The growth in killing by euthanasia and assisted suicide.

Swiss assisted suicide coffin

By Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

A Daily Mail article by Hope Sloop published on July 12, 2023 concerned the assisted suicide death of Catherine Kassenoff in Switzerland.

Kassenoff, a former New York prosecutor who had cancer, suggested in her facebook message that she decided to die by assisted suicide in Switzerland because of her abusive former husband. The article stated:

In a shocking and heartbreaking post on Facebook, Catherine had asserted that Allan abused her and was attempting to ruin her life prior to her death.

The woman, who at one point worked as special counsel to New York Gov. Kathy Hochul, said she was a victim to a 'predatory' court system that kept her kids away.

The couple had, according to Catherine's post, been engaged in a nasty custody battle for their three daughters that continued to escalate.

Catherine Kassenoff lost custody of her children in a divorce battle with her husband. Sloop wrote that Allan Kassenoff, a successful lawyer, was on leave from his work.

The world is aware that suicide tourists die by assisted suicide in Switzerland, but they may not be aware that suicide tourism has spilled into America.

In October 2021, the assisted suicide lobby launched a lawsuit challenging the Oregon assisted suicide residency requirement. In March, 2022 the Oregon Health Authority settled the case by agreeing to remove the residency requirement.

A February 2023 article by James Reinl published in the Daily Mail reported that Dr Nicholas Gideonse was operating an assisted suicide clinic in Oregon to prescribe lethal assisted suicide poison for death tourists.

In August, 2022, the assisted suicide lobby launched a lawsuit challenging Vermont's assisted suicide residency requirement. Lisa Rathke reported in March, 2023 for the Associated Press that Vermont's attorney general's office reached an agreement with the assisted suicide lobby to drop Vermont's assisted suicide residency requirement.

There is currently a lawsuit in New Jersey challenging their state assisted suicide law residency requirement and several US States that have legalized assisted suicide are debating legislation to remove their stateassisted suicide residency requirement.

The US assisted suicide lobby knows that they will not legalize assisted suicide in every US state. By removing the residency requirements in states that have legalized assisted suicide, anyone will be able to die by assisted suicide in the US.

Canada legalized euthanasia in 2016. 

Canada uses the term (MAiD) to avoid the terms euthanasia or assisted suicide. The difference between euthanasia and assisted suicide is how the act is done. Euthanasia requires the doctor or nurse to administer the lethal poison while with assisted suicide, the doctor prescribes the lethal poison but the person takes the poison themselves.

Canada’s original law had a terminal illness requirement in the law. In March 2021, Canada expanded its euthanasia law by removing the terminal illness requirement, removing the 10-day waiting period and allowing euthanasia for mental illness alone.

Once Canada removed the “terminal illness” requirement in its euthanasia law the result was the extension of euthanasia essentially to anyone with an “irremediable medical condition” (undefined phrase). Essentially this means that nearly every Canadian with a disability qualifies to be killed by lethal poison (euthanasia).

There has been media stories of Canadians with disabilities being approved for or dying by euthanasia based on poverty, homelessness, an inability to receive necessary medical care and other social reasons. Canadians were not being approved for euthanasia based on poverty, etc., but they were being approved to be killed based on having an irremediable medical condition, but their reason for asking for death was based on poverty, homelessness, etc.

The issue of euthanasia for mental illness alone remains a hotly contested issue in Canada.

In March 2021, when the government expanded the law, they placed a two-year moratorium on euthanasia for mental illness alone in order to develop “protocols”. The government then stated that no new protocols were needed to implement euthanasia for mental illness alone. The backlash caused the government to delay the implementation of euthanasia for mental illness alone until March 2024.

In late 2023, with the anticipation that euthanasia for mental illness alone would soon begin, many of Canada’s Provincial Health Ministers challenged the federal government on this issue which led to the federal government delaying the implementation of euthanasia for mental illness alone until March 2027.

Euthanasia and autism.

On January 30, 2024, a Calgary father went to court to challenge a decision that approved his 27-year-old autistic daughter for euthanasia. The father argued that his daughter was suicidal but she didn’t have any medical condition that qualified her for being killed under the law.

The Judge granted an injunction until the court could hear the case. The case was heard in March and on March 25^th the Judge stated that the law did not give him an ability to review the euthanasia approval but he held the injunction for another 30 days enabling the father an opportunity to appeal the decision. The decision was appealed on April 2 and an injunction to prevent his daughter from dying by euthanasia remains in place until the appeal is decided.

Rupa Subramanya reported for the Free Press on April 1 that Zoraya ter Beek, an autistic Dutch woman (28) who has depression, is scheduled to die by euthanasia in early May.

Similar to the Calgary woman with autism, no one questions that Zoraya experiences depression and other mental health concerns, but there is question around a decision to kill a physically healthy autistic woman.

Euthanasia and assisted suicide are legalized based on the concept of preventing suffering when a person is close to death.

In nearly every jurisdiction, after legalizing, the killing has expanded.

