Update: Alberta MAID deaths up 34.5%

Update to Alberta's MAID deaths for FY April 1 2022 to March 31 2023. I now have the total number of killings at 1,309, up from 973 in 2021/2022. That's an increase of 34.5% deaths.

Alberta euthanasia costs up 33% in 2022-2023

I received the dollars spent on euthanasia in Alberta for 2022-2023. Total cost was $1,055,399.10. That's an increase of 32.56% over dollars spent in 2021-2022 ($796,166.00).

2022 and 2023 euthanasia deaths haven't been reported yet by Stats Canada.

Cheap to kill people in British Columbia

The document I received through an FOI for MAID deaths in BC. 

Deaths from 2017 to 2021 is 6,510 according to Canada's official MAID deaths and from the document I received. Official numbers only report until 2021. What I received from BC, also reports dollars spent up until April 30, 2023 on MAID. Therefore I assume that is one extra year of dollars spent. Total dollars spent is $8,665,735.

If we assume at least another 2 to 3 thousand additional killings for 2022 (since the numbers increase every year), that would be at least a total of 8,510 deaths at a cost of $8,665,735. Or about $1000/death. That sounds a whole lot cheaper than keeping sick/disabled/poverty stricken people alive.

How the Ontario government hides costs spent on MAID

My recent FOI request to the Ontario Ministry of Health:

"Can you then please provide me with the fee codes that doctors are being told to use for MAID services...I would like to see whatever guide/memo/documentation that exists to inform doctors to appropriately bill for MAID services."

I received a Quick Reference Guide called OHIP Payments for Medical Assistance in Dying (MAID). (You won't find this document on the internet. I looked.)

Good grief--the Ontario government is telling doctors to use Palliative Care billing codes when they kill their patients:

"Procedural Planning and Case Management - K023 Palliative Care Support

• Discussions with other health care providers (e.g., physicians, pharmacist, coroner, CCAC) involved in management of the patient’s MAID

•Minimum of 20 minutes (cumulative) in a day of procedural planning/case management activity

• Medical record must indicate the name(s) of health care providers and the start and stop times

Provision of Medical Assistance in Dying - K023 Palliative Care Support

• Travel time for picking up and returning drugs used for the procedure

• Time spent with patient and family obtaining final consent

• Drug administration

• Pronouncement and certification of death

• Counselling of relatives

• Meeting reporting requirements

• Notification of the coroner’s office

• A maximum of two physicians are eligible to be paid K023 for the provision of medical assistance in dying.

K023 claims for procedural planning, case management, the provision of MAID and travel to patient’s home should be flagged to indicate patient encounter is for the provision of MAID. For these services, patient does not need to be palliative. (But they are using a code for palliative care and it doesn't have to be palliative care?)

Then this:

"If administration of the fatal dose of medication is by intravenous (IV), then G379 can be billed for insertion of the IV." (The charade continues.)

And this:

"A945 Special palliative care consultation is billed and time requirements are met (e.g., K023 is eligible for payment with A945 when duration of the consult exceeds 50 minutes)."

If you look at the Schedule of Benefits Physician Services Under the Health Insurance Act, nowhere does it say to use any of these codes for MAID. In fact MAID is never even mentioned at all in this 990 page document. Clearly a separate (hidden) document had to be created to guide doctors how to bill OHIP when they euthanize their patients. At least Quebec and Alberta don't hide their costs to kill patients. 

So this is really a double cover up: 1) no accurate costs of the dollars spent to kill patients, and 2) inflate the dollars spent on Palliative Care.

The adjective wicked comes to mind.

There is no need to be close to death to get MAID

Dr. Stefanie Green, President, Canadian Association of MAID Assessors and Providers wrote this letter to the National Post on June 7

Take on MAID disingenuous

Jun 7, 2023

Re: Third of Canadians back MAID for poor: poll — Tristin Hopper, May 18; Killing ourselves in Canada — Colby Cosh, May 20; and How to not euthanize the homeless — Chris Selley, May 2

A recent Research Co. poll asked Canadians for their views on the Medical Assistance in Dying (MAID) program.

