Concerns raised over medically assisted deaths
Increasing numbers make some critics fear system is being abused
The number of medically assisted deaths provided annually in Alberta and Canada has been steadily rising, with some critics fearing that reflects a procedure increasingly open to abuse.
In Alberta, the provision was provided 594 times last year, a 6.5 per cent increase over 2020 and nearly three times more than the first full year of legalization in 2017.
Up until July 31 of this year, there were 452 medical assistance in dying (MAID) procedures performed in the province, putting Alberta on pace for 775 this year.
In the rest of the country that number has been growing more rapidly, with the percentage of total deaths due to MAID at 3.3 per cent — in Alberta that figure sits at 1.9 per cent, according to Health Canada.
Across Canada, there were 10,064 assisted deaths last year, a 32.4 per cent increase over 2020.
Of those receiving MAID, 65.6 per cent suffered from cancer while 80.7 per cent received palliative care.
Proponents of the provision and Alberta Health Services say those rising numbers largely reflect a natural growing awareness and acceptance of an option that offers a compassionate end to life that's to be expected over time.
But others say it's a reflection of a system that's being liberalized and widened in scope too quickly, leaving it ripe for abuse.
“The increase in the overall percentage of people who die by MAID has come very quickly, it's very high even when compared to even the most liberal regimes in the world — Belgium and the Netherlands,” said Trudo Lemmens, chair of health law and policy at the University of Toronto.
“We've already passed them after just six years.”
Quebec and B.C.'S deaths from MAID last year were just shy of five per cent of those provinces' total fatalities.
In Belgium, which has offered the provision since 2020, euthanasia and assisted suicide accounted for about two per cent of total deaths in 2017, while in the Netherlands the figure was 4.4 per cent.
Lemmens said it's not entirely clear why Canada's MAID numbers have risen so quickly, but he suspects a growing and troubling acceptance of assisted death in the health-care system and the liberalization of the program that in 2021 widened its criteria beyond people in an irreversible state of decline who face a foreseeable death.
“We need to know more — I'm concerned because MAID is not what was originally put forward … it's clearly no longer an exceptional procedure,” he said.
Next year, the criteria for MAID is to expand further, to include those suffering solely from grievous or irredeemable mental illness, a change that concerns Lemmens.
“We've already had cases of mental illness being the reason people asked for it,” he said.
“Should we accept it becoming some kind of therapy for all kinds of suffering?”
Federal Health Minister Jeanyves Duclos has insisted sufficient protections exist to prevent abuses, while in passing the mental-health expansion, the government has vowed to create an expert panel to advise on protocols and safeguards.
Last year, 81 per cent of requests for MAID in the country were granted, with the largest portion of those who were refused dying before receiving it, says Health Canada.
Three years after her 52-yearold cancer-stricken husband of 25 years followed through on a MAID request, Calgarian Siobhan Chinnery said she shares Duclos' confidence.
Ending his life and intense pain on her husband's own terms was fraught with frustrations and delays, she said.
“Your death doesn't have to be foreseeable or imminent but a person still has to prove they're suffering, there are a lot of quality-of-life (conditions) to prove and you still need two practitioners agreeing to meet that requirement,” said Chinnery, who's a volunteer with the group Dying with Dignity Canada.
She recalled the day her husband, Scott, died at their Coach Hill home — Aug. 20, 2019 — moments she describes as a serene, if melancholy, release.
“It was so peaceful and beautiful, although you're losing someone you love, but he was out of pain,” she said.
Efforts to ease the pain suffered by her husband were futile, strengthening a decision for MAID that was already fortified by the slow cancer death of his father, said Chinnery.
“He watched his dad suffer for a long time, he withered to nothing,” she said.
“If people don't want MAID, fine, but they shouldn't impact my endof-life choices.”
A Leger poll in early 2020 showed Canadians overwhelmingly support MAID, with 74 per cent of respondents agreeing with the provision even when death isn't foreseeable.
It's likely that MAID'S share of total deaths in the country will eventually plateau around four per cent, similar to what's been seen in European jurisdictions, said Helen Long, CEO of Dying with Dignity Canada.
Concerns that the disabled and those in despair over inadequate levels of social supports are vulnerable to assisted death should be monitored, she said.
But those are not reasons to block the provision or even halt expanding its eligibility to include those under the age of 18 considered “mature minors,” which is now under consideration, she said.
“Mental-health supports aren't available for everyone in the country and that is a concern, but from a human-rights perspective, every Canadian who meets the criteria should be afforded MAID,” said Long.
Meeting those standards remains daunting and there's no proof the provision has been abused, she added.
Alberta Health Services, which administers MAID in the province, said a secondary reason for the increasing numbers is the dropping of the foreseeable death standard in March 2021.
“Although the majority of individuals still seeking MAID have a reasonably foreseeable death, we are also seeing a very small proportion of individuals who do not have a reasonably foreseeable death,” AHS said in a statement.
“In Alberta in 2021, this accounted for 3.7 per cent of MAID cases.”
Lemmens said there have been several controversial cases in Canada in which disabled individuals or those suffering from depression have been coerced into MAID, while noting at least one military veteran was improperly offered the provision without asking for it.
Canada, he said, is alone in not prohibiting physicians from offering the option without a patient asking for it.
“When there are red flags, we should be ready to analyze and strengthen the rules,” said Lemmens.
The executive director of Prolife Alberta said he shared Lemmens' concerns.
“In the past year, we have seen the `slippery slope' of euthanasia turn into a cliff. Life is sacred, and every life should be treated with equal value, dignity and respect,” Richard Dur said in an email.
Late last month, Alberta Health Minister Jason Copping said the province is still awaiting details from Ottawa on changes to its MAID program expected to take effect next year.
“What's really important are the standards in practice that are rolled out — we haven't seen that yet but we're having conversations,” he said.
“It's important we can support individuals in the choices they make.”
It was so peaceful and beautiful, although you're losing someone you love, but he was out of pain.