Canadians with nonterminal conditions sought assisted dying for social reasons

An expert committee reviewing euthanasia deaths in Canada’s most populous province has identified several cases in which patients asked to be killed in part for social reasons such as isolation and fears of homelessness, raising concerns over approvals for vulnerable people in the country’s assisted dying system.

Ontario’s chief coroner issued several reports on Wednesday – after an Associated Press investigation based in part on data provided in one of the documents – reviewing the euthanasia deaths of people who were not terminally ill. The expert committee’s reports are based on an analysis of anonymized cases, chosen for their implications for future euthanasia requests.

Canada’s legal criteria require a medical reason for euthanasia – a fatal diagnosis or unmanageable pain – but the committee’s reports show cases in which people were euthanized based on other factors including an “unmet social need”.

AP’s investigation found doctors and nurses privately struggling with euthanasia requests from vulnerable people whose suffering might be addressed by money, social connections or adequate housing. Providers expressed deep discomfort with ending the lives of vulnerable people whose deaths were avoidable, even if they met the criteria in Canada’s euthanasia system, known nationally as Maid, for medical assistance in dying.

“To finally have a government report that recognizes these cases of concern is extremely important,” said Ramona Coelho, a doctor on the expert committee. “We’ve been gaslit for so many years when we raised fears about people getting Maid because they were poor, disabled or socially isolated.”

In the case of a man identified as Mr A, Ontario’s expert committee questioned whether authorities tried hard enough to relieve his pain before he was euthanized. Mr A was an unemployed man in his 40s with bowel disease and a history of substance abuse and mental illness. He was described as “socially vulnerable and isolated”. Some committee members were alarmed that a psychiatrist suggested euthanasia during a mental health assessment.

Another case focused on Ms B, a woman in her 50s suffering from multiple chemical sensitivity syndrome, who had a history of mental illness including suicidality and post-traumatic stress disorder. She was socially isolated and asked to die largely because she could not get proper housing, according to the report.

Committee members could not agree whether her death was justified; some said that because her inadequate housing was the main reason for her suffering, she should have been disqualified from euthanasia. Others argued that “social needs may be considered irremediable” if other options have been explored.

Sonu Gaind, a professor of medicine at the University of Toronto, said the coroner’s reports were alarming for numerous reasons, notably the handling of mental health conditions in those seeking euthanasia.

“What we’re doing in many cases is the opposite of suicide prevention,” he said, citing an example of a man in his 40s who had previously tried to kill himself and did not have a definitive diagnosis when his euthanasia was approved.

Scott Kim, a physician and bioethicist at the National Institutes of Health in Washington, said the real issue was the permissive nature of Canada’s law. Despite polls showing widespread support for expanding euthanasia access, he questioned whether most Canadians understand what is allowed and said it was “baffling” that officials had not previously considered these issues.

The expert committee made numerous recommendations, including assigning patient advocates to support people considering euthanasia and providing more guidance to doctors and nurses who assess requests from nonterminal patients.

The committee noted that legally mandated safeguards were probably not met in nearly 2% of cases. Despite that, experts say, no doctors or nurses have ever been prosecuted.

Trudo Lemmens, a professor of health law and policy at the University of Toronto, said medical professional bodies and judicial authorities in Canada appeared “unwilling to curtail practices that appear ethically problematic”.

“Either the law is too broad, or the professional guidance not precise enough,” Lemmens said. “Or it is simply not seen as a priority to protect some of our most vulnerable citizens.”

So far, Ontario is the only province or territory in Canada to release summaries of cases that could signal problems in euthanasia approvals.