The Rise of Euthanasia in Canada: From Exceptional to Routine

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Reprinted with permission.

Canada had approximately 15,280 euthanasia deaths in 2023 (Article Link).

I would like to thank Alexander Raikin for his research report on the Rise of Euthanasia in Canada that was produced for and published by Cardus.

In one week there have been three exceptional studies on Canada’s euthanasia program published from different perspectives. I hope that the interest in Canada’s euthanasia law will lead to changes and a social shift towards rejecting the killing of people by lethal poison.

The first study was a landmark study by Chelsea Roff and Catherine Cook-Cottone on Assisted Death and Eating Disorders. (Link 2).

The second was a research study by Professor Christopher Lyon that asked the question: Does Canada’s euthanasia law enable healthcare serial killers?

This third study, by Alexander Raikin, examines the change in the attitude towards euthanasia in Canada under the title: The Rise of Euthanasia.

The Rise of Euthanasia in Canada: From Exceptional to Routine.

The key points by Raikin are:

The number of Canadians dying prematurely by “medical assistance in dying” (MAiD) has risen thirteenfold since legalization. In 2016, the number of people dying in this way was 1,018. In 2022, the last year for which data are available, the number was 13,241.
MAiD in Canada is the world’s fastest-growing assisted-dying program.
MAiD is now tied with cerebrovascular diseases as the fifth leading cause of death in Canada. Only deaths from cancer, heart disease, COVID-19, and accidents exceed the number of deaths from MAiD.
Assisted dying was not meant to become a routine way of dying. Court rulings stressed that it be a “stringently limited, carefully monitored system of exceptions.” Then Minister of Justice and Attorney General Jody Wilson-Raybould agreed: “We do not wish to promote premature death as a solution to all medical suffering.” The Canadian Medical Association likewise stated that MAiD was intended for rare situations.
MAiD assessors and providers do not treat it as a last resort. The percentage of MAiD requests that are denied continues to decline (currently it is 3.5 percent). MAiD requests can be assessed and provided in a single day.
Government departments and agencies continue to state that Canada’s MAiD experience is similar to that of other jurisdictions, that the rate of increase is expected, and that the growth is gradual. The data contradict these statements.
Health Canada has dramatically underestimated what a “steady state” of MAiD deaths would look like and how quickly Canada would reach the 4 percent threshold of total deaths. This threshold was reached in 2022, eleven years ahead of what Health Canada predicted only months earlier, and double its prediction just four years earlier.
Despite the importance of accurate vital statistics, some provinces’ death records do not record MAiD as a cause of death, instead recording the underlying condition that led to the MAiD request and subsequent death. Further, Health Canada reports on the number of MAiD deaths, but Statistics Canada does not consider MAiD a cause of death. These inconsistencies in reporting have an impact on research about MAiD and about causes of death more generally.
The systematic underestimation of MAiD in government statements and reporting is a serious impediment to understanding the scale of MAiD’s normalization in Canada and its abnormality with regard to other countries where some form of assisted dying is permitted.
For policymakers and the public to properly understand the Canadian reality, it is essential that government agencies collect consistent data and issue correct statements.

Euthanasia was sold to Canadians as a “last resort” but in fact it has been normalized as “medical treatment.” The number of Canadian euthanasia deaths has far exceeded the projected numbers and euthanasia has been falsely asserted to be a “right” in Canada.

In commenting on Bill C-7 which expanded Canada’s euthanasia law in 2021, Raikin stated:

Unlike the earlier expectations that MAiD requests would be granted only in rare circumstances, Canada is now far beyond the limitations expected or recommended. Just four years after the Supreme Court’s Carter decision, a Superior Court of Quebec judge in Truchon v. Canada ruled that Canada’s MAiD program was unconstitutional because it did not allow for the assisted dying of persons not at end-of-life. Although dozens of disability-rights groups urged then Minister of Justice and Attorney General David Lametti to appeal the ruling, Minister Lametti chose not to do so. Instead, to comply with the lower-court judge, the government introduced Bill C-7, which came into effect in 2021.

