When Parliament legalized euthanasia and assisted suicide in 2016, many warned of a slippery slope. First legalized as a last resort for those nearing natural death, euthanasia and assisted suicide have since been expanded to people not nearing natural death (2021) and to those with mental illness (scheduled for 2027). In the meantime, safeguards have been removed. Between 2016 and 2022, nearly 45,000 Canadians were euthanized.
Professor John Keown, comparing euthanasia in the Netherlands and Canada, writes, “In 40 years, the Dutch have slid down the slippery slope. In fewer than 10, Canada appears to be veritably skiing.”
Bill C-7
Bill C-7, An Act to amend the Criminal Code (medical assistance in dying) was introduced in 2020 and received Royal Assent in March 2021. The bill removed the requirement that a person’s natural death be reasonably foreseeable, thus making persons with non-terminal illness eligible for euthanasia. It also created two different sets of safeguards, one for those who were nearing natural death, and another for those who were not. If a person is nearing natural death, they can be fast-tracked for euthanasia with fewer safeguards. If a person is not nearing natural death, there are a few additional safeguards such as a 90-day waiting period.
The Senate added a clause to Bill C-7 to permit euthanasia for mental illness as the sole underlying medical condition, starting in March 2023. That was later delayed until 2024, and then until 2027.
Care Not Kill Campaign
Since the mental illness expansion had not yet come into effect, ARPA Canada’s Care Not Kill campaign focused from 2021 to early 2024 primarily on cancelling that expansion. Many of you, our supporters, got involved in that campaign by delivering flyers, writing emails to your federal representatives, sending submissions to committee, or running bus ads. You sent a clear message that euthanasia should never be a solution for mental illness.
Last fall, MP Ed Fast introduced Bill C-314, which would have cancelled the plan to permit euthanasia for mental illness. Although the bill failed to pass (by only 17 votes), some members of all parties supported it. Earlier this year, nearly every province asked the federal government to delay the scheduled expansion of euthanasia indefinitely. The Conservative Party of Canada has committed to repealing this expansion if they form government following the next election. We can continue to encourage other parties to do the same.
Euthanasia should never be a solution for suffering. Euthanasia and assisted suicide encourage a culture of neglect for suffering, elderly, disabled, and vulnerable people. Canada should promote suicide prevention and life-affirming care for all. Given the successful pushback across Canada on the mental illness expansion, now is the time to call for additional safeguards in the law.
Repeal C-7
The Care Not Kill campaign is asking the government to repeal Bill C-7 entirely. That would not only cancel the mental illness expansion, but would end euthanasia for those who are not dying. It would also restore other safeguards that Bill C-7 removed.
Bill C-7 changed Canada’s law on assisted suicide to offer it as an escape from what is perceived as a difficult life, or even a difficult period of life. Only people with disabilities or chronic illness are offered assisted suicide as a solution for their suffering. The able-bodied who suffer are offered suicide prevention and various other supports. The implicit message is that some lives matter more than others. We need to call on the government to promote life-affirming care for all.
Just as we advocated for the repeal of euthanasia for those with mental illness, we can call for the repeal of euthanasia for those with disabilities or non-terminal illnesses.
Next Steps
With a federal election looming next year, we have an opportunity to ask candidates and MPs how they will protect vulnerable Canadians from euthanasia. We can encourage candidates to talk about the issue during their campaigns, and we can call on the next government to pass legislation to reverse Canada’s slide down the slippery slope when it comes to euthanasia. Stay tuned over the coming months for updated Care Not Kill materials and action items.
When we talk about euthanasia and politics, we often focus on any new or proposed legislation to expand or reduce access to it. But there are other areas we keep an eye on which also affect Canada’s euthanasia regime, particularly regulatory change. These are changes made not by elected legislators but by government bureaucrats or cabinet ministers. And these regulatory changes impact the way euthanasia is provided on a practical, day-to-day basis. While these adjustments may technically fit within the law, regulations can have an outsized impact on the current system.
