- Holly Honderich
- in Toronto
5 hours before
Credit, Cole Burston/BBC
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Madeline has helped hundreds of assisted suicide patients but now has doubts about moving forward with Canada’s program to legalize euthanasia
As Canada prepares to expand the scope of the euthanasia law to include people with mental illnesses, a section of the population including many physicians is questioning whether the country’s euthanasia program has progressed too quickly.
Doctor Madeline Li recalls the first patient she helped die about a month after Canada legalized euthanasia in 2016. “I remember how surreal it was,” she said.
She is a psychiatrist at Princess Margaret Hospital in Toronto and remembers that day she was checking to make sure her patient had the music and food she wanted for the final moments and being sure she wanted to move on.
The approximately 60yearold patient who suffered from ovarian cancer said yes.
The woman was dead five minutes later.
“The first fall was like jumping off a cliff,” Li said. “It’s how time goes by and everything goes back to normal.”
Since then, she has overseen hundreds of clinically assisted mortalities.
Li has repeatedly stressed that a doctor’s personal opinion should not influence how a patient is assessed for euthanasia.
But she has grave concerns about expanding Canada’s euthanasia and assisted suicide program beyond the terminally ill. She is not alone.
Since 2016, Canada’s Medical Assistance in Death program known as Maid, for Medical Assistance in Death has been available to terminally ill adults.
In 2021, the law was changed to include people with serious and chronic physical problems, even if the condition is not lifethreatening.
new change
A new change is expected this year, which will include some cases of mental illness.
This expansion of the law’s scope sparked controversy about the program as a whole and raised concerns that the path was being made too easy for vulnerable people in Canada.
These fears have been fueled by a series of recent reports suggesting that for some, death has been used as a way out of a life where the social safety net is no longer protective.
“Making death too easy harms the most vulnerable and actually relieves society of its responsibilities,” said Dr. Li. “I don’t think death should be society’s solution to its own failures.”
Credit, Getty Images
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Room at Princess Margaret Hospital in Toronto, where Doctor Madeline Li works
Medically assisted dying was introduced in Canada by a court decision. In 2015, the country’s Supreme Court ruled that prohibiting assisted suicide robs Canadians of their dignity and autonomy. He gave Parliament a year to draft a bill on the issue.
The 2016 law legalized euthanasia for Canadians aged 18 and older with a serious, irreversible illness where death was “reasonably foreseeable.”
In that first year, just over 1,000 people attempted assisted suicide, a number that is increasing every year. In 2021, the latest figures available, 10,064 deaths fell under this legislation, accounting for 3.3% of all deaths in Canada.
Opinion polls show that Canadians are broadly supportive of access to at least some form of assisted suicide.
Death for the terminally ill can often be cruel and slow, doctors have told the BBC, and patients are living out their final days with a conscience tainted by powerful drugs. The existence of euthanasia in these cases, according to these doctors, has become a balm.
“Almost every time I consider a patient suitable [para o programa]this patient stops worrying about how they’re going to die and starts wondering how they’re going to live,” said Dr. Stefanie Green, president of a Canadian association of professionals working on the program.
“It’s objectively therapeutic to give someone that option,” she said.
The program’s expansion last year follows a court ruling after two Montrealers with degenerative diseases were sued.
This put Canada on the shortlist of countries like Belgium and the Netherlands that allow assisted suicide for people without a terminal illness.
The change allowed individuals whose only medical condition was a mental illness to be eligible for the program. However, psychiatric claims would have to wait two years for the federal government to set appropriate safety standards.
Therefore, doubts were raised about the admission of nonterminal patients.
Early critics of the program include three United Nations human rights experts, who wrote to the federal government in 2021 warning that the expanded law could devalue the lives of people with disabilities by suggesting that serious illness is worse than death.
A series of reports that some Canadians have chosen euthanasia because they could not afford adequate housing, at least in part, also raised concerns that the program could be used as a solution to social problems such as poverty, homelessness or extreme loneliness.
“Letting people make that choice [morrer] because the state fails to uphold its basic human rights is unacceptable,” said MarieClaud Landry, chief commissioner of the Canadian Commission on Human Rights, in a statement in May.
Others pointed to the program’s weak protections, which they felt.
“The law is very Canadian. It was worded vaguely so as not to offend anyone,” said Dr. Li
The law, she says, “isn’t specific enough to protect people.”
“I didn’t have a valid diagnosis”
In 2019, after being admitted to a British Columbia hospital, 61yearold Alan Nichols chose euthanasia because he was at risk of suicide.
In the days leading up to his death, he was agitated, confused and refused to wear the cochlear implant that helped him hear, his sisterinlaw Trish Nichols told a Senate committee last year. In his application for euthanasia, the reason given was “hearing loss”.
“Alan didn’t have a valid diagnosis for the show,” Nichols said. “Now would you feel safe taking your suicidal loved one for medical attention if there isn’t close supervision or safeguards for a procedure that involves killing people?”
Last year, authorities launched an investigation after at least four veterans were asked to review the program by a person who worked on veterans’ cases and now no longer works for the department.
In one case, former military and Paralympic athlete Christine Gauthier said the person offered her the option to participate in the dying after asking to have a wheelchair ramp installed in her home.
The federal government says the expanded law protects vulnerable Canadians while respecting patient autonomy. Applicants with serious, terminal, but not lifethreatening medical conditions must be evaluated by two different physicians and wait a period of 90 days.
Supporters of euthanasia say the safeguards for evaluating cases are strong enough.
“I see that the safety precautions are in place, I see that they work,” said Stefanie Green.
“I’m not naive, I understand the lack of support in our community — lack of disability assistance, lack of income support, housing assistance — those things add to a person’s suffering,” she said.
“But if that motivates people to apply, they won’t be considered eligible.”
Derryck Smith, a Vancouverbased psychiatrist and Dying with Dignity board member, told the BBC the standards set ensure that few Canadians without a terminal diagnosis are eligible for the programme.
“Look at the statistics,” he says.
In 2021, the average age of a euthanasia patient was 76 years. 80% of them received palliative care and 65% had cancer.
Credit, Cole Burston/BBC
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Li praised the decision to suspend the euthanasia program for mental illness
However, the inclusion of mental health cases in the proposal raised further concerns.
Last month, amid mounting criticism, Canada’s government said it would seek to suspend mental health inclusion (which was due to begin in March this year) to allow for additional studies.
“We want to be levelheaded, we want to move forward step by step so that we don’t make any mistakes,” said Federal Justice Minister David Lametti.
Much of the controversy revolves around the criterion of the “incurability” of a mental illness i.e. whether it is incurable and how this can be assessed. This is the condition for acceptance into the program.
The Canadian Mental Health Association has warned that it is “not possible” to determine whether a given case of mental illness is terminal and strongly opposes amending the program to include that condition.
Some leading psychiatrists, like Karandeep Sonu Gaind of the University of Toronto, have said that determining whether a mental illness is terminal is worse than turning heads or tails.
It is currently unclear when Canada’s euthanasia law will be extended to include mental illness. The Justice Secretary did not say how long the suspension would last, but there is no indication the pause is temporary as the measure would likely be found unconstitutional in a court of law.
“We listen and we respond,” Lametti said last month. “We know we have to do this right.”
Doctor Li welcomed the government’s decision to postpone it, saying health experts now have a chance to take proper safety precautions.
“The time of debating whether we should do this is over,” she said. “What we need to start talking about is when and how we’re going to get this right.”