Earlier this month, the Supreme Court of Canada declined to hear psychologist Jordan Peterson’s appeal from the decision of his professional regulator—the College of Psychologists of Ontario—requiring Peterson to submit to social media training. The college cited Peterson’s online statements he posted that it alleged may be degrading, posed a “moderate risks of harm to the public,” raised questions about his abilities as a psychologist, and risked bringing the profession into disrepute. Peterson, who has not operated a clinical practice since 2017, denounced the college’s actions as an unjustified imposition on free speech and expression, as well as an improper intrusion by a regulator into a member’s off-duty actions.

While the topic of free speech and professional regulation draws the most public attention, it is just one element in a related series of issues surrounding the mandate, powers, and social role of professions and their regulators. In Canada, professional regulators are primarily self-governing, which means they are not subject to significant government oversight.

They are also numerous. Here in Alberta, with its population of just under five million, health-care professionals alone have 30 different regulators. Compare that to just nine health profession regulators for the entire United Kingdom with its population of almost 70 million. Then, add to those 30 Alberta regulators the gamut of lawyers, teachers, architects, accountants, realtors, etc., and the list multiplies quickly. Replicate this across every province and territory and we find Canada covered by hundreds of regulatory bodies, all busily setting standards, employing staff, and disciplining members. British Columbia, to its credit, has attempted to consolidate and reform its professional regulators with some success.

Among the various problems with this plethora of professional administrators are that many of the organizations are poorly staffed, lack resources to conduct proper investigations, and produce a vast divergence of outcomes with little serious expertise in regulation or the broader issues they address. This might not be such a significant issue if regulators were statutorily limited to dealing with matters of immediate concern to professional competence. But as several examples have demonstrated, including Peterson’s, this is not the case.

In legal terms, this is a matter of jurisdiction. The first question a regulator must ask when faced with a complaint against a member is whether the regulator actually has jurisdiction over the matter. This question is almost always answered in the affirmative, on the basis that the individual is indeed a member of the profession. As a result, professional regulators are emboldened to assume jurisdiction over a broad swath of complaints including those that have little or nothing to do with the member’s on-duty professional behaviour.

Those who defend this regime typically state that it is settled law—that being a member of a profession means you have voluntarily submitted to its standards, including those that involve your off-duty actions. Of course, this isn’t so much an argument as an uncritical statement of the status quo. Historically, professions and trades tended to tightly control their membership. Leftover from this time is the notion that bad behaviour or speech on a professional’s part outside the office can “bring the profession into disrepute”. Originally, this was often used to police members’ morality and to keep out the unwanted. While its targets have changed, the notion of the upstanding professional, now more often “the right-thinking professional” retains its power to control its members’ behaviours and speech.

There are a few problems with this view. First, it is rather condescending and assumes that professionals have more social influence than they likely do. It suggests that the public is waiting with bated breath to hear the latest pronouncement from a professional with the expectation that said public will immediately and uncritically follow the declaration. However, as an adjunct lecturer in community health sciences at the University of Calgary, one of my main areas of interest is patient-centered care, in which the patient takes an active role in their treatment and is viewed as a member of the health team rather than a passive recipient. The patronizing notion of the professional as a revered expert imparting incontrovertible wisdom is largely a thing of the past.

The second problem is that professionals themselves have expertise in their own specialties and can often shine an important and sometimes critical light on areas in need of change within their profession. Recalling COVID-19 measures, one of the worst policies during the pandemic was the isolation of seniors in care facilities. We know now, and have known for some time, that family members are vital care providers to those living in assisted and long-term care homes. When the pandemic struck, family members were dismissed as tangential to patient care, banned from entering the facilities, and often replaced with poorly trained staff who had no experience with the patients under their charge. Had this dangerous policy been challenged or allowed to be challenged publicly by health providers not afraid to voice dissent, numerous deaths could have been prevented.

It is heartening that there have been some recent cases recognizing the importance of a professional retaining a degree of freedom of speech. One of the most important, and one that I had some input on, is the Carolyn Brost Strom case out of Saskatchewan.

Carolyn is a registered nurse who took to social media to publicly criticize the care her dying grandfather received in a long-term care facility. While she did not name a specific caregiver and did acknowledge effective aspects of his care, she made the mistake of naming the facility. This resulted in a complaint by staff at her grandfather’s residence, leading to an investigation and hearing by her professional regulator that fined her $26,000. She appealed the decision to the Court of Queen’s Bench. The justice upheld the regulator’s ruling, citing all the usual old tropes about deference to administrative tribunals and the professional’s willing submission to regulatory interference, all in the name of protecting the profession’s reputation.

Carolyn then took her case to the Saskatchewan Court of Appeal where she won a unanimous decision, overturning the regulator’s disciplinary fine. The court wisely and thoroughly set out several factors to consider when a regulator intervenes in the public speech of a member, finding that the regulator failed to take a contextual approach to the matter at hand.