The reason is that there is only one clear line in the sand, that being, it is always wrong to kill people. Once the line in the sand is crossed, there is no new clear line. Any “safeguards” or new “line in the sand” are seen as discriminatory or creating an obstacle to one’s right to die.

The only answer is to prevent the legalization of killing and if legal, continue to call it what it is, killing.

Hon. Ed Fast MP speaks on euthanasia for mental health in Canada's parliament

Hon. Ed Fast MP

Hon. Ed Fast (Abbotsford, CPC) 

Moved that Bill C-314, an act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

For further information about the Bill C-314 debate in parliament (Article Link).

*Sign our petition supporting Bill C314 (Petition Link).

Hon. Ed Fast MP: 

Mr. Speaker, I am pleased to speak to my private member's bill, Bill C-314, the mental health protection act.

In its very essence, this bill is about reaffirming the dignity and worth of each and every human life. It is about recognizing that it is the most vulnerable among us, the disabled and the mentally ill, to whom we owe the greatest duty: to defend and protect their lives and to provide them with every possible opportunity to live life to the fullest.

Medically assisted suicide was legalized in Canada in 2015 by the Supreme Court's Carter decision and later under the Liberal government's Bill C-14. Under this legislation, medical assistance in dying, or MAID, as it is commonly called, was strictly limited to those consenting adults who had an incurable disease that caused enduring, intolerable suffering that could not be alleviated, and where natural death was reasonably foreseeable, which they call the foreseeability test.

At the time, the government and its supportive stakeholders assured Canadians that this was not a slippery slope, where the scope of MAID would continually be expanded to include more and more vulnerable Canadians. However, not surprisingly, in the intervening eight years since the Carter decision, the government has begun to expand Canada's MAID regime to include more and more defenceless Canadians, most particularly those living with disabilities.

In late 2019, a Quebec lower court judge in the Truchon case ruled that the foreseeability test I just mentioned was unconstitutional, requiring Parliament to respond with additional legislation. Sadly, the Liberal government chose not to appeal the Truchon case to the Supreme Court of Canada, presumably because the decision lined up with the Prime Minister's intent to dramatically expand assisted suicide to other vulnerable Canadians. This leaves us with the perverse situation in which the Supreme Court of Canada, the highest court in the country, has never been allowed to opine on whether the reasonable foreseeability test is constitutional.

In any event, the Liberal government responded to Truchon by tabling Bill C-7, which initially eliminated the foreseeability test but expressly excluded mentally ill persons from being caught up in its MAID regime. Here is what the justice minister said at the time:

The fact that there would be risk of ending the life of a person whose symptoms would have improved...is, in part, why we are of the view that it is safest not to permit MAID on the sole basis of mental illness.... There is also ongoing uncertainty and disagreement as to the potential impact on suicide prevention if MAID were made available to this group.

He went on to say:

...there is no consensus among experts on whether and how to proceed with MAID on the basis of mental illness alone. On a question of such importance and with so much uncertainty and expert disagreement, it is incumbent upon us to proceed with caution and prudence.

Those were our justice minister’s views until the unelected Senate suddenly introduced an amendment that expanded MAID to those Canadians whose sole underlying condition is mental illness. Sadly, the justice minister and the government accepted the amendment without protest and, overnight, became zealous proponents of assisted death for the mentally ill. What happened to the caution and prudence the minister was preaching? What about the impact on suicide prevention the minister was so concerned about? What happened to his view that it was safest not to permit MAID on the sole basis of mental illness?

I agree with the Minister of Justice on one thing, which is that, as he has said, this is indeed a complex issue and is deeply personal. It is deeply personal because it involves life, a precious human life.

I would remind the minister and his government that the issue is also profoundly simple; that is, the principle that all life, all human life is precious and worthy of defence and protection, especially for those who do not have the ability to speak for themselves and have no one to speak for them.

One of the primary functions of government is to protect its citizens, to protect life. In fact, the right to life is expressly enshrined in section 7 of our Charter of Rights. Sadly, the government's Bill C-7 fails to protect the lives of our most vulnerable. It removes the critical safeguards that the original euthanasia legislation included in response to the Carter decision. Removing those safeguards will have irreversible consequences for those who suffer from mental illnesses like depression.

What is equally disturbing is that the Liberal government has also signalled its intention to extend the so-called “treatment option” to minor children. That would arguably make Canada the most expansive, most liberal, assisted suicide jurisdiction in the world. Clearly we are on the slippery slope many of us warned about. Canadians have a right to conclude that the Liberal government has gone too far and too fast in its zeal to implement and expand the scope of assisted death.

My bill will reverse this momentum and repeal the government's decision to extend MAID to the mentally ill. It will put a full stop to the expansion of assisted suicide to mentally disordered persons. Let me be clear. My bill does not in any way reverse the rest of Canada’s MAID regime. Assisted death will remain available for those suffering from irremediable, incurable and intolerable illnesses and diseases. My bill is simply focused on reversing the government’s actions in expanding assisted suicide to include the mentally ill. It would arrest Canada’s slide into normalizing assisted death as an alternative treatment option, something so many of us had predicted would happen.

