Learning from Canada’s experiment with euthanasia

This article was first published in our recent Social Issues Bulletin – Issue 57 which is available to download here.

In the debate over the Leadbeater Bill to legalise assisting the terminally ill to take their own lives, one topic that comes up repeatedly is the other jurisdictions that have already taken that step: either legalised assistance to a dying person in taking their own life (assisted suicide) or the medical administration of a fatal dose of drugs (euthanasia) to end a patient’s life.

Those supporting Kim Leadbeater like to cite the US state of Oregon, which has had assisted suicide with some safeguards for over two decades.^[1] But while the Bill currently before Parliament in the UK is attempting to follow the Oregon template – making it only for those in the last six months of life and with mental capacity, a firm, settled will, and no evidence they are under coercion – there are already activists keen to expand the range of the proposed legislation to include people with chronic illnesses and disabilities.

Sadly, it is not too far-fetched to see even the modest (and almost undoubtedly ineffective) safeguards being proposed in this Bill being loosened very quickly, either at the committee stage or in legal challenges once it becomes law.^[2] And that is because of the precedent of the many other international examples of such laws.

The Netherlands legalised euthanasia in 2002, allowing doctors to take the life of a patient at their explicit request in limited circumstances. That law has now extended to euthanising those in comas (who had said they would accept euthanasia should they be in such a state) and those with dementia (again, having expressed a prior wish when they had the capacity).^[3] There are proposals to extend it to infants and children (with parental consent/requests).^[4]

Belgium introduced a similar law in 2002, and it has extended to those with mental health issues, children, and those with no significant health issues but who feel life is no longer worth living. Belgium also allows foreigners to submit requests for euthanasia in the country.^[5]

Let’s avoid our own home-MAID disaster

The most recent example is Canada, which brought in a law legalising ‘medical assistance in dying’ (or MAID as it is now known) in 2016. This was initially for adults with ‘illness, disease or disability or [whose] state of decline causes them enduring physical or psychological suffering’.^[6] By 2017, legal challenges argued this was too restrictive. These challenges were successful, leading to a 2021 amendment by the Canadian Parliament that ‘no longer limit[ed] eligibility for medical assistance in dying to persons whose natural death is reasonably foreseeable’.^[7]

The consequences have been harrowing.

In the summer of 2019, a 61-year-old man, Alan Nichols, was hospitalised because there were concerns that he was suicidal. Within a month of admission, he was killed under MAID, citing hearing loss as his reason. His family and the health professionals who had been caring for him in the community had tried to raise concerns with the hospital about his suicidal ideas – they were ignored, and a later legal case was thrown out.^[8] This is not the only story of people with mental health issues being offered MAID rather than social and psychiatric support.^[9] And yet there are genuine (albeit temporarily suspended) proposals to bring in legislation extending MAID to those experiencing distress from mental illness.^[10]

But it is not just concerns about how people with mental illness are being railroaded into MAID. Rose Finaly, a 33-year-old woman with quadriplegia, said she was opting for MAID because it would take eight months to get further disability support to allow her and her three children to manage as her health deteriorated. She could no longer afford care, but she could get MAID within 90 days.^[11] Again, this is far from a unique scenario in Canada, where MAID is often easier to access than social assistance and even healthcare.

At the same time, as MAID legislation came into effect, there were already reports that Canada lacked sufficient palliative care doctors to meet end-of-life care needs.^[12]

A lack of access to good end-of-life care, social support, mental health services, and medical care means that MAID has become the more accessible, cheaper, and quicker option for many of the poor and marginalised in modern Canada.

It does not take too much imagination to see how quickly this could happen in the UK. Our hospices are in crisis, with many having to close beds and make staff redundant due to shortfalls in government funding, a drop in charitable giving due to the cost-of-living crisis, and the recent hike in employers’ National Insurance contributions. Social care is collapsing, with care homes shutting down and having difficulty recruiting and retaining care staff. People are struggling to access their GP and face long waits at A&E. Assisted suicide will quickly become the cheaper, easier option here as well.

