Rebranded as “medical assistance in dying” or “MAiD,” euthanasia in Canada has witnessed a remarkable transformation from being illegal to becoming a common practice within a span of less than ten years. Since 2016, doctors have administered approximately 30,000 lethal injections, with one-third of them occurring in 2021 alone, in response to eligible patients’ requests. The number for 2021, at 10,029, saw a 34.7% increase from 7,446 in 2020, accounting for 3.3% of all deaths.
While a significant majority of euthanasia cases involve older individuals with terminal illnesses like cancer, Canadian federal law no longer necessitates a terminal condition since 2021. Instead, it requires the patient’s condition to be serious, incurable, and the attendant suffering to be “intolerable” for them.
Canada’s legal framework for euthanasia is considered one of the world’s most permissive, enjoying widespread public support. Many Canadians, if not the majority, are in agreement with the sentiments expressed by former Justice Minister David Lametti when he stated that there were no indications so far to suggest that they had gone too far.
While the expansion of euthanasia in Canada, as seen in other countries, provides more end-of-life options for patients, it also involves subjective judgment calls made by fallible human beings. As the practice grows, the risk of mistakes or abuses also increases in an environment where errors or wrongdoing lead to irreversible consequences. The question then arises as to how much risk a society can or should tolerate.
These concerns lay at the heart of a striking admonition from Michel Bureau, the president of the Commission on End-of-Life Care in Quebec, a leading regulator of euthanasia. In an open letter to doctors, Bureau expressed his worry about the rising number of cases in Quebec where euthanasia was administered either at the limits of the conditions imposed by law or found to be non-compliant with it. He urged doctors to adhere to the criteria regarding grave and incurable diseases, emphasizing that advanced age and problems associated with aging did not qualify as such illnesses. Bureau reminded them that a new Quebec law allowing euthanasia for people with disabling conditions such as cerebral palsy or spinal cord injuries would not take effect until March 2024.
Bureau further emphasized that the requirement for a second independent opinion on MAiD requests was not a mere formality, and shopping for a favorable second opinion was not acceptable. In an interview, he explained that his aim was to assist doctors who might be confused due to the ambiguity in the law. He stressed the need for caution given the high figures in Quebec. In another interview, he clarified that medical aid in dying was not meant to replace natural death.
Bureau’s letter followed the latest annual report of his commission, which covered the period between the first quarters of 2021 and 2022. The report identified 15 cases of MAiD out of 3,663 that did not comply with Quebec law. After reviewing case files and interviewing doctors, the commission concluded that three patients were unable to provide consent at the time of the lethal injection, six did not have grave and incurable conditions, and one did not receive the required independent second opinion. The remaining five cases involved issues with the paperwork supporting their euthanasia requests. Bureau’s letter implied that the number of noncompliant cases in the commission’s next annual report would likely be higher.
The response to Bureau’s appeal was revealing. President Mauril Gaudreault of the Quebec College of Physicians, responsible for overseeing medical practice and administering professional discipline, denied any deviation from compliance with the law. He suggested that the primary issue with MAiD in Quebec was doctors’ reluctance to perform it due to fear of repercussions from regulators. Gaudreault stated that the college reviewed the 15 allegedly noncompliant cases from the commission’s previous annual report and found no grounds for disciplinary action or criminal referral. However, he acknowledged that the differing criteria between Canada’s federal criminal law and Quebec law, along with ongoing debates over changes to the latter, might have caused confusion. He accurately pointed out that the commission’s latest report found 99% of cases to be compliant with the law, even as euthanasia expanded rapidly in Quebec.
Nevertheless, what should be the perspective on the tiny percentage of cases that didn’t comply? How should the termination of the lives of those 15 individuals be perceived? Is it unpunished homicide? Are these people who were suffering and dying entitled to a doctor’s assistance in ending their pain, even if the necessary protocols weren’t followed? Or is it an unfortunate but acceptable consequence of a policy that, on the whole, reduces society’s burden of suffering?
These are unsettling questions that societies legalizing euthanasia inevitably face sooner or later, while societies that don’t legalize it don’t.
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