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Canada is set to expand medically assisted death, here’s where they and Europe stand

Here’s an overview of Canada’s and Europe’s medically assisted death laws

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Canada is seeking to expand access to medically assisted death.

Canada is seeking to expand access to medically assisted death. According to NPR, “even as early as next March, Canadians living with severe mental health could also be eligible under the law known as medical assistance in dying, or MAID.” Canada has allowed medically assisted death for terminal patients since 2016.

Michelle Budge, Deseret News

Canada is seeking to expand access to medically assisted death.

According to NPR, “even as early as next March, Canadians living with severe mental health could also be eligible under the law known as medical assistance in dying, or MAID.” Canada has allowed medically assisted death for terminal patients since 2016.

Reuters reported that mental health was excluded in the previous 2021 bill, but now Canada is preparing to expand to include mental health as the sole reason for accessing medically assisted death. Bill C-7, which had Royal Assent on March 17, 2021, repealed the necessity for someone’s death to be foreseeable before they accessed medically assisted death. This bill also specified that mental health could not be the sole reason to access it.

However, according to Dying with Dignity, excluding mental health will be automatically repealed on March 17, 2023.

In the federally published third annual report on medically assisted death, they said, “Other aspects of the MAID policy landscape will also receive attention, including questions related to access to palliative care and disability supports, as well as requests from mature minors and advance requests.”

Currently, in Canada, one must be an adult to access medically assisted death. Medically assisted death for mature minors is set for parliamentary review according to S.C. 2021, c. 2.

Those who support medically assisted death have raised concerns about expansion. Madeline Li, a cancer psychiatrist, told Reuters, “I’ve become very comfortable with MAiD for people who are dying. I am less comfortable for expanding indications. ... We’ve made MAiD so open you can request it for basically any reason.”

Canada’s laws have faced scrutiny

The Associated Press reported that 61-year-old Canadian Alan Nichols submitted a reason for euthanasia in Canada, “His application for euthanasia listed only one health condition as the reason for his request to die: hearing loss.” Nichols had a history of depression and other illness, but none of which were life-threatening. Human rights advocates have expressed concerns that the laws in Canada lack safeguards and negatively impact disabled people.

Marie-Claude Landry, head of the Humans Rights Commission said that medically assisted death, “cannot be a default for Canada’s failure to fulfill its human rights obligations.” One disability advocate sees medically assisted death as a significant threat.

Per The Associated Press, “Tim Stainton, director of the Canadian Institute for Inclusion and Citizenship at the University of British Columbia, described Canada’s law as ‘probably the biggest existential threat to disabled people since the Nazis’ program in Germany in the 1930s.’”

According to the third federal annual report, 3.3% of the country’s death were from medically assisted death in 2021. More than ten thousand people accessed medically-assisted death, which constitutes a growth rate of 32.4% from 2020.

Defining terms related to medically assisted death

Medically assisted death is the term that Canada uses, but there are other terms like euthanasia and assisted suicide that are used in these conversations. These words have different meanings.

Euthanasia refers to a doctor ending a patient’s life. Assisted suicide refers to a patient ending their own life with the help of a doctor. According to BBC, euthanasia typically involves a doctor administering a lethal injection while assisted suicide involves a doctor prescribing a lethal medication and the patient takes it.

Where is Europe on medically assisted death?

According to Euro News, euthanasia is legal in Belgium, the Netherlands, Luxembourg, Germany and Spain. Assisted suicide is legal in Switzerland, but not euthanasia. Austria, Finland and Norway allows for passive euthanasia, which is deciding to reject artificial nutrition or hydration.

Of these countries, laws in Belgium, the Netherlands and Switzerland has garnered the most controversy.

Belgium

Rebecca Reingold and Leticia Mora wrote for the O’Neill Institute that Belgium made euthanasia legal in 2002.

Euro News reported that “Under Belgian law, patients qualify for euthanasia only if they have an incurable illness and experience constant, intolerable physical or mental suffering that cannot be alleviated.”

Reingold and Mora said that Belgium’s law allows minors to access euthanasia if they have a terminal illness or incurable illness. The child has to undergo a psychiatric evaluation and parents must consent to euthanasia in Belgium. BBC reported that Belgium law requires that a child make repeated requests before the euthanasia is performed and “suffering based on a psychiatric disorder is excluded.”

According to the Brussels Times, Belgium’s current euthanasia law was ruled unconstitutional. They reported, “This, the Court argued, is both intuitively unreasonable — given that it implies that a doctor who violated a minor procedural condition while administering euthanasia would be technically guilty of murder — but it is also unconstitutional, insofar as it violates the principles of equality and non-discrimination enshrined by Articles 10 and 11 of the Belgian Constitution.”

To explain, the current euthanasia law was ruled unconstitutional because the court found it too restrictive in some ways.

Earlier this year, the Brussels Times also reported that one political party is preparing to discuss allowing euthanasia for those with dementia.

Netherlands

The Netherlands government provides their laws on its website.

Both euthanasia and assisted suicide are legal if specific criteria are met. Minors are able to request euthanasia with parental consent between the ages of 12 and 16. Patients over the age of 16 do not require parental consent, but the website specifies that parents must be involved in the decision-making process.

The Netherlands’ government website said, “Sometimes, a patient may lapse into semi-consciousness just before a scheduled euthanasia. If there are still signs of suffering, the doctor may perform euthanasia despite the patient’s lowered consciousness.”

According to The Atlantic, the Netherlands law does not require that a patient be close to death. Scott Kim summarized the for The Atlantic: The law requires that a patient have “unbearable suffering, without prospect of involvement” with “no reasonable alternative” other than medically assisted death. Additionally, the patient must be informed about their decision and it must be “voluntary and well-considered.” The doctor must be satisfied with the above conditions being met and has to perform the euthanasia properly.

Switzerland

Assisted suicide has been legal in Switzerland since 1942.

According to a study published in BMC Medical Ethics, the requirements for assisted suicide include the people being able to decide, it not be selfishly motivated and they are able to perform it themselves.

In 2022, Switzerland adjusted their guidelines for assisted suicide. Patients who are otherwise healthy now have to prove that their suffering is unbearable and that other options were unsuccessful or the patient said that they were unreasonable, per Swiss Info. Patients also must meet twice with a doctor at least two weeks apart before making the final decision. These guidelines are not legally binding, they are considered an ethical standard.

Per Swiss Info, assisted suicide constitutes 1.5% of the country’s 67,000 annual deaths.

Switzerland has also been connected to a phenomenon called “suicide tourism.” The pilot study on this phenomenon was published in the Journal of Medical Ethics. The authors said that an increasing amount of people traveled to Switzerland for assisted suicide. A 2022 study published in BMC Ethics examined suicide tourism as well.

BBC reported that the creator of a suicide pod is attempting to launch it in Switzerland. This pod would allow someone to end their life by flooding the pod with nitrogen. The company behind the pod, Sarco, told BBC that a Swiss legal expert did not say that it violated any laws, but other lawyers have expressed concerns.

According to an article published in MIT Technology Review earlier this year, Sarco is in its final round of testing. The Associated Press reported Switzerland has not legally approved the pod.

Philip Nitschke, the man behind Sarco, did not have his medical license reviewed in 2015 per The Guardian. His license was not reviewed following allegations of Nitschke having “counselled 45-year-old Nigel Brayley to take his own life. Brayley was suffering depression but was otherwise healthy.” He has faced criticism for his advocacy.