Canada Leads the Way in Liberalizing Euthanasia Around the Globe
The US’ neighbor to the north extends euthanasia to the disabled and mentally ill, considers ‘advance directives’ to kill in case of mental decline.
OTTAWA, Canada — More than a dozen patients are killed by euthanasia daily in Canada, where Liberal Prime Minister Justin Trudeau’s government legalized euthanasia just under four years ago and has announced it will enforce broader new regulations allowing patients who are suffering — but not terminally ill — to have access to Medical Assistance in Dying (MAiD).
MAiD is the government’s euphemism for a procedure that allows doctors and nurse practitioners to administer fatal drugs to patients.
The province of Quebec’s health minister, Danielle McCann, told a news conference on Jan. 21 that people with “mental-health issues who aren’t responding to treatment” would also have access to the procedure, which was recently used to euthanize a depressed man in British Columbia against his family’s objections.
Quebec Superior Court Justice Christine Baudouin’s September 2019 ruling struck down the criteria that patients seeking doctor-assisted death be “near death” and imposed a March 11, 2020, deadline for her province to make MAiD available to those with incurable illness. Rather than challenging the court decision, at the Trudeau government’s direction, the federal Department of Justice has launched a public “consultation” process in preparation for sweeping expansions to the new euthanasia legislation.
In addition to the consultation, which is receiving little media coverage, the Department of Justice also instigated a five-year legislative review to begin this summer. “While this ruling only applies in the province of Quebec, the government of Canada has accepted the ruling and has committed to changing the MAiD law for the whole country,” says the consultation preamble.
Canadians had until Jan. 27 to answer an online questionnaire that assumes public consent to euthanasia, but asks citizens to rate the importance of regulations such as the 10-day waiting period between the request and execution of MAiD.
The questionnaire also asked Canadians to consider “advance directives” for euthanasia, which were clearly prohibited in the law they accepted in 2016. “Imagine that a person is diagnosed with a medical illness that, over time, will affect their mind and take away their decision-making capacity, such as Alzheimer’s disease,” the survey says. “The person prepares a document that says they consent to receive MAiD if specific circumstances arise at a later date, after they no longer are able to consent.”
“In your opinion, should a physician or nurse practitioner be allowed to provide MAiD to a person in this situation … even if they can no longer consent?” the survey asks.
“Advance-directive measures mean that legally you can’t change your mind,” said Alex Schadenberg, executive director of the Ontario-based Euthanasia Prevention Coalition. “It’s a difficult place to be in.”
Schadenberg points to the Netherlands, where advance directives have led to state-sanctioned forced euthanasia.
In a widely publicized 2017 case, a demented Dutch woman was slipped a sedative in her coffee and was physically restrained by family members while doctors administered a fatal injection. This case highlights the reality that, once a patient is deemed mentally incompetent after he or she had previously directed to be euthanized, it can be impossible for that same patient to counter the earlier directive.
“We’ve crossed the line we shouldn’t have crossed,” Schadenberg said. “The question should be ‘Should we kill you or should we not kill you?’ Once you’ve crossed the line and allowed state-sanctioned killing, everything is open to negotiation, and this is where we going and we’re going there very fast.”
“The pace that Canada is moving on euthanasia is just astonishing,” said Daniel Sulmasy, a professor of biomedical ethics and acting director of the Kennedy Institute of Ethics at Georgetown University. “Already it’s outpacing the Netherlands and Belgium.”
At least 13,000 Canadians have been deliberately killed by a doctor or nurse practitioner since the procedure was legalized in June 2016, according to Schadenberg, who contests the lower 6,700 figure cited by the government.
Five thousand of those patients were euthanized in 2019 alone, reflecting a growing trend across the country.
“Every line that gets drawn to limit euthanasia is, on the face of it, untenable because of the principle that justifies doing it in the first place,” said the Kennedy Institute’s Sulmasy.
That principle is the concept of “A Life Not Worth Living,” or “LNWL,” as ethicists refer to it. The current issue of the Journal of Medical Ethics (published by The British Medical Journal) includes a discussion of how the public views “allowing disabled children to die.” In the discussion, ethicists including Julian Savulescu and Claire Brick from Oxford University in England and Monash University in Australia define “LNWL” as a “life in which future burdens for the individual outweigh benefits. There is negative net future well-being.”
Sulmasy said the LNWL concept is not new but was first published by German law professor Karl Binding and psychiatrist Alfred Hoche who co-authored a 1920 paper, “Allowing the Destruction of Life Unworthy of Life.” Originally written in German, this document became one of the intellectual foundations for the Nazi Holocaust.
In the Quebec decision rendered in September, Justice Baudouin considered the cases of plaintiffs Nicole Gladu, then 73, who suffered from post-poliomyelitis, which left her paralyzed on one side of her body, and Jean Truchon, then 51, who had cerebral palsy from birth and experienced gradual weakening of his legs and paralysis of his right arm. He told the court he had considered driving his wheelchair into a bus or river.
Baudouin described Gladu as “a prisoner of her body and illness” and Truchon as a man who “says he has been dead since 2012.” She concluded that the requirement that their deaths be reasonably foreseeable violated the plaintiffs’ “rights to liberty and security” and forced them to endure harsh physical and psychological suffering” and was unconstitutional.
Baudouin gave legislators six months to extend the laws providing for legal euthanasia to other suffering citizens. In her ruling she exempted Gladu and Truchon, so they could immediately access medically assisted suicide — a service neither has yet sought to employ at the time this story was filed.