The evidence from mental health experts is very clear. Contrary to what our justice minister is now saying, there is absolutely no consensus in Canada that the mentally ill should be covered by Canada’s medically assisted death regime. In fact, here is what experts and other stakeholders in the mental health community are saying. John Maher, psychiatrist with Canadian Mental Health Association, states that:

Inducement to suicide while simultaneously denying mental health care to two-thirds of Canadians who urgently need it is an unconscionable failing.

Directly undermining suicide prevention efforts is an insidious and ablest perversion of our mental health care duty.

Dr Ramona Coelho

Drs. Ramona Coelho and Catherine Ferrier, co-founders of Physicians Together with Vulnerable Canadian, penned a statement that was endorsed by over 1,000 physicians. This is part of what it said, 

“Given that there is no medical evidence to reliably predict which patients with a mental illness will not get better, MAID for mental illness will end the lives of patients who would have recovered…Medicine …would fail in its mission if it were to deliberately end the lives of patients living with mental illness… Legislators must work towards safeguarding the lives of the most vulnerable including those placed at a greater disadvantage because of mental illness.”

Dr Sonu Gaind

Dr. Sonu Gaind, chief of the Department of Psychiatry at Sunnybrook Hospital, Toronto, stated, 

“The Ministers have provided false reassurances that we can somehow separate people who are suicidal from those who are seeking psychiatric euthanasia. That is simply not true. In my opinion, that is dangerous misinformation coming from our federal Minister of Justice and our federal Minister of Mental Health and Addictions providing a false sense of safety that does not exist.”

Trudo Lemmens

Trudo Lemmens, professor and chair in health law at the University of Toronto, said, 

“I urge Parliament to take very seriously how offering MAID for mental illness deprives disabled persons, particularly those with mental illness, from equal protection against premature death. Persons experiencing mental illness deserve to be protected against premature death by an unreserved focus on ensuring access to all required health care and social support services. Facilitating their death does exactly the opposite.”

Sephora Tang

Finally, Sephora Tang, psychiatrist and assistant professor in the Department of Psychiatry at University of Ottawa, said, 

“One cannot prevent suicide while at the same time facilitating it. Placing expectations upon mental health professionals to do both undermines the effective delivery of recovery-oriented mental health care. Canadians deserve to live in a country that is committed to safeguarding the right to life and security of every person. Current MAID legislation fails to achieve this overarching social good.”

Even Canada's justice minister has publicly acknowledged the fact that issues such as irremediability, competency and suicidality are not anywhere close to being resolved to justify such a major policy shift in favour of death. Furthermore, medically assisted death flies in the face of the government’s own promotion of suicide prevention programs, including the recent creation of a national 988 suicide hotline.

It cannot be both ways. It cannot claim, as the Liberal government has, that it wants to prevent suicide deaths on the one hand, when it actively promotes assisted suicide for the mentally ill on the other. Over the last eight years, many of us have expressed our concern and expectation that the Carter decision and Bill C-14 would be expanded by future court decisions, and that these decisions would leave more and more vulnerable populations exposed to the reach of medically assisted suicide.

Our concerns were pooh-poohed. We were accused of fearmongering and of misrepresenting the intentions of this Liberal government. Yet, today, the Truchon decision and the travesty of Bill C-7 bear out our concerns. That is why more and more disability groups have set the alarm bells ringing and are vehemently opposing this legislation. They argue that this legislation amounts to a deadly form of discrimination, making it easier for persons with disabilities to die than to live.

We are hearing more and more reports of the poor and homeless approaching food banks to ask for assisted death, not because they are suffering from a grievous illness but because they do not want to go hungry and homeless. The headline in the British magazine The Spectator asked last year, “Why is Canada euthanising the poor?”

The response from some bioethicists appears to be, “Well, why not?” In fact, a new paper by two bioethicists at the University of Toronto makes the case that euthanizing the poor should be socially acceptable. That is indicative of the path on which our country finds itself. It is terrifying.

We also have verified reports of veterans suffering from PTSD who are being counselled by the Liberal government to consider medical assistance in dying rather than being provided with the treatment and supports they need to recover.
These are the vulnerable that the Liberal government promised to protect. Canadians have the right to ask whether this government is exercising the requisite caution and care to avoid unnecessary overreach and ensure that MAID is not abused or misapplied.

Let me conclude. My private member's bill, Bill C-314 gives all of us parliamentarians an opportunity to take a deep breath and reconsider the perilous road we have embarked upon. As I mentioned, my bill simply reverses the expansion of Canada’s assisted death laws to the mentally ill. At the very least, I would ask my colleagues to allow my bill, at second reading, to go to committee where there could be more discussion.

Have we gone too far and too fast with Canada's assisted suicide program? Will we evolve into a culture of death as the preferred option for those who suffer from mental illness or will we choose life?

