Assisted dying is again becoming a hot topic in the UK. In the media, one country is mentioned repeatedly by proponents and opponents alike: Canada. So, what is the situation in Canada, and how has it gained such a divisive reputation?
Canada legalised assisted dying in 2016 after their Supreme Court ruled in favour during the 2015 case Carter v Canada. During the case, the Court was warned that legalising assisted dying risks sliding down the so-called ‘slippery slope’. This refers to the concern that once assisted dying is legalised for some, any initial arbitrary limitation will be redrawn and many more than originally intended will access the service, as has happened in Belgium. In Belgium, it was initially intended for those with terminal illnesses, but today people are also now routinely euthanised solely on the grounds of mental health issues. Canada’s Supreme Court was warned of this, but it dismissed concerns, stating in its ruling: ‘the permissive regime in Belgium is the product of a very different medico-legal culture’.
When it was first legalised in 2016, Canada limited assisted dying to the terminally ill (those whose death was ‘reasonably foreseeable’). In 2021, this was expanded to allow those whose death was not reasonably foreseeable. In 2024, it was due to be expanded again to include those applying on solely mental health grounds, but this has been delayed until 2027. Therefore, in just three years’ time, Canada will become the most permissive assisted dying jurisdiction in the world, flying in the face of the Court’s dismissal of the ‘slippery slope’.
Assisted dying is referred to as ‘MAiD’ in Canada (Medical Assistance in Dying). It permits both assisted suicide (where the lethal drugs must be administered by the patient themselves, usually via oral ingestion) and euthanasia (where a third party administers lethal drugs to a patient, usually a doctor via injection).
Since its legalisation in Canada, the number of assisted deaths has dramatically increased each year. In just the first year there were 1,018 assisted deaths. By 2022, this had climbed to 13,241, representing 4.1% of all deaths in Canada (more than 36 a day).
For comparison, we must look at California. Both California and Canada legalised their respective ‘assisted dying’ laws in 2016; both have a similar population (38.93 million versus 39.03 million respectively in 2022); and, culturally, both are famously politically progressive jurisdictions. This makes them an excellent comparison point for analysing the impact of their two very different ‘assisted dying’ laws.
California only legalised assisted suicide for those with terminal illnesses, meaning patients must self-administer the lethal drugs.
Comparing Canada and California’s raw numbers suggests that the availability of euthanasia rather than just assisted suicide significantly increases the number of people who have an assisted death.
For example, in the first full year of implementation (2017), California had 374 assisted deaths to Canada’s 2,838. In most recent year for which we have data for both jurisdictions, 2022 saw 890 assisted deaths in California to Canada’s 13,241 (California saw just 6.7% of Canada’s figure).
While both jurisdictions have seen significant increases from their first year of implementation, California has kept assisted dying at a relatively low level, accounting for well under 1% of annual deaths, compared to Canada’s 4.1% in 2022.
It is noteworthy that while both assisted suicide and euthanasia is available in Canada, in well over 99% of cases patients opt for euthanasia.
This is not to advocate for California’s system. It is almost identical to the older Oregon system which itself several significant issues. For instance, between 2010-2022 there was an 11% complication rate as a result of taking lethal drugs, including regurgitation and seizures. At least 9 people have reawakened and survived the lethal drugs, and last year the longest assisted death tragically took 137 hours. Additionally, in 1998, just 13% of people who applied for assisted dying in Oregon did so because they felt like a burden on their family. Since 2017, over 52% have applied because they felt like a burden, suggesting that once assisted dying is legalised, those who qualify increasingly feel pressure to use it. The neighbouring state of Washington, which also based its law off Oregon’s, has seen similar trends, with 59% saying they felt like a burden in 2022 compared with just 23% in 2009. California, despite being an almost identical system, does not record any of the above data – but just because no one is looking, that does not mean it is not happening.
There is also a financial incentive for governments to pursue assisted dying, and Canada is no exception. In 2020, the Canadian Parliament Budget Office predicted that its 2016 assisted dying law (Bill C-14) was producing a net reduction in health care costs of $86.9 million annually. Their 2021 expansion of the law, to people whose death was not expected in the relatively near future (Bill C-7), was being predicted to save $149 million (Office of the Parliamentary Budget Officer 2020). Since then, the number assisted deaths has only increased, thereby increasing savings.
Meanwhile, Canada’s assisted dying regime has resulted in tragic outcomes:
- One individual suffering from Multiple Chemical Sensitivity, who could not find affordable housing compatible with their disability, said: “I’ve applied for MAiD [medical assistance in dying] essentially because of abject poverty.”
- Amir Farsoud, could not afford his rent on his disability benefits alone. So, he applied for assisted dying. Despite telling the doctor he was applying to avoid homelessness, not because of his disability, he was still approved. Fortunately, a GoFundMe was set up for him and enough money was raised to pay for his rent and for him to retract his application.
- In 2022, Canadian Paralympian and armed forces veteran, Christine Gauthier, requested a new wheelchair ramp to her house. She was instead asked if she had ever considered MAiD. Other veterans seeking support for their PTSD have also been offered MAiD unprompted
- A 71-year-old man was told he was terminally ill with end-stage chronic obstructive pulmonary disease (COPD) and offered MAiD. He was euthanised within 48 hours of first his assessment, but autopsy revealed he did not have COPD.
- In 2018, Roger Foley took legal action against his local hospital, other health agencies and both the state and federal governments on the grounds that he was not provided with the assisted home care support he wished for, but was instead offered MAiD. His lawyer, Ken Berger, commented: ‘Here he is, needing society’s help and care and we turn our back on him and we’re in essence … asking him if he is interested in assisted dying rather than working with him to provide the services he needs’.
- Kathrin Mentler, 37-year-old Canadian from Vancouver, last year (2023) visited a hospital seeking help for her suicidal thoughts. Instead of support, she was asked “have you considered MAiD?”.