This law was based on a decision by the Supreme Court of Canada (Carter v. Canada) which opened the trap door to deaths by lethal injection. The Supreme Court of Canada had foolishly and naively stated that “properly designed and administered safeguards would protect … vulnerable people from abuse and error.” This false belief has led to 13,946 deaths since 2016 by assisted suicide, according to Health Canada’s first annual report, released in July 2020. Canada’s rate of death by euthanasia has increased more rapidly than in other permissive countries, with annual numbers that are double the deaths from motor vehicle accidents.
Canadians can justifiably ask what has happened that Canadians are so readily tumbling into this death trap?
A reliable answer to this question has been provided by three Canadian palliative care physicians, Doctors Leonie Herx, Margaret Cottle, and John Scott, who published The “Normalization” of Euthanasia in Canada: the Cautionary Tale Continues in the World Medical Journal, April 2020. These physicians are engaged in a nightmare, struggling to maintain respect for the dignity of human life in face of the widening maelstrom of euthanasia. They have pointed out that the major flaws in the legislation are:
- Ambiguous eligibility criteria for death
- A lack of adequate and appropriate safeguards
- The erosion of conscience protection for healthcare professionals
- The failure of adequate oversight, review and prosecution of non-compliance with the euthanasia legislation
Their article reports on the terrible consequences of this legislation, deliberately and misleadingly called “Medical Assistance in Dying” (MAID). Their article, which has been endorsed by 142 other Canadian physicians, serves as a warning to other countries, which may be considering similar legislation. The article undercuts the popular portrayal of euthanasia in Canada, which is presented only in positive terms. Instead, the three physicians provide evidence to demonstrate that there are tragic, negative and dangerous consequences to the euthanasia legislation, which is a radical shift in medicine, and especially in palliative care medicine.
The authors also point out that, in four years, Canada has moved from approving euthanasia for so-called exceptional cases, to euthanasia being used as a normal, almost routine, option for death. This has been due in part to Canadian judges reinterpreting the law to widen it by inserting their own personal interpretation of the issues. Also, a less restrictive interpretation of eligibility criteria is being used by the providers of euthanasia, who do not face intervention from the courts. Euthanasia providers have referred to this expansion as merely “a maturing of the understanding of what we’re doing”. This has led euthanasia providers to approve cases they would not have previously approved due to earlier fears of criminal prosecution. In short, although reports of violations of the Criminal Code and of regulatory body regulations have been documented, no charges have been laid in Canada.
No Real Safeguards
Another important point the authors make is that the supposed safeguards written into Canada’s legislation are illusionary. The failure of safeguards preventing unnecessary assisted suicide in any country was confirmed in an article recently published in the Dutch Medical Association Journal by Dr. Bert Keizer. (The Netherlands legalized assisted suicide in 2001). Dr. Keizer, a long-time practitioner of euthanasia, who now works at an end-of-life clinic run by the Dutch Right to Death Society, is pleased with the slippery slope effect of euthanasia legislation, which has gradually expanded eligibility for euthanasia death. Dr. Keizer regards this slippery slope as a “beneficial progress” in the practice of euthanasia. He explains this in his article,
Every time a line was drawn, it was also pushed back. We started with the terminally ill, but also among the chronically ill it turned out to be hopeless and unbearable suffering. Subsequently, people with incipient dementia, psychiatric patients, people with advanced dementia, elderly who struggled with an accumulation of old-age complaints and finally [the] elderly who, although not suffering from a disabling or limiting disease, still find that their life no longer has content.
Amendments to Canada’s Current Euthanasia Law
The Trudeau government is proposing the expansion of the euthanasia law to delete the criterion that assisted suicide should occur in only those cases where there is a “reasonably foreseeable natural death”. The removal of this criterion opens up euthanasia to those with chronic conditions, disabilities and mental health issues. As a result, in the near future, euthanasia in Canada will almost certainly be open to any person who feels their suffering cannot be addressed except through intentional death. Regrettably, the Board of Directors of the Canadian Psychiatric Association, on February 10, 2020, supported euthanasia for all patients whether or not they are capable of providing a valid consent because of, for example, schizophrenia or depression, etc., even though these are treatable.