I implore my colleagues to choose life. I wish them much wisdom as they make that choice.

Barbara kay: Canada's Death System is Top of the Line

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Barbara Kay

Barbara Kay wrote an excellent opinion column that was published in the National Post on Saturday March 18 titled: Thanks to Trudeau, Canada's death-care system is top of the line.

Kay begins her article by announcing that Ed Fast MP introduced Bill C-314 titled the Mental Health Protection Act which would prevent euthanasia for mental illness alone. She then points out that Senator Stan Kutcher, who was responsible for the amendment to Bill C-7 that extended euthanasia for mental illness alone is arguing against Bill C-314 by stating that the issue is already decided.

• Sign our petition supporting Bill C-314 (Link).

Kay states that with reference to Canada's euthanasia law, slippery slope which conjures up an avalanche is more like a toboggan ride.

Kay continues:

Writing in National Review in the fall, one American commentator called Justin Trudeau “modernity’s Doctor of Death,” whose willed expansion of MAiD makes Canada “arguably the assisted-death capital of the world.” An exaggeration? Consider that California, with the same population as Canada, and universally regarded as a singularly progressive domain, legalized medically assisted death in 2016, just like Canada. In 2021, 486 Californians availed themselves of the program. In the same year, 10,064 Canadians ended their lives with MAiD (a term for euthanasia used only in Canada, and brazenly stolen from palliative care, where it rightly belongs.)

Kay points out how Canada's MAiD law has become an international cautionary tale. A British writer used Canada's euthanasia law as an example bad public policy that is based on "good" intentions. Kay writes:

Canada’s MAiD, “originally marketed as a rational choice for sensible adults and therefore an indisputable moral good, it is now being used to kill the poor and the mentally ill as well as the physically sick and the elderly.”

Kay continues:

Too many reported incidents of MAiD chosen and executed for bad reasons — including credit card debt, poor housing, and difficulties getting medical care — attest to the truth of this criticism. In the legislative pipeline are “advance requests” — and consent by “mature minors.” Be afraid , be very afraid.

Kay then refers to the $86 million in health-care spending savings due to the original euthanasia law, as stated by the parliamentary budget office in October 2020. The budget office estimated, based on the expansions of euthanasia in Bill C-14, that there would be $149 million in health-care savings. 

I estimated that the numbers in the report were low based on several factors. First, I stated that there would be more deaths than predicted. Sadly I was right. Secondly, the shortened time of life was under-estimated by the budget office, meaning many people would die months, if not years before their death would otherwise had been. Sadly I am right.

Kay then writes about the fact that doctors are required to falsify the death certificate:

the medical certificate of death, physicians are obliged to list the illness, disease or disability leading to the request for MAiD as the cause of death, rather than the medications administered, the actual cause.

Kay argues that if euthanasia is a public good, then why the deflection?

Kay concludes:

This deliberate obfuscation is consistent, however, with the honed tactics of boundary-pushing activists whose Dignity-R-Us rhetoric captured the nabobs. Liberals settled on a winning strategy. Don’t make euthanasia a political plank; do use the courts to keep the expansion ball rolling. The fix was always in for expansion of the death as “reasonably foreseeable” guardrails established by the 2015 Carter decision. Thus, the 2019 Quebec Truchon decision that found Carter’s limits to MAiD access unconstitutional went unchallenged by Quebec and Ottawa, in spite of a flawed trial process.

• Canada's Healthcare Savings attributed to euthanasia (Link).
• Study: Legalizing euthanasia saves money (Link).

Canada’s Euthanasia (MAiD) law is the most permissive in the world. How did this happen?

Alex Schadenberg

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In 2015 the Supreme Court of Canada struck down Canada’s laws that protected people from euthanasia and assisted suicide. The case, known as the Carter case, was based on Kay Carter (89), who was not terminally ill but lived with spinal stenosis and died by assisted suicide in Switzerland, and Gloria Taylor, who lived with ALS.

At that time I wrote how the Supreme Court of Canada's decision was irresponsible and dangerous, but the Supreme Court did state that the federal government was to create a “carefully-designed system” with “stringent limits that are scrupulously monitored and enforced.” Clearly, the government ignored that requirement.

In 2016, while the federal government was debating euthanasia Bill C-14, there were many attempts to amend the bill or to define the language in the bill to fulfill the requirement of the Carter decision. The problem with Bill C-14 was evident, the bill gave doctors and nurse practitioners the right in law to cause the death of their patients, without defining the terminology within the law.

For instance, Bill C-14 stated that euthanasia would be restricted to people “whose natural death was deemed reasonably foreseeable.” The government claimed that this phrase would limit euthanasia to terminally ill people but because the phrase was not defined it created confusion.

Based on a lack of definition I predicted that the euthanasia law would expand based on the practise and the law would be interpreted in an expansive manner.

Soon after the passing of Bill C-14 a couple of people with disabilities launched court challenges to the legal requirement that that their “natural death must be deemed reasonably foreseeable.” They argued that it was discrimination to deny euthanasia to someone who is suffering but not terminally ill.

