Joanna Alphonso:

Euthanasia is legally defined as the deliberate killing of someone by action or omission for the intention of relieving that person of their suffering. Belgium, Canada, Colombia, the Netherlands, Luxembourg, New Zealand, Spain, and most recently Portugal as of 2023, permit active euthanasia (administration of lethal drugs) for irreversible terminal illnesses for adults and in some of these countries, for children and infants. Passive euthanasia, the refusal of treatment or removal of life-support is permitted in numerous countries, including the U.S., five African countries, nine Asian countries, a vast majority of European countries, eight North American countries, and almost all South American countries. Active and passive euthanasia remain largely unregulated in Africa, far east Asia and the Pacific islands, the Caribbean, and the Middle East. Euthanasia is completely illegal in four countries: Russia, Kenya, Belarus, and Belize.

Figure 1: Analysis of MAiD deaths in Canada. Data is available from 2016-2021. The number of NRFD is part of the total for that year. Recent NRFD data is unavailable; projections cannot be made as there are no trends to analyze. The arrow indicates introduction of Bill C-7 expansion of MAiD to NRFD diagnoses. Percent change from the previous year is calculated ((Current year total)-(Previous year total))/(Previous year total). The orange line indicates total MAiD deaths in Canada since legalization. Dashed line extensions and bars represent projections based on calculations. The red dotted line shows the trendline for annual MAID deaths in Canada.

Euthanasia differs from assisted suicide. According to the Euthanasia Prevention Coalition (EPC), assisted suicide is the “counselling, abetting, or an act of aiding someone to kill him or herself.” This is legal in Canada, New Zealand, Spain, Colombia, Belgium, parts of Australia, and in Switzerland for citizens and non-citizens. Assisted suicide is also permitted in parts of some countries such as the U.S. in Oregon, Washington, and California, as well as some states of Australia and Mexico. The EPC reports that Nevada Governor Joe Lombardo recently vetoed a bill permitting assisted suicide, protecting vulnerable people in the state. Conversely, Canada has expanded medical murder from those who suffer severe terminal illnesses to those who suffer with illness where there is no reasonably foreseeable death (NRFD).

Upon diagnosis of an irreversible and unbearable illness, euthanasia – euphemistically called Medical Assistance in Dying (MAiD)– can be requested by the patient. The Criminal Code of Canada does not permit MAiD requests on behalf of another person and requires the patient to be fully informed and aware of their decision to commit suicide. After a request is made, there must be a witness to attest to a written request, as well as approval from counsellors and doctors. The patient can either self-administer or request a doctor or nurse practitioner to administer the lethal drugs.

EPC suggests that with the heightened pressure from physicians to opt for MAiD instead of treatment, as well as the ease of MAiD approval compared to disability benefit approval, the legal requirement for patient choice is a “cruel illusion.”

According to Statistics Canada’s 2021 MAiD in Canada report, MAiD deaths accounted for 3.3 per cent of the country’s total 2021 death toll, an increase from the 2020 rate of 2.5 per cent.

Interestingly, Canada and the state of California are roughly the same in population size and both decriminalized euthanasia in June of 2016 – but California’s physician-assisted suicide numbers are vastly lower than Canadian numbers. This may first be attributed to the criteria for approval in Canada being broader than California’s. Canada originally required death to be reasonably foreseeable; per Bill C-7, it is expanded to anyone with a diagnosis of a “grievous and irremediable medical condition,” and will include those suffering solely from mental illness beginning in March 2024. In California, the End Of Life Act (EOLA) affects only those diagnosed with “an incurable, terminal condition with a life expectancy of six months or less,” (EOLA). Second, Canada permits doctors and nurse practitioners, as well as the patients to self-administer the lethal drugs (which accounts for a minute proportion of overall MAID deaths, but is still notable). California only allows doctors to prescribe the lethal medication, but they are forbidden from active participation, leaving the patient to self-administer. This results in 30-35 per cent of prescriptions never being filled, implying withdrawn consent. In Canada, only 1.9 per cent of MAiD requests are withdrawn. Perhaps the most likely explanation is that the practice of Canadian medicine has departed from life-saving to life-taking.

Figure 2: Comparison of the proportion of euthanasia deaths in Canada and California. Comparison was made because of the similar population size. Data analysis demonstrated that euthanasia accounts for a far higher death rate in Canada than in California despite the similar population size. Empty data points are due to lack of available information.

Common between both regions are the diagnoses of those who request euthanasia. Over 65 per cent of requests are from cancer patients. Other requests come from cardiovascular, neurodegenerative, non-cancer respiratory, and autoimmune disease diagnoses.

The Euthanasia Prevention Coalition reports that Quebec has become the world leader in euthanasia deaths, accounting for more than 7 per cent of all deaths in the province – now more than 5000 people annually. Since Quebec Bill C-11 and the decriminalization of assisted suicide with the 2015 Carter decision, the province has had an accelerated rate of euthanasia compared to the rest of the country, and countries wherein euthanasia has been legal for much longer. Quebec has additionally increased the accessibility for people to access MAID, including physician-administered legal drugs outside of healthcare settings – including funeral homes. EPC suggests that Quebec has significantly higher euthanasia rates because of malpractice. The mandatory 10-day reflection period is waived in more than 60 per cent of cases, with 40 per cent of those cases violating the Criminal Code. This may be attributed to the expansion of privatized healthcare, the already ailing medical system, and court cases affirming the “right to die.”

Canada’s rapid acceptance of euthanasia, with its radically-inclusive MAiD laws and health care practices, violates the Charter’s section 7: right to life. The 1993 Rodriguez decision affirmed the “sanctity of life,” which cannot be read at odds with the other section7 rights to liberty and security of the person. Today’s regime of Medical Assistance in Dying is a product of judicial activism from the dissenting opinion in Rodriguez turned majority opinion in Carter and the Trudeau government’s relentless expansion of medicalized murder.