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Canada’s Parliament legalized euthanasia and assisted suicide in 2016. Since that time, the federal government has continued to expand euthanasia to more Canadians. Euthanasia was expanded to people with disability or chronic illness in 2021, and there is a scheduled expansion to those with mental illness in 2027. Recently, the federal government also announced it would be starting a “national conversation” about advance requests for euthanasia. Advance requests allow a person diagnosed with an illness to specify at what stage of the disease they would like to be euthanized even if they are no longer able to give consent at that time.

While the Criminal Code’s eligibility criteria for euthanasia is the responsibility of the federal government, provincial governments ought to also do more to protect people in their province from euthanasia. Provincial governments oversee the regulation and delivery of healthcare. Provincial law cannot redefine what is criminal, but it can put in place various standards, procedures, or safeguards to protect the health of patients. Provinces can thus improve the way euthanasia is delivered through provincial legislation or regulation.

In light of this, ARPA Canada focuses on five recommendations that provinces should implement to better protect people in their province.

#1. Provinces should prohibit health care workers from initiating a conversation about euthanasia with a patient.

Just recently, a woman in Nova Scotia was asked about euthanasia as she was on her way into surgery for cancer. Some people try to distinguish between raising the topic of euthanasia and offering it to a patient. There’s a very fine line between the two, if any. The Criminal Code clearly prohibits counselling a person to commit suicide, but there is no prohibition on asking a patient if they have considered euthanasia. If a healthcare provider brings up euthanasia, the patient may feel pressured to consider it or to think that their suffering will be intolerable, and that death is the recommended way out. Even if the comment is not intended as a suggestion, it can very easily be interpreted as such by the patient.

#2. Provinces should ensure that euthanasia is not provided for mental illness, even if the patient also has a physical disability or illness.

Although people with a mental illness as the sole reason for their request cannot receive euthanasia, people with mental illness are eligible for euthanasia if they also have a disability or physical illness. Recent reports from the Ontario Coroner’s office highlighted cases where this has happened. One man had a history of mental illness, suicidal episodes, and drug and alcohol addiction. He was euthanized because of a disease that made him eligible for euthanasia even though the mental health and addiction issues were left unaddressed. Another patient had multiple mental illnesses and had attempted suicide just a year before being euthanized, ostensibly because of his physical illness.

Although people may have physical illnesses alongside mental illness, the mental illness is often ultimately the reason for their request to die. Nearly 60% of people being euthanized on track 2 (where death is not reasonably foreseeable) are women, mirroring the ratio of female-male suicide attempts.

Some jurisdictions require counselling if a patient’s request to die may be influenced by mental illness. At least one American state requires that everyone who requests assisted suicide must be referred for counselling to ensure that mental illness is not impacting the request. Canada would do well to follow suit.

#3. Provinces should protect freedom of conscience for medical professionals.

Medical professionals should be able to refuse to participate in euthanasia without professional consequences. This is not simply a benefit for doctors, but also an important safeguard for patients. Many patients want a doctor who they know will never participate in providing euthanasia and who shares their moral values on the topic. This issue is discussed in depth in ARPA’s policy report on conscience in healthcare.

#4. Provinces need better safeguards to help medical professionals consider and address external pressures behind a patient’s request to die.

The reports from the Ontario Coroner’s office highlight socioeconomic and relational factors that contribute to a patient’s request to die. One woman experienced social isolation, was unable to find adequate housing for her medical needs and suffered from mental illness. These issues greatly contributed to her request for euthanasia, even though the official reason for euthanasia was her disease. The reports also emphasize the importance of including family and loved ones in the conversation about euthanasia.

There are currently no requirements to include or speak with family members. Additionally, there is no requirement for patients to try other appropriate services or supports before choosing euthanasia. Doctors should ensure that all possible treatments and supports have been tried, and that family members are included in the conversation as much as possible.

#5. Provinces should clarify the difference between Track 1 and Track 2 euthanasia.

Track 1 euthanasia includes fewer safeguards and is for those whose death is ‘reasonably foreseeable.’ Track 2 includes additional safeguards and is for those whose death is ‘not reasonably foreseeable.’ But the term ‘reasonably foreseeable’ is unclear and the law gives no timeline on what this means. As a result, patients are being placed on track 1 even though they ought not to be. With the additional safeguards in track 2, patients have more time to receive supports and change their mind about wanting to die. Provinces should clarify that ‘reasonably foreseeable’ means a patient’s prognosis for natural death is within less than six months. This clarification would help to ensure that existing safeguards are actually applied.

What Can You Do?

While we hope to see the federal government restrict euthanasia in Canada, we can also encourage our provincial governments to implement safeguards within the current law. The five safeguards recommended here are not exclusive but are examples of important safeguards that ought to be implemented. Canadians across the political spectrum are concerned about problems with our euthanasia law, and other jurisdictions see Canada as an example of what not to do. Send an EasyMail to your provincial representative, asking them to implement better safeguards around euthanasia in your province.