‘It’s social murder’ — is Canada’s assisted dying a model or a warning?

Mitchell Tremblay ran through all the mental health problems he had been diagnosed with: PTSD, borderline and histrionic personality disorders, major depressive disorder and, most recently, generalised anxiety and bulimia.

When he learnt this year that Canada was planning to widen its assisted dying legislation to include chronic mental illness, he saw a way out.

“I wanted to end it but I’m a coward and I know I could never do it myself,” said Tremblay, 42, who lives on disability allowance. “I would have scheduled that first consultation with the doctor in March when the law passed and would have had the second, final one around now. I would already be dead.”

 

At the last minute, the government decided to delay the extension to allow more research into its impact, and, on balance, Tremblay is glad to still be here.

Since Canada legalised euthanasia in 2016 it has become the global capital of assisted dying. With similar legislation now heading towards the UK parliament and a vote expected before Christmas, the question facing England and Wales is whether Canada offers a model or a warning.

About three quarters of Britons are in favour of assisted dying, according to the largest survey of public opinion on the issue, published by Opinium Research in March.

A month earlier the English author Wendy Mitchell, who had been suffering from dementia and ended her life by starvation, issued a posthumous plea to ministers to legalise assisted dying so that others would not have to do the same.

 

Canada’s “medical assistance in death”, known by the acronym Maid, is available for adults with terminal illness as well as those with a serious and chronic physical health condition, even if the condition is not life-threatening.

The number of Canadians ending their lives through Maid, which usually takes the form of a lethal injection administered by a physician, has grown so fast that it outpaces every other nation with similar laws.

Assisted deaths accounted for more than 4 per cent of all deaths in the country in 2022, or 13,241 — up from 1 per cent in 2017, the first full year the legislation was in place.

For comparison, California, which legalised euthanasia the same year and has roughly the same population, recorded 853 assisted deaths in 2022.

“What this increase tells me is that Canada has paid the most attention to individual human rights and autonomy,” said Dr Chantal Perrot, a Toronto-based Maid provider who is on the advisory council of the advocacy group Dying with Dignity and has helped people die in their own home, as well as hospitals, hospices and even hotels.

“The last days, weeks or months of life can be horrific,” she added. “Why would they want to go through that if they could have a peaceful death surrounded by their family and loved ones? I am grateful to live in Canada, where delivering this kind of compassionate care is possible, and where patients can be treated with respect and dignity right up to their final breath.”

Dying with Dignity, a champion of Maid legislation, has called euthanasia a fundamental human right, arguing death for the terminally ill can often be cruel and slow. Of those helped to die in 2022, 96.5 per cent had terminal illnesses or faced imminent death. Of the 13,241 total, 463 suffered from a chronic, but lesser, condition, and their average age was 76.

Eligible patients must wait 90 days before receiving an assisted death and be approved on the assessments of two independent doctors or nurses.

Critics in the UK, however, have warned about the difficulties in defining who is eligible, the danger of people being pushed into a decision and subsequent attempts to widen the law. They also have concerns over how an already overstretched National Health Service would deal with the additional burden.

They point to Canada’s permissive rules, which are far looser than those of other countries offering assisted dying, such as Belgium and the Netherlands.

Requests for medically assisted death in Canada are now much more frequently approved than in 2019, when nearly 9 per cent of requests were denied. In 2022, that figure fell to 3.5 per cent, according to a Health Canada report.

The report said 17 per cent of those who applied cited “isolation or loneliness” as a reason, while nearly 36 per cent believed that they were a “burden on family, friends or caregivers”.

 

It concluded by saying the authorities underestimated how many people would use the assisted death programme.

It has proved a headache for the courts. Over the summer, the father of a 27-year-old autistic woman from Calgary applied to block her request for assisted suicide for what she called “intolerable” suffering. The judge sided with the father.

The federal government is facing pressure from the Senate, the upper house of parliament, to broaden the legislation to include mental illness as a reason for an assisted death. “To deny them this right while permitting it for people whose illness is not a mental disorder is not just stigmatising; it is exclusionary,” Senator Stan Kutcher, a professor emeritus of psychiatry at Dalhousie University, said.

Human rights advocates, however, say Canada’s euthanasia laws lack safeguards. They claim the government is killing people who are not receiving enough state support to continue living — “tantamount to social murder”.

Some recipients of Maid have opted for assisted death at least in part because they cannot afford adequate housing, the advocates claim.

“Leaving people to make this choice [to die] because the state is failing to fulfil their fundamental human rights is unacceptable,” said Marie-Claude Landry, chief commissioner of the Canadian Human Rights Commission.

 

Tremblay has struggled over the past two decades with homelessness and insecure accommodation, which he said exacerbated his mental health problems. His monthly allowance barely covers the rent on his home in Guelph, Ontario — the province with the highest rate of euthanasia. “When we lose our housing and have a disability, it just compounds so quickly,” he said. “It has been so bad that I even wished I had cancer, anything, just so I would be covered.”

With seven diagnosed mental health disorders, most of which he has suffered through his entire adult life, he is sure he would qualify under an expanded Maid. He said he knew dozens of others in his situation who would be likely to apply for assisted death should it be made available, describing a “rush for the doors”.

Krista Carr, executive vice-president of Inclusion Canada, a disability rights group, said her organisation received about ten calls a month from people like Tremblay. “Situations have gotten so desperate that they are wondering if there’s any other choice,” she said. “It’s a lot cheaper for the system to end people’s lives than it is to support them to live well.”

Tremblay has mixed feelings. He still struggles with the problems that prompted him to consider assisted death but in many ways is grateful to still be alive and has begun campaigning for greater disability benefits.

“It’s not a black and white issue for me,” he said. “I support Maid, while at the same believing Canada should, and could, be doing more.

“I felt coerced — by poverty, by my situation — when really I needed proper support. It made me wonder just how many assisted death patients felt like I did.”