Dr. Leonie Herx:

I thank the committee for having me. I am a palliative medicine specialist, clinical professor of palliative medicine at the University of Calgary and former president of the Canadian Society of Palliative Care Physicians.

In Canada the administration of lethal drugs to end life intentionally is called medical assistance in dying, MAID. This includes both euthanasia, where a clinician administers the lethal drugs, and assisted suicide, where the patient self-administers the lethal drugs. Over 99.9% of cases of MAID in Canada involve euthanasia.

At the outset of the Canadian euthanasia legislation, we were told that a "carefully designed and monitored system of safeguards" would limit harm and prevent wrongful death. Yet year after year there have been documented cases of non-compliance with safeguards and misapplication of both law and policy regarding MAID. The chief coroner of Ontario, the end-of-life care commission in Quebec and the correctional investigator of Canada have all reported on these issues. There is no real-time monitoring of MAID or stop mechanisms if red flags are raised. A recent report in the Canadian Journal of Bioethicsconcluded that the Canadian MAID programme has failed to provide Canadians with evidence to show that it is operating as mandated by the requirements of the law, regulations and the expectations of stakeholders.

In 2021, the Canadian MAID legislation was expanded to include people living with chronic illness and disability. For such cases without foreseeable death, a 90-day assessment period is required before receiving MAID, but experts agree that 90 days is wholly inadequate. Suicidality and depression peak around 90 days after a diagnosis of serious illness. Specialist care such as psychiatry, chronic pain and rehabilitation often requires much more than 90 days to assess and to see therapeutic improvements. Doctors are now facilitating suicide completion rather than providing mental healthcare and suicide prevention.

An actively suicidal patient with all the high-risk indicators for suicide completion was seen in my oncology clinic. Psychiatry was consulted and, rather than admitting the patient, as would have routinely been done before MAID, gave the MAID team phone number to the patient, stating that he was eligible for MAID and that it would be easier than committing suicide himself.

What happens if a severely depressed person refuses all treatment and support measures for depression and insists on obtaining MAID instead? I have seen a patient with an underlying condition that qualified them for MAID but their suffering was driven by an untreated major depressive episode. That person received MAID the same day as requesting to end their life, with no other supports provided.

In March 2024, our MAID law will expand to those with mental illness as a sole underlying condition, which will put more people at risk of suicide completion, especially those with structural vulnerability. With changes to MAID legislation and progressive interpretations of MAID law and policy over time, increasing numbers of Canadians are asking for and receiving MAID due to fear, loneliness and depression, social deprivation and isolation, lack of access to supports and adequate care needed for living, lack of access to parole for some prisoners, high cost of care and poor conditions at residential facilities.

The former federal Minister for disability inclusion, Carla Qualtrough stated to the House of Commons justice committee in Canada that “in some places in our country, it's easier to access MAID than it is to get a wheelchair.” MAID has been radically normalised as routine medical care. Some physician regulatory bodies and now Health Canada are recommending MAID be raised to all potentially eligible patients as one of the options. If a doctor offers unsolicited MAID, this may be all that is needed to push a vulnerable patient to want to end their life. Patients take the recommendations of their doctors seriously due to trust in their expertise and that doctors have their best interests in mind.

MAID has also had a profound effect on palliative care in Canada. Expressions of a desire to die are common and are expressions of grief, anger, loss or despair in response to a devastating diagnosis or change in condition. This lament or cry for help now often results in a MAID consult before palliative care has been involved. Recently, a patient was struggling with wanting to die and specifically asked to see the palliative care team but the MAID team was sent instead. This is not uncommon.

All healthcare facilities are expected to provide MAID, including hospices, whose core palliative care philosophy does not include hastening death. In Quebec, MAID legislation now requires all hospices and palliative care units to provide MAID. There are no euthanasia-free safe spaces.

A culture of silence has evolved around concerns with MAID. Family members and healthcare professionals who voice questions or concerns about safety are routinely dismissed as being anti-MAID or accused of trying to block access to MAID. Once MAID is legalised, it progressively becomes normalised as routine care and seen as a solution for virtually any form of suffering. I urge the committee to learn from our experience and not follow in Canada’s footsteps.