Poll analyses by the National Post’s Tristin Hopper, Colby Cosh and Chris Selley unfortunately created an exaggerated and disingenuous narrative over Canadians’ attitudes over the possibility of choosing MAID due to catastrophic societal failures, such as poverty and homelessness.

The current state of Canada’s MAID law is clear — a Canadian who lives in poverty or is homeless is not eligible for MAID as a result of such unacceptable social inequities. While these factors may indeed contribute to a person’s suffering, the law does not allow access to MAID based on these factors alone. There is an extremely rigorous process in place whereby multiple eligibility criteria and procedural safeguards must all be met before anyone in Canada can proceed with MAID.

As subject matter experts, and as the national association representing Canada’s health-care practitioners of MAID, providing support, education and training on all aspects of MAID, the Canadian Association of MAID Assessors and Providers (CAMAP) does not support any individual’s ability to access MAID based simply on a person’s economic situation or living condition.

Dr. Stefanie Green, President, Canadian Association of MAID Assessors and Providers

---------------------------------------------------------------------------------------------------------------------------------

Dr Catherine Ferrier MD, Montreal responded on Jun 14, 2023

"Re: Take on MAID disingenuous — Dr. Stefanie Green, Letter to the editor, June 7

Dr. Stefanie Green calls several National Post columnists disingenuous for expressing concerns about Canadians requesting MAID for poverty, homelessness and other social problems.

Dr. Green knows perfectly well that, contrary to her claim of an “extremely rigorous process,” the Canadian law is so broad that anyone with a serious chronic illness or disability is eligible for MAID, regardless of whether that is their reason for requesting it. There is no need to be close to death and no need to have tried other options to relieve suffering, or even have them available.

The 10-day waiting period for people close to death was eliminated in 2021, and the 90-day delay for other people still makes it easier to obtain MAID than to see a specialist in many parts of Canada.

Amir Farsoud stated on CBC’S The Fifth Estate that he was approved for MAID on the basis of his chronic back pain, but requested it because he could not find housing he could afford on his disability pension. Alan Nichols, whose case was documented in the National Post, died through MAID for an official diagnosis of hearing loss, which was not his real reason either.

The Canadian Association of MAID Assessors and Providers (CAMAP), of which Dr. Green is the president, is well aware that poverty drives many MAID requests. An article by Alexander Raikin in the New Atlantis in December 2022 quoted from many CAMAP seminars discussing exactly this issue.

There are reasons why Canada has the highest MAID rates in the world after only seven years, and why over 10,000 Canadians died through MAID in 2021, compared with 486 through assisted suicide in California, which has a similar population to ours, and legalized assisted death the same year."

Well said Dr Ferrier, and thank you for calling out Dr. Green.

Then this letter on June 17 from Dr. Richard R. J. Smyth:

Re: Take on MAID disingenuous — Dr. Stefanie Green, June 7; and Poor seeking MAID — Dr. Catherine Ferrier, June 14

Dr. Stefanie Green, the president of the Canadian Association of MAID Assessors and Providers, defends her institution from a precarious position. She attempts to console us by saying that reporters, who write about well-documented cases of euthanasia occurring in response to impoverished social circumstances and inadequate services, are misleading us.

It is worth recalling that Jean Truchon himself, whose case eradicated the “reasonably foreseeable natural death” safeguard, confessed that he may not have sought MAID had he been able to access better care.

But Green’s own position is undermined by something far more serious than an unlikely bias in reporting. The very name of her organization tells us that the assessors and providers of MAID are the same persons: they are judge, jury and executioner. As a result, mistaken and unalterable determinations as to eligibility for death will continue to be made, no matter how “rigorous” the criteria. No doubt she will say this is an exaggeration, too, but in truth she presides over a monumental failure of fundamental justice.

Dr. Richard R. J. Smyth, Thompson Rivers University; University of British Columbia, (retired)

Costs to euthanize Alberta citizens in 2021-2022

Alberta's MAID costs and billing codes below for 2021-2022 fiscal year.

Alberta and Quebec don't hide their patient execution costs unlike Ontario. Is it even remotely possible that Ontario is ashamed of MAID and so they want to keep it secret?

Ontario hides tax dollars used to euthanize citizens

We now know that Quebec paid almost $6 million dollars in 2022 to euthanize citizens.