Even though the interpretation of “reasonably foreseeable” had expanded beyond its original interpretation, in September 2019, a Québec lower court struck down the requirement that a person’s death must be “reasonably foreseeable” in the Truchon decision. Even though this was a lower court decision, the federal government did not appeal the decision, thus expanding euthanasia to people who are not terminally ill.

The original law required that a person must have an “irremediable medical condition” combined with that their “natural death being reasonably foreseeable.” By removing the reasonably foreseeable death requirement, euthanasia became available to nearly anyone with a disability or chronic condition.

The federal government “codified” the Truchon decision into the law by passing Bill C-7 in March 2021. Bill C-7 removed from the original law that death must be “reasonable foreseeable” but C-7 also eliminated the 10-day waiting period for people who are terminally ill, it created a 90-day waiting period for those who are not dying and it permitted euthanasia for people with mentally illness. The government declared a two-year moratorium on euthanasia for mental illness, meaning that on March 17, 2023 euthanasia for mental illness could begin. On December 15, 2022 the federal government announced that they will delay the implementation of euthanasia for mental illness alone.

During the C-7 debate, the disability community were adamant that, if passed, it would lead to people with disabilities dying by euthanasia for social reasons. Due to a lack of definition in the law, they predicted that almost everyone with a disability would qualify for death yet the reason people would ask for death may be related to poverty, an inability to receive medical treatment and other social concerns.

Canada has the most permissive law.

In April, 2022; CTV news story reported on a euthanasia death in February 2022 of a 51-year-old woman who had multiple chemical sensitivities (MCS). According to Favaro, the woman was not terminally ill but living with a chronic condition that made her highly sensitive to chemicals and environmental allergies. I stated that this story represented the ultimate form of abandonment whereby this woman was killed not because of an “irremediable medical condition” but because she couldn't afford appropriate housing.

Soon after CTV news reported on a 31-year-old woman with MCS who was also approved to be killed by euthanasia. These reports of euthanasia for MCS created awareness that euthanasia was becoming a “treatment” for people with disabilities who were living with poverty or issues related to housing or other social conditions. The good news was that this story resulted in a GoFundMe campaign that raised money to enable this woman to afford a clean place to live.

Donna Duncan's daughters

CTV news also reported that the euthanasia death of Donna Duncan was being investigated by the Abbotsford police. Duncan (61) was diagnosed with a concussion after a car accident in February 2020. Due to Covid restrictions, Duncan was unable to access medical treatment or rehabilitation. The concussion symptoms led to other health problems as well as deep depression. Duncan was assessed, approved and then died by euthanasia even though her condition was treatable.

After these stories were published, other stories began to be featured by reporters. There have been several stories concerning people who were approved for euthanasia but were unable to access medical treatment. Some of these people with disabilities required treatment for their symptoms and found that getting approved to be killed was easier than accessing treatment. 

Canada had now become the most permissive jurisdiction in the world for euthanasia and the world began to wonder why Canada is euthanizing the poor.

Another powerful story was the Canadian veteran who was seeking treatment for PTSD and a Veteran’s Affairs worker told him that he should apply for “MAiD.” When this story was reported, the Ministry of Veteran’s Affairs stated that it had only happened once. Since then it has been reported that several veterans died by euthanasia and at least 6 veterans were told to apply for “MAiD.”

There was the story of a disabled man who was seeking death by euthanasia to avoid homelessness. He was unable to find a new place to live after the building he was living in was sold. This man relied on a disability benefit and he was unable to find an affordable place to live. He said that he would rather die than become homeless. Thankfully a GoFundMe campaign raised enough money to enable him to find a place to live.

Alan Nichols with his brother

A woman with disabilities died by euthanasia based on inadequate home care, a 23-year-old with diabetes was approved for euthanasia, and the story of Alan Nichols keeps coming back as his family wonders why they killed their brother.

To make matters worse, the Quebec College of Physicians are now urging the federal government to legalize euthanasia for newborns, otherwise known as infanticide.

In a few short years Canada went from legalizing euthanasia for terminal illness, then extending it to people with chronic conditions and disabilities and Canada is now considering euthanasia from "mature minors," newborns, people with dementia and more.

There is only one clear line in the sand, that being, is it acceptable for one group of people to kill other people. By legalizing euthanasia, Canadian doctors and nurse practitioners gained the right in law to kill their patients. Once Canada decided that it was acceptable to kill, the only remaining questions are who can be killed and for what reasons. 

