Is Canada ‘Killing Itself’ With Doctor-Assisted Suicide?
(ANALYSIS) The Religion Guy’s Answer": This is a landmark year for what’s variously labeled “medical assistance in dying” (MAID), “doctor-assisted suicide,” death by choice,” “death with dignity,” “the right to die,” “euthanasia” or “mercy killing.” As this is written, Great Britain is on the brink of joining the West European nations that allow suicide under specified conditions.
The same for New York State, which would follow 11 states plus the District of Columbia that have legalized suicide, starting with Oregon in 1994 and including Delaware as of May 20. Another 16 states are considering such legal changes.
Then this. The September issue of The Atlantic magazine has a significant 15-page investigation of the evolution in Canada’s MAID program. Staff writer Elaina Plott Calabro’s blockbuster carries an arresting headline: “Canada Is Killing Itself.” As of 2023, 60,300 legal suicides had been performed and now make up about 5% of Canadian deaths — and 7% in Quebec province, the world’s highest rate.
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For doctors, the age-old ethical rule requires that they “do no harm,” so even secular thinkers raise weighty moral objections to this dramatic change, alongside religions’ tradition that only God should end a life. Disability activists are understandably concerned when lives are deemed not worth living. Also, media accounts tell of troubling legal suicides by young adults, or suicides over an eating disorder, loneliness, high blood pressure, a hip fracture, and cancer with 65% odds of a cure.
MAID proponents emphasize the emotion-laden plight of patients who are close to death and suffering from severe pain or disability. On that, moral theologians generally endorse “palliative” treatments intended to reduce pain or suffering, even if such treatment will hasten death as a “secondary effect.” Also, they believe that modern “extraordinary” methods to artificially extend the life of a terminally ill patient are not morally required.
Opponents of MAID fear that many do not actually want to die because of their own suffering. Rather, roughly half of Canadian applicants want to remove burdens on family and friends if they keep living, and 47% in an Oregon survey. Politicians may favor the idea only to avoid funding end-of-life treatments. The fact that economically poor precincts are the most opposed to MAID suggests the medical system is the real problem. There’ve been ghoulish accounts of deaths hastened to acquire organs needed for transplant. Another debate involves whether doctors should avoid mention of the suicide option till it has been raised first by the patient.
Britain’s pending law passed the House of Commons June 20 by a mere 52%, and awaits approval or amendment by the unelected House of Lords. Suicide remains illegal with patients under age 18. Two doctors must certify that a person seeking suicide has a terminal illness with a projected six months or less to live, and obtain guidance from a social worker, lawyer, and psychiatrist. Full implementation of the program could take several years.
The Royal College of Physicians neither supports nor opposes the law in principle, but protests that it lacks adequate protection for patients and for medical staffs. The physicians also cite the concern of the Royal College of Psychiatrists that existing mental health services are too limited “to meet a new range of demands.”
Awaiting the governor
New York’s state Senate passed the suicide bill June 9 by 56%, following state Assembly approval in April by 55%, but Governor Kathy Hochul (a practicing Catholic up for re-election next year) has not yet decided whether to sign it into law. As in Britain, the bill applies to patients with an incurable terminal illness and six months or less to live, as certified by two physicians. A psychiatric evaluation of the patient’s mental competence to choose death only occurs if one of the physicians requires it.
During the New York State debate, the American Medical Association (AMA) reaffirmed its longstanding ethical policy that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.” Instead, the AMA code urges doctors to “aggressively” provide “appropriate comfort care and adequate pain control.” Yet the code also allows “considerable latitude” for doctors’ “well-considered, deeply held beliefs,” indicating suicide aid should not cause removal of medical licenses.
In Canada, a unanimous 2015 Supreme Court ruling abolished as unconstitutional the criminal law that prohibited doctors from assisting in suicide desired by patients, but suspended implementation till Parliament enacted such legislation by comfortable margins the next year. Treatments need not involve a doctor familiar with the patient’s condition and are readily booked via 800 phone numbers.
Calabro interviewed one Montreal practitioner who has presided at around 600 suicides, while another in Vancouver counted 430. Demands for suicide doctors are beginning to exceed the number available to perform them, even as the nationalized health system is already plagued by staff and money shortages and serious delays for surgery. Ontario’s chief coroner reports 480 suicides in which the legal rules have been violated.
Infusion or Injection?
In Canada, the lethal prescription is administered by a doctor or nurse practitioner, or by the patient. Canada prefers use of intravenous infusion, though injection is common in other nations. In case of vein failure, an injection gun can insert the poison directly into bone marrow. Drugs are first applied to numb sensations and induce a coma, after which rocuronium brings death by halting lung and heart functions.
Originally, Canada limited cases to “intolerable suffering” of “gravely ill patients” at “the end of life” when death is “reasonably foreseeable.” But a 2021 amendment expanded coverage to those afflicted with “serious medical conditions but not facing death,” allowing younger Canadians to participate. The required 10-day waiting period between request and death was also eliminated. Doctors are expected to inform patients about available treatments to mitigate suffering but these are not required. A further expansion that goes into effect in 2027 adds suicide for mental illness alone without pain or physical disability.
Beyond that, Canada’s Parliament is discussing suicide for those under age 18 and also by advance directives without an end-of-life crisis. Quebec’s College of Physicians has proposed infanticide for children under age one with “severe” medical problems. So far, only The Netherlands permits purposeful killing of infants, which The Atlantic reminds us is the first nation to do so since Germany under Nazi rule.
Calabro concludes that Canada “enshrines a right before reckoning with the totality of its logic.” In practice, an “incurable” condition has come to mean one not curable by methods a patient accepts. When full patient autonomy “is entrenched as the guiding principle, exclusions and safeguards begin to seem arbitrary and even cruel.” Once legalized, medical suicide “becomes exceedingly difficult” to restrain. As the system has evolved, she wonders, “is there anyone who shouldn’t be helped to die?”
On another dispute over state-sanctioned deaths, the American Medical Association and other professional guilds prohibit members from participating in executions of convicted criminals, so non-medical personnel apply the chemicals. Paradoxically, numerous legal suicides occur without incident and yet states have sometimes botched executions or have been forced to halt them because manufacturers refuse to supply the needed poisons.
Anyone considering suicide or otherwise in emotional distress should contact the confidential Suicide and Crisis Lifeline, available toll-free 24/7/365 by phoning or texting 988. Related resources are listed at https://speakingofsuicide.com/resources/.
This article has been republished courtesy of Patheos.
Richard N. Ostling was a longtime religion writer with The Associated Press and with Time magazine, where he produced 23 cover stories, as well as a Time senior correspondent providing field reportage for dozens of major articles. He is a recipient of the Religion News Association's Lifetime Achievement Award. He has interviewed such personalities as Billy Graham, the Dalai Lama, Mother Teresa and Joseph Cardinal Ratzinger (later Pope Benedict XVI); ranking rabbis and Muslim leaders; and authorities on other faiths; as well as numerous ordinary believers. He writes a bi-weekly column for Religion Unplugged.