A Brief Report on MAiD in Canada

The slippery slope is already here

I’ve had a few days to go through the Fourth annual report on Medical Assistance in Dying in Canada 2022 and I think I am finally ready to report on it. In fact, I have been so disturbed by this that I have been unable to report on AIDS, so I might as well get this over with.

Before I will get started, I want to tell you something about my experience having grown up in Canada. I was born in Malawi in 1974, and moved via the U.K. to Canada in 1975, where I remained (minus six months bartending in London) until 2002. Canada has NO freedom of speech. There is even a euphemistically named Human Rights Commission whose entire purpose is to suppress speech. Moreover, the concept of the right of the citizens to bear arms for their own protection is seen as extreme among most Canadians. On the other side, they have it right on the death penalty, which is a curious departure for a culture that seems to fetishize death.

Another thing about Canada that most people don’t realize that haven’t lived there is that our health care system is not what it is painted to be. It goes beyond the fact that you certainly can’t choose your doctor and that the waiting periods are insane. If you have a condition that falls outside the ordinary—and they do do “ordinary” (or common) like breast cancer and broken arms rather well—you’re out of luck. My father had Parkinson’s disease and during Covid he did not see his neurologist for three years, resulting in his death. Additionally, you still need to purchase insurance for things like dental and vision care, as well as prescription drugs, if you’re over eighteen. It’s not exactly “single payer.” I think what most people realize is that for fully government funded health care to work we need to be taxed at about 75%. It’s simply that expensive, and that isn’t even addressing the specter of putting your health decisions in the ultimate hands of the government.

Moving on. One unfortunate, and possibly to be foreseen, result of Canada’s health care system is that more and more people with terminal illness are being offered euthanasia, at least in part because the level of taxation cannot support an aging population any longer. MAiD was legalized in 2016, and it has steadily increased in uptake each year since, to the point that last year, MAiD deaths comprised a full 4.1% of all deaths in Canada.

Euthanasia has always been around. The difference is that it used to be you had to ask for it; whereas now it is offered, which somehow seems fundamentally wrong because humans are wired to want to live. This seems to say to me that something very bad has infected the collective psyche. You have to wonder at the underlying motivation.

Some updates to MAiD legislation included the provision that, in certain cases, the final consent can be waived. This is wildly alarming. Think about what it means—some other entity, possibly the state, can step in and say that you don’t get the final veto at the last minute over whether you live or die. Before this legislation, it used to be required that immediately before administration of MAiD, the provider was required to ask if you had changed your mind and no longer wanted it. Now for many situations this is no longer offered. The reasoning behind this is that the “capacity [of the patient to consent] might be lost” due to their final illness, so this amendment is supposedly meant to “alleviate suffering.” I’m skeptical.

There are more ways in which the legislation is growing more and more creepily toward eugenics and the targeting of certain groups. Just last year, the biggest change made to the legislation was the provision of MAiD in cases where mental illness is the sole indication.

On March 9, 2023, the Minister of Justice and Attorney General of Canada, the Minister of Mental Health and Addictions and Associate Minister of Health, and Minister of Health tabled the former Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying). This legislation extends the temporary exclusion of eligibility for MAID where a person’s sole medical condition is a mental illness until March 17, 2024. This one-year extension provides the Government of Canada, Provinces and Territories, and medical regulatory bodies the additional time needed to prepare for the safe and consistent assessment and provision of MAID where the person’s sole underlying medical condition is a mental illness.

What else has progressed? We have the following amendments (bold face added by me):

On March 17, 2021, the former Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), received Royal Assent and immediately came into force. This revised law, [was] introduced in response to the Superior Court of Québec's 2019 Truchon decision in which it found the "reasonable foreseeability of natural death" eligibility criterion in the Criminal Code, as well as the "end-of-life" criterion from Québec's Act Respecting End-of-Life Care, to be unconstitutional. The law was also informed by broad consultations with the Canadian public, provinces and territories, Indigenous Peoples, health care providers, experts, and key stakeholders. It contained a number of changes to Canada's MAID framework, including: removal of the requirement for a person's natural death to be reasonably foreseeable in order to be eligible for MAID; introduction of a two-track approach to procedural safeguards based on whether or not a person's natural death is reasonably foreseeable; and permitting eligible persons whose natural death is reasonably foreseeable, who have a set date to receive MAID and who have been advised they are at risk of losing capacity in the interim, to waive the requirement for their final consent at the time MAID is provided.

