Latest news with #MedicalAssistanceinDying
Canada Standard
09-05-2025
- Health
- Canada Standard
OntarioChiefCoroner reports raise concerns that MAID policy and practice focus on access rather than protection
The Chief Coroner for Ontario recently released two new reports of its interdisciplinary MAID Death Review Committee: on Same or Next Day Provision of MAID and on Waiver of Final Consent. The MAID Death Review Committee - of which I am a member - reviews cases of Medical Assistance in Dying (MAID) that are selected by the coroner's MAID team for the common issues they raise. The review helps inform policy recommendations. Committee reports contain case summaries and summaries of committee discussions, and the Chief Coroner's recommendations. The newly released reports appear to confirm what is argued in several chapters in our recently co-edited volume, Unravelling MAiD in Canada: Euthanasia and Assisted Suicide as Medical Care , and in other publications: Canada's MAID law, policy and practice focuses excessively on promoting access to death, not on protection. Some of the cases suggest a troubling prioritizing of ending patients' lives with MAID rather than a precautionary approach. In my opinion, they reveal an urgent need for more rigorous legal and professional standards. Committee members' starkly contrasting views on the ethics of some of the practices, which can be gleaned from the anonymous summaries of the committee's discussions, are striking. The topics of the reports illustrate how Canada's MAID law reform has prioritized access over protection. Most assisted dying laws or policies in other countries prohibit same-day provision of MAID and waiving of final consent. Many impose a reflection period to protect patients against rushed and desperate decision-making, for example following a devastating diagnosis. Before 2021, Canada's MAID law had a 10-day reflection period, which could be shortened by request. This was removed in the 2021 expansion of MAID, which also removed the safeguard of a reasonably foreseeable natural death. At the time, concerns that removing the 10-day reflection period could lead to rushed decisions were dismissed, with a hypothetical example involving same-day MAID provision being described as "absurd." An official report now documents the practice. Waiver of final consent, which was also introduced in 2021, moves Canada clearly away from unambiguous or clear consent, which the Supreme Court emphasized as a key safeguard in its 2015 Carter decision - the decision that declared an absolute criminal law prohibition on euthanasia and assisted suicide to be unconstitutional. A waiver enables track 1 patients (those with a reasonably foreseeable death) who are at risk of losing capacity to receive MAID at a specific time in the near future. In contrast, with an advance request for MAID, a patient authorizes someone else to request MAID on their behalf in the future, when they have lost capacity and specified conditions are met. Quebec recently introduced advanced requests, and Health Canada has organized public consultations on the topic, seemingly considering it. But it remains prohibited under the Criminal Code. Rightly so, since it raises unique ethical, legal and professional challenges. The coroner's report on waiver of final consent includes cases, and notes on case discussions, that demonstrate the fine line between flexible use of such waivers and circumventing the prohibition of advance request. In some cases, it appears that different guidance documents of the Canadian Association of MAID Assessors and Providers have been combined to facilitate MAID: guidance on waiver of final consent and on dementia. In a journal publication, my co-authors and I warned that combining these guidance documents, which we consider to be obfuscating, could lead to advance requests for MAID even though they remain prohibited under the criminal code. Take the case of Mr. A. Distressed by short-term memory loss and a diagnosis of an onset of Alzheimer's disease, he signed a waiver scheduling MAID 3.5 years later. Some, but not all, members of the committee opined that scheduling it so much in advance was incompatible with a track 1 approval, since it revealed that he was not approaching his death, not in an advanced state of irreversible decline of capability and could hardly be considered to suffer intolerably at the time of approval. The MAID provider ended up not using the waiver for Mr. A's consent for MAID. However, his MAID death remains problematic due to concerns about how the provider accepted he was able to provide final consent. Less than a year after signing the waiver, he was hospitalized after a fall. He was deemed delirious, confused and had hallucinations. During "a period of cognitive improvement" the MAID provider deemed him capable of confirming final consent and provided MAID based on the original assessment. Informed consent concerns also arose in the case of 80-year-old Mrs. B, who told a first MAID assessor she preferred palliative care because of personal and religious values. When a palliative care physician noticed her husband's "caregiver burnout," he requested hospice care for Mrs. B, which was rejected. Her husband then contacted a second MAID assessor, who approved her for MAID and who rejected the first assessor's request to talk to Mrs. B. the next day. A third assessor confirmed the second assessor's approval and Mrs. B received MAID the same day. The case of Mr. C involved a man in his 70s, diagnosed with metastatic cancer, who requested a MAID assessment five