When Choice Becomes Coercion: The Perils of Legalised Euthanasia

Part 2 - Looking at Canada's MAiD and revealing how assisted dying disproportionately affects low income and disabled people

Medical Assistance in Dying (MAiD) was made legal in Canada in 2016. When introduced its scope was to allow any adult suffering from a ‘grievous and irremediable medical condition’ with only 6 months to live, to apply to have a doctor kill them. Note the similarity with the current UK Bill on the point in bold, but note below the expansion of MAiD in Canada – what I fear will happen in the UK if the Assisted Dying for Terminally Ill Adults Bill comes into being as law.

In March 2024 the Canadian government sought to further extend MAiD to include those solely suffering from mental illness. This inclusion has been delayed until 2027, (thank god), and someone with an underlying medical condition of mental illness is not presently supposed to be able to apply for MAiD, unless they also have a ‘grievous and irremediable’ physical health condition.

In Canada ‘grievous and irremediable’ is a term which means that a medical condition is serious and incurable, and which is supposed to also involve two other criteria being (1) the condition has become permanent and cannot be reversed and (2) the condition causes unbearable physical or psychological suffering for the person, and this suffering cannot be relieved in ways that the person considers acceptable. However, a person’s death does not now need to be “reasonably foreseeable” for the person to be eligible for MAiD. This means that the person does not need to be at the end of their life to qualify for the procedure.

I have placed the above in bold because you will note that the 6 months to live criteria has disappeared since MAiD’s introduction. In 2021, the law was changed to include people with serious and chronic physical conditions, even if they are not life threatening. Like I keep saying – slippery slope.

You will be unsurprised to find out that it is health practitioners in Canada who get to decide if a person meets all the criteria for MAiD, including if their illness is grievous and irremediable. And this is how it is going to play out in the UK. But how can anyone, doctor or not, be sure that an illness is ‘irremediable’. What if natural treatments – disregarded by allopathic medicine - could help someone? There is also the fact that there is no one size fits all approach for each person suffering from any illness, meaning you cannot just lump everyone suffering from the same illness together in one homogenous category of being ‘severe and irreversible’. And lastly, and I think this might in fact be the case, what if the real issue is that people just cannot get access to decent care and support to help them with what they are suffering with?

MAiD has been framed as a compassionate response to suffering in Canada. However, upon closer examination, this legislation reveals itself as a form of social murder, disproportionately affecting the poor and disabled. While advocates argue that MAID offers autonomy and choice, these choices are often made in contexts of desperation, coercion, and systemic failure. People simply do not decide to die in a vacuum, and, in Canada at least, it seems that it is largely social factors contributing to decisions a lot of people are making about ending their lives – lack of adequate housing, low disability payments, terrible palliative support and care, poverty, and vulnerability due to disabilities and illness.

There is also a ‘money saving’ aspect that needs to be considered when looking at Canada, that could equally apply in the UK. This Spectator article sums it up nicely by commenting “Despite the Canadian government’s insistence that assisted suicide is all about individual autonomy, it has also kept an eye on its fiscal advantages. Even before Bill C-7 entered into force, the country’s Parliamentary Budget Officer published a report about the cost savings it would create: whereas the old MAiD regime saved $86.9 million per year – a ‘net cost reduction’, in the sterile words of the report – Bill C-7 would create additional net savings of $62 million per year. Healthcare, particular for those suffering from chronic conditions, is expensive; but assisted suicide only costs the taxpayer $2,327 per ‘case’. And, of course, those who have to rely wholly on government-provided Medicare pose a far greater burden on the exchequer than those who have savings or private insurance”.

Given all the above, let’s have a look at just a few of the consequences of MAiD in Canada. They really are horrific.

Alan Nichols aged 61 had a history of depression and was hospitalised as a suicide risk in 2019. Within a month of this he was dead, his application for MAiD having been accepted, even though the only health condition it cited as intolerable was “hearing loss”. After Alan was put to death, his family objected that he was never suffering unbearably, but rather had been refusing to take his medication and wouldn’t use the cochlear implant that helped him hear. Unfortunately, the medical brigade didn’t ever contact his relatives about his decision to be killed, citing respect for ‘patient confidentiality’.

Rose Finlay, a 33-year-old quadriplegic single mum raising two kids has said she can access Canada's MAID program after a 90-day eligibility assessment, but that accessing disability services could take up to eight months. She claims Canada is forcing her to die by assisted suicide.

