Trigger Warning: This article discusses suicide.
Many more Canadians are dying from assisted suicide as it expands beyond those experiencing terminal illness to include adults and minors experiencing depress or struggling with mental illness.
With the increasing acceptance of medically assisted suicide and euthanasia, the supply and demand of the practice are on the rise in Canada. Some people are concerned by the “slippery slope” that these policy moves present and the expanding definitions of who qualifies to die. Others argue that the right to a “death with dignity” should be extended to many more people, including minors and people with mental illnesses and depression.
(Editor’s Note: The drug used by doctors to end patients’ lives is the same drug used in death penalty lethal injections.)
Euthanasia, where doctors use drugs to end patients’ lives, is legal in seven countries: Belgium, Canada, Colombia, Luxembourg, Netherlands, New Zealand, and Spain. It is also legal in some parts of Australia. [i]
During 2021 in Canada, for example, 10,064 medical assistance in dying (MAID) deaths were reported, making up 3.3% of all deaths in Canada. This number is a growth rate of 32.4% over 2020. Since 2016, when it was legalized, 31,664 reported deaths were from MAID in Canada.
In Canada in 2021, 139 voluntarily euthanized patients were between 18 and 45.
In the U.S., options for assisted suicide are available in Washington D.C. and in ten states, including California, Colorado, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington. Assisted suicide is different from euthanasia in that the patients themselves administer the fatal drugs, typically orally.
Depending on how the question is phrased, a 2018 Gallup poll found that 65-72% of Americans believe medically assisted suicide should be legal. 54% said it was a morally acceptable practice, and 42% said it was morally wrong.
While many might agree that sometimes the most humane course could be to give someone suffering from a terminal disease a fast and dignified end of life, suicide becomes increasingly controversial as it is made available to more and more people.
The controversial practice has faced increased scrutiny recently from cases in Canada and Europe.
Broadening Availability in Canada
In August 2022, a Canadian military veteran who has PTSD and a “traumatic brain injury” was asked by an employee of Veterans Affairs Canada (VAC) if he would consider MAID. The veteran and his family expressed outrage that this was suggested to him. The VAC confirmed that “[MAID] was discussed inappropriately” and “appropriate administrative action will be taken.”
VAC said that “providing advice” on MAID is not a service VAC offers.
It is unclear how often MAID was erroneously recommended to veterans before this.
Of course, not only veterans have been affected. Since 2016 when MAID was legalized, the definition of who is eligible for MAID has expanded. For example, in 2019 the courts decided to remove the requirement that a person’s natural death must be reasonably foreseeable[ii] to be eligible for MAID. This means that younger people without terminal diseases qualified. And starting March 17, 2023, mental illness can be considered as the sole underlying justification for euthanasia programs.
According to the Canadian Government, there will be a requirement for “Ministers of Justice and Health to initiate an expert review panel tasked with making recommendations on protocols, guidance, and safeguards for MAID for persons suffering from mental illness.”[iii]
To be eligible for MAID today: “an individual must experience intolerable physical or psychological suffering that is caused by their medical condition or their state of decline, and that cannot be relieved under conditions that the individual finds acceptable.” In 2021, the top reasons cited for applying for MAID in Canada were the “loss of ability to engage in meaningful activities (86.3%), followed by loss of ability to perform activities of daily living (83.4%), and inadequate control of pain, or concern about controlling pain (57.6%).”
Besides the veteran’s case, outrage has been voiced over other cases, especially when applicants are not terminally ill or are young.
Sixty-one-year-old Alan Nichols was admitted to a hospital in June 2019 for fears he might be suicidal. The family was horrified to learn that he chose euthanasia in the hospital, especially given Nichols even “asked his brother to ‘bust him out’ as soon as possible,” according to A.P. News.[iv] The only reason given on the application for death was “hearing loss.”
Nichols’ family reported the case to the police and claimed the hospital improperly persuaded him to request euthanasia. “Alan was basically put to death,” said brother Gary Nichols. In Alan’s life, “he needed some help from us, but he was not so disabled that he qualified for euthanasia.”[v]
The Associated Press reported that “the health minister, Adrian Dix, said the province’s oversight unit reviewed the case and ‘has not referred it for further inquiry.’ He pointed out that the euthanasia law does not allow families to review euthanasia requests or be privy to hospitals’ decisions.”
The authorities concluded everything was in order.
Trudo Lemmens, chair of health law and policy at the University of Toronto, said, “This case demonstrates that the rules are too loose and that even when people die who shouldn’t have died, there is almost no way to hold the doctors and hospitals responsible.”