days after admission into palliative care. But before he could be assessed, he experienced cognitive decline and "loss of ability to communicate." When the palliative care team told a MAID provider the next day that he had lost capacity to consent, the provider "vigorously roused Mr. C., who opened his eyes and mouthed 'yes'" when asked if he wanted MAID. After withholding pain medication for 45 minutes, the provider considered him more "alert." A second MAID assessor confirmed his eligibility after an online assessment, also accepting mouthing yes, and "nodding his head in presumed agreeance" as clear and capable informed consent, and he was euthanized. These and some other cases described in the committee reports raise several concerns. They show how MAID has been provided in cases where assessors clearly disagree about the application of access criteria, with two seemingly limited assessments favouring MAID overriding others. Some patients received MAID after capacity and informed consent procedures that appear problematic, in the case of Mr. C overriding a capacity assessment by a treating palliative care team. Family pressures, such as caregiver burnout, may also be insufficiently investigated, as in the case of Mrs. B. And MAID appears to have been delivered in the case of Mr. C. when the patient appeared otherwise comfortable in palliative care and may not have had capacity to consent. The reports also reveal that even patients specifically hospitalized for suicidal ideation and in need of mental health care are offered MAID, as earlier coroner reports already revealed. Some cases appear to stretch the contours of MAID law. The committee discussions included in the report further suggest starkly different views among MAID Death Review Committee members, including on standards for assessing capacity for consent. As discussed in a recent study I co-authored, most of Canada's MAID practice is driven by a relatively small group of frequent providers. The study found that there are 1,837 MAID providers in Canada, but up to 336 of these are frequent providers who are likely responsible for the majority of annual MAID deaths. This adds to concerns about arguably overly flexible provision of MAID among these providers. Another committee member recently discussed how the report on same- or next-day provisions reveals this practice is disproportionately present in some geographical locations. This suggests, as others have discussed in relation to Quebec's MAID practice, that there may be starkly different professional standards and approaches among providers. To date there have been no known cases of criminal or professional sanctions against a MAID provider. However, the Chief Coroner's reports, as well as media reports, indicate that this does not mean Canada's MAID practice is exemplary, safe and compliant. When reading these cases, many likely wonder, as I do, what it will take for political, judicial and professional authorities to provide firmer guidance, investigate thoroughly and put a halt to problematic delivery of MAID. The United Nations Committee on the Rights of Persons with Disabilities, after hearing evidence from both the federal government and civil society organizations, recently urged Canada to withdraw track 2 MAID (MAID cases in which the patient's death is not reasonably foreseeable), not to introduce MAID for mental illness and with advance requests, and to improve MAID monitoring and safeguards. The UN committee cited the earlier coroner reports. The two most recent reports, which the UN committee did not have yet at its disposal, clearly confirm the urgent need for a revisiting of our MAID law, and for refocusing on protection, not on further expansion.
The Herald Scotland
08-05-2025
- Health
- The Herald Scotland
It'll be easier for disabled Scots to access help to die than to live
Its definition of "terminal illness" is broad and vague - far looser than the definition in the Westminster Bill. It opens the door to pressure, whether direct or indirect, on people already dealing with pain, isolation, or fear. It tells people like us that our lives may be considered no longer worth living. And once that message is out there, it is impossible to take back. Read more Pam recently wrote to every MSP with a warning that cuts to the heart of this issue: "If this bill passes, there is a real risk that, for people like me, it will be easier to access help to die than to live." That is not a rhetorical flourish. It is a statement grounded in the harsh realities many disabled people face. Long waits for social care. A patchy mental health system. Barriers to housing, work, and accessible healthcare. These are daily facts of life. Yet instead of fixing these systems, this Bill offers a fast track to death. Is that really the message we want to send? Proponents of the Bill say it is about choice. Choice, however, only exists when all options are truly available. When people lack proper care, support, or community, "assisted dying" starts to look less like a choice and more like surrender. For many disabled people, the choice this Bill offers is a false one, shaped by disadvantage, not dignity. We also worry about how the law will evolve. In other countries where assisted dying has been legalised, the criteria have expanded over time. What starts with "terminal illness" often becomes "unbearable suffering." And who decides what counts as "unbearable"? An anti-assisted dying campaigner (Image: Jonathan Brady/PA Wire) Too often, it is a judgement made through the lens of assumptions, not lived experience. Let's