Providers of Canada’s euthanasia programme, Medical Assistance in Dying (MAiD) may have failed to comply with federal criminal regulations on hundreds of occasions – and that information was kept from the public, whilst even repeat and “blatant” offenders were not pursued with criminal charges, a new investigation says.
428 cases of possible criminal violations have been documented in a set of newly leaked documents.
The revelations raise further questions about the country’s headline-making euthanasia regime, as both the UK and Ireland consider plans to legalise assisted suicide.
The documents were recently provided by three physicians who had access to them, on the grounds of anonymity, to the publication The New Atlantis, which reports on a “pattern of noncompliance” with regards to euthanasia providers in the Canada province of Ontario.
Around 50,000 Canadians have died through MAID since the practice became legal in 2016, with the number climbing annually. Both assisted suicide and euthanasia are legal through the law, which was originally introduced for those whose death was deemed “reasonably foreseeable”. However, in March 2021, the law was further amended to include those suffering from “a grievous and irremediable condition” whose death was not reasonably foreseeable.
The planned inclusion of those with mental illness has been repeatedly delayed due to controversy and pushback, and the planned expansion of the law is currently subject to a legal challenge.
Assisted suicide and euthanasia are supposed to be subject to legal safeguards “protecting vulnerable people from abuse and error,” according to the Supreme Court of Canada. However, the leaked documents have led to allegations that oversight of the MAID system is only shielding providers from a litany of abuses and errors coming to light.
The New Atlantis reports that for 2023 alone, the Office for the Chief Coroner for Ontario, Dirk Huyer, identified 178 compliance problems related to the provision of MAID – an average of one every other day. This brings the total number of possible criminal violations of the 2016 law to 428.
“Out of all those 428 compliance issues, spanning roughly a five-year period, only four cases triggered a report to a regulatory body. All others were deemed lower-level offences, and not a single case was reported to the police,” the outlet reports.
Findings disclosed by the media outlet reveal that in 2023, a quarter of all euthanasia providers in Ontario received at least one response from the Coroner’s Office about a compliance issue.
Many of these concerns were for more complicated medical situations: 12 percent of all euthanasia deaths of dementia patients and 8 percent of all deaths of chronic pain patients required a response from the Coroner about a compliance issue.
For euthanasia deaths where the patients were not terminally ill, 15 percent required a response about a compliance issue.
“Again for euthanasia deaths where the patients were not terminally ill, in some cases practitioners reported that they were not experts in the illness that caused the person’s suffering, and no outside expert was consulted — violating a safeguard mandated by federal criminal law,” The New Atlantis reports.
ONTARIO’S FIRST 100 EUTHANASIA DEATHS
The report refers to “compliance problems” with Ontario’s first 100 euthanasia deaths from 2016 to 2017. It refers to a paper published in June 2017 in the journal Academic Forensic Pathology that examined these deaths based on reports to the coroner’s office by euthanasia providers.
“The paper shows early warning signs that providers were not complying with the federal criminal regulations for MAID,” it notes.
The paper noted that: “The MAID regulations require clinicians to notify the pharmacist of the purpose of the MAID medications before they are dispensed.”
“However, some physicians listed that they did not abide by these regulations,” it states, with only 61 per cent having done so. The New Atlantis notes that federal legislation at the time also required a 10-day waiting period between the request for euthanasia and the administered death to ensure that patients really did wish to die, a safeguard that could be waived only if the patient was approved and on the verge either of losing capacity to consent or of imminent natural death.
“Yet according to the paper, euthanasia providers recorded expediting deaths for reasons including not only loss of capacity or imminent death but “persistent requests” and “inconvenient timing of the death in relation to other familial life events.”
The leaked documents show that these sorts of issues with compliance, present early on, “never went away.”