Background
While the law around euthanasia is under federal jurisdiction, the provinces are the ones who carry it out in practice. For example, the Criminal Code lists the requirements a person must meet to be eligible for euthanasia. But medical professionals are given guidance on what those requirements look like from their provincial College of Physicians and Surgeons, which regulates the conduct of medical professionals within the province. Each province has published guidelines to help medical professionals deal with questions around euthanasia.
Over the past couple of years, some have argued that the concerns with Canada’s euthanasia regime will be alleviated by having clear, standardized guidelines for medical professionals to guide their response to a request for euthanasia. An Expert Panel Report published in 2022 recommended that “federal, provincial and territorial governments should facilitate the collaboration of physician and nurse regulatory bodies in the development of Standards of Practice for physicians and nurse practitioners for the assessment of MAiD requests in situations that raise questions about incurability, irreversibility, capacity, suicidality, and the impact of structural vulnerabilities.”
Based on this recommendation, the federal government tasked six people to create standards that provincial regulators can adopt. If enough provinces adopt these standards, there will be a consistent approach to providing euthanasia in Canada. The recommendations are explained in a new document titled “Model Practice Standard for Medical Assistance in Dying.” We want to point out a few particularly concerning recommendations where standardization would make a bad approach commonplace in Canada.
Conscientious Objection
The group recommends that medical professionals who have a conscientious objection to providing euthanasia “must complete an effective [referral/transfer of care] for any person seeking to make a request, requesting, or eligible to receive MAID.” Currently, only Ontario and Nova Scotia explicitly require an effective referral, which means that a doctor must connect their patient to a doctor who will provide euthanasia. Other provinces currently have systems in place that more appropriately protect freedom of conscience for medical professionals. Expanding effective referral policies across the country will have detrimental effects on the healthcare system and on doctors’ consciences. You can read more about effective referral and ARPA Canada’s campaign to protect freedom of conscience in Ontario here.
Suggesting Euthanasia
A second concerning element of these guidelines is a recommendation that, if a medical professional believes a person may be eligible for euthanasia and has reason to believe that “MAID is consistent with the person’s values and goals of care,” they must advise the patient of the option of MAID even if it is not requested. Counselling a person to commit suicide is (and ought to be!) a crime in all circumstances and should extend to suggesting euthanasia as an option. Instead, the authors of the guideline document clarify that “Advising persons of potential eligibility for MAID is distinct from counselling persons to consider MAID.”
Whether or not euthanasia is consistent with a person’s values, no doctor (or anyone else for that matter) should ever suggest it to a patient. We have seen various stories in the media over the past couple of years where this did happen, such as when an employee of the Ministry of Veterans Affairs suggested euthanasia to four veterans. Proactive suggestions for MAiD devalue a person’s life and make them question whether it is worth living or if they are too much of a burden to their family or the healthcare system. At the same time, the guidelines recommend that medical professionals must not tell others (including the patient’s family and friends) about the request for or provision of euthanasia unless the patient gives consent to do so or if the doctor needs to clarify the patient’s values and goals of care. If implemented, these recommendations will contribute to dividing families and deteriorating existing safeguards.
Mental Illness
Finally, the document does not recommend any additional regulations to protect those with mental illness. It simply states that the existing regulations will apply to those with mental illness when MAiD for mental illness becomes legal in 2024.
The guidelines do not adequately address the question of whether patients who request euthanasia are suicidal. The authors recommend ensuring that the euthanasia request is “rationally considered during a period of stability, and not during a period of crisis.” They also note that a medical professional must consider making a referral for suicide prevention supports if the patient is deemed ineligible for euthanasia and if the ineligibility increases the risk of suicide. But this is absurd. The request for euthanasia is a suicidal one. The guidelines are trying to strike a balance between suicide prevention and suicide assistance, but instead remind us that it is impossible to have both. It seems inevitable that a patient who is denied access to euthanasia will be at increased risk of suicide because they have already requested death. As one psychiatry professor states, “On the face of it, even if you look at what the word means, when somebody wants to die and they’re not dying, of course that means that they’re suicidal.” Euthanasia should never be an option for these patients in a country that claims to care about suicide prevention for the mentally ill.