not kid ourselves: if this Bill passes, vulnerable people - disabled people, older people, people with mental illness - will feel it most. We have seen it happen elsewhere. We cannot let it happen here. We need only look to Canada for a warning. Roger Foley, a man living with severe disabilities including spinocerebellar ataxia, has endured firsthand the dark consequences of a system where assisted dying has been normalised. Despite leading an accomplished life - earning two degrees, working in banking, and volunteering across his community - Roger's deteriorating health left him fully dependent on care. Instead of receiving the self-directed support he needed to live, he says he was trapped in a hospital for over eight years, denied the basic help that would allow him to return home. Worse, Roger reports being pressured by healthcare staff to consider assisted death. Neglect, verbal abuse, and suggestions that he should opt for Medical Assistance in Dying (MAiD) replaced the compassion and support he sought. Roger's experience shows what happens when a society makes death more accessible than care. He's a real-life example of the fact that some vulnerable people are not given real choices - they are steered toward giving up. Roger calls himself a "canary in the coal mine." His story is a stark reminder: once assisted dying becomes an accepted "solution" for suffering, the pressure on disabled, ill, and elderly people to end their lives quietly will grow. We must also learn from Belgium's experience. Tine Nys was just 38 when she died by assisted dying under Belgian law. As a child, she struggled with severe psychiatric problems and had previously attempted suicide. But according to her sisters, Lotte and Sophie, Tine was not incurably ill as the law required - she was suffering from the emotional fallout of a recent breakup. She had not received psychiatric treatment for 15 years. Just two months before her death, she was diagnosed with autism, but no treatment had yet begun. Despite these facts, her death was later ruled legal. This outcome highlights how dangerously broad and poorly defined assisted dying laws can become in practice. When short-term distress is treated as a reason for ending a life, and when people in vulnerable situations are steered toward death instead of being offered proper support, the system fails. Disabled people, especially, are at risk of being overlooked and underserved. This is not about questioning anyone's compassion. It is about whether the law can safely draw the line—and keep it. Real dignity is not guaranteed by legal access to assisted death. It is guaranteed when people have access to quality care, social support, and a life worth living right to the end. The focus should be on fixing what is broken, not making death a fallback for those failed by the system. When we talk about dignity, we must talk about life - about providing the support, services, and social structures that allow people to live with purpose and without fear of being abandoned or forgotten. We urge our fellow MSPs: don't risk it. Don't risk sending the wrong message to disabled people, to the most vulnerable in our society. Don't risk creating a system where the right to die overtakes the right to live with support, care, and respect. Scotland can do better than this. And we must. We must choose a path that upholds the values we all hold dear - compassion, dignity, and respect - for everyone, no matter their age or ability. Our responsibility is to ensure that no one ever feels like they are better off dead than living in a society that supports them. Scotland's future must be one where every life is worth living, and every person is given the chance to live with hope, dignity, and security. We can do better. We must. Pam Duncan-Glancy, Jeremy Balfour, and Emma Roddick are MSPs from across the political spectrum.
Yahoo
04-04-2025
- Health
- Yahoo
'I could live 30 years - but want to die': Has assisted dying in Canada gone too far?
April Hubbard sits on the theatre stage where she plans to die later this year. She is not terminally ill, but the 39-year-old performance and burlesque artist has been approved for assisted dying under Canada's increasingly liberal laws. Warning: This article contains details and descriptions some readers may find disturbing She is speaking to BBC News from the Bus Stop Theatre, an intimate auditorium with a little under 100 seats, in the eastern city of Halifax, Nova Scotia. Illuminated by a single spotlight on a stage she has performed on many times before, she tells me she plans to die here "within months" of her imminent 40th birthday. She'll be joined by a small group of her family and friends. April plans to be in a "big comfy bed" for what she calls a "celebratory" moment when a medical professional will inject a lethal dose into her bloodstream. "I want to be surrounded by the people I love and just have everybody hold me in a giant cuddle puddle and get to take my last breath, surrounded by love and support," she says. April was born with spina bifida and was later diagnosed with tumours at the base of her spine which she says have left her in constant, debilitating pain. She's been taking strong opioid painkillers for more than 20 years and applied for Medical Assistance in Dying (Maid) in March 2023. While she could yet live for decades with her condition, she qualified to end her life early seven months after applying. For those who are terminally ill it is possible to get approval within 24 hours. "My suffering and pain are increasing and I don't have the quality of