Canadian doctors who oppose euthanasia are sounding the alarm about governmental pressure on health professionals to initiate MAiD discussions with their ailing patients.

The doctors are reacting to a little-known 2023 Health Canada document urging health authorities and professional bodies to adopt a set of “practice standards” that would mandate doctors and nurse practitioners to raise the issue of MAiD (medical assistance in dying) with certain patients.

Vancouver family physician Will Johnston, head of B.C.’s Euthanasia Resistance Coalition, said implementing Health Canada’s Model Practice Standard for MAiD would “coerce” medical professionals and lead to a troubling rise in euthanasia deaths. Johnston is one of several Canadian doctors who are publicly opposing any move, in Canada or abroad, to mandate initiation of MAiD discussions.

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Health Canada’s model practice standard states that medical practitioners “must not” assume every patient knows about MAiD’s availability. The model further states that, upon forming reasonable grounds to believe a person may be eligible, doctors and nurse practitioners — the only medical personnel legally permitted to perform MAiD — “must determine whether MAiD is consistent with the person’s values and goals of care.” If it is, they must then “advise the person of the potential for MAiD,” or, if they have a moral objection, transfer the patient’s care to another practitioner.

Those instructions alarm Johnston. 

“Whoever is in charge of ‘Death Canada,’ as I’ll call them, seems to have forgotten the promises that were made to the medical community when euthanasia was first proposed — that no one would be forced to become complicit in it,” Johnston said. “And now they’re simply reneging. They’re violating that promise by insisting on compelled speech.”

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, said that despite Health Canada’s model not being law, he knows that many doctors commonly initiate MAiD discussions because they perceive euthanasia to be a medical treatment for the chronically ill and elderly. 

“In fact,” he said, “because the intention of MAiD is to kill the patient, it is the very opposite of medical treatment.”

Schadenberg is also concerned a government-supported suggestion in Canada may become a government-mandated law in Australia. That country’s state of Victoria is planning an expansion of euthanasia eligibility that would let doctors initiate discussions about assisted death. 

Schadenberg has produced a video highlighting the concerns of three Canadian doctors — Johnston, David D’Souza of Toronto, and Catherine Ferrier of Montreal — who describe problems associated with initiating MAiD discussions in Canada.

D’Souza said that if a physician suggests euthanasia as an option for a patient’s pain or suffering, “a patient is more likely to take this option given that a health professional has suggested it.”

Health Canada media relations officer Karine LeBlanc said in an email to The B.C. Catholic that the Model Practice Standard for MAiD was developed by a task group convened in September 2022. Members were chosen for their expertise in MAiD practice and professional regulation.

Health Canada cannot compel provinces or health authorities to adopt the guidelines, and a limited review by The B.C. Catholic found no evidence that any public agency or professional body in B.C. has done so.

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Vancouver’s Catholic health authority, Providence Health Care, explicitly prohibits its employees from initiating a discussion about MAiD. 

“We don’t proactively mention MAiD as an option to consider,” Providence spokesman Shaf Hussain said in an email earlier this year. “We never initiate an offer of MAiD.”

On the other hand, there are widespread anecdotal reports from the public system that doctors and nurses do initiate such discussions. After Canada legalized MAiD in 2016, and then expanded eligibility in 2020 to include people not dying but suffering from incurable diseases, numerous reports surfaced of patients being pressured about euthanasia options. The B.C. Catholic first exposed the problem in a 2021 investigation.

Not only is initiation of MAiD discussions ethically and practically problematic, but it also may be illegal, said Luke Chen, an associate professor of medicine at the University of B.C. Chen said the Health Canada recommendation appears to contravene Section 241(a) of the Criminal Code of Canada, which makes it illegal to counsel a suicide.

The Canadian Association of MAiD Assessors and Providers rejects that notion, saying in a policy document that “so long as they do not have the aim of inducing, persuading or convincing the patient to request MAiD, any health-care professional can legally provide information ... about MAiD.”

It may be legal, but initiating a MAiD discussion sends a powerfully negative message, says Deacon Tim Kostamo, a surgeon who is a member of Christ the Redeemer Parish in West Vancouver. 

“Fundamentally the problem with it is that as soon as you offer MAiD to someone — or, as it really is, ‘medical killing’ — the message you are telling them is that you think their life is not worth living,” he said.

Kostamo said the Health Canada document is yet another indication that there’s something fundamentally wrong with the medical system in Canada. As a surgeon, he sees patients wait up to three years for needed hip replacement surgery. On the other hand, “two clicks (on your computer) and you’re connected to someone who will coordinate your death,” he said.

Johnston said he is troubled by the fact the model even exists. 

“The very process of a doctor notifying ... potentially suggestible people of suicide-by-doctor validates it and is an inducement to consider it,” he said, calling the practice an “outrage against decency.”

Schadenberg said he is “saddened, shocked and angered” by Health Canada’s guidelines, which he has known about since their publication. He believes every major hospital in Canada now has a MAiD team tasked with informing patients about euthanasia’s availability. 

“That’s why I’m getting so many phone calls from patients complaining they are being ‘pestered and pestered’ to succumb to MAiD… Some of the MAiD teams are very sales-oriented,” Schadenberg said. “They can’t understand why you don’t want it.”

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The issue is serious enough to warrant legislation making it an offence for any medical practitioner to initiate a discussion of MAiD, he said.

“We’re simply seeing too many people who feel pressured and coerced to agree to MAiD.”