A group of 72 organizations that support disability rights issued a formal request for appeal in the wake of the Quebec decision, noting in their letter that while the preamble of Canada's euthanasia law states that society must “affirm the inherent and equal value of every person’s life and to avoid encouraging negative perceptions of the quality of life of persons who are elderly, ill or disabled,” the Quebec decision, by giving only disabled Canadians the right to be euthanized, rejects this affirmation and instead “will entrench stereotypes and exacerbate stigma for Canadians with disabilities, contributing to the adversity and oppression experienced by this vulnerable group.”
Like the Netherlands and Belgium — where notorious euthanasia cases include a patient who was suffering “unbearable emotional distress” following a botched sex-change operation; 45-year-old twin brothers diagnosed with a condition that would lead to blindness eventually; and a sex-abuse victim in her 20s suffering from post-traumatic stress — Canada has a fair share of disturbing stories of how legalized euthanasia is being implemented:
- The documentary film Fatal Flaws features Newfoundland resident Candice Lewis, a 25-year-old with cerebral palsy who was sick in the hospital when a doctor called her mother “selfish” because she refused to euthanize her disabled daughter. Despite the fact that Lewis was repeatedly pressured to accept medically-assisted death, the young woman recovered fully.
- Roger Foley, a patient with neurodegenerative disease in his 40s, released an audio recording of staff at an Ontario hospital repeatedly pressuring him to use MAiD and repeatedly denying his requests to go home.
- Alan Nichols, a 61-year-old man, was euthanized in British Columbia, even though his family said he suffered from mental illness and they tried to stop the process. Krista Carr, an advocate for people living with intellectual disabilities, told CTV News that cases like Nichols are commonplace — patients are going to the hospital for procedures and being offered medicalized death, and parents of intellectually impaired patients are told, “We can ensure your child doesn’t wake up from this surgery.”
- Sean Tagert, a British Columbia father in the late stages of amyotrophic lateral sclerosis, said he was forced to choose MAiD when the government refused to provide him funding for four additional hours of health care per day so he could be at home rather than institutionalized. He was euthanized in August 2019.
Notwithstanding earlier official assurances that euthanasia would be voluntary for all involved, in the public health-care system, funds have been tied to demands.
Immediately in the wake of Judge Baudouin’s decision, the organization that oversees hospitals in the eastern Canadian province of Nova Scotia quietly changed its policy to force a Catholic hospital to provide euthanasia services.
The Nova Scotia Health Authority told St. Martha’s Regional Hospital in Antigonish, which was formerly run by the Sisters of St. Martha, that it had to provide MAiD services though it was previously exempt under a 1996 provincial agreement with the Catholic order.
Tim Guest, the health authority’s vice president of health services, told The Canadian Press at the time that under federal legislation euthanasia would be available at one wing of the hospital complex at the Antigonish Health and Wellness Centre.
This “agreement” was unchallenged legally.
In a separate case in the western province of British Columbia, the Irene Thomas Hospice, a 10-bed palliative care program, located minutes from a British Columbia hospital offering MAiD, has been told by local health authorities that it must offer euthanasia or lose its funding. Doctors with the program, which is not faith-based, have observed that 30% of Canadians need proper palliative care — which is recognized as a right in Canada — but the government’s top priority is that 100% have the right to be euthanized.
“So while MAiD needs to be funded provincially and accessible to all Canadians, the same does not apply to palliative care,” Dr. Leonie Herx, a palliative physician and the president of the Canadian Society of Palliative Care Physicians, told Catholic News Agency.
As well, doctors are being pressured to perform euthanasia in Canada.
According to a 2013 poll by the Canadian Medical Association, only one in five doctors in Canada would want to participate in euthanasia. Yet one ethicist recently suggested that Canadian medical schools should begin barring students who are unwilling to personally provide abortion and euthanasia.
“Medical schools, pharmacy schools should go out of their way to basically eliminate applicants who they know already will not provide these services,” said Queens University professor Udo Schuklenk, the Ontario research chair in bioethics and joint editor in chief of the journal Developing World Bioethics, in an interview with Global News.
While Canada’s euthanasia movement is part of a global phenomenon, its trailblazing precedent has so far caused at least one country to resist liberalizing euthanasia laws.
Last week, the Isle of Man, a self-governing subject of the United Kingdom, debated a measure to decriminalize euthanasia before it was roundly defeated. Gordon Macdonald, chief executive of Care Not Killing in the United Kingdom, issued a press release stating that evidence from Canada’s experience decided the Manx bill’s fate.
“No wonder not a single doctors’ group or major disability-rights organization supports changing the law, including the British Medical Association, the Royal College of General Practitioners, the Royal College of Physicians, the British Geriatric Society and the Association for Palliative Medicine," Macdonald said.
The Euthanasia Prevention Coalition’s Schadenberg predicts tales from north of the border will help bring down fledgling efforts in the U.S. to legalize euthanasia/assisted suicide in Indiana, Kentucky and Arizona, though he considers New York state’s Bill A2694 for “medical aid in dying,” introduced in 2019, “more concerning.”
As for Canada, Schadenberg said, “This is becoming just too depressing. We have now passed the crisis point; too few people are concerned, and [euthanasia] has become normalized.” What’s needed, he told the Register, is a counter to the “culture of loneliness and despair” and for Catholics and Catholic health care to be more involved in palliative care.
For its part, the Catholic Church remains the most stalwart defender of the disabled against state-assisted killing — a point recently underscored by Pope Francis.
“In your work, may you always strive to promote the dignity and life of each person and reject any compromise in the direction of euthanasia, assisted suicide or suppression of life, even in the case of terminal illness,” Pope Francis exhorted medical professionals everywhere in his message for this year’s World Day of the Sick to be observed on Feb. 11. “Life must be welcomed, protected, respected and served from its beginning to its end.”
Register correspondent Celeste McGovern writes from Nova Scotia, Canada.