life anymore that makes me happy and fulfilled," April says. Every time she moves or breathes, she says it feels like the tissues from the base of her spine "are being pulled like a rubber band that stretches too far", and that her lower limbs leave her in agony. We meet April as, almost 3,000 miles away, MPs are scrutinising proposals to legalise assisted dying in England and Wales. They voted in principle in support of those plans in November 2024, but months of detailed scrutiny have followed - and further votes in the Commons and Lords are required before the bill could possibly become law. This week, the BBC witnessed a man's death in California, where assisted dying laws are far more similar to those being considered in Westminster. Critics say Canada is an example of the "slippery slope", meaning that once you pass an assisted dying law it will inevitably widen its scope and have fewer safeguards. Canada now has one of the most liberal systems of assisted dying in the world, similar to that operating in the Netherlands and Belgium. It introduced Maid in 2016, initially for terminally ill adults with a serious and incurable physical illness, which causes intolerable suffering. In 2021, the need to be terminally ill was removed, and in two years' time, the Canadian government plans to open Maid to adults solely with a mental illness and no physical ailment. Opponents of Maid tell us that death is coming to be seen as a standard treatment option for those with disabilities and complex medical problems. "It is easier in Canada to get medical assistance in dying than it is to get government support to live," says Andrew Gurza, a disability awareness consultant and friend of April's. Andrew, who has cerebral palsy and uses a wheelchair, says he respects April's decision, but tells us: "If my disability declines and my care needs got higher, I'd still want to be here. To know there's a law that's saying you could easily end your life - it's just really scary." Before she was approved for Maid, April was assessed by two independent physicians who were required to inform her of ways to alleviate her suffering and offer alternative treatments. "The safeguards are there," she says, when we press her about disabled people who feel threatened by assisted dying, or whether Maid is being used as a shortcut to better quality care. "If it's not right for you and you're not leading the charge and choosing Maid, you're not going to be able to access it unless it's for the right reasons," she adds. There were 15,343 Maid deaths in 2023, representing around one in 20 of all deaths in Canada - a proportion that has increased dramatically since 2016 and is one of the highest in the world. The average age of recipients was 77. In all but a handful of cases, the lethal dose was delivered by a doctor or nurse, which is also known as voluntary euthanasia. One doctor we spoke to, Eric Thomas, said he had helped 577 patients to die. Dr Konia Trouton, president of the Canadian Association of Maid Assessors and Providers, has also helped hundreds of patients to die since the law was introduced. The procedure is the same each time - she arrives at the home of the person who has been given approval for Maid and asks if they wish to go ahead with it that day. She says the patients always direct the process and then give her the "heads up and ready to go". "That gives me an honour and a duty and a privilege to be able to help them in those last moments with their family around them, with those who love them around them and to know that they've made that decision thoughtfully, carefully and thoroughly," she adds. If the answer is yes, she opens her medical bag. Demonstrating to the BBC what happens next, Dr Trouton briefly puts a tourniquet on my arm. She shows me where the needle would be inserted into a vein in the back of my hand to allow an intravenous infusion of lethal drugs. In her medical bag she also has a stethoscope. "Strangely, these days I use it more to determine if someone has no heartbeat rather than if they do," she tells me. A list of organisations in the UK offering support and information with some of the issues in this story is available at BBC Action Line Some 96% of Maid provisions are under "track one" where death is "reasonably foreseeable". Dr Trouton says that means patients are on a "trajectory toward death", which might range from someone who has rapidly spreading cancer and only weeks to live or another with Alzheimer's "who might have five to seven years". The other 4% of Maid deaths come under "track two". These are adults, like April, who are not dying but have suffering which is intolerable to them from a "grievous and irremediable medical condition". That is in stark contrast to Labour MP Kim Leadbeater's bill to legalise assisted dying in England and Wales, which says patients must be expected to die within six months. The Westminster bill would not allow doctors to give a lethal dose – rather patients would have to self-administer the drugs, usually by swallowing them. Death via intravenous infusion normally takes just a few minutes, as the lethal drugs go straight into the bloodstream, whereas swallowing the drugs means patients usually take around an hour or two to die, but can take considerably longer, although they are usually unconscious after a few minutes. Dr Trouton told me she regarded the Canadian system as quicker and more effective, as do other Maid providers. "I'm concerned that if some people can't swallow because of their disease process, and if they're not able to take the entire quantity of