The stories are too disturbing to dismiss. In 2022, a 51-year-old woman from Ontario was hypersensitive to chemicals and odours, had spent years fruitlessly appealing to the authorities to provide her with affordable housing free of cigarette smoke and chemical cleaners. She couldn’t take it any more and believed that death was her only way out – and knew the state would help her.
‘The government sees me as expendable trash, a complainer, useless and a pain in the a**,’ she said in a video filmed eight days before she died.
Later that year, a military veteran reportedly approached a Veterans Affairs Canada caseworker to ask for help with his PTSD following horrors he had endured on the battlefield.
The caseworker appalled the veteran by suggesting assisted dying – for which, to be fair, the caseworker was suspended.
But not before offering as many as five veterans who had turned to them for help the option of ‘medical assistance in dying’ (MAID). Veteran and former paralympian, Corporal Christine Gauthier, had tried for five years to get a wheelchair ramp installed at her home to no avail. When she complained to the same caseworker about her deteriorating condition, she was informed that assisted dying was an option – the caseworker even gallantly offered to supply MAID equipment to her.
Or take Kiano Vafaeian, a 23-year-old unemployed man with diabetes who was depressed, had lost vision in one eye and decided he wanted to die.
Vafaeian eventually found a doctor, Joshua Tepper, who agreed to assist him, and had even scheduled the appointment.
It was only when Vafaeian’s desperate mother publicly shamed Tepper that he was forced to renege on his promise.
David’s aunt Rosie was forced to go to Switzerland to die because assisted dying remains illegal in the UK
The number of tales like these is growing in Canada, where assisted dying has been legal since 2016.
And they serve as an unignorable lesson for Britain after Labour MP Kim Leadbeater’s Terminally Ill Adults (End Of Life) Bill was published this week. It will be debated towards the end of the month.
The Bill is understandably contentious. Only this week, thousands of doctors, nurses and other healthcare staff warned, in an open letter to the Prime Minister, that the legalisation of assisted dying would be an added burden on a ‘broken’ NHS.
I support assisted dying. Last month, I wrote of how my aunt Rosie went to Zurich to die. She was forced to make the journey to Switzerland because assisted dying remains illegal in the UK.
Under section 2(1) of the Suicide Act 1961, you can go to prison for assisting or encouraging someone else to die, even if they are a loved one living in agony.
Swiss law, however, permits the non-profit organisation Dignitas to offer assisted suicide to those with terminal or severe incurable illnesses, as well as unbearable physical or mental suffering.
Rosie had muscular dystrophy, which meant that her body’s skeletal muscles steadily degenerated until she lost the ability to walk and even dress herself properly. Sustained torture was her future.
That she had to travel so far concerned me. Rosie’s great fear was that she would deteriorate to the point that travel would be impossible, so to be safe she went sooner than was necessary.
Protesters gather near Parliament to demonstrate against Labour MP Kim Leadbeater’s assisted dying Bill
If the trip had involved a taxi to central London rather than a flight to Europe, she would have been with us for longer.
Rosie was more like a mother to me than an aunt. I was devastated by her death. But she made the right decision. As she once asked me: ‘Do you really want to see me get to the stage where I have to be winched out of bed?’
The new Bill states it will ‘allow adults who are terminally ill, subject to safeguards and protections, to request and be provided with assistance to end their own life’. The indispensable phrase here is ‘subject to safeguards’.
Death must be an option only for those who are in incurable pain, terminally ill or facing a future of sustained misery that amounts to a form of torture.
This must be an inviolable principle of any legislation on this matter. Assisted dying should not become an option for those who are merely depressed or suffering privation, and should certainly not be used by the medical establishment to dispose of people who are a drain on resources that it feels could be better deployed elsewhere.
Which brings me back to Canada. Since Rosie’s death, I have read and thought about the issue of assisted dying almost daily and it quickly became clear to me on a visit to Canada that the country offered some troubling insights into what the future might hold.
Ever since it became legal nearly a decade ago, campaigners have sought to liberalise its restrictions and there is currently huge controversy around the idea of extending assisted dying to include people suffering solely from mental illness.
Thankfully, moves to introduce such a huge reform have been repeatedly delayed.