In another case, in July 2022, 23-year-old Canadian Kiano Vafaeian was approved for MAID. He had diabetes and onsetting blindness. He struggled with depression. The process was only stopped after his mother discovered what her son was doing. She took to social media: “Can you F….. believe it!!! The doctor literally has given him the gun to kill himself.”
The social media attention led to a national outcry against the doctors who planned to facilitate his termination. In response, the doctors changed their minds and refused to cooperate with the planned suicide.
But Vafaeian was disappointed when the doctors refused to assist him with suicide. “I was so ready,” he said. “I was actually very looking forward to ending my pain and suffering.”[vi]
Other parents will support their child’s decision to end their life.
In Belgium, 23-year-old Shanti De Corte survived a 2016 ISIS attack on a Brussels airport and was never the same after the attack. She suffered from anxiety and depression for years because of the attack. She attempted suicide in 2018 and 2020. She chose euthanasia because of this and was approved in 2022 by two psychiatrists.
Her mother said she supported her daughter’s decision. She explained that Shanti was afraid of large crowds and that “Even balloons bursting at a birthday party scared her.” Her mother said ultimately, “It [euthanasia] was Shanti’s wish. I am convinced she is at peace now. It brings us comfort, makes it more bearable, to know that it is what she wanted.”
Belgian prosecutors are investigating the case. The Christian advocacy organization Alliance Defending Freedom International (ADF) has issued a statement: “Once the laws are passed, the impact of euthanasia cannot be controlled. Belgium has set itself on a trajectory that, at best, implicitly tells the most vulnerable their lives are not worth living.”
Euthanasia for Children
Advocates, including Dying with Dignity, a Canadian organization, say euthanasia law is intended to be compassionate. They argue that even children should have the right to assisted suicide. Canada is considering legalizing euthanasia for “mature minors” in 2023, and children who are deemed mature could decide to receive euthanasia without the consent of their parents.
Belgium and Dutch laws both allow minors to receive euthanasia or assisted suicide. The Dutch require a minimum age of 12 years old, parental consent, and the child must be “deemed to have a reasonable understanding” of his interests. Belgium’s laws are similar, including proof of a terminal or incurable disease.
Dr. Derryck Smith, a psychiatrist at the University of British Columbia, said MAiD “is about relieving suffering, respecting human dignity, and recognizing the inherent right for individuals to make decisions affecting their health and even their death.” He has said, “Before MAiD, patients who were going to die were assisted along the way with high doses of narcotics.” “The rationale was to ‘make people comfortable.'”
Smith never took the Hippocratic Oath because he thought it was “archaic.”
Although some advocate for euthanasia, others believe that both children and adults with mental health issues cannot make such decisions and that providing care rather than euthanasia is the better path.
Common Sense reports: “Dr. Dawn Davies, a palliative care physician who supported MAiD when it was first conceived, said she had ‘tons of worries’ about where this might lead. She could imagine kids with personality disorders or other mental health issues saying they wanted to die. ‘Some of them will mean it, some of them won’t,’ she said. ‘And we won’t necessarily be able to discern who is who.'”
Oncologist Dr. Ellen Warner, a professor at the University of Toronto’s medical school, said, “My objection to MAiD, from day one, was that there was no way we would be able to avoid this slippery slope because these aren’t black and white cases,” she said. “I’m 100 percent against MAiD. I’m an old-fashioned Hippocratic Oath kind of doctor.”
When You Can’t Afford to Live…
Because of the increasingly open eligibility requirements of euthanasia in Canada, many people with moderate disabilities are considering euthanasia for financial reasons.
Many people with moderate disabilities are considering euthanasia for financial reasons.
Heidi Janz is an assistant adjunct professor in Disability Ethics at the University of Alberta. She said, “a person with disabilities in Canada has to jump through so many hoops to get support that it can often be enough to tip the scales.” Many choose euthanasia because they simply cannot afford to live any longer.
The Canadian government includes euthanasia as part of Canadian medical insurance. Because the government has made it easier to die, some consider it a viable alternative to facing financial hardship.
65-year-old Les Landry, who suffered from PTSD, epilepsy, and had three strokes, said: “There’s a tipping point where you can’t afford to live…MAiD is the new society safety net.”
Studies, one by the Canadian government and another published in the Canadian Medical Association Journal, find that MAID (including the more recent addition of mentally ill as qualifying cases) will save the government millions of dollars per year, even as high as $149 million. In essence, by eliminating the most financially, physically, and mentally vulnerable members of Canadian society, the government will not have to devote resources to support that group.
