douglas todd: canadians adopting assisted death at 22 times the rate of americans
5 minute read
british columbians have has long been at the forefront of the euthanasia movement, including key activists such as sue rodriguez, gloria taylor and kay carter. this photo on march 8, 1993, rodriguez and former bc mp svend robinson go to press conference after supreme court decision.
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province vancouver sun
canadians are far more likely to end their lives by physician-assisted suicide than are americans in the states where it’s legal.
and british columbians could lead the world in streaming to this form of death.
in canada, which has a smaller population than california, physicians or nurse practitioners directly ended the lives of 31,664 people between 2016 and 2021. that compares to just 3,344 in california.
memorial university bioethicist daryl pullman, who is in the faculty of medicine, this month told ubc’s centre for applied ethics that canadians could learn from the u.s. about safeguards against unnecessary assisted suicides.
one in 33 canadians who died in 2021 chose euthanasia. the canadian rate contrasts with just one in 750 deaths via assisted suicide in california, which is the largest of the 10 states that allow it. that amounts to a canadian euthanasia rate 22 times higher than california’s.
pullman astutely notes that, since the liberals made assisted death legal seven years ago, media outlets have reduced their coverage of the issue and, with exceptions, largely ignored how the evolving law is working for the dying and their loved ones.
we can be grateful to pullman for following up, since the moral quandaries raised decades ago have not gone away. despite euphemisms such as maid (medical assistance in dying), questions are only expanding about what has also been called the right to die and death with dignity.
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one overriding issue focuses on whether assisted suicide should be restricted to only those facing imminent death. another centres on whether medical personnel should directly administer the lethal injection, as in canada. or should they just prescribe the deadly medication, as in the u.s.?
about two in three canadians accept the country’s current laws covering maid, which allows a patient to request death under certain circumstances, without having a terminal illness. but angus reid pollsters found just three in 10 (31 per cent) support the liberals plan to offer maid for irremediable mental illness.
of all people, such questions may be most relevant for british columbians. residents of b.c. were not only leaders in canada’s decades-long legal battle for assisted suicide, they’re adopting the practice more ardently than other canadians and americans, as well as citizens of european nations.
almost one in 20 british columbians who died in 2021 (4.8 per cent) had medical personnel end their lives.
and b.c.’s rate is growing much faster than in the netherlands, which became the first nation to legalize euthanasia more than 30 years ago. the dutch rate of physician-assisted suicide has risen more slowly and, at 4.4 per cent of deaths, is still lower than b.c.’s.
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while prime minister justin trudeau has pressed for some of the most liberal euthanasia laws in the world, pullman wrote an article in the canadian journal of bioethics that indirectly details how individualistic b.c has long been at the forefront of the euthanasia movement.
b.c. women have been key euthanasia activists, including patients sue rodriguez, gloria taylor and kay carter. they formed the heart of landmark cases largely decided by justices from b.c., such as lynn smith and beverley mclachlin. b.c. also stands out for campaigners such as dr. ellen wiebe, who has ended the lives of hundreds.
i’ve interviewed or written about all these figures, particularly taylor, a united church member, and the carter family. like most canadian journalists my coverage was basically sympathetic.
are canadians putting the value of individual autonomy above an “ethic of care?” in this photo, gloria taylor, the plaintiff in a landmark assisted suicide case, arrives at b.c. supreme court, pushed by her sister patty ferguson dec. 1, 2011.
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pullman, however, deserves credit for keeping track of the mixed ramifications of canada’s revolution in assisted dying, particularly as polls reveal about one in 10 have experienced friends or family members ending their lives this way.
philosophically, pullman maintains many proponents of maid have adopted an ethic of individualism and personal autonomy over an ethic of mutual care.
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pullman does not oppose assisted death for people in exceptional circumstances. but he questions how policymakers have given up their earlier commitment to making sure euthanasia was available mainly to those facing a “reasonably foreseeable natural death,” which typically means within six months.
in canada there is now virtually no limit on how soon before an expected death a person can have medical staff end their lives, unlike in the u.s.
there is another safeguard issue for canada, where in almost all cases physicians and nurse practitioners directly inject patients with lethal drugs. that’s in contrast to american states, which use an “oral protocol.” u.s. physicians simply prescribe medication to patients who are then expected to administer it themselves.
that contributes to about one in three u.s. people who are prescribed the medication who either die before they take the prescription, says pullman, or have second thoughts. in canada, however, only two per cent of those who start on the road to assisted death withdraw their request.
in canada medical staff inject patients with lethal drugs. that’s in contrast to american states, where physicians simply prescribe the medication and leave it up to the patient to use them, says prof. daryl pullman, a bioethicist in the faculty of medicine at memorial university.
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citing feminist psychologist carol gilligan’s landmark book, in a different voice, which argued for an “ethic of care” over what she believed is the mostly male value of individual autonomy, pullman says canadians could think deeper about opting too quickly for assisted death over adequate care.
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and that goes far beyond the plight of canadian veterans with ptsd who were offered assisted death instead of treatment. in many cultures, pullman suggests, there is no stigma against struggling people being dependent on others.
while canadian governments pay for an assisted death, pullman says politicians won’t necessarily finance other medications, adequate housing, full-scale social and medical services or, perhaps most importantly, good palliative care.
regardless of their views on assisted suicide, canadians would be smart to not pretend such thorny ethical issues have been resolved once and for all.
twitter at @douglastodd
if you or someone you know is having thoughts of suicide, call 1-800-784-2433 (1-800-suicide), or call your local crisis centre. help is available in over 140 languages. you can also reach the mental health support line at 310-6789.
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