Paralympian Christine Gauthier has been asking for a disability ramp for 5 years - and was recently offered euthanasia instead. She claims that a caseworker told her that they could give her assisted dying, even offering to supply the MAiD equipment for her.

A woman undergoing life-saving cancer surgery in Canada was offered assisted suicide by doctors as she was about to enter the operating room.

Canadian woman Heather Hancock has spoken out about how Canada’s euthanasia system is ‘coming badly off the rails’. Hancock has suffered from cerebral palsy since infancy. In 2019 a nurse was helping her into the bathroom at night, and casually stated “you should do the right thing and consider MAiD” - “You're being selfish. You're not living, you're merely existing”.

In 2020, another disabled woman applied to die because she simply could not afford to keep on living. She claimed her liveable income was literally a matter of life and death and only an increase in income support would help make her life bearable.

In 2020 a Vancouver woman with disabilities, who said she had been forced into debt as a result of the same, sought to end her life through MAiD.

In February 2022 after pleading for affordable housing that would very much help ease her chronic health condition, but failing to get the same, a Canadian woman ended her life through MAiD.

There is more here in this article “A homeless man refusing long-term care, a woman with severe obesity, an injured worker given meagre government assistance, and grieving new widows. All of them requested to be killed under Canada’s euthanasia system, and health care workers grappling with requests from people whose pain might be alleviated by money, adequate housing or social connections”. “Internal data obtained exclusively by AP from Canada’s most populous province suggest a significant number of people euthanised when they are in unmanageable pain but not about to die live in Ontario’s poorest and most deprived areas”.

Read the AP report here part of which states “In Ontario, more than three-quarters of people euthanised when their death wasn’t imminent required disability support before their death in 2023, according to data from a slideshow presentation by the province’s chief coroner, shared with AP by both a researcher and a doctor on condition of anonymity due to its sensitive nature”

The rhetoric surrounding MAiD emphasises personal autonomy and the right to choose. Yet for many individuals, particularly those who are already marginalised by society, this choice is anything but free. Those facing chronic illnesses or disabilities often live in environments characterised by poverty, inadequate healthcare, and limited support systems. When faced with unbearable suffering, the option of assisted dying is presented as a viable escape, giving an illusion of choice when real alternatives—such as comprehensive healthcare, mental health support, and social services—are absent.

For economically disadvantaged individuals in Canada, the pressure to opt for MAiD seems profound, as societal narratives equate suffering with burdensomeness, leading vulnerable individuals to feel they are a financial or emotional burden to their families and society. This sentiment seems particularly pronounced among low-income individuals who lack access to resources that could alleviate their suffering.

One of the most troubling aspects of MAiD is the potential for coercion. Vulnerable populations, including those with disabilities and chronic illnesses, may be subtly pressured into choosing death. This pressure can manifest in various ways: from family members who express a desire to avoid the financial burden of care, to a healthcare system that may not prioritise ongoing treatment needs.

MAiD, while positioned as a compassionate choice, represents a troubling final escapism from suffering that is rooted in systemic failures and societal neglect. MAiD disproportionately impacts the poor and disabled, revealing the dark underbelly of a society that prioritises efficiency and cost over care and compassion. What does this mean? That true autonomy about assisted dying does not exist, because viable alternatives are absent and vulnerable individuals are navigating a cruel and indifferent system.

Has anyone questioned whether, instead of offering euthanasia, the Canadian government should prioritize enhancing support systems to ensure that all individuals have access to the care and financial assistance they need? It would certainly seem that many in Canadian governance have not. Perhaps this is due to the fact that such measures wouldn’t provide the same bottom-line savings—around $150 million annually—that euthanasia does.

I ask myself every day now what is wrong with society. That we are even contemplating going down this road in the UK sends chills down my spine given all we saw during 2020 and 2021 – unlawful DNR’s, end of life medications where they were not needed, informed consent for experimental products swept away. How did we arrive there, and yet now think we can trust the state and the medical profession to get involved in something as complex and final as euthanasia? Please stop the world – I want to get off.

I’ve read the Assisted Dying for Terminally Ill Adults Bill. I suggest you do too, as you will note in it that “for purposes of subsection (4)(c), the attending doctor and independent doctor can regard the person as having a clear and settled intention to end their own life if they are satisfied, on the basis of in-depth discussions with the person, that the person is acting on their own free will, without undue influence, coercion or duress”.

