Canada’s legalisation of euthanasia should be a warning sign for other countries considering the move amid reports of people being offered help to die if they do not have adequate access to social support and care, MPs have been told.
The country has a “very aggressive medical delivery system of euthanasia”, a parliamentary committee heard as it listened to experts on the issue.
Concerns were aired that people who lack access to disability services or outpatient psychiatric treatment can be offered euthanasia in what was described as a “very disturbing societal norm”.
I would say Canada is a warning sign for countries that contemplate legalising medical assistance in dying (Maid) or assisted suicide and euthanasia— Professor Trudo Lemmens, University of Toronto
A number of experts gave evidence to the Health and Social Care Committee’s assisted dying/assisted suicide inquiry on Tuesday.
Dr Scott Kim, a professor in psychiatry at the University of Michigan and senior investigator at the department of bioethics at the National Institutes of Health in the US, said Canada’s medical assistance in dying (Maid) law is not a last-resort measure.
He told MPs: “The law itself says this doesn’t have to be last resort, which means that a person could genuinely lack access to disability services, to outpatient psychiatric treatment, which is common in Canada. Those people would still qualify. And I think that’s a very disturbing societal norm.”
Canadian Professor Trudo Lemmens said he had been a supporter of initial legislation but it has become a “form of harm reduction”.
He said: “I would confirm that one of the concerns that people like me have who have supported actually the initial legislation is that originally there was a denial of the fact that we had cases of people who were asking for Maid because they lacked adequate support.
“There is now an explicit admission of some of the strong advocates for broader access to Maid that these cases are happening, that they’re a solution to a worse-off situation. So it has been defended even as a form of harm reduction, to offer Maid when people don’t have adequate access to social support and care. So I think that’s a serious concern.”
Prof Lemmens, who is professor and Scholl chairman in health law and policy at the University of Toronto, said: “I would say Canada is a warning sign for countries that contemplate legalising medical assistance in dying or assisted suicide and euthanasia.”
I would say that it's very impressive the process that you've embarked on - this inquiry - which is a very careful, bipartisan, open ended, evidence based inquiry— Dr Scott Kim, University of Michigan
He said the system began in response to “the typical more exceptional cases of suffering where there was a perceived need to allow euthanasia and assisted suicide in a case of a person with a degenerative disease approaching natural death” but expanded to become “the most open-ended system in the world”.
He said euthanasia has in “some way become a first line therapy” which is “accessible largely on demand in very broad circumstances in response to suffering associated with medical illness or disability more broadly”.
Dr Kim agreed with the “warning sign” assessment and praised the MPs for holding a thorough inquiry on the issue for the UK.
He said: “I would say that it’s very impressive the process that you’ve embarked on – this inquiry – which is a very careful, bipartisan, open-ended, evidence-based inquiry.”
But Professor James Downar, from the division of palliative care at the University of Ottawa, said it is a “bit of a misconception”, in response to Dr Kim’s comments on Maid not being a last resort.
Prof Downar said: “I don’t think that Maid has often been taken as a first resort.”
While there are access issues broadly in Canada, in the UK, in the US...those access issues very much do not seem like they are driving Maid decisions to any substantial degree at all— Professor James Downar, University of Ottawa
He accepted there are issues around people having access to services, but said the vast majority of people using Maid had access to the relevant services and access is not the main driver for people.
He told the committee: “I would say there definitely are issues of access to services in parts of this country, that is absolutely true.
“I would simply state that what we know of the individuals who are receiving Maid that, you know, 96% received or had good access to disability supports, 98% received or had access to palliative care supports. That’s not just a self-report. That was corroborated by coroners’ reports in Ontario for the first 3,000 cases. I published work on that.
“Again, it’s important to distinguish that, you know, while there are access issues broadly in Canada, in the UK, in the US – this is a very, very true statement – that those access issues very much do not seem like they are driving Maid decisions to any substantial degree at all.
“I’d love to see those numbers be 100% instead of 98. But again, to focus on that as the issue, I think is to miss the point.”