I asked Ontario for the same information:

"Can you please provide me with all information relating to the payments made to health professionals in providing Medical Aid in Dying (MAID) to patients. I am looking for the total fees paid to these providers, for their MAID services (ie for MAID consults, counseling, injecting the drugs, etc). I understand that MAID is not put on death certificates, so I would like to understand how health professionals are paid for these services, since usually there are doctor's billing codes associated with all services. How are the health professionals paid for MAID services? Time Period: June 1, 2016 to April 30, 2023"

 

So what does Ontario do? They hide the fees paid. Doesn't surprise me. They also hid abortion numbers until we were forced to take them to court. And won.

Here is the response I received from Ontario:

"This is to inform you that no responsive records were located.  A reasonable search of the Strategic Policy, Planning & French Language Services and The Ontario Health Insurance Plan was conducted, and no responsive records were found. Greg Hein, Assistant Deputy Minister, Strategic Policy, Planning & French Language Services is responsible for this decision. 

 

Physicians

 

The Ontario Health Insurance Plan (OHIP) Schedule of Benefits for Physician Services (‘the Schedule’) does not include fee codes exclusive for the provision of Medical Assistance in Dying (MAID); rather, the services related to MAID are eligible for payment through existing OHIP fee codes for insured services.

 

As such, there is no way to determine, using the OHIP claims data, specific MAID patients and/or the payments made to physicians in providing MAID services to these patients.

 

Nurse Practitioners (NPs)

 

NPs are provided a salary to provide comprehensive patient care, and MAID services are considered part of the comprehensive basket of services that NPs may provide to patients.

 

The ministry does not receive information on the portion of an NP’s salary that is allocated for the provision of MAID services from the health service providers that employ them.

 

Pharmacists

 

The ministry does not compensate pharmacists for the provision of MAID-related services (e.g., dispensing MAID drugs).  Drugs used for the provision of MAID are reimbursed by the ministry according to the amounts specified in this Notice from the Executive Officer. 

 

The total amounts reimbursed referenced in the notice refer to the maximum amount that may be reimbursed for each specific type of MAID kit. Where appropriate, a lower total amount is to be claimed in situations where a prescription does not require one or more of the drugs or components in the kit. The lower amount claimed by pharmacists is the acquisition cost of the drugs within the kit that are dispensed.

 

Other Providers

 

The ministry does not receive information from health service providers on the proportion of salary or fees otherwise paid to health care professionals in their employ (e.g., nurses) for MAID services."

At least Quebec will tell us how much they spend to kill people. Ontario hides it.

Costs to euthanize Quebec citizens in 2022

My Freedom of Information request to the Quebec government on the tragedy of euthanasia: 

"Can you please provide me with all information relating to the payments made to health professionals in providing Medical Aid in Dying (MAID) to patients. I am looking for the total fees paid to these providers, for their MAID services (ie for MAID consults, counseling, injecting the drugs, etc)"

The first document below is what I received back in French. I used Google Translate to provide the English translations of the descriptions, and posted them below the French. Total cost of MAID was $5,880,162. That's nearly $6 million dollars to euthanize Quebec citizens.

Imagine instead of killing these people, we spent that money on helping them with their poverty, their mental illness, their pain, and their suffering? Isn't that what a caring society is supposed to do?

Stop normalizing suicide as a solution to suffering

"ARPA Canada urges the government to stop and reverse the expansion of MAiD. Canada already has one of the most permissive euthanasia regimes in the world. Canada has utterly failed to protect vulnerable Canadians. Instead, we have taken a fast track to devaluing the lives of the sick and disabled and to normalizing suicide as a solution to suffering."

Dear Mona Fortier,

Please read this excellent press release from ARPA, regarding expanding euthanasia to minors.

On the one hand we say we are against suicide. On the other hand, we support suicide with MAID. You can't have it both ways.

As my representative in Parliament I am asking you to not support any expansions to this deadly policy.

I am also asking that you support some real concrete, tangible, and measurable improvements to both palliative care and mental health supports for Canadians. I know people in both these categories who would greatly benefit from these improvements, especially since they are unable to get these kinds of help now. But they can get MAID. 

It is both a tragedy and unethical that we allow and promote MAID instead of providing actual care to people who need it.

Thank you.

Sincerely,

Patricia Maloney

Ottawa

3,985 MAID deaths in Ontario

Medical Aid in Dying deaths as of Oct. 31, 2019

What a tragedy all these deaths are.

The youngest person put to death was 22 years old.

Statistics as of October 31, 2019:
• Total number of cases completed in Ontario: 3,985

• Type:
– Clinician-administered: 3,984
– Patient-administered: 1

• Setting of death:
– Hospital: 47%
– Private Residence: 43%
– LTC Facility/Nursing Home: 5%
– Retirement Home/Seniors Residence/Other: 5%

• Number of Unique MAiD Providers:
– Clinicians: 480
– Physicians: 446
– Nurse Practitioners: 34
– Hospitals: 134

• Sex:
– Female: 50%
– Male: 50%
• Age:
– Average Age: 75
– Youngest: 22
– Oldest: 106
• Underlying conditions:
– Cancer-Related: 63%
– Circulatory/Respiratory: 17%
– Neurodegenerative: 11%
– Other: 9%
• Total number of cases with organ donation: 30

The report also breaks down the numbers by county.

Data provided by the Office of the Chief Coroner/Ontario Forensic Pathology.

Assisted death involves a doctor along with the patient

Shanaaz Gokool, CEO of Dying With Dignity Canada, and Richard W. Ivey, chair of Dying With Dignity Canada’s Patrons Council agree with medical assisted death, or more correctly called, euthanasia.

They wrote a letter to the National Post saying this, in reply to Barbara Kay's article where Kay discusses the need for palliative care.

I responded to Gokool and Ivey's letter with my own letter published today in the National Post.

National Post 4 Apr 2018 Patricia Maloney, Ottawa

Re: Choosing how we die. Letter to the editor, March 31 

I am strongly opposed to medical assistance in dying, but that’s not the point I want to make. 

When discussing medical assistance in dying, Shanaaz Gokool and Richard W. Ivey are being disingenuous. They state: “We don’t get to decide for others; they don’t get to decide for us.” 

Technically I agree with that statement as it stands. Clearly, if someone wishes to commit suicide, they decide this for themselves and I can’t decide for them. 

What I have a problem with is that by definition, assisted suicide is much more. It involves a doctor. A doctor who is against medical assistance in dying must still refer that patient. 

So the “decide” above is actually deciding for someone else: the doctor. And this I cannot agree with.

Sincerely,
Patricia Maloney 

How the defeat of Cassie and Molly’s Law could endanger abortion

by Barbara Maloney

Cathay Wagantall’s Private Members Bill C-225 (Cassie and Molly’s Law) was defeatedby a wide margin (209 to 76) in the House of Commons last week. This means the bill will not be sent to a committee for study and is now dead.

Bill C-225 would have allowed charges to be laid for harming or causing the death of a preborn child while committing a criminal offence against a pregnant woman. Such a law would act as a strong deterrent to committing violent acts against pregnant women, increasing the chances she and her baby could make it safely through her pregnancy. It was a compassionate and common sense response to an all too common problem.

Not a single MP from any party other than the Conservatives voted for the bill. This suggests the vote may have been whipped by leaders of the Liberals, the NDP, and the Bloc, which is odd since Prime Minister Justin Trudeau and the other party leaders have repeatedly argued in favour of women’s reproductive choice. Bill C-225 would have strengthened reproductive choice for women by making it a criminal offence for a third party to intentionally kill a pregnant woman’s fetus (thus terminating her pregnancy) while committing a criminal offence against her – a pregnancy termination to which she clearly did not consent. We are talking here about someone who attacks a woman and takes away her choice by ending the life of the child who otherwise would have been born alive. Nothing could undermine women’s reproductive choice more than that.

My MP, Chandra Arya (Liberal) wrote to me last month saying that he would not be supporting the bill. I had seen comments from other Liberal MPs as well. No doubt, the Liberal MPs were given a set of talking points to use to try to defend their opposition to C-225. But their arguments don’t stand up to scrutiny, which suggests something else was behind their opposition to the bill, as I explain below.

Criticism: C-225 doesn’t address the broader issue of gender-based violence

The Liberal government criticized the bill for failing “to address the broader issue of violence against women.” But why would any MP not support a law that at least partially addresses the problem? No bill ever completely addresses an issue, and so why should C-225 be held to a higher standard than any other bill?

Mr. Arya also told me that “Our government believes that gender-based violence has no place in our society, and we are committed to developing and implementing a comprehensive federal strategy against gender-based violence.” That’s great, and bill C-225 could have been one important part of such a comprehensive strategy. Voting for this bill in no way would have precluded the government from enacting further laws and policies that address gender-based violence. Pregnant women are sometimes attacked precisely because they are pregnant. Cassie and Molly’s Law would act to deter such violence, given the stiff penalties in the bill for purposely causing the death of the woman’s unborn child.

Criticism: C-225 might be challenged under the Charter

My MP also told me the bill “would likely be challenged under the Charter.” Yet, as far as I’m aware, there has been no credible legal opinion by any reputable lawyer arguing that the bill violates the Charter. On the contrary, renowned constitutional expert Eugene Meehan has provided a legal opinion, posted on Cathay Wagantall’s website, defending the constitutionality of the new offences created in the bill.

Most Liberal MPs voted in favour of the government’s bill C-14, Medical Assistance in Dying, even though several lawyers were of the opinion it was unconstitutional. So if the Liberal MPs were not deterred by the constitutional concerns regarding C-14, it is incredible that constitutional concerns were behind their opposition to Cassie and Molly’s Law.

What was the real reason for opposing C-225?

Given C-225 respects the constitution, including the Charter; given it is one concrete way that MPs can help tackle gender-based violence which they claim they want to do; and given it is supported by amajority of Canadians, it seems that MPs’ opposition to this bill stemmed from something else – something they may not have been even consciously aware of.

Which brings us to the issue of abortion.

Fear that C-225 could reopen the abortion debate

My MP told me that this bill could “reopen the abortion debate.” This bill and the abortion issue do have something in common – they both deal with pregnant women and preborn children. But anyone who is truly pro-choice ought to recognize the difference between an abortion which a woman freely chooses, and a situation where a woman has not chosen abortion and is violently attacked by a third-party who wants to kill her and/or her baby and unilaterally takes away her choice to bring her child safely to term.

So how do we account for supposedly pro-choice MPs voting against a bill that would have made it a crime to forcefully end a woman’s pregnancy against her will? Why did these MPs ignore the significant role that the woman’s free choice plays in differentiating C-225 from abortion? Are these MPs not pro-choice after all, but rather pro-abortion, even pro-forced abortion?

I don’t believe so – I don’t believe a majority of our MPs voted against C-225 because they actually believe that a dead fetus is better than a live fetus.

The only remaining explanation is that they voted against C-225 out of fear of what it would mean for abortion if we recognized in law that it can sometimes be wrong to kill a preborn child. They would have been asking themselves, even if only at an unconscious level: if it is wrong to kill a fetus during a brutal attack on a woman against her will, how can we justify abortion, which also kills a fetus?

But as MikeSchouten writing in the National Post points out, there would be no reason for anyone who is pro-choice to fear that C-225 would endanger abortion if they actually believed in their own pro-choice rhetoric: that a woman’s freedom to choose is enough to justify abortion (that is, that the choice of the woman trumps the life of the fetus.)

The defeat of C-225 was in essence, then, a sign that a majority of our MPs do not believe that freedom of choice, in and of itself, can justify abortion. A majority of our MPs could not get past focusing on how C-225 and abortion are alike (preborn child’s death), rather than how they differ (woman’s choice). It was apparently easier for our MPs to deny that it can ever be wrong to kill a fetus – and vote against C-225 – than to be put into the uncomfortable position of having to justify why abortion is not wrong. They are apparently only able to defend abortion if they deny there is any inherent value in the life of a preborn child. They would have had the confidence to defend abortion if they truly believed deep down that the choice of the woman trumps the life of the fetus.

Thus in defeating C-225 for fear it could endanger abortion, our Members of Parliament ended up revealing a lack of confidence in their own ability to defend abortion. If even our supposedly staunch “pro-choice” MPs feel so ill-quipped to defend abortion, then what kind of message does that send about the acceptability of abortion? C-225 itself could never have endangered abortion. The irony is the MPs who opposed the bill might end up doing just that.

The Carter decision and what it says

What does Carter really say about terminal illness?

by Barbara Maloney

The federal government’s Bill C-14 has been loudly criticized for limiting “medical assistance in dying” (MAID) to those whose death is “reasonably foreseeable.” Critics say that in Carter the Supreme Court did not limit “physician-assisted death” (PAD) to those with a terminal illness and to do so in C-14 is unconstitutional. They point out that Kay Carter, mother of one of the plaintiffs, was not terminally ill and so would not qualify for MAID under Bill C-14.

However, importantly, the Supreme Court was silent on whether Kay Carter would have qualified for PAD.

That’s because Kay Carter’s right to seek PAD was not at issue in Carter. Gloria Taylor’s right was. The court expressly stated it was pronouncing only on the rights of Ms. Taylor and “people like Ms. Taylor” and only in the “factual circumstances in this case. We make no pronouncement on other situations where physician-assisted dying may be sought.”¹

And Ms. Taylor did have a terminal illness.

(Kay Carter’s daughter, Lee Carter, challenged the law prohibiting assisted suicide as a violation of her right to liberty, it putting her at risk of criminal prosecution for assisting in someone else’s suicide. The Supreme Court did not deal with this issue but confined its decision “to the rights of those who seek assistance in dying, rather than of those who might provide such assistance.”² )

Consequently, whether or not Kay Carter would be eligible for MAID under bill C-14 is irrelevant to a discussion of the bill’s constitutionality.

What is relevant is whether or not the Supreme Court intended that PAD must be available to those who were not “terminally ill” / at the “end of life” (however imprecise those terms may be). While the court did not explicitly state that PAD may be restricted to those with a terminal condition, it is reasonable to conclude that the court implied this, based on the trial judge’s ethical analysis of PAD. The trial judgment is of particular relevance because the Supreme Court relied on it so heavily and unequivocally affirmed it.

The trial judge, Justice Smith, said that a central question in this case “is whether it is ethical for physicians to provide [PAD].”³ The ethical debate is relevant, she said, because “both legal and constitutional principles are derived from and shaped by societal values.”⁴

Her lengthy ethical analysis was based on a comparison between PAD and existing end-of-life practices which are lawful, such as withdrawal or refusal of life-sustaining /life-saving treatments. She was persuaded by the ethicists who said there is “no ethical distinction” between PAD and these other “end-of-life practices whose outcome is highly likely to be death.”⁵ 

It is important to note that Justice Smith’s ethical analysis involved only a category of people who would, without treatment, die. In short, her ethical analysis and the analogy she relies on are only applicable to people at or near the “end of life.” One cannot, therefore, assume that Justice Smith (or the Supreme Court) would have applied the same ethical analysis or arrived at the same conclusion with respect to people who were not terminally ill.

It is entirely reasonable to assume that the Supreme Court was considering only that category of patients whom Justice Smith was considering in her ethical analysis, that is, those who, but for a life-sustaining/life-saving treatment, would die.

A further hint that the Supreme Court was contemplating only terminal/end-of-life patients can be found in its discussion about the types of treatments that those with a “grievous and irremediable medical condition” are currently allowed to request or refuse: the same treatments applicable to end-of-life patients that formed the basis of Justice Smith’s ethical analysis.⁶

Thus a reasonable reading of the Supreme Court’s Carter decision permits Parliament to restrict MAID to those who are terminally ill /nearing the end of life. Parliament could choose, of course, not to require terminal illness, but requiring it would not be contrary to Carter.

Barbara Maloney is a freelance writer living in Nepean, Ontario.

1 Carter v. Canada (Attorney General), [2015] 1 S.C.R. 331, paras. 126 and 127.

2 Ibid. para. 69.

3 Carter v. Canada (Attorney General), 2012 BCSC 886 (CanLII), para 164.

4 Ibid. para. 317.

5 Ibid. para. 335

6 Carter v. Canada (Attorney General), [2015] 1 S.C.R. 331, para. 66.