Professor Trudo Lemmens:

I hold the Scholl chair in health law and policy at the University of Toronto. I have been an expert witness for the Canadian Government in two cases related to Canada’s assisted dying law and I was a member of the Council of Canadian Academies' MAID expert panel. My work in this area focuses on the human rights dimensions and the professional regulatory challenges of MAID practice. I supported the first Canadian MAID law. I considered it a proper response to the Supreme Court Carter decision, which confirmed the role of the criminal law in protecting life but declared, and I emphasise, an absolute prohibition on assisted dying unconstitutional.

Parliament first carved out, as it was invited to do, so-called MAID as an exemption from the remaining criminal law prohibition in the end-of-life context but, under pressure from advocates for broad access, MAID practice quickly went beyond this context. The Government used a lower court decision to push through an expansion of the law to make it de factoavailable for disabled persons who are not dying. It did so notwithstanding opposition from almost all disability organisations, indigenous organisations and law, medicine and ethics experts, including three United Nations special rapporteurs on human rights, who warned that Canada’s law exposes disabled persons to systemic discrimination by exposing them to disproportionate risk of death.

I am increasingly troubled by the normalisation, even trivialisation, of ending of life as therapy for suffering in Canada’s MAID law and practice. In seven years, Canada has become the country with the highest number of euthanasia deaths at more than 10,000 per year.

Two provinces bypassed the percentage of euthanasia deaths of the Netherlands and Belgium, which legalised euthanasia in 2002. In Quebec, more than 7% now die by MAID. With the 2021 expansion of the law, which facilitates an early death of persons with disability who are not approaching their natural death, soon to include mental disability, this will further increase.

Advocates see this as a confirmation of the benefits of legalisation. They focus on access, not protection, with high numbers confirming consumer need. However, healthcare provider and state-funded ending of life is not a standard consumer good. It occurs in a challenging healthcare context, characterised by vulnerability, ambiguity, complex healthcare provider-patient relations, significant wait times for needed care, pressures on caregivers and family members, growing rates of poverty, discrimination, indigenous trauma and so on. This has largely been ignored by MAID advocates, or worse. Some have framed it now as an acceptable remedy for gaps in care and social injustice.

Official data raise concerns about why people opted to die by MAID. More than 35% held that being a burden on caregivers and loved ones created unbearable suffering. Some 57% indicated inadequate pain control or concern about that, whereas inadequate pain relief should be rare with good care. A further 54% felt they lost dignity, an experience influenced by societal messaging in healthcare settings and often ableist perceptions of the quality of disabled lives. One in five indicated loneliness and 3% even existential suffering.

The high number of MAID deaths is associated with several factors. I will enumerate some here quickly. First, vague access criteria are interpreted excessively broadly. Other jurisdictions have a terminal illness diagnosis with a six-month survival prognosis, offering at least some protection against premature death. Second, Canada’s main practice overwhelmingly involves physicians and nurse practitioners directly ending lives. This is associated with higher uptake than assisted suicide regimes. Third, MAID is explicitly not treated as a last resort in Canadian law. Contrary to the few other liberal regimes, and Belgium and the Netherlands in particular, healthcare providers do not need to agree that no other options remain. There is no obligation to make care or support available and try it first. Death has been transformed into first-line therapy for often only remotely disease-related suffering.

Individual case reports further illustrate the troubling normalisation of offering death to patients with chronic illness and disability, often in a context of troubling social injustice. I urge the committee to listen to these stories, some of which it will have heard, and watch some of the investigative fact-check media reports. I refer to the case of Kiano Vafaeian, 23 years old, who I met and encouraged, who has diabetes and resulting vision loss and who was saved only because his mother launched a public letter-writing campaign after discovering that his life was about to be ended by MAID. There is also Rosina Kamis, aged 41, who did not want to die but was isolated and lonely and struggling with tragic poverty, which made her chronical illness so much more challenging. These reports, as well as the data I just discussed, reflect the price we pay for an overly aggressive promotion of MAID in Canada. They should raise a red flag for other jurisdictions that are exploring broad legalisation of this practice.

I thank the committee for paying attention to our concerns.