Canadians with non-terminal conditions sought assistance in dying for social reasons
An expert committee investigating euthanasia deaths in Canada’s most populous province has identified several cases in which patients requested partial death for social reasons such as isolation and fear of homelessness, raising concerns about approvals for vulnerable people in the system of assisted dying in the country.
Ontario’s chief coroner released several reports Wednesday — following an Associated Press investigation based in part on data from one of the documents — assessing euthanasia deaths of people who were not terminally ill. The expert committee reports are based on an analysis of anonymized cases, chosen for their implications for future euthanasia requests.
Canada’s legal criteria require a medical reason for euthanasia — a fatal diagnosis or uncontrollable pain — but the commission’s reports show cases where people were euthanized based on other factors, including an “unmet social need.”
The AP investigation showed that doctors and nurses struggled with it privately euthanasia requests from vulnerable people whose suffering can be addressed through money, social connections or adequate housing. Providers expressed deep discomfort at ending the lives of vulnerable people whose deaths were preventable even if they met the criteria of Canada’s euthanasia system, known nationally as Maid, for medical assistance in dying.
“It is extremely important to finally have a government report that recognizes these worrying cases,” said Ramona Coelho, a doctor on the expert committee. “We have been under fire for so many years when we expressed the fear that people would get maid because they were poor, disabled or socially isolated.”
In the case of a man identified as Mr. A, Ontario’s expert committee questioned whether authorities tried hard enough to relieve his pain before he was euthanized. Mr. A was an unemployed man in his 40s with intestinal disease and a history of substance abuse and mental illness. He was described as “socially vulnerable and isolated”. Some committee members were alarmed that a psychiatrist suggested euthanasia during a mental health assessment.
Another case involved Ms B, a woman in her 50s who suffered from multiple chemical sensitivity syndrome and had a history of mental illness, including suicidality and post-traumatic stress disorder. According to the report, she was socially isolated and was asked to die, largely because she could not get proper housing.
Committee members could not agree his or her death was justified; some said she should have been excluded from euthanasia because her inadequate housing was the main reason for her suffering. Others argued that “social needs may be considered irreparable” once other options have been explored.
Sonu Gaind, a professor of medicine at the University of Toronto, said the coroner’s reports were alarming for many reasons, particularly the treatment of mental illness in people seeking euthanasia.
“What we are doing in many cases is the opposite of suicide prevention,” he said, citing an example of a man in his 40s who had previously attempted suicide and had no definitive diagnosis when his euthanasia was approved.
Scott Kim, a physician and bioethicist at the National Institutes of Health in Washington, said the real problem was the permissive nature of Canadian law. Despite polls showing broad support for expanding access to euthanasia, he questioned whether most Canadians understand what is allowed. He said it was “baffling” that officials had not thought about these issues earlier.
The expert committee made numerous recommendations, including appointing patient advocates to support people considering euthanasia and providing more guidance to doctors and nurses reviewing requests from non-terminal patients.
The committee noted that in almost 2% of cases the legally required safeguards were probably not met. Despite this, experts say no doctors or nurses have ever been prosecuted.
Trudo Lemmens, a professor of health law and policy at the University of Toronto, said medical professional organizations and judicial authorities in Canada “seem unwilling to curtail practices that appear ethically problematic.”
“Either the law is too broad, or the professional guidance is not precise enough,” says Lemmens. “Or it is simply not seen as a priority to protect some of our most vulnerable citizens.”
So far, Ontario is the only province or territory in Canada that has released summaries of cases that could indicate problems in approving euthanasia.