As a former lawyer with 25 years of experience, I can confidently say that it is impossible to determine definitively whether anyone is free from undue influence, coercion, or duress. The assessment of capacity—another critical requirement for ‘assisted dying’—also lacks objectivity; rarely do two professionals evaluating an individual arrive at the same conclusion, because determining capacity is inherently subjective and nuanced.

The concepts of capacity, undue influence, coercion and duress in England are rooted in legal principles established by case law and statute - Banks v. Goodfellow (1870) for Wills and capacity, the Mental Capacity Act 2005 for capacity in other matters, Barton v. Armstrong (1976) regarding duress, and Royal Bank of Scotland v. Etridge (No 2) on undue influence, are just a few examples. Throughout my career, I had to apply the principles of these cases as well as many others, and consider the many statutes covering these areas, just to decide if the person instructing me in a legal matter was doing so of their own free will. Do we really expect medical professionals to be able to navigate these complex legal determinations and statutes and apply them correctly in every case? Even if they could, I learned over 25 years of practice that I could never be 100% certain that there were no underlying issues influencing the individual in front of me—issues they might withhold due to fear, shame, or psychological factors like Stockholm syndrome. Are we truly willing to gamble with lives based on such uncertainties? I would never take that risk as a legal professional, and I do not believe that medical professionals should either.

If euthanasia is legalised in the UK I believe that safeguards against its abuse will ultimately fail. We are likely to see a gradual expansion of qualifying categories, just like in Canada, as activists push for broader access. We could also see also social pressure mounting on those who hesitate to consider ending their own lives.

Instead of resorting to euthanasia, we should promote healthier living and engage in honest discussions about the root causes of so much illness in society. We also need to invest in better palliative care and, most importantly, reform a broken political and social system that leaves people without access to support, imposes high taxation and watches on as people struggle with an ever-increasing cost of living.

Given that the number of British people travelling abroad to commit assisted suicide or euthanasia is very small (273 in 13 years) according to Care Not Killing, why are we considering such a big shift to our law to accommodate the wishes of a very small number of people?

Resources

Care Not Killing

Right to Life

Our Duty of Care

Not Dead Yet UK

Below I have set out the proposed Declaration contained in the Assisted Dying Bill. This is what people will have to sign to end their lives. Two doctors signatures are required. The Declaration is hardly in-depth is it? And nowhere can I see that any opinions need to be produced as evidence to be lodged with the Declaration

FORM OF DECLARATION

Declaration: Assisted Dying for Terminally Ill Adults Act 2024

Name of Declarant:                                                                                  

Address:

Date of Birth:

I have [condition], a terminal condition from which I am expected to die within six months of the date of this declaration.

The Attending Doctor and Independent Doctor identified below have each fully informed me about that diagnosis and prognosis and the treatments available to me, including pain control and palliative care.

Having considered all this information, I have a clear and settled intention to end my own life and, in order to assist me to do so, I have asked my attending doctor to prescribe medicines for me for that purpose.

I make this declaration voluntarily and in the full knowledge of its significance.

I understand that I may revoke this declaration at any time.

Signature:              Date                                                                                                        

This declaration was signed by [name of declarant] in my presence and signed by me in [his/her] presence.

Witness Signature

Name of witness:

Address: Date

Countersignature: Attending Doctor

I confirm that [name], who at the date of this declaration is [age] years of age and has been ordinarily resident in England and Wales for [time]:

(1) is terminally ill and that the diagnosis and prognosis set out above is correct;

(2) has the capacity to make the decision to end their own life; and

(3) has a clear and settled intention to do so, which has been reached on an informed basis, without coercion or duress, and having been informed of the palliative, hospice and other care which is available to [him/her].

Signature:                                                                                                         Date:

Name and Address of Attending Doctor:

Countersignature: Independent Doctor

I confirm that [name], who at the date of this declaration is [age] years of age and has been ordinarily resident in England and Wales for [time]:

(1) is terminally ill and that the diagnosis and prognosis set out above is correct;

(2) has the capacity to make the decision to end their own life; and

(3) has a clear and settled intention to do so, which has been reached on an informed basis, without coercion or duress, and having been informed of the palliative, hospice and other care which is available to [him/her].

Signature:                                                                                                         Date:

Name and Address of Independent Doctor: