"Health Canada is gaslighting Canadians on medical assistance in dying."
This article originally ran in The Hill Times on December 25, 2024.
Health Canada is gaslighting Canadians on medical assistance in dying.
On Dec. 11, Health Canada finally released—months late—its legally obligated annual report on the number of medical assistance in dying (MAID) cases in Canada for 2023. And while criticisms of these reports are not new and limitations of the data well established, this latest report minimizes concerns and even misrepresents key data and facts. In simple terms, it is a public relations exercise rather than meaningful monitoring of MAID.
There are some errors that see variable labels misreported. For example, the report uses the term “inadequate pain control” where it should actually say “inadequate pain control, or concern about it.” There are sloppy changes to reference periods, such as the categorization of months of disability supports. But there are also several larger bones we have to pick with the report authors.
For one, Health Canada’s report glosses over MAID’s continued growth. In contrast to its previous reports where the year-over-year MAID growth was documented, the 2023 report provides no such comparison. Instead, it emphasizes how growth is “slowing” in 2023, compared to the previous year. However, it still grew almost 16 per cent from 2022—four times the annual rate of increase of euthanasia deaths in the Netherlands, the previous euthanasia capital of the world.
In fact, for the eighth straight year, the number of MAID deaths increased in Canada by at least double digits—from 13,241 deaths in 2022 to 15,434 in 2023. This continues to be far beyond expectations and more than double Health Canada’s own projections, with 4.7 per cent of total deaths in 2023 now being MAID deaths. By any objective metric, as Cardus demonstrated, Canada remains the fastest-growing assisted-dying program in the world.
In another large concern, Health Canada’s report displays the raw numbers, but unlike the previous year, it fails to spell it out: more people are choosing to die through MAID because of social suffering rather than their physical ailments. Using the raw data from Health Canada, our calculations find that in a single year, MAID providers reported that 22 per cent of their patients chose death because of “isolation and loneliness,” up by five per cent. Meanwhile, almost half of their patients felt they were a “burden on family, friends, or caregivers,” up 10 per cent.
Meanwhile, Health Canada minimizes concerns with the availability and quality of palliative care, and disability supports for MAID recipients. The report trumpets how 75 per cent of MAID recipients received palliative care, a data point that is practically meaningless because we have no idea what quality of palliative care was received: was it care from a specialist team, or merely receiving some opiates? We also don’t know whether or not it was timely.
Even at face value, the fact that one-quarter of Canadians receiving MAID due to unbearable suffering did not receive palliative care is horrifying. It is a figure to prompt alarm, rather than a pat on the back. After all, research has continued to point to gaps in the provision of high-quality, timely care.
Last—but not least—is the report’s response to criticism of the lack of MAID reporting in Canadian vital statics. Emphatically and repeatedly, Health Canada argues that because “MAID is not considered a cause of death by the World Health Organization [WHO],” it should not be viewed as a cause of death in vital statistics. This misrepresents the WHO’s classification, which neither includes nor excludes MAID—it simply doesn’t mention it since most countries continue to ban euthanasia.
Yet what the WHO considers a cause of death is immaterial. Like Switzerland, Canada could simply adapt the classification with a supplementary code. Health Canada just needs to follow its own previous advice to the provinces to record MAID as a cause of death on death certificates.
Despite the report reading more as public relations materials than the robust monitoring of an assisted dying program, Canadians should read more deeply into the data. MAID was supposed to be for exceptional, rare situations—not for social suffering—and the government’s monitoring systems should reflect this, rather than paper over such concerns.
- Rebecca Vachon, PhD, is health program director at Cardus. Alexander Raikin is a visiting fellow in bioethics at the Ethics and Public Policy Center.
December 25, 2024
