VACHON: Are doctors steering patients toward death... Canada's MAiD debate heats up

Rebecca Vachon is the Health program director at the non-partisan think tank CardusCanada continues to have the fastest growing euthanasia program in the world, as confirmed by data released this week by Health Canada. The report, which was expected months ago — it is normally released mid-year — reveals that 15,343 Canadians died from MAiD in 2023, representing 4.7% of total deaths in 2023. Canada is now at total of 60,301 deaths from assisted suicide between 2016 to 2023.Although Health Canada emphasizes that growth of MAID slowed somewhat, it still saw 15% growth over the previous year. A Cardus study published this past summer plotted Canada’s growth against that of international jurisdictions, revealing the dramatic and unprecedented rise of euthanasia in Canada. In just eight years, Canada has become second only to the Netherlands — with their much older program — in terms of MAiD deaths as a percentage of total deaths.Intriguingly, this rate owes itself to a small number of MAiD providers with, as the report describes, 89 practitioners (out of 2,200 total) providing MAiD in 35.1% of Track 1 and 28.6% of Track 2 cases, “suggesting that MAID is becoming an area of focused expertise for some.” Track 1 refers to people who have a reasonably foreseeable death, while Track 2 refers to people whose deaths are not reasonably foreseeable but are deemed eligible based on chronic conditions or disabilities.The suffering that drives MAiD deaths should raise significant concern among Canadians. Indeed, as recent polling has shown, 62% of Canadians agree they are “worried about financially or socially vulnerable people considering MAID because they can’t access adequate, quality care.” The Annual Report fails to ease these worries, identifying a growing trend of patients identifying “isolation or loneliness” as a source of suffering driving MAiD, and nearly half of patients identifying feeling like a burden.Worse, these numbers are even higher among ‘Track 2’ MAiD recipients, (see above.) Of Track 2 recipients, 47.1% reported isolation or loneliness, for instance, compared to 21.1% of Track 1 recipients. And an analysis leaked from Ontario’s Office of the Chief Coroner revealed, Track 2 recipients come from much more highly marginalized categories than other MAiD recipients or the general population.Such data points surprise no one who has been listening to the long-held concerns and cases raised by disability advocates. A coalition of disability rights organizations, as well as two individual plaintiffs, announced a Charter challenge against the government over its Track 2 MAiD program, pointing to the “alarming trend where people with disabilities are seeking assisted suicide due to social deprivation, poverty, and lack of essential supports”.In light of these sky-high numbers, the government should consider strengthening the monitoring of MAiD and enhancing its safeguards. One such safeguard could be prohibiting clinicians from raising MAiD unsolicited, something we know occurs in significant numbers in Canada. Jurisdictions like New Zealand and some Australian States have such a measure, requiring the conversation to be patient-initiated.And while polling released just this week points to a split of Canadian views on this, 40% of Canadians would support this ban, and 41% agree that patients may feel pressured to choose MAiD if offered as an option by a doctor. Moreover, Canadians living with more severe forms of disability support such a prohibition in higher numbers: 50% support vs. 38% support among those with no disability challenges.Health Canada also minimizes concerns with the care patients are receiving, highlighting how 75% of MAiD recipients in 2023 received palliative care. Meanwhile, a full quarter were not. Furthermore, this data provides little indication as to the quality of palliative care received. Was the patient seen by a specialist palliative care team, or merely received some opiates from a general practitioner with minimal palliative care training? We don’t know. Nor do we know whether palliative care was provided in a timely manner. While palliative care should begin at the point of diagnosis of a life-limiting or life-threatening illness or condition, Canadian data has repeatedly shown that it is often received far too late. It is unlikely that MAiD recipients would be any different. We have similar knowledge gaps with the reporting of disability support services required and received by MAiD recipients.The continued rise in deaths, documented compliance problems among MAiD providers (albeit not documented by Health Canada’s reporting,) and the evident need to ensure equitable access to health care and disability supports for Canadians necessitates real, meaningful leadership to address Canadians’ needs in living — and not merely in facilitating their dying. Rebecca Vachon is the Health program director at the non-partisan think tank Cardus. She holds a PhD in public administration from the University of Ottawa.