Hayward: Canada -- Quebec Doctor Warns Euthanasia No Longer a 'Last Resort'

Dr. Michel Bureau, head of Quebec’s End of Life Care Commission, told the Canadian Press on Tuesday that Medical Assistance In Dying (MAID) has become so common in the province that he fears suicide is no longer seen as a “last resort.”

MAID is Canada’s preferred euphemism for physician-assisted suicide. Canada has one of the most liberal – and arguably most aggressive – euthanasia programs in the world. MAID was supposed to expand to include patients with mental illnesses but no physical ailments this year, but that proved to be a step even euthanasia-happy Canada was reluctant to take, so it has been postponed until at least 2024.

As things stand in Canada, MAID is no longer reserved for people with terminal illnesses or unbearable pain, and there is pressure to begin offering it to minors. Doctors are encouraged to bring up euthanasia as an option before patients ask for it.

Bureau said these measures have produced an environment in which Quebecers no longer view MAID as an “exceptional treatment,” but rather one that has become “very frequent.” In fact, Bureau estimated that seven percent of all deaths in Quebec will be doctor-assisted suicides by the end of 2023.

“That’s more than anywhere else in the world: 4.5 times more than Switzerland, three times more than Belgium, more than the Netherlands. It’s two times more than Ontario,” he said.

“We see, more and more, that the cases receiving medical aid in dying are approaching the limits of the law. It’s no longer just terminal cancer; there are all kinds of illnesses – and that’s very good, but it requires a lot of rigor from doctors to ensure they stay within the limits of the law,” Bureau said.

The latter comment includes the sort of logical and ethical contradiction that haunts every step of Canada’s rush to become the euthanasia capital of the world: The same doctor and influential commission chair who worries that MAID has become too widespread and easily accepted also thinks it is “very good” that the number of diagnoses that end in euthanasia is rapidly increasing. Once a society begins to view assisted suicide as something other than a tragic last-ditch escape from guaranteed misery and inevitable demise, the slope becomes very slippery.

Quebec’s End of Life Care Commission found a handful of cases in which the province’s rules for MAID were not followed, including some patients who were given euthanasia without meeting the requirements. No disciplinary action was taken against the doctors in any of those cases, which does not exactly send a message that MAID is an “exceptional treatment” that must be handled with the greatest of care.

Bureau’s primary concern appeared to be elderly patients who requested MAID even though their health was not poor enough to meet Quebec’s requirements. He stressed that MAID is not meant as a replacement for “natural death,” but the logic behind Canada’s euthanasia drive makes one wonder why older people who do not want to live anymore should be denied the procedure – especially after next year’s legalization of MAID for mental illness.

Critics of MAID already worry that Canada’s badly overstressed healthcare system will use suicide to clear up patient backlogs. Its overstressed social system might be equally tempted to trim the high cost of caring for elderly retirees.

As for why Quebec has such a high number of assisted suicides compared to the rest of Canada, bioethics researcher Dr. Mona Gupta told the Canadian Press that Quebec got started on MAID before the rest of the country – its right-to-die law was passed in 2014 – and its residents “tend to have secularized attitudes toward individual moral choices, including divorce and abortion.”

The New York Times (NYT) reported in June that the rest of Canada is catching up to Quebec and people across the country are growing a little queasy about where MAID is headed, but it still has “broad public acceptance” and “strong support” in polls.

“It’s a state-funded, state-organized, medical system providing end of life. What I find particularly troublesome is that there is no other jurisdiction that treats the ending of life by a physician as a standard medical practice,” said University of Toronto chair of health law and policy Trudo Lemmens, making the same point as Quebec’s Dr. Bureau.

Most of the serious qualms among Canadian doctors, politicians, and commentators concern the impending legalization of MAID for people with mental illness only, and possibly for minors.

The NYT cited a few other criticisms of the existing rules, including family members who felt “shut out of the process” when loved ones opted for euthanasia, the damage legal suicide inflicts on suicide prevention and other mental health efforts, and “the possibility that people facing economic or housing challenges may now simply give up and opt to die.”