Santé Canada (Canada Health) has just released its 4th annual report on Medical Assistance In Dying (MAD). Covering euthanasia and assisted suicide, MAD represented 4.1% of deaths in 2022, which is a new record since its legalisation.
The situation in Canada is particularly alarming when one considers that the first law on the subject is dated 2016. In 6 years, Canada has reached the highest percentage of deaths by euthanasia/assisted suicide among those nations which have legalised administered death.
Increasing numbers and extensive eligibility criteria
In 2022, 13,241 cases of euthanasia were registered, representing an increase of 31.2% compared with 2021. Suicide assistance remains very exceptional: less than 7 people “self-administered” the lethal products.
The main medical affliction is cancer (63.0 %): neurological disorders represent 12.6 % including 9% for dementia. A total of 22.6 % of people were recorded by doctors in the group “other diseases” or “multiple disabilities”. “A quarter of those suffering from these disabilities were suffering from fragility (25.0 %). The other most common diseases were diabetes (11.9 %), chronic pain (8.0 %) and auto-immune diseases (5.0 %). A certain number were suffering from arthritis, osteoporosis, fractures, loss of eyesight and hearing, dysphagia and frequent falls.“
As reported in a 2022 study, the criteria for eligibility have been considerably relaxed since 2016.
The sources of suffering most frequently stated are “loss of the ability to take part in significant activities (86.3 %), followed by loss of the ability to accomplish the activities of day-to-day life (81.9 %) and inadequate pain management or concern about the subject of pain management (59.2 %)“.
Finally 35.1% of patients mentioned the fact of being a burden on their entourage – family, friends or helpers – and 17.1% the isolation or solitude as a suffering leading to applying for euthanasia. These observations can but challenge society as a whole on the relationship toward vulnerability and inter-generational solidarity.
Diversity of locations and of euthanasia-providing practitioners
Some 40% of euthanasia are conducted in the home, 30.5 % in hospitals and 20.8 % in palliative care. Nearly 70 % of the practitioners providing euthanasia are family doctors which correspond to general practitioners in France, 9.4 % nurses, 8% palliative carers. Then come various specialists: oncologists, anaesthetists, A & E doctors etc. and 0.8% psychiatrists.
Although adopted in 2021, the application of the extension of MAD to those suffering from mental disorders has been deferred until 17th March 2024 due in particular to the difficulty in distinguishing between suicidal tendencies and mental health problems liable to justify a request for MAD. According to John Maher, a psychiatrist specialising in mental diseases and Editor in Chief of the Journal of Ethics in Mental Health “MAD has profoundly undermined decades of efforts in suicide prevention.“
Doubling of euthanasia with no predicable death prognosis
The revised 2021 law extended the criteria for the eligibility for MAD to the handicapped suffering from a “serious and incurable” disease with no predictable death prognosis.
463 people were euthanised whereas their “natural death was not reasonably predictable”, i.e. double the number for the previous year when that criterion was made legal. In half of those cases, their ailments were “neurological”.
Among those, 34.8 % were granted palliative care and 53.8 % needed support services for the handicapped. Several cases of applications for euthanasia because the patients could not manage to obtain adequate assistance due to inadequate financial resources, were widely publicised over the last two years. Experts at the UN alerted through a common statement concerning the Canadian law: “Handicap should never be a reason to end a life“.
An alarming rise in euthanasia in Quebec
The largest numbers of administered euthanasia took place in Quebec (4801), Ontario (3934) and British Columbia (2515). Quebec and British Columbia experienced the highest percentage of deaths by euthanasia (6.6 % and 5.5 % respectively).
In view of the increase of almost 46% of MAD cases in Quebec, the Quebec Minister Sonia Bélanger, in charge of the elderly and delegate for health, asked the College of Doctors for an explanation. She called for an investigation of the doctors who caused the death of 23 patients who did not meet all the criteria laid down in the law. Already last September, the Commission on end of life care had called upon doctors to follow the law more strictly. Indeed, a scientific study released in August 2023 on the Cambridge University Press web-site alerted on the serious loopholes in the euthanasia procedure. The authors denounced the lack of supervision and control in the Canadian system.
Note: The figures provided below are taken from the report for Canada as a whole for 2022. The links to articles published in the Quebec press show some variations, because Quebec simultaneously published its own yearly report of activities for a slightly offset period between 1st April 2022 and 31st March 2023.
MAD is impacting the development of palliative care and more generally society as a whole
In Canada, MAD is presented to patients as a “therapeutic option”, even if they have not asked for it.
In recent years, several studies have shown the lack of development of palliative care. The Canadian Society of Palliative Care Doctors underlines that a mere 15% of those who would need palliative care have access to it. They also highlight the shortage of pain management specialist practitioners.
In 2022, 19.6% of Canadians euthanised did not receive palliative care.
A report published at the end of October 2023 by the Canadian Cancer Society (SCC), insisted on the increasing under-equipment “in quality palliative care for people suffering from invasive diseases such as cancer, in particular in palliative care centres, which provide few beds and are widely scattered“. In order to provide quality palliative care, Canada should have 7 beds per 100,000 inhabitants. However the report indicates that Canada can only muster 3.97.
“Since the legalisation of induced death, [Canada] has dropped 10 places in the international ratings” according to the President of SFAP (Société française d’accompagnement en soins palliatifs – French Society for Accompaniment in Palliative Care). On the other hand, induced death has been apprehended as a new standard.
The legalisation of MAD has led to a worrying evolution in mentalities: A survey by the Research Institute co. dated May 2023 on the Canadian Federal law revealed that 73% of those questioned approved the current law and 20% approved euthanasia without conditions; when mentioning specific cases relative to the economic situation, 28% supported extending the criteria to the homeless and 27% for those afflicted with poverty.