medication because of breathing difficulties or swallowing difficulties, what will happen?" But opponents argue it's being used as a cheaper alternative to providing adequate social or medical support. One of them is Dr Ramona Coelho, a GP in London, Ontario, whose practice serves many marginalised groups and those struggling to get medical and social support. She's part of a Maid Death Review Committee, alongside Dr Trouton, which examines cases in the province. Dr Coelho told me that Maid was "out of control". "I wouldn't even call it a slippery slope," she says "Canada has fallen off a cliff." "When people have suicidal ideations, we used to meet them with counselling and care, and for people with terminal illness and other diseases we could mitigate that suffering and help them have a better life," she says. "Yet now we are seeing that as an appropriate request to die and ending their lives very quickly." While at Dr Coelho's surgery I was introduced to Vicki Whelan, a retired nurse whose mum Sharon Scribner died in April 2023 of lung cancer, aged 81. Vicki told me that in her mum's final days in hospital she was repeatedly offered the option of Maid by medical staff, describing it as like a "sales pitch". The family, who are Catholic, discharged their mother so she could die at home, where Vicki says her mum had a "beautiful, peaceful death". "It makes us think that we can't endure, and we can't suffer a little bit, and that somehow now they've decided that dying needs to be assisted, where we've been dying for years. "All of a sudden now we're telling people that this is a better option. This is an easy way out and I think it's just robbing people of hope." So is Canada an example of the so-called slippery slope? It's certainly true that the eligibility criteria has broadened dramatically since the law was introduced nine years ago, so for critics the answer would be an emphatic yes and serve as a warning to Britain. Canada's assisted dying laws were driven by court rulings. Its Supreme Court instructed Parliament that a prohibition on assisted dying breached the country's Charter of Rights and Freedoms. The extension of eligibility for those who were not terminally ill was in part a response to another court decision. In Britain, judges in the most senior courts have repeatedly said any potential change to the law around assisted dying is a matter for Parliament, after the likes of Tony Nicklinson, Diane Pretty and Noel Conway brought cases arguing the blanket ban on assisted suicide breached their human rights. April knows some people may look at her, a young woman, and wonder why she would die. "We're the masters of masking and not letting people see that we're suffering," she says. "But in reality, there's days that I just can't hide it, and there's many days where I can't lift my head off the pillow and I can't eat anymore. "It's not a way I want to live for another 10 or 20 or 30 years." Additional reporting by Joshua Falcon. California man invites BBC to witness his death as MPs debate assisted dying What is assisted dying and how could the law change? How assisted dying has spread across the world and how laws differ
BBC News
04-04-2025
- Health
- BBC News
'I could live 30 years - but want to die': Has assisted dying in Canada gone too far?
April Hubbard sits on the theatre stage where she plans to die later this is not terminally ill, but the 39-year-old performance and burlesque artist has been approved for assisted dying under Canada's increasingly liberal This article contains details and descriptions some readers may find disturbingShe is speaking to BBC News from the Bus Stop Theatre, an intimate auditorium with a little under 100 seats, in the eastern city of Halifax, Nova by a single spotlight on a stage she has performed on many times before, she tells me she plans to die here "within months" of her imminent 40th birthday. She'll be joined by a small group of her family and plans to be in a "big comfy bed" for what she calls a "celebratory" moment when a medical professional will inject a lethal dose into her bloodstream."I want to be surrounded by the people I love and just have everybody hold me in a giant cuddle puddle and get to take my last breath, surrounded by love and support," she was born with spina bifida and was later diagnosed with tumours at the base of her spine which she says have left her in constant, debilitating pain. She's been taking strong opioid painkillers for more than 20 years and applied for Medical Assistance in Dying (Maid) in March 2023. While she could yet live for decades with her condition, she qualified to end her life early seven months after applying. For those who are terminally ill it is possible to get approval within 24 hours."My suffering and pain are increasing and I don't have the quality of life anymore that makes me happy and fulfilled," April says. Every time she moves or breathes, she says it feels like the tissues from the base of her spine "are being pulled like a rubber band that stretches too far", and that her lower limbs leave her in meet April as, almost 3,000 miles away, MPs are scrutinising proposals to legalise assisted dying in England and Wales. They voted in principle in support of those plans in November 2024, but months of detailed scrutiny have followed - and further votes in the Commons and Lords are required before the bill could possibly become week, the BBC witnessed a man's death in California, where assisted dying laws are far more similar to those being considered in say Canada is an example of the "slippery slope", meaning that once you pass an assisted dying law it will inevitably widen its scope and have fewer now has one of the most liberal systems of assisted dying in the world, similar to that operating in the Netherlands and Belgium. It introduced Maid in 2016, initially for terminally ill adults with a serious and incurable physical illness, which causes intolerable suffering. In 2021, the need to be terminally ill was removed, and in two years' time, the Canadian government plans to open Maid to adults solely with a mental illness and no physical of Maid tell us that death is coming to be seen as a standard treatment option for those with disabilities and complex medical problems."It is easier in Canada to get medical assistance in dying than it is to get government support to live," says Andrew Gurza, a disability awareness consultant and friend of April' who has cerebral palsy and uses a wheelchair, says he respects April's decision, but tells us: "If my disability declines and my care needs got higher, I'd still want to be here. To know there's a law that's saying you could easily end your life - it's just really scary." Before she was approved for Maid, April was assessed by two independent physicians who were required to inform her of ways to alleviate her suffering and offer alternative treatments."The safeguards are there," she says, when we press her about disabled people who feel threatened by assisted dying, or whether Maid is being used as a shortcut to better quality care. "If it's not right for you and you're not leading the charge and choosing Maid, you're not going to be able to access it unless it's for the right reasons," she were 15,343 Maid deaths in 2023, representing around one in 20 of all deaths in Canada - a proportion that has increased dramatically since 2016 and is one of the highest in the world. The average age of recipients was all but a handful of cases, the lethal dose was delivered by a doctor or nurse, which is also known as voluntary euthanasia. One doctor we spoke to, Eric Thomas, said he had helped 577 patients to die. Dr Konia Trouton, president of the Canadian Association of Maid Assessors and Providers, has also helped hundreds of patients to die since the law was procedure is the same each time - she arrives at the home of the person who has been given approval for Maid and asks if they wish to go ahead with it that day. She says the patients always direct the process and then give her the "heads up and ready to go"."That gives me an honour and a duty and a privilege to be able to help them in those last moments with their family around them, with those who love them around them and to know that they've made that decision thoughtfully, carefully and thoroughly," she adds. If the answer is yes, she opens her medical to the BBC what happens next, Dr Trouton briefly puts a tourniquet on my arm. She shows me where the needle would be inserted into a vein in the back of my hand to allow an intravenous infusion of lethal her medical bag she also has a stethoscope. "Strangely, these days I use it more to determine if someone has no heartbeat rather than if they do," she tells me.A list of organisations in the UK offering support and information with some of the issues in this story is available at BBC Action Line Some 96% of Maid provisions are under "track one" where death is "reasonably foreseeable". Dr Trouton says that means patients are on a "trajectory toward death", which might range from someone who has rapidly spreading cancer and only weeks to live or another with Alzheimer's "who might have five to seven years".The other 4% of Maid deaths come under "track two". These are adults, like April, who are not dying but have suffering which is intolerable to them from a "grievous and irremediable medical condition".That is in stark contrast to Labour MP Kim Leadbeater's bill to legalise assisted dying in England and Wales, which says patients must be expected to die within six months. The Westminster bill would not allow doctors to give a lethal dose – rather patients would have to self-administer the drugs, usually by swallowing via intravenous infusion normally takes just a few minutes, as the lethal drugs go straight into the bloodstream, whereas swallowing the drugs means patients usually take around an hour or two to die, but can take considerably longer, although they are usually unconscious after a few Trouton told me she regarded the Canadian system as quicker and more effective, as do other Maid providers. "I'm concerned that if some people can't swallow because of their disease process, and if they're not able to take the entire quantity of medication because of breathing difficulties or swallowing difficulties, what will happen?" 'Canada has fallen off a cliff' But opponents argue it's being used as a cheaper alternative to providing adequate social or medical of them is Dr Ramona Coelho, a GP in London, Ontario, whose practice serves many marginalised groups and those struggling to get medical and social support. She's part of a Maid Death Review Committee, alongside Dr Trouton, which examines cases in the Coelho told me that Maid was "out of control". "I wouldn't even call it a slippery slope," she says "Canada has fallen off a cliff." "When people have suicidal ideations, we used to meet them with counselling and care, and for people with terminal illness and other diseases we could mitigate that suffering and help them have a better life," she says. "Yet now we are seeing that as an appropriate request to die and ending their lives very quickly."While at Dr Coelho's surgery I was introduced to Vicki Whelan, a retired nurse whose mum Sharon Scribner died in April 2023 of lung cancer, aged 81. Vicki told me that in her mum's final days in hospital she was repeatedly offered the option of Maid by medical staff, describing it as like a "sales pitch".The family, who are Catholic, discharged their mother so she could die at home, where Vicki says her mum had a "beautiful, peaceful death". "It makes us think that we can't endure, and we can't suffer a little bit, and that somehow now they've decided that dying needs to be assisted, where we've been dying for years."All of a sudden now we're telling people that this is a better option. This is an easy way out and I think it's just robbing people of hope." 