This led the current Health Secretary, Wes Streeting, to announce he won’t support the Leadbeater Bill. He has also expressed concerns that making assisted suicide legal in the UK will inevitably lead to a diversion of NHS resources to fund its provision rather than investing in social and palliative care.^[13]

The evidence from Oregon is that the majority of requests for assisted suicide are not due to pain or intolerable suffering but from fear of being a burden and worries about life losing colour and meaning in the final months and weeks of life.^[14] Real assisted dying is about helping people to live until they die. Intractable pain can usually be managed. A loss of joy and a fear of being a burden is a spiritual anxiety that can be alleviated. Offering good support in the community for those with chronic conditions, the elderly, the disabled, and the dying – including good social care, palliative care, and wider social support networks – is the real choice we should be offering.

We should actively support Wes Streeting as he seeks to improve health and social care and improve funding for palliative care. Furthermore, as Christians, we should not only be behind that, but we should also be at the forefront of offering spiritual hope and support to those at the end of their lives. We believe in living life to the full, right up to natural death, and beyond into eternity. We have good news to share.

Canada is a sobering case study for where this country could end up in a few years if the Leadbeater Bill comes into law. As Christians, our concern should be justice – especially for the poor and the marginalised – and seeing all human life afforded dignity. In the long run, this Bill will neither offer justice nor afford dignity to the dying.

For the church and individual Christians across the UK, that means more than campaigning against the Leadbeater Bill. It is also about supporting our local hospices, volunteering with chaplaincy teams, and being good news to our neighbours, especially the isolated and elderly, in practice as well as in word.

Footnotes:

^[1] Oregon’s Death with Dignity Act. Oregon Health Authority. https://bit.ly/3Z3AvCF

^[2] See: Marriott S. What is Kim Leadbeater proposing? CMF Blogs. 13 November 2024. https://cmf.li/3AGCzXT

^[3] Euthanasia: Dutch court expands law on dementia cases. BBC News. 21 April 2020. https://bbc.in/4fMNpdY

^[4] Netherlands to broaden euthanasia rules to cover children of all ages. The Guardian. 14 April 203. https://bit.ly/3O7AwPI

^[5] Has Belgium become a haven for people wanting to end their life? Euronews. 2 November 2023. https://bit.ly/3Z8z3iC

^[6] First Session, Forty-second Parliament, 64-65 Elizabeth II, 2015-2016. STATUTES OF CANADA 2016
CHAPTER 3: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), 17 June 1916. https://www.parl.ca/Content/Bills/421/Government/C-14/C-14_4/C-14_4.PDF

^[7] C-7, 43rd Parliament, 2nd session. Wednesday, September 23, 2020, to Sunday, August 15, 2021. An Act to amend the Criminal Code (medical assistance in dying). https://www.parl.ca/LegisInfo/en/bill/43-2/C-7

^[8] Cheng M. ‘Disturbing: Experts troubled by Canada’s euthanasia laws’. Associated Press. 11 August 2022

^[9] Gamage M. ‘She Sought Help in Crisis and Was Suggested MAID Instead’. The Tyee. 9 August 2023. etyee.ca/News/2023/08/09/Medical-Assistance-Dying-Slippery-Slope-Mental-Illness-Disabled/

^[10] Honderich H. ‘Who can die? Canada wrestles with euthanasia for the mentally ill’. BBC News. 14 January 2023. https://bbc.in/3CsHM6i

^[11] Riches R. ‘Quadriplegic Ontario mother says her only option is assisted suicide due to lack of support’. National Post. 22 June 2023

^[12] Vogel L. ‘Canada needs twice as many palliative specialists’. CMAJ. 2017 Jan 9;189(1):E34-E35. doi: 10.1503/cmaj.109-5354. Epub 2016 Nov 14. PMID: 28246259; PMCID: PMC5224958.

^[13] Campbell D. ‘Legalisation of assisted dying may force NHS cuts, Wes Streeting warns’. The Guardian. 13 November 2024

^[14] Oregon Death with Dignity Act 2022 Data Summary. https://bit.ly/3Yt2886