Rebecca Vachon: Skyrocketing MAID deaths must prompt urgent reassessment

Usually, governments welcome high adoption rates for new policies. But when that new policy is an exception within the Criminal Code for euthanasia and assisted suicide, which then sees more than 30 percent annual growth in use, no government should be celebrating. And when such rates shoot past Health Canada’s official projections by nearly a decade, any government should be deeply worried. 

Health Canada’s 2022 report on deaths by euthanasia and assisted suicide, or medical assistance in dying (MAID), showed the continued, increasing numbers of MAID deaths. They accounted for 4 percent of total deaths in Canada in that year. A joint Toronto Star and Investigative Journalism Bureau (IJB) analysis revealed how this growth outpaces what we see in other countries around the world–including places where euthanasia and/or assisted suicide have been legal for decades. The Star/IJB conclusions match those of a forthcoming Cardus Health report, which provides a detailed look at the rise compared to other jurisdictions.

This high rate of growth is more than a statistical curiosity. It should prompt policymakers and all Canadians to reflect seriously on what the data tells us about the practice of euthanasia.  

For one, the legislation and regulations surrounding MAID aren’t terribly useful because the eligibility definitions are vague. Initially, there was limited eligibility for those whose deaths were “reasonably foreseeable”, without specifying what “foreseeable” meant. This has allowed for a significant range of interpretation when assessing for MAID. Likewise, the criteria for “unbearable suffering” is also highly subjective. 

Without more tightly defined criteria, we cannot ensure a consistent application of MAID. This is something Drs. Tang, Gaind, and Lau discuss in a recent scholarly book (see page 278). Vague criteria with multiple interpretations lead to a system where patients can “shop” for assessors and providers willing to euthanize them if at first they receive a rejection. Without an updated system that would inform MAID assessors of previous requests, they may be unaware of the request history. Without a review function where rejected applications can be sent and evaluated, patients may continue “shopping” until they reach their objective. 

Another built-in problem with the existing criteria for MAID is that it does not require patients to exhaust treatment options. They need only be “informed of” them, “offered consultations,” or “have discussed and given serious consideration” to them. While medical interventions do not require patients to exhaust their options, an intervention meant to cause an early end to a patient’s life is different. It requires a higher standard, particularly considering that patients may have had difficulty getting quality, timely health care already. 

Consider that the trend in the proportion of MAID requests considered ineligible continues to drop, year over year. In 2019, Health Canada reported 8 percent of requests were found ineligible, dropping to 4.1 percent in 2021, and just 3.5 percent in 2022. This suggests a weakness in euthanasia eligibility criteria. 

The federal monitoring and reporting system is based on conflicting interests, making enforcement of the system very difficult. The MAID assessors and providers self-report data. So, while those performing MAID do have criminal liability, they are also the ones reporting on whether all eligibility criteria and procedures were followed. Effectively, they oversee their own legal compliance.

Sadly, there is no independent verification of compliance reports. As documented by Dr. Jaro Kotalik, a health-care ethicist, in his edited volume on MAID, the monitoring system was never intended to ensure compliance. It merely provides information for a “societal perspective ” according to the government. This is unlike other international approaches, including in the Benelux countries, which were pioneers in introducing euthanasia/assisted suicide. Instead, Canada’s federal monitoring via Health Canada has no review function and no ability to refer compliance issues for investigation.

Provincial authorities, meanwhile, provide only limited and partial data on MAID. Only Ontario and Quebec provide publicly available reports on their reviews. And, while Quebec reports have pointed to compliance issues and missing data in some cases, they provide no details about how these cases were investigated or handled.

Perhaps we should not be surprised, then, with the continued growth of euthanasia, when considering the inherent weaknesses of the existing system. This sort of growth is not, however, “destiny.” California, for instance, legalized assisted suicide also in 2016. Despite its slightly larger population size to Canada, only 3,344 Californians died by assisted suicide from legalization in 2015 through to 2021. By contrast, 31,664 Canadians died by euthanasia or assisted suicide within that same period.

And while the government has temporarily delayed further expansions of MAID for mental illness as a sole underlying condition, this staggering rate of growth in the current system should prompt not only reflection but a commitment to investigating what is going on.