An expert panel reviewing euthanasia deaths in Canada's most populous province has identified several cases of patients who were partially euthanized for social reasons, such as isolation and fear of homelessness, raising concerns about consents for vulnerable people in the country's assisted dying system.
Ontario's chief coroner on Wednesday released several reports, based on data provided in a document based on an Associated Press investigation, that reviewed non-fatal euthanasia deaths. The expert panel's reports are based on an analysis of anonymous cases, which were selected for their implications for future euthanasia requests.
Canada's legal criteria require a medical reason for euthanasia (a life-threatening diagnosis or uncontrollable pain), but the group's reports show cases where people have been euthanized based on other factors, including ” satisfied social need”.
The AP investigation found that doctors and nurses personally struggle with euthanasia requests from vulnerable people whose suffering could be resolved with money, social connections or adequate housing. Even when meeting the criteria of Canada's euthanasia system, known nationally as Stewardship for Medical Assistance in Dying, providers expressed deep discomfort at ending the lives of vulnerable people whose deaths could have been prevented.
“It is very important to finally get a government report that recognizes these alarming cases,” said panel doctor Ramona Coelho. “We have been gassed over the years when we have raised fears that the poor, the disabled or the socially isolated will get housekeeping.”
In the case of a man identified as Mr. A, the Ontario panel of experts questioned whether authorities did enough to alleviate his pain before euthanizing him. Mr. A is unemployed, in his 40s, and suffers from an intestinal disease and a history of substance abuse and mental illness. He was described as “socially vulnerable and isolated”. Some committee members were alarmed when a psychiatrist recommended euthanasia during a psychiatric evaluation.
Another case focused on Ms. B, a woman in her 50s with multiple chemical sensitivity syndrome who had a history of psychosis including suicidality and post-traumatic stress disorder. She was socially isolated and was often asked to die because she could not find a suitable home, according to the report.
The committee members could not agree on whether his death was justified; Some attributed her suffering to inadequate housing, which should have disqualified her from euthanasia. Others argued that if other options had been explored, “social needs might have been considered insurmountable.”
Sonu Caint, a professor of medicine at the University of Toronto, said autopsy reports are dangerous for several reasons, particularly when it comes to addressing the mental health conditions of those seeking euthanasia.
“What we do in many cases is the opposite of suicide prevention,” he said, citing the example of a man in his 40s.
Scott Kim, a physician and biological scientist at the National Institutes of Health in Washington, said the real problem is the permissive nature of the Canadian law. Even though polls show widespread support for expanding access to euthanasia, he questioned whether most Canadians understood what was allowed and said it was “shocking” that officials had not considered these issues sooner.
The expert panel made several recommendations, including hiring patient advocates to support those considering euthanasia and providing additional guidelines for doctors and nurses evaluating patient requests.
The panel noted that legally mandated safeguards were not met in about 2% of cases. Despite this, so far no doctor or nurse has been prosecuted, experts say.
Trudeau Lemmens, a professor of health law and policy at the University of Toronto, said medical professional organizations and judicial officials. Canada appeared “unwilling to restrict practices that appear ethically problematic.”
“Either the law is too broad or the professional guidance is inadequate,” Lemons said. “Or protecting some of our most vulnerable citizens is not considered a priority.”
So far, Ontario is the only province or territory in Canada that has released case summaries indicating problems with euthanasia permits.
