Canada’s euthanasia and assisted suicide programme has created “a system of structural abandonment” where loved ones are dying because of “unmet medical or social needs”, according to two members of the Chief Coroner of Ontario’s Medical Assistance in Dying (MAiD) Review Committee (MDRC).
Dr Ramona Coelho, a family medicine practitioner and adjunct research professor, and David Shannon, a Canadian lawyer and disability and human rights activist, published an expansive article criticising Canada’s euthanasia and assisted suicide programme based on their extensive experience as part of Ontario’s MDRC.
The two insiders said that “Canada’s experience with MAiD has become a cautionary tale of how legali[s]ed euthanasia and assisted suicide can erode into a system of structural abandonment”, to the extent that it has become the “default response to unresolved suffering driven by poverty, disability, mental illness, and social isolation”.
Euthanasia was first legalised in Canada in 2016 for those who may have had a reasonably foreseeable natural death as a result of a medical condition. This legislation was expanded in 2021 so that an individual’s death did not have to be reasonably foreseeable to access MAiD, known as Track 2.
Criticising the expansion of the eligibility criteria, Coelho and Shannon said “[N]early half of Track 2 MAiD deaths involved suffering from loneliness or isolation, while almost half indicated that they felt like they were a burden”.
“Ontario’s MAiD Death Review Committee (MDRC) found most Track 2 recipients were low-income and 61 per cent were women, a group statistically more likely to attempt suicide yet recover with care. Less than half received mental health or disability supports and less than 10 per cent received housing or income assistance”.
They added “MAiD providers have described ending lives where suffering due to poverty, loneliness, or obesity was driving the request for MAiD”.
Coelho and Shannon are calling for the abolition of Track 2, to “[r]emove the pathway for persons whose natural death is not reasonably foreseeable, including those with physical disabilities and mental illness”.
Lack of safeguards driving euthanasia and assisted suicide
One of the key reasons for the prevalence of euthanasia and assisted suicide in Canada is that adequate safeguards are absent, according to Coelho and Shannon. They refer to the experience of palliative care physician Dr. David Henderson, who testified that “health professionals have effectively been given ‘a licence to kill’ without sufficient safeguards”, adding that Henderson “testified that MAiD assessments often bypass the root causes of suffering”.
The authors point out clear flaws in Health Canada’s “Model Practice Standard for MAiD”, which, they say, “[entrenches] a system that funnels patients toward death”. They note that, in one recorded training session for euthanasia and assisted suicide doctors, “a trainee asks about withdrawing [a patient from MAiD] if MAiD is being driven by socioeconomic reasons. The expert affirms the right to withdraw but concludes, ‘You’ll then have to refer the person on to somebody else, who may hopefully [fulfil] the request in the end.’ This ‘effective referral’ mechanism subverts any pause or stopping MAiD for genuine assessment or care”.
Coelho and Shannon warned that Canada’s euthanasia and assisted suicide programme increases the risk of suicide and harms suicide prevention among vulnerable people.“[V]ulnerable individuals can be steered toward MAiD in ways that mirror structural coercion and violate established suicide prevention principles”, they write. They cited an example of a patient who, when “seeking emergency psychiatric care for suicidality”, was instead told about the euthanasia and assisted suicide programme. The authors said that “Such responses undermine the core principles of suicide prevention where messaging that promotes death and access to lethal means, of which MAiD does both, exacerbates risk of suicide”.
Issues in Canada serve as an important warning in England and Wales
Coelho and Shannon have called for all Canadians to receive “guaranteed, funded access to palliative care, mental health, and disability supports” if they need them, alongside abolishing Track 2 entirely.
Speaking in opposition to the proposed introduction of assisted suicide in England and Wales, Dr Sarah Foot, Association for Palliative Medicine member and palliative care doctor, shared how patients may “change their minds” about opting for assisted suicide after receiving adequate support, saying “I meet so many patients who wish they could die from their disease. But I know that when they come to me, they come to my colleagues in hospices, they get the pain relief they need, they get the listening ear they need, they get the hospice support, and they change their minds”.
Spokesperson for Right To Life UK, Catherine Robinson, said “It is clear that Canada’s disastrous euthanasia and assisted suicide programme is being used as a response to systemic failures in healthcare and social support, and we should be grateful for Coelho and Shannon’s insider knowledge in highlighting these issues”.
“In instances where inadequate healthcare is causing further suffering, the response should never be to offer death”.
“The administration of assisted dying in Canada should serve as a warning about what will likely occur in England and Wales if Kim Leadbeater’s assisted suicide Bill becomes law. It is clear that this Bill lacks adequate safeguards to protect vulnerable individuals”.
“MPs and peers would do well to heed these warnings from Canada and work to prevent this Bill from ever becoming law”.