'Not a way I want to live' So is Canada an example of the so-called slippery slope? It's certainly true that the eligibility criteria has broadened dramatically since the law was introduced nine years ago, so for critics the answer would be an emphatic yes and serve as a warning to assisted dying laws were driven by court rulings. Its Supreme Court instructed Parliament that a prohibition on assisted dying breached the country's Charter of Rights and Freedoms. The extension of eligibility for those who were not terminally ill was in part a response to another court Britain, judges in the most senior courts have repeatedly said any potential change to the law around assisted dying is a matter for Parliament, after the likes of Tony Nicklinson, Diane Pretty and Noel Conway brought cases arguing the blanket ban on assisted suicide breached their human knows some people may look at her, a young woman, and wonder why she would die."We're the masters of masking and not letting people see that we're suffering," she says. "But in reality, there's days that I just can't hide it, and there's many days where I can't lift my head off the pillow and I can't eat anymore."It's not a way I want to live for another 10 or 20 or 30 years."Additional reporting by Joshua Falcon.
The Guardian
27-01-2025
- Health
- The Guardian
Is assisted suicide a ‘clear and present danger' to people with disabilities? A new film asks tough questions
In 1983, Elizabeth Bouvia, a 26-year-old woman in California with a non-terminal but debilitating illness, tried to starve herself to death in a hospital. 'I've made a confident, rational decision,' she said. Doctors began force-feeding her, which she resisted. The ensuing legal case turned her into a focus of intense public attention. A headline declared: 'Elizabeth Bouvia is young, pretty, smart – and ready to die.' Bouvia, who had cerebral palsy and severe arthritis, could live 15 or 20 years with treatment, according to her doctors. But she maintained that life did not feel worth living and that she found life in a hospital intolerable. She lost her case; a court ruled that she did not have the right to die. After Bouvia lost her case, she disappeared from public view. Reid Davenport, a documentary filmmaker, wanted to know more. Life After, his feature documentary premiering this month at Sundance, looks at Bouvia's story and asks larger questions about euthanasia and assisted dying. Davenport also has cerebral palsy, and his documentary research left him with a sense that disabled or chronically ill people who request assisted dying are often reacting to a lack of support or believe that the world does not want them. 'Assisted suicide presents a clear and present danger to disabled people,' Davenport told me during a recent video call. 'I take that position from a leftist point of view.' Today, in some jurisdictions, Bouvia would have the right to die. In 2019, Canada expanded its Medical Assistance in Dying program (Maid) to allow applicants with chronic illnesses to request euthanasia by medical overdose even if their deaths by illness are not 'reasonably foreseeable'. Canada plans to begin allowing applications from people with solely mental illnesses in 2027. More than 13,000 Canadians died through assisted dying in 2022 – 4.1% of Canadian deaths. This marked a 30% rise over the year before, according to reporting by Leyland Cecco for the Guardian. Ten US states and the District of Columbia allow 'medical aid in dying', though with stricter requirements, which usually require a diagnosis of natural death within six months. California, which has a population size similar to that of Canada, had only 853 assisted dying deaths in 2022. The UK is currently debating legislation to legalize assisted dying. One of Davenport's previous films was a documentary, I Didn't See You There, that sought to convey life with a disability not by turning the camera on himself, but by pointing it outward, from the vantage of a roving wheelchair, at the rest of society. Bouvia's life, Davenport says, is a 'touchstone for all these other issues disabled people face'. Her story is complicated and doesn't necessarily lend itself to partisan conclusions. In 1986, three years after she first addressed the court about her wish, a judge reversed the earlier decision. By that time, Bouvia was on treatments that would have made death by starvation excruciating. She chose to keep living, but told the press that this was a practical decision and she still would have preferred to die. In Life After, Davenport and Colleen Cassingham, one of the film's producers, track down Bouvia's sisters with the help of a private investigator. They learn that she died in 2014, about a decade later than doctors had predicted. The interviews, plus home-video footage supplied by the family, paint a picture of a woman who benefited from technological advances and better support, was a voracious reader and seemed content, even happy. Rather than in a hospital, she was living in her own apartment, with a live-in nurse. 