Further reading:

• Supreme Court of Canada Assisted Suicide decision is irresponsible and dangerous (Link).
• Quebec Court expands euthanasia law by striking down the terminal illness requirement. (Link).
• Canada passes Bill C-7 allowing euthanasia for mental illness (Link).
• Canada's law will provide not prevent suicide for some psychiatric patients (Link).
• Euthanasia for mental illness. Killing people with an uncertain prognosis (Link).
• Abbotsford police investigating euthanasia death (Link).
• Canada is not as advertised. Euthanasia is eugenics (Link).
• Canada's euthanasia law is the most permissive in the world (Link).
• (MAiD) euthanasia for disability and poverty (Link).
• (MAiD) euthanasia for mental illness and poverty (Link).
• Veterans affairs worker advocates euthanasia for PTSD (Link).\
• Abandoning people. Canada's broadening euthanasia laws (Link).
• Mother wants to stop 23-year-old son from dying by euthanasia (Link).
• Bereaved mother speaks out against euthanasia (Link).
• Woman died by euthanasia because of inadequate home care (Link).
• Infant euthanasia proposed by Quebec College of Physicians (Link).
• How poverty not pain is driving people with disabilities to euthanasia (Link).
• Ontario man seeks euthanasia to avoid homelessness (Link).
• Why did they kill my brother? (Link).
• Canada's doctors offer euthanasia before receiving a request (Link).
• Food bank clients asking for euthanasia based on poverty (Link).
• No other options. An expose on euthanasia in Canada (Link).
• Poverty and euthanasia creates public interest but euthanasia is abhorent on its own (Link).

No clear guidelines in report concerning MAiD (euthanasia) for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Final Report of the Expert Panel on MAiD and Mental Illness was submitted to Canada's Minister of Health, Jean-Yves Duclos and Justice Minsiter, David Lametti on May 6, 2022.

Similar to previous "expert" reports the Expert Panel offers recommendations but few clear guidelines.

Canada legalized euthanasia and assisted suicide under the term Medical Aid in Dying (MAiD) when the government passed Bill C-14 in June 2016. Previous to that, the Supreme Court of Canada struck down protections in Canadian law that prohibited euthanasia and assisted suicide in its Carter decision and euthanasia became legal in Québec in December 2015 with the implementation of Bill 52.

In March 2021, the Canadian govenment passed Bill C-7 which expanded the MAiD law by permitting euthanasia for people who are not dying, by eliminating the 10 day waiting period for people who are terminally ill, by permitting euthanasia for incompetent people who were previously approved for MAiD and at the last minute, Bill C-7 was amended to permit euthanasia for people with mental illness.

When passing Bill C-7 the government acknowledged that euthanasia for mental illness was different than other forms of MAiD, so they stated that their would be a two year moratorium on MAiD for mental illness providing time to develop guidelines around the killing. I believe the two-year moratorium is unenforceable making euthanasia for mental illness legal already.

The Euthanasia Prevention Coalition opposes MAiD. We oppose giving doctors and nurses the right in law to kill people. But considering that the recommentations from the "Expert" Panel on MAiD and Mental Illness concern guidelines for killing people with mental illness, one would think that the guidelines would offer fixed rules and yet the 19 recommendations for implementing MAiD for mental illness, lack clarity on key recommendations.

For instance, recommendation 2 concerning: Establishing Incurability, states

MAiD assessors should establish incurability with reference to treatment attempts made up to that point, outcomes of those treatments, and severity and duration of illness, disease or disability.

It is not possible to provide fixed rules for how many treatment attempts, how many kinds of treatments, and over what period of time as this will vary according to the nature and severity of medical conditions the person has and their overall health status. This must be assessed on a case-by-case basis.

The Panel is of the view that the requester and assessors must come to a shared understanding that the person has a serious and incurable illness, disease or disability. As with many chronic conditions, the incurability of a mental disorder cannot be established in the absence of multiple attempts at interventions with therapeutic aims.

Incurability is a requirement in Canada's MAiD law, and yet the Expert Panel has stated that it is not possible to provide fixed rules concerning treatment.

In the Netherlands, a person requesting euthanasia for mental illness must be willing to try effective treatment. This is not an onerous request considering that the person is requesting to be killed.

Similarly, the Expert Panel deals with recommendation 3 concerning: Establishing Irreversibility in the same manner. It states:

MAiD assessors should establish irreversibility with reference to interventions tried that are designed to improve function, including: recognized rehabilitative and supportive measures that have been tried up to that point, outcomes of those interventions, and the duration of decline.

It is not possible to provide fixed rules for how many attempts at interventions, how many types of interventions, and over how much time, as this will vary according to a requester’s baseline function as well as life goals. Therefore, this must be assessed on a case-by-case basis.

The Panel is of the view that the requester and assessors must come to a shared understanding that the person is in an advanced state of irreversible decline in capability.

Once again, Canada's MAiD law requires that the person's condition be irreversible and yet the Expert Panel states that it is not possible to provide fixed rules.

I am concerned that the current Special Joint Committee on Medical Assistance in Dying will also follow the same direction of this Expert Panel, by offering recommendations but few clear lines.

The Special Joint Committee on Medical Assistance in Dying (AMAD) is composed of Senators and MPs who are to study and make recommendations concerning:

1. MAiD for mature minors,
2. Advance directives for MAiD,
3. Regulations for Psychiatric MAiD once the C7 sunset clause is lifted March 2023,
4. The state of palliative care in Canada (was required as part of the 5 year review after C-14 but never completed),
5. Protections for persons with disabilities.

The mandate of the Special Joint Committee appears oriented to expanding MAiD in Canada.

The Expert Panel made some good recommendations, such as suggesting that assessments be done by independent experts, increasing the reporting requirements, providing income or housing support where necessary, having consultations with First Nations, Métis, and Inuit peoples, nonetheless, some of these recommendations are too little or too late a response.

People have been lethally injected for loneliness, depression, poverty, chemical sensitivities, fear of isolation and more.

The Expert Panel appears to be attempting to improve Canada's MAiD law while in reality the fundamental recommendations include no fixed rules.

Remember, the law only requires that a physician or nurse be of the opinion that the person fits the criteria of the law. Therefore, the Report of the Expert Panel on MAiD for Mental illness does not provide any assurances that people who are living with suicidal ideation will not die by euthanasia.

Sadly, Canada legalized euthanasia by giving doctors and nurses the right in law to kill their patients. It only requires that the assessors and the practitioner who lethally injects their patient be only of the opinion that the person, who they killed fit the criteria of the law.

Canada has now expanded the killing to people with mental illness alone and this "Expert Panel" suggests that the killing be done without clear rules.

When will people wake up and realize that killing people is not a solution?

More articles on this topic:

• The truly awful cost of Canada's assisted death program (Link).
• Abbotsford police investigating euthanasia death (Link).
• Euthanasia for mental illness. Killing people without a certain prognosis (Link)
• Profound social change with euthanasia for mental illness (Link).
• Article supporting euthanasia for mental illness provides excellent argument against euthanasia (Link).
• New euthanasia rules put psychiatrists into an impossible position (Link).
• The complexity of assessing mental health and capacity (Link).

Canada: Euthanasia is promoted while caring options are not readily available.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr John Maher

Dr John Maher, who is a leading psychiatrist and editor-in-chief, of the prestigous Journal of Ethics in Mental Health wrote an excellent analysis of the current euthanasia (MAiD) practise in Canada that was published in the Hamilton Spectator on January 4. Maher examines the current situation through the lens of how Canada got into this situation. Maher writes:

Step 1: Supreme Court Carter decision (2015): Some Canadians with progressively debilitating terminal diseases (like ALS) said they were forced to end their own lives sooner than they would wish because as their disease progressed they wouldn’t be able to physically end their own lives. If physically unable to complete suicide themselves, the Supreme Court said a doctor could assist in order to help preserve extra months of life.

Step 2: Bill C-14 (June 2016): Despite the very narrow focus in the Carter decision the federal government opened the door for a physician assisted death for anyone whose death is “reasonably foreseeable” (terminal). In 2021, three per cent of all deaths in Canada were through MAID. Counter to the Supreme Court’s stated principle to preserve length of life, people are now dying by MAID who could have lived longer, and very comfortably, if only palliative care were available. Only 30 per cent of Canadians have access to basic palliative care and fewer than 15 per cent have access to specialist palliative care. Oddly, the universal provision of MAID across Canada was added as a mandatory requirement within the purview of the Canada Health Act while the universal provision of palliative care never has been.

Step 3: Truchon decision (2019): In a lower court in Quebec one judge said MAID should be available to those who were not terminally ill. This egregiously violated the Supreme Court’s principle to preserve life. Some Canadians with disabilities are now pressured within a stigmatized system to choose MAID when they could live decades longer if only disability supports were universally funded.

Step 4: Bill C-7 (March 2021): 7 million Canadians have disabilities, 44 per cent of Canadians over age 20 have a chronic illness (16 million people) and 50 per cent of all Canadians have, or have had, a mental illness by age 40 (19 million people). Millions of nonterminally ill Canadians can qualify for MAID under Bill C-7. There are approximately 100,000 doctors/NPs in Canada. How do you prevent the kind of abuse we have seen in the three European countries that allow nonterminal MAID?

Maher continues by stating that Bill C-7, that was passed in March 2021, blindsided mental health experts, as the approval of euthanasia for mental illness alone was added only a month before the bill went to a final vote, which was after the consultations were already completed. He then states:

Unlike physical illnesses, in psychiatry you can’t predict who will get better over what period of time, or who might have (in the legal language of the bill) “irremediable” suffering. How do you offer death when it is impossible to know if someone will get better and live a long life without further suffering?

He states that only one in three Canadians who need mental health care have access to it and yet they can offer death to people who are denied treatment.

He concludes by acknowledging that Charter Rights have been contravened:

My right to life as guaranteed in the Charter of Rights is contravened by a government that won’t provide universal palliative care, disability supports or mental health care. And we know why. It’s cheaper. It’s also morally bankrupt.

Previous articles by Dr John Maher:

• Standing firm against assisted suicide (Link).
• Psychiatrist and disability leaders react to Canada's expansion of euthanasia (Link).
• Going over the Falls with euthanasia (Link).
• Euthanasia for mental illness - Myth and Facts (Link).