So, a person can now request MAiD when their natural death is not even foreseeable. What? Well, at least we have “safeguards” so that we separate the not foreseeable from the foreseeable deaths. I’m sure that will protect people. Again, we have the “waiver of final consent” amendment, which is totally insane and I can’t believe this is happening. Regarding the minimum time to approve a MAiD request:

As required by the legislation, the minimum of 90 days must elapse between the start of the assessment process and the provision of MAID for individuals whose natural death is not reasonably foreseeable. This period can be shortened if the individual is about to lose the capacity to make health care decisions, as long as both assessments have been completed. There is no minimum assessment period required for persons where natural death is reasonably foreseeable. It generally takes much longer for an individual whose natural death is not reasonably foreseeable to be assessed and receive MAID than an individual who is closer to a natural death.

Moving on to the implementation of MAiD in Canada since its inception in 2016, we see that its popularity is increasing at what I can only describe as an alarming rate. In 2016, we have 1,018 MAiD deaths; in the years following it goes from 2,828 to 4,493 to 5,665 to 7,611 to 10,092 to a whopping 13,241 (3.5% of which were “not reasonably foreseeable”). The report says this like it’s a good thing.

MAiD has been typically dispensed to men and women roughly equally, and the average age at death in 2023 was 77. The most common precipitating condition was cancer, but cardiovascular disease, neurological and respiratory as well as “other conditions” were represented. Among those whose death was not reasonably foreseeable, neurological conditions were the most common presentation of morbidity. These deaths were also over represented in the 18-49 age categories. In 2024, statistics will be collected and reported regarding uptake among racial groups, which makes me a little nervous. MAiD is most frequently administered to the 70-79 age group, but the data show a sharp jump at the 50-59 category, which seems awfully young.

There is a section on the availability and uptake of both palliative care and disability support services, which gives the impression that it was added in to make the report looks only slightly less horrifying.

The drugs used in MAiD are alarming, as well. Three medications are given in a cocktail, including potassium chloride or propofol, the drug most famous for having killed Michael Jackson. We also have midazolam, referred to very euphemistically as an “anxiolytic;” also famous for having killed people in long term care facilities at the beginning of Covid. Finally, we have either rocuronium or cisatracurium. They are described as being “neuromuscular blockers to stop respiration.” Let me translate that for you. They paralyze the patient, making it impossible for them to speak, breathe, or move. So if they are in distress, there is no way to know this for sure. Wow. Just wow.

The rest of the document discusses settings of MAiD deaths and practitioner profiles by specialty, which I won’t bother summarizing because I’m getting depressed, and we’ve covered the relevant information already. There is also a section on “source of the written request” for MAiD (although there are already moves being made to eliminate the requirement that the request be in writing), which, perhaps unsurprisingly, is not always the actual patient. (Wouldn’t requiring that it actually be the patient appear to at least be a minimum requirement to end your life?) We also have “determination of the request as voluntary,” another thing which seems ought be be ironclad, but again, can be determined without any consultation with the patient at all, and can be determined from “consultation with other health or social service professionals” or from “medical records.” What is going on? What is the purpose of this?

Also, there are a number of MAiD requests that do not result in death, either due to the request being declined or deemed ineligible, or—most commonly—because the patient died before administration of MAiD. Infilled requests typically comprise just under 20% of total requests.

The report concludes with the statement “The year 2022 was an eventful year, with many significant developments and accomplishments to help to inform the evolution and practice of MAID moving forward.” They say this like it’s a good thing.

I don’t even know what to say about this. How have we gotten to this point? Why is this happening now? Is this simply the natural result of propping up a health care system we literally can’t afford? Where is this heading in the future? The move to allow MAiD for mental illness is disturbing enough; I can only imagine where this might go in the future with historically disenfranchised groups, especially given that the safeguards of final consent are being walked back, leaving the ultimate decision with someone other than the individual. It’s past time to push back on this weird death fetish that is overtaking our culture, or the future looks very scary indeed.

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