My personal interest in Carolyn’s five-year ordeal, and the role of regulators in general, comes from my own family’s personal experience when my sister, a registered nurse, was wrongly investigated by her own regulator. The context for this harrowing experience was my father’s badly managed death in a care facility, a situation in which my sister was not on duty but was a member of the public simply questioning care. Eventually, the regulator dismissed the allegations against her, but only after conducting an eight-month investigation that caused harm to my family, the very people the regulators are mandated to protect. To its credit, the regulator then reviewed its complaint processes and made changes, including an informal decision not to take jurisdiction on cases like my sister’s.

My sister’s regulator recognized that its broad interpretation of its statutory jurisdiction ended up harming the very public it was tasked with protecting. Professional regulators should not have the authority to delve into the off-duty actions or speech of their members. In legal terms, their jurisdiction should be limited to behaviors directly related to their professional duties, or where a member has been engaged in criminal conduct. Anything further exposes members and the public to abuse by regulators as well as a vast divergence in outcomes due to the excess of regulators across Canada. There are other examples I could cite, including the behaviour of the Law Society of Ontario. That these are so common is indication enough that it is time to curtail the inappropriate authority granted to Canada’s professional regulatory regimes.

When the Supreme Court of Canada decriminalized euthanasia and assisted suicide, it tasked Parliament to create “a stringently limited, carefully monitored system of exceptions.” Instead, within a decade, Canada created the world’s largest and fastest-growing euthanasia program, a trend that we wrote about in a recent report for Cardus.

The trendline is staggering. In just six years, the number of deaths from euthanasia or MAiD increased thirteenfold, from 1,018 deaths in 2016 to over 13,200 deaths in 2022. More Canadians die by euthanasia than from liver disease, Alzheimer’s, diabetes, or pneumonia. In fact, MAiD is now effectively tied as the fifth leading cause of death in the country.

This rapid growth rate is a uniquely Canadian problem. While the number of euthanasia deaths is increasing in every jurisdiction that legalized permissive euthanasia, no other jurisdiction has ever seen such a rate of growth in euthanasia, especially not so soon after legalization.

It took the Netherlands, the first country to effectively decriminalize euthanasia in 1981 and to formally legalize it in 2002, 32 years for it to become the only jurisdiction in the world where more than 3 percent of total deaths were caused by euthanasia. Not even next-door Belgium, which legalized euthanasia two months after the Netherlands, has ever passed the 3 percent threshold.

But then Canada legalized euthanasia. It took Canada just six years after legalization to cross the 3 percent threshold. In the seventh year, Canada crossed the 4 percent line. By the time we receive the latest year of mortality data for 2023, if current trends hold, Canada is set to pass 4.7 percent of total deaths to be caused by euthanasia.

Proponents of MAiD frequently claim that these numbers were expected. Stefanie Green, the president of the Canadian Association of MAiD Assessors and Providers, for instance, claimed two years ago in a parliamentary committee that “data to date suggests that the expected number of Canadians are accessing and receiving MAID.”

Yet the reality is that no one expected this increase. Not the courts, who believed it would be limited, nor the lead lawyer for the plaintiff in Carter v. Canada who argued that it would only be a “last resort.”  Not the New England Journal of Medicine, which predicted in 2020 only 2,000 deaths annually (it was 7,511 MAiD deaths that year). Not Health Canada, which predicted in 2018 that Canada’s “steady state” of MAiD deaths would be 2 percent of total deaths, and even when Health Canada doubled its estimate in 2022, it predicted that Canada would reach 4 percent only in the 2030s—instead of just months after.

Not the Trudeau government, which continues to maintain that MAiD is only for those “where everything has been tried,” as then Minister of Justice David Lametti testified, or for those who “have tried everything imaginable to address their suffering,” as claimed Ya’ara Saks, then parliamentary secretary to the minister of Families, Children and Social Development. Not the Canadian Medical Association, which believed euthanasia would be only appropriate for “rare occasions.”

Not even the critics. Bioethicist Margaret Somerville testified to the Special Joint Committee on Physician-Assisted Dying on February 4, 2016, that she estimated that there could be “between 11,000 and 12,000 Canadians being killed by lethal injection” every year if Canada followed the Belgium and Netherlands model—although “I could almost not believe it when I worked out those figures.” It was intended to shock the committee, yet in 2022, we have already surpassed Somerville’s worst-case estimate.

MAiD is simply no longer exceptional or rare. Canada now serves as an international clarion call for what happens when governments prioritize an assisted death over an assisted life—as even supporters of euthanasia abroad distance themselves from Canada’s MAiD program.

It is a scandal, it seems, everywhere but here at home. In terms of funding, we simply prioritize death care over health care. The facts speak for themselves.

A million and a half Canadians have at least one chronic health condition. and yet do not have a primary care provider, according to the latest Commonwealth Fund Survey. Only 30.8 percent of Canadians can see a specialist in under a month and only 26 percent can receive an elective surgery in under a month, the lowest rate of all 10 high-income countries polled.

Yet while wait times for medical care have been increasing to all-time highs, the median number of days for MAiD, from request to death, is disturbingly short. Not even COVID-19 increased wait times for MAiD. The median number was only 11 days in 2022; the previous year it was nine days.

Based on this data, is it any surprise why so many Canadians are opting for assistance to die, rather than fighting for aid to live?