Canadian report sheds light on Europe's assisted dying debate

The 83-year-old grandmother who was known as “GG” and “Oma”, had allegedly made a request to end her life after a stomach cancer battle. Yet, the attempt to euthanise her was rushed and against her will, her family says to The New York Post. When her granddaughter and caregiver, Brigitte Kranendonk, informed her about her upcoming death, she cried for several minutes and admitted: “I’ve made a mistake.”

Despite, Stegemann failing every question in cognitive testing and having no memory of opting for MAiD, doctors proceeded with her initial request. The nurse responsible for administering the medicines in her death had to pierce her arm several times to insert the IV. Blood began to stream all over Stegemann’s nightgown and bedding. “There was so much blood,” Kranendonk, said in the report.

When the first attempt did not work, a doctor asked if he could give her some medicine. Stegemann’s eyes were closed, and she lay motionless, unable to say a word. Still, the doctor proceeded to give her the medication. Ten minutes afterward, Stegemann was officially declared dead. Now, as the family demands answers, an investigation into her death is underway.

A current picture

Stegemann’s circumstances are the opposite of the “dignified death” that many proponents of assisted death/suicide promise their applicants. And what is worse, Right to Life UK recently reported that the Canadian government has proposed that those with a progressive “incurable illness” can still give consent to end their lives at a future time when they may be unable to give informed consent.

And amid grandparents applying for “the right to die,” assisted death has now extended to young adults and even toddlers in some EU states. Take for example 25-year-old Noelia Castillo in Spain who had her euthanasia application approved after being diagnosed with a “incurable” condition, along with “severe” suffering. Euronews revealed that Castillo’s condition involved a years-long battle with mental illness along with attempts to take her life at least twice.

Despite the court’s repeated approvals, her family believes that she could not give consent because of her mental health status. And as each year passes, euthanasia’s applicants are getting younger than Castillo. In 2023, the Netherlands approved euthanasia for those ages 1 and 12 years old.

Last year, Euronews recently reported that a 1-year-old was euthanised in the Netherlands. The toddler suffered from various debilitating conditions including extensive brain damage as well as severe forms of epilepsy and cerebral palsy. The parents requested a termination of the child’s life after it became apparent that there would be “no hope for improvement.”

A cross-cultural study on assisted dying

As assisted dying gets younger, so is the push to raise awareness of how it is really being implemented and whether safeguards are present. The Canadian think tank Cardus looked into these points as part of a two-part paper it had published entitled: An International Comparison of Assisted Dying Regimes by Rebecca Vachon and Étienne-Alexandre Beauregard.

In the first paper, Vachon and Beauregard defined the differences in assisted suicide which involves “self-administered death”. Euthanasia, however, is defined as death being initiated by the clinician. It also looked at the legal status and the eligibility criteria of these practices across various international states.

More recently, in the second part, the paper focuses on various safeguards that have been implemented by various international governments.

Looking closer at the report’s findings, Canada lies somewhere in the middle when it comes to implementing these safeguards within its MAiD (Medical Assistance in Dying) framework. Canada implements more restrictive measures toward assisted dying that is similar to Australia, New Zealand, and the US. However, many of the assisted dying/euthanasia practices adopted in Europe are considered “more permissive,”. When it comes to eligibility criteria, Canada appears to be more lenient compared to more restrictive states such as Australia, New Zealand, and the US.

One of the paper’s authors, Étienne-Alexandre Beauregard, says that in the research process, what matters most is context and understanding how these concepts are actually being applied outside of their legislation.

“If the model is individual choice, then the model should be focused on the patient,” he says. But sometimes, that is not always the case if a country has adopted more of a clinician/physician approach.

He adds that the degree of consent regarding the patient’s autonomy also presents a varied picture throughout Canada and even the world.

In South Australia, for example, patients must initiate that conversation if they want to go forward with assisted dying. Clinicians as well as other healthcare practitioners in certain fields are barred from raising the issue unsolicited with the patient. In Canada, however, this type of safeguard is not in the law.

The government “encourages clinicians to raise MAiD in some cases.” In these cases, physicians are permitted to bring up MAiD if the patient qualifies or sees that MAiD is in line with an individual’s “values and goals of care.” Yet, as detailed in a previous Cardus report, much of the Canadian population is concerned that physicians are bringing up MAiD unsolicited which may result in pressuring patients to choose MAiD.

The report also compared the request process and the differences when it comes to witnesses. In many US states that permit assisted dying for example, the waiting period from the time of the request to the procedure can average from two days to as long as fifteen. In making that request, the patient can state it first in writing or orally to the physician, then make a second written request in the presence of two witnesses, and finally another oral and written request.

When it comes to Belgium, Luxembourg, and the Netherlands, the process looks different. According to Dutch law, the physician must determine that the “patient’s request is voluntary and well-considered.” Belgium and Luxembourg present nearly an identical picture but requires that request in writing.

Canada is similar to these countries in the fact that it requires a written request after determining eligibility. Most parts of Australia require a “sequence of requests” where the physician must first determine eligibility, then inform the patient about additional options such as palliative care and finally, have the patient discuss their wishes to their physician.

And what about witnesses? That particular requirement can also vary across the world. Australia and the US require the presence of two witnesses in writing the written request. These states also have regulations in place as to who can actually be a witness.

For example, some US states require the witness to not be a beneficiary. In Australia, the witnesses cannot be assessors when it comes to the request. In Belgium, Luxembourg, New Zealand, Spain, and Uruguay, the witnesses do not need to be present during the procedure. Austria, however, does not require witnesses but that the request be approved by a public notary or a member of the (Patientenvertretung) body of patient representatives.

In the case of Canada, two witnesses were originally required but that law was relaxed in 2021. Now, only one witness needs to be present, and they can include professional caregivers, healthcare workers, and even family members.

Awareness

Cardus will continue their research on the topic with a third part of this international comparison which will be released sometime next year. They will analyze procedural safeguards before MAID is administered across countries, such as minimum delays between assessment and administration, external reviews and requests for final consent. In light of the research done so far, they stress that governments should take a closer look at implementing protections to their most vulnerable populations before it is too late.

Although much has yet to be done in reversing the legislation on euthanasia/assisted suicide throughout the world, some pushback and awareness on its dangers are starting to surface.

While Beauregard did say that the Canadian government planned to expand MAID to patients with mental health conditions, that provision has repeatedly been deadlocked within its parliament. He predicted that such an expansion was not going to go through this year. And he was right.

Cardus recently reported that while Canada’s government will increase access to “advance euthanasia requests” (which remains deeply concerning), MAiD’s expansion to those with mental health conditions has been delayed indefinitely.

And across the pond in the Netherlands, considerable backlash has been felt there as assisted dying is being offered to more youth with mental health challenges. Perhaps Canada’s latest decision will set a precedent for other nations to follow.

“I think more and more people are realizing that we need stronger safeguards to protect vulnerable patients, and that the tide is turning,” Beauregard says.