What can you do?
These recommendations from Health Canada are not binding on individual provinces, but they do create some pressure for provinces to adopt a consistent approach with other Canadian jurisdictions. But what can you do when regulatory changes are introduced, since it is not elected law makers who are making these particular changes?
First, In the area of freedom of conscience, if you live in Ontario we ask you to participate in our campaign to protect conscience and improve healthcare in Ontario. If you live in another province, encourage your MLA or MNA to protect the freedom of conscience for doctors. Many of the talking points used in our Ontario campaign can also help you explain why you value freedom of conscience for your doctor.
Second, in relation to euthanasia and mental illness, continue to be involved in the Care Not Kill campaign. This is an important area where we can continue to push to protect vulnerable Canadians. While some politicians will talk about the need for safeguards, it is increasingly evident that safeguards will not protect the vulnerable. We need a full stop to expansion.
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Quick Update on CareNotKill.ca – and your efforts are being recognized!
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https://carenotkill.ca
This morning Mike Schouten was interviewed on the Wake Up America show in the USA. Canada’s euthanasia laws are raising concerns internationally and we are thankful that pressure is mounting on Canada’s Parliament to slow down the rapid expansion to MAiD in our country.
Queen’s Park reception, staff and board highlights, and more momentum for Care Not Kill!
In March, we launched the updated Care Not Kill campaign, with a focus on the deadline of March 2023 when the government will expand euthanasia to those with mental illness.
So many of you have responded and joined the campaign out of concern for the direction Canada is heading. Over 100,000 flyers have now been distributed across the country, with tens of thousands more on the way. We have been blown away by the response!
We have loved hearing from many supporters how they have been encouraged and excited by the response they’re getting to our Care Not Kill flyers. We often deal with polarizing issues, so it is a blessing to learn how many Canadians are on the same page when it comes to concerns about euthanasia.
ARPA supporters have had the opportunity to interact with Canadians while handing out flyers and have found that most are genuinely concerned about the expansion of euthanasia to those with mental illness. Those receiving the flyers have responded overwhelmingly positively, indicating that they didn’t know this was happening and they do not think it’s right.
If you’d like to join in, order your flyers today (they’re free!) and distribute them on your own or with others to add to the growing awareness in Canada around the issue of euthanasia. Go to carenotkill.ca for more information.
Joint Parliamentary Committee wraps up for the summer
On the political advocacy side, ARPA staff have had the opportunity to respond to the formation of the Special Joint Committee on Medical Assistance in Dying, a joint committee made up of Senators and MPs. Their task is to review euthanasia in Canada, study recommendations for including mental illness as a qualification and investigate further expansion, including access for minors. Both ARPA Canada and the Care Not Kill campaign were able to submit briefs to this committee for their consideration, and we are thankful for several supporters who also took the time to write and send a submission to this committee.
The committee also studied a recently-released report from a panel of experts appointed by the Trudeau government to provide recommendations around regulating euthanasia for mental illness. In their report the experts state: “In permitting MAiD, society no longer requires everyone to accept that life is a benefit in all circumstances. When it is, and when it is not, is a question for the individual requester according to their values and in those circumstances permitted by law.” In other words, euthanasia is defensible for virtually anyone for virtually any reason at all. The philosophy behind this shocking statement is something we have been warning about since euthanasia was first legalized.
At the end of June, the parliamentary committee published an interim report on their findings, confirming many of the conclusions of the Trudeau expert panel.
The Conservative members of the committee also published their dissenting (disagreeing) report. We were pleased to see them echoing our calls to postpone the expiration of the sunset clause in March 2023. They conclude their dissenting report by saying, “Legislation of this nature needs to be guided by science, and not ideology. We have been warned by several experts that [expansion]…will facilitate the deaths of Canadians who could have gotten better…such an outcome is completely unacceptable and preventable.”
On the other hand, pressure against the expansion of euthanasia has been mounting. News articles both from Canada and abroad have been voicing concern with the accelerating pace. We pray that we can still make a difference by continuing to get the message of the Care Not Kill campaign to Canadians.