On December 11, Health Canada released its fifth annual report on Medical Assistance in Dying (MAiD). From legalization in 2016 until the end of 2023, at least 60,301 Canadians have been euthanized. The report concludes that “The Government of Canada will continue its work to help ensure that the framework for MAID in Canada is safe, reflects the needs of people in Canada, protects those who may be vulnerable, and supports autonomy and freedom of choice.” But ultimately, the government’s approach reveals an emphasis on autonomy over protecting anyone from euthanasia.  

The Numbers 

In total, 15,343 Canadians died at the hands of doctors or nurses in 2023. Canada permits both euthanasia (where a doctor or nurse practitioner ends a patient’s life) and assisted suicide (where a patient ends his own life using prescribed pills). But assisted suicide is almost non-existent in Canada, with fewer than 5 people using this option last year.  

 The number of euthanasia deaths in 2023 is a 15.8% increase over 2022. While lower than the 30% rate of increase in previous years, this still represents over 2,000 more euthanasia deaths than in 2022. Euthanasia deaths as a percentage of all deaths in Canada jumped from 4.1% in 2022 to 4.7% in 2023. This means that nearly 1 in every 20 deaths in Canada is state-sponsored. The only country with a higher rate of euthanasia deaths is the Netherlands, at 5.4%.  

Nearly 85% of euthanasia deaths took place in British Columbia, Ontario, and Quebec, although these provinces represent roughly 70% of the country’s population. Of the 15,343 Canadians who were euthanized in 2023, 622 died on track 2 (where natural death is not ‘reasonably foreseeable’) compared to 463 in 2022, an increase of 34%.  

Of nearly 20,000 verbal and written requests for euthanasia, only 915 patients were deemed ineligible and 496 withdrew their request. A person might also request euthanasia but then die naturally before they can be killed by their doctor. This happened in nearly 3,000 cases. The report states: “These findings bring into focus how even modest delays can interfere with a person’s ability to receive MAID.” That’s an odd way of saying that some patients (roughly 1/6) seeking MAID die before they can be euthanized, but it signals that the government sees MAID as a valuable service, rather than a tragedy to avoid. 

Illness and Suffering 

Reasons a person might request euthanasia include cancer, organ failure, or neurological, respiratory, or cardiovascular conditions. But there is also a category listed as ‘other.’ The most common conditions in the ‘other’ category include frailty and chronic pain. Frailty, according to the report, “may include loss of muscle mass and strength, cognitive impairment, fatigue or exhaustion, weakness, and reduced tolerance to medical interventions, leading to poor health outcomes.” This condition was reported for nearly 1,400 euthanasia deaths in 2023, significantly higher than those in 2022. While many patients have multiple conditions, frailty was the only condition for 92 patients.  

The cases of frailty raise serious questions about how doctors might be assessing patients’ eligibility for euthanasia. If something like frailty can make a person eligible, doctors can be quite loose in their interpretations. Frailty may also be interpreted as a condition where death is ‘reasonably foreseeable.’  

In addition to frailty, the ‘other’ category includes chronic pain. Nearly 1,000 patients listed chronic pain as a reason for requesting euthanasia. Yet the report notes challenges in assessing chronic pain. Namely, patients may experience fluctuations in severity of pain, they often have difficulty accessing treatment, and they often have a psychiatric condition such as major depressive disorder. This shows that people may be seeking euthanasia due to mental illness even if it is another condition that makes them eligible for euthanasia.  

Health Canada also notes the nature of suffering that is listed by patients who are euthanized. Many patients list multiple sources of suffering. The most cited suffering is the loss of ability to engage in meaningful activities (over 95%), followed by loss of ability to perform activities of daily living (over 83%). Pro-euthanasia advocates often list stories of severe pain in requests for expansion, but fewer than 60% of patients cite inadequate pain control as a source of suffering. Loss of dignity has become the third most cited reason for suffering.  

In 2022, 17.1% of patients listed isolation or loneliness as a source of their suffering. In 2023, that number for those nearing death jumped to 21.1%. But for those requesting euthanasia who were not nearing death, it skyrocketed to 47.1%. Another disturbing increase is in those who felt like they were a burden on family, friends or caregivers. In 2022, that number was 35.3%. In 2023, the number for those who were dying increased to 45.1%. For those who were not dying, it was even higher at 49.2%. Nearly half of all who died by euthanasia saw themselves as a burden.  

These numbers indicate a difficult reality about why people are requesting death. Pain, disease, or disability may be a factor. But so are loneliness, dependence, and a faulty view of human dignity. And these social factors are increasingly contributing to euthanasia deaths in Canada as euthanasia becomes more normalized.  

Suffering is real and can be caused by various factors. But the response should never be to offer to kill those who are suffering. These numbers speak to the ways we must improve care for suffering people. It also shows the need for suicide prevention, rather than suicide assistance, in all cases. 

Euthanasia Providers 

The report notes that 2,200 doctors and nurses euthanized at least one patient in 2023. However, just 89 medical practitioners were responsible for over 5,300 euthanasia deaths. That’s an average of 60 deaths each in one year. Health Canada argues that this is good because it lets providers keep pace with demand and suggests that “MAID is becoming an area of focused expertise for some.” But is it a comfort to know there are doctors who specialize in killing patients? Some doctors are known to interpret the law loosely and will approve patients who other doctors might refuse to euthanize. Recently, a woman who was declined euthanasia in Alberta found a doctor in B.C. who was willing to kill her. Thankfully, a court intervened and stopped that death from happening. The same doctor who approved the woman for euthanasia has admitted to killing over 400 patients.  

But in how many cases do doctors interpret the law loosely and kill patients who are not eligible for euthanasia? We don’t know. The lack of oversight in nearly every province increases concerns about doctors who specialize in euthanasia. Health Canada emphasize that euthanasia is a health care service. This mindset leads to a lack of caution, and a lack of adequate safeguards and oversight. But euthanasia isn’t health care. It is an exception to the criminal prohibition on homicide and is essentially the “service” to end health care services.  

Conclusion 

Health Canada’s report once again reveals, as expected, the rapid growth rate of euthanasia in Canada. The current federal government has shown no desire to slow this growth. Other party leaders in the House of Commons have also said little about the problems with euthanasia. Check out ARPA’s Care Not Kill website for action items where you can raise awareness and ask your Member of Parliament to commit to protecting Canadians from euthanasia.  

Provincial governments also have a responsibility to reduce the rates of euthanasia in their jurisdiction. If you live in Alberta, participate in the government’s ongoing review of euthanasia. If you live in another province, ask your provincial government to take action on this issue as well. Together, we can continue to speak up for inherent human dignity and meaningful care for those who are suffering.