Second Annual Report on Medical Assistance in Dying reveals concerning trends
Garifalia Milousis
On June 30, 2021, the Government of Canada released its Second Annual Report on Medical Assistance in Dying (MAID) in Canada. The report reveals some disturbing data that, unfortunately, confirms some of the concerns that CLF and others have repeatedly warned decision makers about (see here). The statistics remind us of the inherent risks of expanding Canada’s MAID regime and the pressing need to continue to support marginalized Canadians seeking assistance to live with dignity.
Increase in MAID in 2020: 2.5% of all deaths in Canada
The Annual Report indicates that there were 7,595 cases of MAID reported in Canada in 2020, bringing the total number of deaths from euthanasia and assisted suicide in Canada up to 21,589 reported cases since mid-2016. In 2020, MAID accounted for 2.5% of all deaths in Canada, and there was a 34.2% increase in the number of MAID cases from 2019 to 2020. While this increase itself is concerning, there were a number of other problematic findings outlined in the First Annual Report—findings that Christian Legal Fellowship (CLF) identified in its submissions to the House of Commons on Bill C-7—that seem to be continuing and are evident in the Second Annual Report.
Lack of supports
Statistics from the Second Annual MAID Report indicate that, in 2020 alone, 126 patients who died by MAID neither received nor were able to access palliative care if they needed it, and the accessibility of palliative care was unknown in an additional 170 cases. Furthermore, 123 patients required disability supports but did not receive them. In all of these cases, these patients ultimately received MAID, raising serious ethical questions about the provision of MAID—which is supposed to be presented as a last resort—when palliative care and disability supports were needed but inaccessible. CLF identified these problems based on the First Annual MAID Report for 2019, and it is concerning to see that these problematic trends have only continued and worsened in 2020.
Sources of suffering: 35.9% accessed MAID because of perceived burden
The First and Second Annual MAID Reports also reveal concerning trends about the nature of the suffering of those seeking MAID. One or more of the following sources of suffering was identified by those who accessed MAID in 2020 (as reported by MAID providers): “loss of dignity” (53.9% or 3,980 people); “perceived burden on family, friends or caregivers” (35.9% or 2,650 people); “isolation or loneliness” (18.6% or 1,373 people); and “emotional distress/anxiety/fear/existential suffering” (5.6% or 413 people). Each of these percentages increased between 2019 and 2020, with the biggest increase being “isolation or loneliness”, increasing from 13.7% in 2019 to 18.6% in 2020.
MAID and suicidality
It is heartbreaking to learn that so many individuals chose to end their lives for these reasons. It is worth noting that each of these descriptions of the nature of the person’s suffering can easily apply in contexts of suicidality. According to Crisis Services Canada, approximately 80% of people who attempt or die by suicide exhibit warning signs such as “[i]solation, withdrawal from previously enjoyed relationships and activities”, “protracted anxiety or agitation”, and “[e]xpressions of hopelessness, helplessness, purposelessness”. Once again, this raises serious ethical questions about whether Canada’s health care system should be facilitating the deaths of people whose suffering so closely mirrors the suffering of suicidal individuals and could be due to suicidality.
Hundreds of patients change their mind about MAID, even after requesting it in writing
Some of the changes made by the passage of Bill C-7 included the removal of the (previously) mandatory 10-day waiting period and the introduction of the final consent waiver for those whose death is reasonably foreseeable. Many groups—including CLF—raised concerns about the removal of these safeguards, since these safeguards helped ensure that the patient had time to reflect on, and consent contemporaneously to, MAID. The need for such safeguards is further highlighted by the report, which indicates that, in 2020 alone, 232 patients (representing 2.5% of all written MAID requests) withdrew their requests after making them in writing. Of these 232 patients, 47.8% indicated that their withdrawal was motivated at least in part because palliative measures were sufficient to address their suffering, while 66.4% said that they changed their minds. Of these 232 withdrawals, 22% (51 patients) occurred immediately before the MAID procedure when the patient was asked to provide final contemporaneous consent. CLF reiterates its grave concerns about Bill C-7’s removal of the mandatory reflection and contemporary consent safeguards, particularly since the evidence is clear that they were useful checkpoints for patients who chose to opt-out of the MAID process.
Existing safeguards are not always adhered to
Finally, while safeguards such as these are vitally important, CLF has expressed ongoing concern that existing safeguards are not being properly adhered to. CLF pointed to examples of this in its submissions to the House of Commons. The Second Annual MAID Report suggests that these problems have continued to impact the lives of Canadians. For example, when asked to indicate how they confirmed whether the patient made a voluntary request for MAID that was not a result of external pressure, MAID providers indicated that they consulted directly with the patient in 99.2% of the MAID cases. This means that in 0.8% of MAID cases—representing 59 patients—the patient was not directly consulted to ensure that the MAID request was voluntary and not the result of external pressure. This is deeply problematic. The government must ensure that all of the safeguards designed to guarantee the safety of vulnerable individuals are strictly adhered to, and this should be prioritized over and above expanding MAID eligibility.
The work ahead
Overall, government statistics continue to reveal some disturbing trends about MAID in Canada. Unfortunately, with the passage of Bill C-7, the expansion of MAID to those whose death is not reasonably foreseeable, and the removal of critical safeguards, these trends are unlikely to improve. CLF will continue to monitor this issue and make submissions to the relevant bodies, calling for better enforcement of existing safeguards and the addition of new safeguards to protect vulnerable Canadians.
Further Reading
CLF’s Submissions to the Standing Committee on Justice and Human Rights re: Bill C-7 (October 31, 2020)
CLF’s submissions to the Standing Senate Committee on Legal and Constitutional Affairs re: Bill C-7, in English and French
CLF’s letter to all members of both houses of the Canadian Parliament urging them to halt Bill C-7, and drawing their attention to specific UN concerns about the legislation (February 8, 2021)
CLF’s letter to Parliament re: Bill C-7, urging them to reject Bill C-7, as amended by the Senate (February 22, 2021)
CLF’s blog explaining what Bill C-7 means for Canadians
Second Annual Report on Medical Assistance in Dying in Canada 2020
CLF’s Submissions to the College of Physicians and Surgeons of Ontario (CPSO) re: policies concerning its MAID and human rights policies (May 14, 2021)
CLF’s Submissions to the World Medical Association (WMA) re: its proposed amendments to the International Code of Medical Ethics pertaining to mandatory effective referrals in cases of conscientious objection (May 28, 2021)
Detailed summary of CLF’s ongoing advocacy in support of the equal right to life