Canada is Killing Itself

Canada is Killing Itself

Elaina Plott Calabro

Article from The Atlantic, September 2025

This article turned me on my head. The first paragraph found me looking up the author because it felt, “reactionary.” The impression given was that Canadians can be euthanized as easily as ordering products from Amazon?  Right…….I was reassured that her other works would not lead to such a conclusion of religious or right wing bias.

So the article articulates the movement supporting  Death with Dignity as an evolving one in Canada.

She reports:

Canada, as some states, (like Washington)  established a law that allowed for Death with Dignity. This applies to gravely ill people: one has to have a terminal illness, get two doctors certifying that your chances of dying in the next six months are significant, have a waiting period, have a psychiatric evaluation to screen for treatable depression, and then if still willing, a prescription of drugs that the patient could use to end their life, providing they self administer the drugs.  The relative administering such drugs would technically be guilty of murder. There are statistics on this approach in both Washington and Oregon that, to date, have been reassuring to me; it remains an option in these circumstances. In my mind, so far, these are defensible outcomes with no alarming trends.

In 2016, Canada’s Parliament amended this approach by legalizing euthanasia; doctors could now administer drugs to kill a patient requesting an end to their life. The trend since this was passed has led to the outcome that roughly 5% of deaths in Canada in 2023 were from Death with Dignity patients—more than die of Alzheimer’s and diabetes combined.

This did not happen in a vacuum. Patient autonomy advocates—Puritans of a sort if you will, with a vision and a confidence in a secular movement who are zealots standing on the principles of equality, access, and compassion as well as personal autonomy as absolute rights. For those of us who are not Puritans or secular zealots, this leads to problems both moral and practical.

The law was vague: “reasonably foreseeable death” without a specific time-frame is subject to interpretation and doctors who are passionate apply their judgement to what this means with no check or balance. This standard could apply to virtually anyone.

A case is presented: a patient in their late thirties has a with newly diagnosed cancer. The good news: the cure rate is 65%  with surgery and chemotherapy. The surgeon is stunned when the patient wants no referral but to a doctor who will provide euthanasia. The surgeon punts the problem to a medical oncologist. Perhaps the patient simply does not understand  the diagnosis or the math.  The math proved irrelevant: the patient was intolerant of sustaining any discomfort whatsoever. The patient asserted their colonoscopy had been intolerable. Pain medication after surgery? Well, you would have to feel pain to need pain medication, right? Side effects from chemo? The same. So the dilemma: “reasonable foreseeable death” is typically considered when there are no more treatments to offer. What do you do with this refusal in which case, it was  (now)nin fact a reasonable foreseeable outcome?

A doctor who performs euthanasia in terminally ill patients consulted with this patient. In their experience, this was a first case where the usual treatment was being refused up front. Consultants from “the field”(of Euthanasia!) Considered her problem and mostly were untroubled: Autonomy, access, and compassion guided them to the recommendation to do what the patient requested. “We are just tools in the hands of the patients,” they might have said.

This doctor performed the euthanasia and instantly regretted it.  The take-home lesson for her? Being eligible does not mean that you (the doctor, the tool) should participate in it.

A number of cases follow and conclusions are made: there is no standard that holds. Each doctor and patient decide for themselves. The life may be completed or simply one with burdens. There is no oversight with teeth that reflect back on this lack of standards.

Can you control euthanasia once it is legal?

Court cases confronting this process ended in a court case where comparing the process and outcomes of other countries was deemed irrelevant because, “Canada is different,” culturally, legally, medically……

It got stranger:

2021 amendments: For people with the traditional grave diagnosis waiting periods were no longer required.

A new category was introduced that did not require an immediate (six month) risk of death to qualify (identified in the law as track II) and weighs suffering which is subjective and is ultimately a mental state. The original law specifically aimed at avoiding death with dignity in people with a mental state such as depression arguing that this was treatable. Now in Canada, this is a muddle and many doctors choose to not participate.  In 2023 of 2,200 doctors known to provide services for  for death with dignity, 89 individual were responsible for 30% of track II patients.

In 2023, track II was 622 deaths: 4% of cases under the law..

Most places like WA, the request is made  by the patient of the patient’s doctor.  In Canada this  service is accessed on-line and usually with a stranger ie a physician with no  pre-existing relationship or knowledge of the patient over time.

There were deaths by this process reviewed reflecting on people with chronic disease but who could not access resources needed to make their lives bearable. One patient taking this route is quoted: “Ultimately it was not a genetic disease that took me out, it was a system…..I could have had more time if I had more help.”

The other side of that coin most of us can identify with ie not wanting to be a burden. Populations at risk for this psychological symptom are the elderly and disabled. The author suggests that half people accomplishing death through these laws cite not wanting to be a burden. One story was all too familiar as it reflected more generally our broken health care systems and expectations: a disabled patient in an emergency room developed bed sores waiting for a disposition out of the hospital. Once this occurred, the patient requested and got euthanasia.

A Vancouver, BC  doctor performed a consultation with a patient in Alberta by a zoom meeting; a second opinion and witnessed signature were all done by zoom. The patient’s husband angrily objected and went to court to stop it, successfully at first but the injunction timed out and no further action was taken; the patient came to Vancouver and was euthanized.

Lawsuits seem to point out a lack of oversight or accountability. The government to date has not intervened and so that burden is up to loved ones to try to stop it when their subjective sense of right and wrong are offended. Records from Ontario’s compliance office has found cases where necessary consults were never sought and the discipline in these cases is done behind closed doors.

A case is presented identifying a patient with a request for euthanasia who before it could be executed became incompetent to sign documents. The oncology team wanted Hospice but the doctor consulted for euthanasia“vigorously” tried to rouse the patient to get consent (mouthed “yes”) and the procedure went through. This movement, motivated by the need for patient  autonomy has at least one supporter of this death where it was clearly absent.

One consultant sounds like officials in the current American federal administration:  If the assessor (meaning the doctor providing euthanasia) believes that they qualify, then under the law, they are not guilty of a crime.

Advanced requests are presented as a moral dilemma. If I am competent but fear dementia, can I give consent for euthanasia in the setting of when I lose my competence and have specific symptoms (like not recognizing one’s children, spouse, or having to live in a supported non-independent home)? What if in that setting, relatives disagree?

Mental illness has proven no barrier. The advocates of patient autonomy think suicide by proxy is fine.  One patient on suicide watch applied and months later (when out of lock up) was euthanized with the medical dx of “hearing loss.”

The article concludes with the observation that a shrinking number of doctors are willing to perform this work, and a demand from citizens that is climbing. There are not enough doctors to do this work so what happens next? That is a practical question. The tone of the article reflects much that I feel which remains: can you control euthanasia once you make it legal?

And of course, my favorite reflection, “What can go wrong?”

Completing the last paragraph of the article, my thought was, “I hope MAGA does not work this one up.”

Fifty first state for their own good?