metamitya ·
When Canada’s justice minister announced plans to legalise medically assisted dying nearly a decade ago, she acknowledged the proposed law might prove divisive. “For some, medical assistance in dying will be troubling,” Jody Wilson-Raybould told reporters in 2016. “For others, this legislation will not go far enough.”
A fresh delay in expanding the scope of who can access a medically assisted death has once again put a spotlight on the system, which critics and advocates agree is one of the most liberal in the world. But the two groups remain sharply divided on what that means for improving the quality of life – and death – in the country.
Medical assistance in dying (Maid) laws, crafted in response to a supreme court decision, initially permitted only terminally ill Canadians to be eligible for the procedure. But in 2019, a Quebec judge ruled that restricting access to those who had a “reasonably foreseeable death” was unconstitutional, forcing federal lawmakers to amend and expand the existing laws.
In the years since, Canada’s experiment in physician-assisted death has made international headlines – including a feature article in the Atlantic magazine last year that investigated how the country’s assisted dying laws “went wrong”. In 2021, three UN human rights experts cautioned that an expansion to the law, which permitted people with chronic conditions to apply for assisted death, would create a “two-tiered system” and push people with disabilities towards suicide.
Government figures show that 13,102 people ended their lives under Maid in 2022 – an increase of 30% on the previous year.
“Maid is different depending on what it’s provided for and how it’s provided. It’s not only one thing,” said Sonu Gaind, chief of psychiatry at Toronto’s Sunnybrook hospital. “And in that context, these expansions of assisted death in Canada are way beyond what most Canadians would actually support.”
In a survey of those 13,102 Canadians who ended their lives under Maid, the vast majority cited the “loss of ability to engage in meaningful life activities” as the reason for wanting to die. But other responses have troubled healthcare experts. More than one-third of respondents said their decision was, in part, informed by a feeling they were a perceived burden on family, friends or caregivers.
The surge means Canada has one of the highest rates of euthanasia in the world, with 4.1% of deaths aided by doctors.
“No other country has had these numbers in terms of the rate of growth after introducing assisted dying laws,” said Gaind. “The precipitous growth that we’ve had is unparalleled anywhere.”
For others, however, that increase reflects a system working as intended – and serving a group of Canadians looking to ease immense suffering.
“What this increase tells me is that Canada has paid the most attention to individual human rights and autonomy,” said Chantal Perrot, a physician and Maid provider. “An increase in deaths with Maid means to me that people are choosing to die with their loved ones around them. The last days, weeks or months of life can be horrific. Why would they want to go through that if they could have a peaceful death surrounded by their family and loved ones?”
Of the 13,102 people who died using assisted death, 96.5% had terminal illnesses or faced imminent death. Only 463 people suffering from a chronic condition accessed Maid.
“I work in the healthcare system and see people with severe chronic medical conditions all the time,” said Mona Gupta, a psychiatrist at the University of Montreal and the chair of the federal panel on Maid and Mental Illness. “The idea that 400 of them – in a country of 40 million people – had reached the point where they had exhausted all treatment options, and wanted to access Maid, does not seems extreme to me.”
In the UK there have been renewed calls for parliament to vote on a law change after a report in the Observer in December about an impassioned plea from the actor Diana Rigg to legalise assisted dying, made in a message recorded shortly before her death from cancer three years ago.
Just before Christmas, the Childline founder and broadcaster Esther Rantzen revealed how she has considered assisted dying if her lung cancer treatment does not improve her condition.
Critics of a potential British assisted dying law have warned about the difficulties in defining who is eligible, the danger of people being pressured into a decision, and subsequent attempts to widen the law.
Quebec – the province with the highest rate of Maid – is studying why people are accessing assisted dying in greater numbers each year. Officials in the province have also requested an amendment to the criminal code that would permit people to consent to medically assisted death before the onset of conditions like Alzheimer’s.
Still, a string of prominent cases that critics say reflect a broken system have put physicians on the defensive.
In one instance, a Canadian Forces veteran claimed she had been o…