'I would say she was in a better place than she was in the 80s,' Davenport says, though he acknowledges it is difficult to say because Bouvia can't speak for herself. 'Everybody wants to know, did she change her mind?' her sister, Teresa Castner, says in Life After. She sighs and throws out her hands. 'Who the fuck knows? I don't think she changed her mind per se. I think she accepted her fate. I think she came to the realization that this was not how she wanted to die.' Bouvia's sisters say that she was happiest when she had the most autonomy. She was crushed when she was discouraged from pursuing her dream of being a social worker, despite her college education – one of the incidents that seems to have precipitated her original request to die. 'I think there are a lot of parallels between Elizabeth Bouvia and the arguments disabled people are making about [Maid],' Davenport says. In the documentary, he travels to Canada. Although the overwhelming number of Maid deaths there are related to terminal illnesses, activists and reporters have identified cases and practices that call the system's guardrails into question. The patients and doctors who speak to Davenport express concern that non-terminal euthanasia requests have a lot to do with the limits of Canada's overstretched healthcare and welfare systems, plus the fact that people with disabilities – including Bouvia, in some of her public remarks – are often fearful of being a 'burden' on their families or on society. During a protest in Canada, a critic holds a sign: 'Assisted Suicide: The World's Cheapest Healthcare.' Advocates for assisted dying view it as 'having control over your life', Davenport says, but 'the decision is not truly free choice in many cases. There are other factors dictated by external forces', like poverty, a lack of in-home support or months-long waiting lists for specialist doctors. Davenport believes the enthusiasm for assisted dying has 'a lot to do with cost savings'. The Canadian parliamentary budget officer, the documentary notes, estimated that expanding Maid would save $149m in healthcare costs. Some experts have called fears about Maid overblown. They note that most patients are people with terminal illnesses choosing to die on their own terms. 'You have to meet rigorous eligibility criteria,' Jocelyn Downie, a law professor who studies end-of-life policy, told the Guardian in 2022. The exact number of Canadians who have died through Maid, as well as the breakdown of types of patients, is difficult to know – in part because medical authorities in Ontario and Quebec 'explicitly instruct doctors not to indicate on death certificates if people died from euthanasia', according to the AP. According to available data, about 3.5% of the people who died through Maid in Canada in 2022 were people with chronic, non-terminal illnesses. 'I work in the healthcare system and see people with severe chronic medical conditions all the time,' Mona Gupta, a psychiatrist at the University of Montreal and the chair of a panel studying Maid and mental illness, told the Guardian last year. 'The idea that 400 of them – in a country of 40 million people – had reached the point where they had exhausted all treatment options, and wanted to access Maid, does not seems extreme to me.' Davenport worries that society encourages people with disabilities or chronic medical conditions to view life as not worth living. Life After discusses the case of Jerika Bolen, a 14-year-old in Wisconsin with spinal muscular atrophy who in 2016 was allowed to end medically necessary treatment. She died in hospice care after the community threw her a prom, widely celebrated in the media, called 'J's Last Dance'. Bolen's mother has said: 'My only words to anyone questioning this is that I love that girl with every cell in my being [and] no one in their right mind would let someone suffer like she was.' An anti-euthanasia group, Not Dead Yet, questioned the 'one-sided applause for her suicide', however, asking a local newspaper: 'If she were a 14-year-old diabetic refusing insulin, would the reactions be the same?' In reviewing footage of Bolen's 'prom', Davenport says, 'it seemed to me like Jerika was surrounded by people who thought she would be better off dead … No one, much less a child, should be told that ending her life would be an admirable decision.' I ask Davenport if adults with terminal illnesses should be able to end their lives voluntarily. 'Theoretically, I think assisted suicide could be safe,' he says. But he feels that it is inherently unsafe in a 'neoliberal' society where doctors and patients are subject to tremendous social and economic pressures. 'Let's have that discussion when it is safe.' Although some leftwing publications have expressed concern, most skepticism of euthanasia so far has come from disability activists or conservatives, with the subject treated as 'cut-and-dried in liberal circles', Davenport says. He worries that progressives will dismiss his documentary as cynical or alarmist. 'The 'slippery slope' is considered fear-mongering,' he says. 'But there are instances where it's a valid argument.' In the US, you can call or text the National Suicide Prevention Lifeline at 988, chat on or text HOME to 741741 to connect with a crisis counselor. In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@ or jo@ In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at
