The optics are not good: lessons from euthanasia in Canada


A closer look at the official figures is is disturbing.  Four years after euthanasia was legalised throughout Canada on 17 June 2016, the “first annual report” covering euthanasia deaths in 2019 was released in July 2020.

As the dead bodies pile higher – 13,946 of them in three and a half years according to the report – there are at least nine lessons to be learned for other jurisdictions considering legalising euthanasia or assisted suicide.

1. Once euthanasia is legalised numbers continue to increase from year to year 

The report states that there were 5,631 cases of euthanasia and assisted suicide under the Canadian law in 2019, with a total of 13,946 cases since legalisation. Cases increased by 57% from 2017 to 2018 and by 26% from 2018 to 2019.

Euthanasia and assisted suicide accounted for 1.96% of all deaths in Canada in 2019, 2.4% in Quebec and 3.3% in British Columbia.

2. Where both are offered euthanasia is preferred to assisted suicide and the overall rate is higher than where assisted suicide only is offered

Less than seven of the 5,631 cases in 2019 were assisted suicide.Canadian practice overwhelming uses euthanasia.The report states that “providers are less comfortable with self-administration [assisted suicide] due to concerns around the ability of the patient to effectively self-administer the series of medications, and the complications that may ensue”.

Euthanasia deaths accounted for 1.96% of all deaths in Canada in 2019 – four times the rate in Oregon, where assisted suicide accounted for 0.5% of all deaths in 2019.

3. Broadening access

Although 66% of cases of euthanasia in Canada in 2019 involved a person with cancer, there were also 9.1% of cases for “multiple comorbidities”, which may be code for what the Dutch call “a stack of old aged disorders”, and 6.1% of all cases as performed for “other conditions”, which “includes a range of conditions, with frailty commonly cited”.

4. Lack of specialist involvement

5. Doctors who kill … a lot

6. Coercion or lack of voluntariness can be missed

7. Decision making capacity not properly assessed

8. Not a last resort

9. Euthanasia is chosen for loneliness or feeling a burden on family

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