In February, a Canadian parliamentary committee recommended a pause on further expansion of the law – originally planned for March of this year – until 2027. But an array of irresponsible actors, coupled with multifarious failings in social care, mean that Canada’s euthanasia regime has already become permissive to the point of absurdity.
If this sounds hyperbolic, consider that a 2022 Canadian government report found the most cited source of suffering by individuals requesting MAID was ‘the loss of ability to engage in meaningful activities’ (86 per cent).
Yet more worrying and, indeed, horrifying, is that people are being driven to assisted dying by what can be described as social problems – and euthanasia providers know it.
The Canadian Association of MAID Assessors and Providers (CAMAP), the leading organisation of assisted dying providers, has conducted training seminars in which poverty and social issues alone impel the patient’s desire for assisted dying, and yet participants are advised to authorise assisted dying regardless.
But it didn’t have to be like this. When the Medical Assistance in Dying Bill was passed in 2016, it allowed for euthanasia and assisted suicide for people aged 18 and over who had a serious condition, disease or disability, were in an advanced, irreversible state of decline or were enduring ‘unbearable physical or mental suffering that cannot be relieved under conditions that patients consider acceptable’.
Their death also had to be ‘reasonably foreseeable’ and the request for euthanasia had to be approved by at least two physicians. These are known as Track One patients.
Critics claimed the new legislation was too restrictive.
They complained that it prevented people with degenerative conditions – like my aunt Rosie – from seeking assisted suicide.
The authorities responded by saying that MAID was only a first step and its provisions could be extended in the future. These words would prove not just ominous but prophetic. In the 12 months after the legislation was introduced, just over 1,000 people received an ‘assisted’ death.
This total has grown every year since and, by 2021, there were 10,064 MAID cases (over 3 per cent of all deaths in Canada that year). By 2022, it had risen to 13,241 cases.
Between 2020 and 2022, more people died from assisted dying in Canada than anywhere else in the world.
To give a sense of the scale, both Canada and California have roughly the same population and both legalised assisted dying in 2016.
But in 2021, when some 10,000 died through assisted dying in Canada, the equivalent figure in California was just 486.
In March that year, the law was changed, allowing assisted dying for patients who have a serious and chronic physical illness, even if it was non-life-threatening.
This meant patients whose death was not ‘naturally foreseeable’ could access the procedure, too; these are known as Track Two patients. In the following year, just 3.5 per cent of those who submitted written requests were deemed ineligible. Clearly the ‘subject to safeguards’ test was not being met.
The situation was becoming so egregious that UN human rights experts expressed concern about the proposed expansion of assisted dying, noting that it ‘would not be consistent with international human rights standards’ and that ‘it would appear to violate the right of persons with disabilities to life, protected by Article 3 of the Universal Declaration of Human Rights’.
While I was in Canada, I spoke to Michael Coren, a British-Canadian Anglican priest and writer who, like me, supports the principle of assisted dying.
‘It’s got terribly out of hand over here,’ he told me. ‘If death is imminent, and the person is really suffering, and there is no chance of any improvement, then a dignified death, surrounded by loved ones, makes sense.’
He added: ‘But here it has become, in parts, hideous.
‘There really are certain people who appear to have a different definition of what humanity and life is, who want to introduce mental health as a criterion; to make assisted dying an option for people who are not terminal but, for example, homeless.
‘I was recently at a [religious] retreat and a nurse who supported MAID told me that, if a child said they wanted to die, then they should be allowed to do it. We are caught between two extremes: between those who believe that suffering can be a good thing on the one hand, and those who think any kind of discomfort is a valid reason to die.’
That the Canadian government introduced assisted dying into law almost a decade ago is, to my mind, an example of humane legislation. I applaud them for it.
But what has happened since is a kind of sinister ‘mission creep’ in which the noble impulse at the heart of MAID – the right to allow people who are suffering appallingly a dignified death – has become lost.
Instead, it has been replaced by something dangerous: death as a kind of perverse lifestyle choice, assisted dying available a la carte.
When Britain’s MPs vote, they would do well to bear in mind the Canadian experience.
They should vote with the understanding that assisted dying under the very tightest safeguards for those truly in need of it is an unimpeachably just cause, but only remains so if those safeguards stay in place and it is confined to those who truly need it – like my aunt Rosie.
Otherwise, it will become a malign parody of itself, made all the worse because it perverts something that is, in its essence, unequivocally humane.