Canada's New Law Will Provide, Not Prevent, Suicide for Some Psychiatric Patients

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Mark Komrad

The renowned psychiatrist and ethicist, Dr Mark Komrad, his latest article was published by the Psychiatric Times on June 1: Oh, Canada! Your New Law Will Provide, Not Prevent, Suicide for Some Psychiatric Patients. 

Komrad, who is well known for his opposition to psychiatric euthanasia, analyses how euthanasia for people with mental illness affects psychiatry.

Komrad comments on the laws in Belgium, the Netherlands and Luxembourg (Benelux countries) that permit euthanasia and assisted suicide for people with physical and psychological suffering. The term psychological suffering has led to approximately 200 people per year dying by euthanasia based on a psychological condition.

He then compares the Benelux countries acceptance of euthanasia for psychiatric reasons to the American Psychiatric Association position statement from 2016 which states:

“A psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”

Psychiatrists traditionally have done all they could to prevent suicide. Should they really facilitate it instead?

Komrad then comments on the Canadian developments which began with the passing of Bill C-14 in June 2016 and now to the passing of Bill C-7 on March 17, 2021. He states:

Initially, Bill C-7 clearly excluded psychiatric disorders, as it did in the original C-14 law. However, there was ambiguity in this proscription, because psychological suffering (which is not defined in either legislation) continued to be a criterion for eligibility. In addition, many protested that such an exclusion discriminated against those with mental illnesses. The Canadian Psychiatric Association (CPA) was one such voice, declaring broadly that, in the interest of parity: “Patients with a psychiatric illness should not be discriminated against solely on the basis of their disability, and should have available the same options regarding MAID as available to all patients.”

This led to a dramatic turn of events in the (unelected) Canadian Senate when it considered Bill C-7 in February 2021. In an unprecedented move, Senator Stan Kutcher, MD, who is also a psychiatrist, declared that the exclusion of individuals with psychiatric disabilities would be discriminatory. He introduced an amendment that would allow MAID for mental illness 18 months following the passing of the bill. When the modified legislation was returned to the House of Commons, discussions were shut down after 3 hours by a liberal coalition and the bloc party from Quebec (a province that has promoted euthanasia and aimed to restrict conscientious objection to euthanasia by health care professionals). As a result, the vote was forced and, on March 17, 2021, the C-7 expansion of euthanasia in Canada became the law of the land complete with a last-minute amendment to sunset the mental illness exclusion after 2 years.

Komrad comments on the expert panel that over next two years will establish standards for evaluating patients and procedures to distinguish between those patients with psychiatric disorders whose suicide should be prevented and those for whom it should be provided. Komrad quotes me as stating:

“there isn’t a prosecutor in the land who would prosecute someone for doing euthanasia for mental illness before the 24-month time frame has passed because it is technically legal.”

Komrad emphasizes that legalizing euthanasia for mental illness is a serious change. He points out that many psychiatrists in Canada are deeply concerned by the recent developments. In the face of Bill C-7, the psychiatrist editor of the Journal of Ethics in Mental Health reported:

A few days ago, a 30-year-old patient with very treatable mental illness asked me to end her life. Her distraught parents came to the appointment with her because they were afraid that I might support her request and that they would be helpless to do anything about it. It’s horrific they have to worry that by going to a psychiatrist, their daughter might be killed by that very psychiatrist.

Komrad also shows how the Canadian law may become far more permissive than the euthanasia laws in Belgium and the Netherlands he states:

Moreover, as with C-14, there is no requirement that additional, evidenced-based treatments be implemented, although patients are urged to give all treatments serious consideration Yet, despite its liberal approach, Belgium recently established a requirement that individuals applying for euthanasia due to a mental disorder must not have refused any evidenced-based treatments.

Komrad ends his article by stating:

The American Medical Association has repeatedly concluded that MAID practices are “fundamentally incompatible with the physician’s role as a healer,” and the World Medical Association “is firmly opposed to euthanasia and assisted suicide.” Nevertheless, these laws have been adopted around the world, most recently in Victoria Australia, New Zealand, Spain, and Portugal. In US states, there have been attempts to expand initially strict criteria and practices. The justifications for euthanasia and assisted suicide (eg, autonomy, self-determination, intolerable suffering, and irremediability) are now being applied to psychiatric disorders, despite lack of any widespread agreement that treatments for psychiatric disorders are ever futile.

Concluding Thoughts

Bill C-7 and similar laws would represent a terrible shift in the deep ethos of psychiatry. Psychiatrists would have to decide which suicides should be prevented and which should be abetted.

More articles on this topic:

• Canada passes Bill C-7 permitting euthanasia for mental illness alone (Link).
• Lack of evidence surrounding euthanasia for mental illness (Link). 
• Euthanasia for mental illness ignores safeguards for vulnerable people (Link).
• Trudeau government will permit euthanasia for mental illness alone (Link).