Bill C-7 moved far beyond the judicially imposed ruling in Truchon, let alone the Supreme Court’s ruling in Carter. Existing safeguards were weakened. The minimum ten-day assessment period for MAiD was removed entirely, allowing for the same-day assessment and provision of assisted dying for almost all MAiD requests. The requirement that the patient give final consent before administration of MAiD was no longer mandatory. Moreover, MAiD became available to persons whose death is no longer “reasonably foreseeable” but who consider that their physical suffering, from a disability for example, is intolerable to them. In a surprise last-minute amendment to C-7 in the Senate, MAiD was expanded further, without any additional legal safeguards, to include mental illness as a qualifying condition. This clause was scheduled to take effect in March 2023 but has since been deferred to 2027.

Raikin examines the outcome of the law based on the Supreme Court of Canada Carter decision. He wrote:

The original intention of MAiD safeguards was to ensure that MAiD requests would be carefully scrutinized rather than merely rubber stamped. The trial judge in Carter twice cited that only one in ten explicit assisted-suicide requests in Oregon ended in assisted death as evidence of the meticulous deliberations that physicians would take if assisted dying were to be legalized in Canada. 28 This was also a key argument in the Supreme Court’s decision. 29 Yet in 2022, over 81 percent of all explicit MAiD requests ended with death from MAiD. A notable reason for this unprecedented high mortality rate from assisted dying is that the percentage of MAiD requests that is denied in Canada is low and has continued to decrease each year. According to federal data, 8 percent of total written requests for MAiD in 2019 were deemed ineligible. In 2020, the percentage was 6.1 percent, in 2021 it was 4.1 percent, and in 2022 it was 3.5 percent.

Raikin then compares Canada’s euthanasia regime to other jurisdictions that have legalized assisted death.

While the rate of assisted dying generally increases in every jurisdiction that legalizes it, the rate of increase in Canada has been unusual. California, with a population similar to Canada’s, legalized assisted dying the same year that Canada did. As of 2022, California still has not reached the rate of assisted deaths that occurred in Canada in year one of legalization.

The Netherlands is the only country with an assisted-dying rate that is comparable to Canada’s. It was the first country to effectively decriminalize euthanasia in 1981 and to formally legalize it in 2002. In 2013, thirty-two years after the country’s effective decriminalization, the percentage of total deaths crossed the 3 percent bar. Canada crossed the 3 percent threshold just six years after legalization. No jurisdiction with an assisted-dying program other than Canada and the Netherlands has crossed the 3 percent threshold. In the seventh year of its legalization, Canada crossed the 4 percent line.

Raikin writes about the inconsistency in reporting of euthanasia deaths and the fact that monitoring euthanasia has been minimal at best. Canada uses a self-reporting system for euthanasia that enables euthanasia providers to cover-up controversial deaths. Raikin writes:

Additionally, the data-reporting mechanisms do not include any input from MAiD recipients prior to death, nor from medical professionals not otherwise involved in the assessment or provision. Instead, all reporting is self-reporting, recorded and submitted by the same persons who assess and provide MAiD. The same persons who could face criminal repercussions for not strictly following the criminal exemptions for assisted suicide and homicide under Canada’s federal laws regulating MAiD are the only ones reporting whether they adhered to the regulations.

Raikin concludes his research by stating that Canada’s euthanasia law has gone from exceptional circumstances to routine. He states:

Yet, as demonstrated by the data discussed in this paper, MAiD in Canada is no longer unusual or rare. Federal predictions about the expected frequency of MAiD have significantly underestimated the numbers of Canadians who are dying by this means. More troubling, instead of physicians acting as “reluctant gatekeepers” for assisted dying, as the lawyers for the plaintiff in Carter envisioned, they appear highly favourable to MAiD requests, as shown by the available data on length of time from assessment to provision, the percentage of MAiD requests that are denied, and the sheer prevalence of occurrences.

Internationally, Canada is increasingly an outlier, as the world’s fastest-growing assisted-dying program and heading toward further liberalization of the eligibility criteria. It is difficult to understand how the Government of Canada continues to claim that the rate of MAiD in Canada is similar to rates in other jurisdictions. Understanding this growth is essential for evaluating the use and possible abuse of MAiD, particularly in light of future expansion to eligibility criteria.

For policymakers and the public to properly understand and respond to the Canadian reality, it is essential that government agencies collect consistent data and issue correct statements.

Raikin has outlined how Canada’s euthanasia law was sold to Canadian’s as a “last resort” but in fact it has become routine and falsely labelled as “medicine.”

Link to previous articles by Alexander Raikin (Link).

Header image: Sarco, a euthanasia device invented by Philip Nitschke, designed by Dutch industrial designer, Alexander Bannink via wikipedia.org