If Canadians needed any more reasons to demand a pause in the expansion of euthanasia, Health Canada’s release of its fourth annual report on “medical assistance in dying” (MAiD) is it. This 2022 data shows Canada continues to have a more-than-30% year-over-year growth in euthanasia deaths. In fact, MAiD deaths in 2022 accounted for more than 4% of all deaths in Canada that year: In Quebec, 6.6% of those who died, did so via euthanasia.In light of these staggering numbers, Canadians — and our leaders especially — should question the quality and accessibility of care patients receive. After all, eligibility for MAiD requires a grievous and irremediable condition which causes them to experience unbearable suffering. Good medical care should ensure suffering never gets to the point when it is unbearable and makes premature death preferable to ongoing life. If more and more Canadians are choosing premature death through MAiD, this suggests that all is not well in the care they’re getting. Health Canada’s report also presents a misleading picture of palliative care in connection with those who die by euthanasia. It states that a majority of MAiD recipients received palliative care, yet the data tells us nothing about the quality of palliative care Canadians received before death through MAiD, nor does it define access to palliative care. We do not know if specialist palliative care teams were involved; we do not know if patients who were offered palliative care but declined it or even understood what palliative care is.Inadequate data collection also makes it difficult to understand the nature of suffering before Canadians die by euthanasia. For instance, one category is “inadequate pain control (or concern,)” which was an issue in almost six in 10 cases, according to the report. However, because both actual, current pain is lumped in with concern for future pain, we do not know what is actually driving the request to die. In circumstances where a fear of future pain is a key driver, is the patient fully aware of how palliative care could address future pain? We just don’t know.Importantly, the report did indicate that of those who withdrew their MAiD request, 42% did so because palliative care had made it so that the patient no longer wanted a premature death. And yet, nearly one in five of those who died by euthanasia did not have any palliative care.This continuing increase, and the continued issues with available palliative care, is yet another reason to press pause on the ongoing expansion of MAiD. Assisted dying eligibility will be expanded in a few short months to include those suffering from mental illness as a sole underlying condition.This is not something Canadians want. Angus Reid Institute polling, in partnership with Cardus, found only a minority of Canadians support the next expansion. A colossal majority of 82% want the government to improve mental health care first, before expanding euthanasia. There’s also a majority that fear mental health won’t be a priority if this expansion occurs, while 64% of Canadians fear those with existing challenges in accessing mental health care will be made more vulnerable by the change.These fears are founded, given the existing barriers and inadequacies that exist for mental health care. Where costs and wait times are prohibitive for care, euthanasia is available in a much timelier manner. This raises enormous ethical issues of equity and justice, where the advantaged can afford mental health care and the disadvantaged can more easily access death, rather than care. As the report reveals, Canada has already gone very far, very fast. Clearly, our leaders need to pay more attention to providing high-quality, timely care, particularly palliative care. This only highlights further the need for Canada to get mental health care right, before any such expansion occurs next winter.Rebecca Vachon is the program director for health at the non-partisan think tank Cardus. She holds a PhD in public administration from the University of Ottawa.
If Canadians needed any more reasons to demand a pause in the expansion of euthanasia, Health Canada’s release of its fourth annual report on “medical assistance in dying” (MAiD) is it. This 2022 data shows Canada continues to have a more-than-30% year-over-year growth in euthanasia deaths. In fact, MAiD deaths in 2022 accounted for more than 4% of all deaths in Canada that year: In Quebec, 6.6% of those who died, did so via euthanasia.In light of these staggering numbers, Canadians — and our leaders especially — should question the quality and accessibility of care patients receive. After all, eligibility for MAiD requires a grievous and irremediable condition which causes them to experience unbearable suffering. Good medical care should ensure suffering never gets to the point when it is unbearable and makes premature death preferable to ongoing life. If more and more Canadians are choosing premature death through MAiD, this suggests that all is not well in the care they’re getting. Health Canada’s report also presents a misleading picture of palliative care in connection with those who die by euthanasia. It states that a majority of MAiD recipients received palliative care, yet the data tells us nothing about the quality of palliative care Canadians received before death through MAiD, nor does it define access to palliative care. We do not know if specialist palliative care teams were involved; we do not know if patients who were offered palliative care but declined it or even understood what palliative care is.Inadequate data collection also makes it difficult to understand the nature of suffering before Canadians die by euthanasia. For instance, one category is “inadequate pain control (or concern,)” which was an issue in almost six in 10 cases, according to the report. However, because both actual, current pain is lumped in with concern for future pain, we do not know what is actually driving the request to die. In circumstances where a fear of future pain is a key driver, is the patient fully aware of how palliative care could address future pain? We just don’t know.Importantly, the report did indicate that of those who withdrew their MAiD request, 42% did so because palliative care had made it so that the patient no longer wanted a premature death. And yet, nearly one in five of those who died by euthanasia did not have any palliative care.This continuing increase, and the continued issues with available palliative care, is yet another reason to press pause on the ongoing expansion of MAiD. Assisted dying eligibility will be expanded in a few short months to include those suffering from mental illness as a sole underlying condition.This is not something Canadians want. Angus Reid Institute polling, in partnership with Cardus, found only a minority of Canadians support the next expansion. A colossal majority of 82% want the government to improve mental health care first, before expanding euthanasia. There’s also a majority that fear mental health won’t be a priority if this expansion occurs, while 64% of Canadians fear those with existing challenges in accessing mental health care will be made more vulnerable by the change.These fears are founded, given the existing barriers and inadequacies that exist for mental health care. Where costs and wait times are prohibitive for care, euthanasia is available in a much timelier manner. This raises enormous ethical issues of equity and justice, where the advantaged can afford mental health care and the disadvantaged can more easily access death, rather than care. As the report reveals, Canada has already gone very far, very fast. Clearly, our leaders need to pay more attention to providing high-quality, timely care, particularly palliative care. This only highlights further the need for Canada to get mental health care right, before any such expansion occurs next winter.Rebecca Vachon is the program director for health at the non-partisan think tank Cardus. She holds a PhD in public administration from the University of Ottawa.