‘THE DECEASED PERSON SUFFERED TREMENDOUSLY’
One case noted in the leaked documents by Chief Coroner for Ontario, Dirk Huyer, involved a patient who was given the wrong drugs, and who “suffered tremendously” at the hands of a MAID practitioner. Huyer, in an address to practitioners, instructively notes:
“One is a blatant situation that’s published through the College of Physicians and Surgeons of just being completely unprepared and bringing wrong medications. They brought scopolamine and Ativan. Those were the drugs that the clinician brought to the home to administer MAID. And it was just horrible. It was horrible. The family, and I’m talking about what’s public, so this isn’t anything non-public, the family and the deceased person suffered tremendously.”
The case, however, did not trigger a criminal investigation. The New Atlantis reports that the case was never reported to police, but was instead reported to the regulatory body, the College of Physicians and Surgeons. The College concluded by saying it was “disturbed” by the doctor’s failings, including a lack of preparation and use of the wrong drugs, as well as leaving the dying person’s bedside for over two hours (to get more drugs as the ones she had used did not fully work).
An independent review of the case found that the euthanasia provider “continued to underestimate the magnitude of providing medically-assisted death and the responsibility attached.”
However, as The New Atlantis reports: “And yet the practitioner, Dr. Eugenie Tjan, remains a licensed physician in Ontario. The College did prohibit her from practising euthanasia, but kept her licence to practise palliative care, as long as it is under the supervision of another physician.”
‘A PATTERN OF NONCOMPLIANCE’
Another case flagged by the coroner’s officer involved a woman whose son brought a complaint that she had been improperly assessed before being euthanized and that the roughly 4 weeks between her MAID request and her death was not enough time to understand her condition, since she did not experience any physical pain.
The College reviewed the case in light of the complaint, but decided against taking action.
It said that “the Coroner’s office … is responsible for reviewing each case to ensure that all the proper checks and balances were in place and that the process was followed properly,” and it “did not find any concerns.”
Other concerns listed by the Coroner’s office, and outlined in a 2020 presentation, included problems with “documentation and compliance with legislation” – including “poor/no completion of accompanying assessment notes” on how eligibility for euthanasia was decided by the clinician. It also included “missing documents,” and “partial completion / no completion of federal reporting requirements by clinicians.”
There were also concerns about whether patients had the necessary capacity to consent to be euthanized.
“These problems included “incompatible or contradictory conclusions of capacity by MAID assessors in comparison to other documented clinical assessments in medical records,” a “paucity of formal capacity assessments or further specialist consultation” in cases where patients had a “known history of dementia or cognitive impairment,” and “variability in quality of assessments in cases of wavering capacity or evidence of impaired cognition.”
Huyer noted in a 2020 presentation that there existed “consequent challenges in determining the capacity of a patient seeking MAiD from an oversight perspective after death has occurred.”
At the 2024 annual conference of the Canadian Association of MAID Assessors and Providers, held in May, Dirk Huyer gave another slideshow presentation, “Lessons Learned from the Coroner,” providing more detailed information up until 2023.
The New Atlantis, which accessed the slides, says that the presentation shows that for 2023 alone, Huyer’s office identified 178 compliance problems — an average of one every other day — bringing the total since implementation of the level system to 428.
It reports on a number of worrying findings, including that in 2023, a quarter of all euthanasia providers in Ontario received at least one response from the Coroner’s Office about a compliance issue.
“Many of these concerns were for more complicated medical situations: 12 percent of all euthanasia deaths of dementia patients and 8 percent of all deaths of chronic pain patients required a response from the Coroner about a compliance issue.”
For euthanasia deaths where the patients were not terminally ill, 15 percent required a response about a compliance issue, the presentation noted.
For euthanasia deaths where the patients were not terminally ill, in some cases practitioners “reported that they were not experts in the illness that caused the person’s suffering, and no outside expert was consulted — violating a safeguard mandated by federal criminal law.”
“In a recorded video of Huyer’s conference presentation, also obtained by The New Atlantis, he described these cases as “a learning opportunity, let’s put it like that.”