Lack of Access to Care for the Disabled
Another concern expressed by Herx, Cottle, and Scott is that Canadians are requesting euthanasia because of lack of access to proper care, and availability of disability supports. There are documented cases in which individuals have been told by health care providers to consider euthanasia as an “answer” to a perceived poor quality of life caused of a lack of healthcare resources to meet their needs. In short, the lack of support and societal inequality for those experiencing disabilities are now being used to justify the termination of their lives. The fact that a person’s life can be ended, based solely on their disability, further stigmatizes and devalues their lives.
Palliative Care Undermined by Assisted Suicide Legislation
During the debates on legalizing assisted suicide, it was argued that access to palliative care would be a “safeguard” against euthanasia for vulnerable individuals. In reality, fewer than 30% of Canadians have access to any form of palliative care. If euthanasia is supposed to be an informed choice, this has no meaning when there is no access to palliative care as an alternative. Euthanasia is significantly cheaper than rigorous, traditional palliative care, and the financial savings of euthanasia for the healthcare system have already been published in medical journals. With an aging demographic and diminishing fiscal resources, the option to save money in this way may become increasingly acceptable to healthcare decision makers.
Confusion About Euthanasia with Palliative Care
A further problem in Canada is that supporters of euthanasia, such as the Dying With Dignity organization, are deliberately confusing the language of end of life to promote the concept that palliative care also includes assisted suicide. Palliative care would never intentionally hasten death. Also, Dying With Dignity, among others, such as the B.C. government and physicians supporting euthanasia, are pressuring palliative care providers to incorporate euthanasia within the scope of practise. This has occurred with the ten-bed palliative care hospice in Ladner, B.C., operated by the Delta Hospice Society and in North Bay, Ontario, where physicians involved with assisted suicide attempted to pressure a palliative care hospice to open beds for their use. They argue that euthanasia should be “one of the many items in the palliative care basket”. It is not.
Palliative Care NOT Equally Funded
The federal legislation on euthanasia has positioned it as a healthcare “right” under the Canada Health Act so that it must be publically funded and accessible to all Canadians. Palliative care, however, is not afforded the same status. There is no similar requirement for it to be funded and accessible to Canadians. This is highly inequitable since 98% of deaths in Canada are natural deaths, not via euthanasia. Dying patients should have access to palliative care as a right.
The availability of euthanasia has had, in another way, a profound effect on palliative care. When a patient states, “I just want this to be over”, there is now a knee-jerk reaction to consult the euthanasia team as a first response and neglect what palliative care has to offer. It has always been a standard of care, however, to engage a patient in serious dialogue or try to understand the nature of their suffering and grief in order to determine what supports might be helpful. That is, an expression of distress needs to be explored and supported in order to help a person and their loved ones to focus on their living, even while dying, and to provide support to people on their journey so they do not feel abandoned or alone. The ready availability of euthanasia prevents this from happening.
Reasons Why Patients Receive Assisted Suicide
The official Health Canada report on euthanasia states that it is requested for the following reasons: Loss of ability to engage in meaningful life activities (82.1%) followed closely by loss of ability to perform activities of daily living (78.1%), inadequate control of symptoms other than pain or having concerns about it (56.4%). Disturbingly, 34% reported being a perceived burden on their family, friends or caregiver as reason for the euthanasia request, and 13% reported isolation or loneliness.
Canada’s rate of death by euthanasia has increased more rapidly than in other permissive countries. Eligibility criteria has expanded and safeguard mechanisms have been weakened. Pain, fear, loss of control and a sense of being a burden are not solved by hastening death by injection, but by providing palliative care that honours and protects our most vulnerable citizens at a most difficult time in their lives.