For seven days The Telegraph is running a series of exclusive essays from international commentators examining the impact of Canada’s progressive legislation on issues such as drugs, free speech, trans rights and assisted dying.
Our sixth essay is by Michael Cooper, Conservative MP for St Albert-Edmonton, Alberta.
With the prospect of assisted dying being legalised in the UK, the Canadian experience serves as a cautionary tale of what can go horribly wrong.
In 2015, Canada’s Supreme Court ruled that it is a fundamental right of Canadians who suffer from a “grievous and irremediable” medical condition to be assisted to kill themselves. The Court dismissed as fallacy warnings of a “slippery slope” leading to the devaluing of human life and potential harms to vulnerable persons. The Court reasoned that vulnerable persons could be protected though “stringent and well-enforced safeguards.”
Fast forward to today. In less than a decade, the “slippery slope” has arrived, with Canada arguably having the world’s most permissive assisted dying regime – or medical assistance in dying (MAiD) as it is referred to in Canada. According to the latest Health Canada data, Canada will soon have the highest per capita MAiD death rate in the world. Year-on-year MAiD deaths have increased at a staggering rate of approximately 30 per cent.
The “stringent and well-enforced safeguards” envisioned by the Supreme Court largely do not exist. What few safeguards there are have been ineffective. There are well-documented and shocking cases of vulnerable persons receiving MAiD due to poverty and social isolation.
The discourse around MAiD in Canada has become perverse. During a parliamentary committee hearing, a physician representing the Québec Medical Association disturbingly recommended euthanising infants with severe deformities.
How did MAiD go off the rails so quickly in Canada? It didn’t happen in a vacuum. It happened because Justin Trudeau’s government has approached MAiD almost exclusively through the ideological lens of individual autonomy without appropriate regard for negative impacts to vulnerable persons.
The Trudeau government, after being elected in 2015, was effectively forced by the Supreme Court’s decision to craft a legislative framework for MAiD, including eligibility criteria and safeguards. Initially, the Trudeau government took a somewhat cautious approach. The government’s original MAiD legislation required patients to meet certain criteria, including that their natural death be “reasonably foreseeable.”
It did not take long, however, for the Trudeau government to throw caution to the wind.
In 2019, a Québec lower court judge ruled that the eligibility requirement that death be reasonably foreseeable was unconstitutional. Instead of defending a law passed by Parliament only three years earlier, Trudeau’s Attorney General opted against appealing the decision, and introduced legislation to remove the criteria.
The Trudeau government did this despite near universal opposition from the disability advocacy community. These groups warned that MAiD would lead to ableism and discrimination against persons with disabilities.
Now persons with disabilities qualify for state-administered death on the basis that they are disabled – stigmatising and devaluing the lives of persons with disabilities. As Canadian disability advocate Gabrielle Peters aptly put it, “Canada has made disabled people a killable class.”
By removing any connection to the foreseeability of natural death, eligibility has become significantly more subjective. This has widened the door for potential abuse. And it has devalued life, with persons who could potentially live for decades becoming eligible.
The Trudeau government has proceeded to push the expansion of MAiD even further. Persons suffering solely from an underlying mental health disorder will soon be eligible. According to the Chair of the Trudeau-appointed Expert Panel on the implementation of MAiD for mental illness, anyone with a mental disorder listed in the American Psychiatric Association’s DSM5-TR could qualify. That includes persons suffering from depression, anxiety, schizophrenia, and personality disorders. This should horrify anyone of decency and demonstrates how depraved Canada’s MAiD regime has become under Trudeau’s watch.
While eligibility criteria have significantly widened, from the start, the so-called legislative safeguards have proven inadequate.
To qualify, a patient needs only the sign-off of any two physicians or nurse practitioners. There is nothing to stop a patient from doctor-shopping until they are approved.
Under the law, there is no mechanism to review MAiD assessments. Accordingly, once approved by any two clinicians, there is no practicable means to stop a patient from receiving MAiD – even where there is evidence that the patient is not eligible.
There is no legal requirement that a patient undergo standard treatment options – only that they be advised of such options. Accordingly, a patient could qualify after declining treatments that would have ameliorated their condition.
There is a real risk of coercion when healthcare professionals proactively raise MAiD as a treatment option, given the power imbalance between physician and patient. Yet Health Canada’s practice standard, incredibly, encourages this practice. This is in contrast to other jurisdictions, such as the Australian State of Victoria, where this is prohibited.
Meanwhile, there is no comprehensive system in place to monitor and enforce the less-than-robust safeguards and compliance with the law. While the Trudeau government and Health Canada insist that instances of non-compliance are rare, this is almost certainly due to a lack of proper monitoring and oversight. Indeed, so permissive are the eligibility criteria, and so lacking are the safeguards, Canada’s MAiD regime is rife for abuse even if such abuse occurs in technical compliance with the law.
This is evidenced by a growing list of disturbing cases of vulnerable persons who received MAiD under apparently questionable circumstances. Take the case of Rosina Kamis. In her last days alive, she documented that her MAiD request was motivated primarily by poverty, loneliness, and a lack of support. In another case, an Ontario woman with severe chemical sensitivities received MAiD after she was unable to find adequate subsidised housing free of cigarette smoke.
Whether the letter of the law was technically followed in these and other similar cases, is in some ways, beside the point. MAiD was initially sold to Canadians as a more “compassionate” and “humane” alternative to suffering at the end of life. Instead, Canada’s MAiD regime now resembles a state-facilitated suicide programme, with the lives of the poor, disabled, and soon the mentally ill, uniquely at risk.
This is the very antithesis of what is compassionate and humane. For governments around the world considering assisted dying, it is a lesson on what not to do.