In response to criticism about allowing access to those solely with mental illness, safeguards were added, requiring that patients be informed about all treatments, including mental health support and palliative care, before they may request euthanasia. Some are now calling for secondary panels to analyze borderline situations.
At least three officials from the United Nations have expressed their concern about Canada’s permissive euthanasia stance. They said Canada’s willingness to euthanize patients with disabilities who are not terminally ill may “have a potentially discriminatory impact” and may “risk reinforcing (even unintentionally) ableist and ageist assumptions about the value or quality of life of persons with disabilities and older persons with or without disabilities.”[vii]
A recent study concluded that “legalization of euthanasia or assisted suicide is a threat to suicide prevention.”[viii] Normalizing suicide through advocacy for assisted suicide and euthanasia may encourage self-harm in those who don’t meet the requirements for legal euthanasia or assisted suicide.
With the supply and demand for medical assistance in dying increasing due to broadening definitions of eligible users, hard questions will likely continue to be raised wherever it is used. People who might not otherwise ever consider committing suicide on their own are willing to die when it has the imprimatur of the government and medical establishment. The option of “do it yourself” suicide will inevitably increase.
Is assisted suicide what people need to end their suffering, or is it the easy answer to costly and difficult treatment?
With the increasing availability of government-funded medically assisted suicide, there is a strong likelihood that suicide will no longer be considered a social taboo. Now is the time to ask the tough questions – are advocates supporting MAiD because it is what people need to end their suffering, or is it because suicide is the easy answer to costly and difficult treatment? If people can request assisted suicide without the consent of family members, will the confused end up dead when their lives could have been saved? Or can family members who might gain from inheritance or the freedom from caring for an ill family member pressure them to commit suicide? Will insurance companies or government healthcare payers see it as a way to save money on costly end-of-life care? Will those who feel like they’re a burden be able to withstand the gentle pressure from family members or doctors who present it as a “compassionate” option? Finally, how can society balance the rights and autonomy of the individual while preserving safeguards and protections for the most vulnerable groups?
Perhaps Marie-Claude Landry, the head of Canada’s Human Rights Commission, was right when she said, “In an era where we recognize the right to die with dignity, we must do more to guarantee the right to live with dignity.”[ix]
If you or someone you know is having suicidal thoughts or struggling with mental health issues, please call the U.S. National Suicide Prevention Lifeline at 800-273-8255 (or just by dialing 988) to speak with a counselor. In Canada, support is available 24/7 by calling Talk Suicide Canada (1-833-456-4566). In Canada, 988 will be available after November 23, 2023.
Caden Benedict is a Senior at Pepperdine University majoring in Economics and minoring in Great Books. He is the Founder and Editor-in-Chief Emeritus of The Pepperdine Beacon, a media and news organization preserving and promoting the values and mission of the university through a relentless pursuit of truth. He plans to attend law school and enter the film industry after his education.
[i] Canada’s New Euthanasia Laws Carry Upsetting Nazi-Era Echoes … – Forbes. https://www.forbes.com/sites/gusalexiou/2022/08/15/canadas-new-euthanasia-laws-carry-upsetting-nazi-era-echoes-warns-expert/
[ii] Second Annual Report on Medical Assistance in Dying in Canada 2020. https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2020.html
[iii] Third annual report on Medical Assistance in Dying in Canada 2021. https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2021.html
[iv] KATHRYN JEAN LOPEZ: Re-thinking end-of-life care | Opinion …. https://www.albanyherald.com/opinion/kathryn-jean-lopez-re-thinking-end-of-life-care/article_e0b09b12-222d-11ed-a202-ff2606e5f60b.html
[v] ‘Disturbing’: Experts troubled by Canada’s euthanasia laws. https://nypost.com/2022/08/11/disturbing-experts-troubled-by-canadas-euthanasia-laws/
[vi] Scheduled to Die: The Rise of Canada’s Assisted Suicide Program. https://www.commonsense.news/p/scheduled-to-die-the-rise-of-canadas
[vii] Mandates of the Special Rapporteur on the rights of persons with …. https://spcommreports.ohchr.org/TMResultsBase/DownLoadPublicCommunicationFile?gId=26002
[viii] New research finds legal euthanasia leads to increased ‘self-suicide’ rates. https://aleteia.org/2022/11/13/new-research-finds-legal-euthanasia-leads-to-increased-self-suicide-rates/
[ix] Canada’s New Euthanasia Laws Carry Upsetting Nazi-Era Echoes … – Forbes. https://www.forbes.com/sites/gusalexiou/2022/08/15/canadas-new-euthanasia-laws-carry-upsetting-nazi-era-echoes-warns-expert/