‘I was offered assisted dying over cancer treatment’

“MAID has become a way to compensate for lack of resources and reduce healthcare costs.”

Kotalik maintains that there had been far too little investigation or oversight of MAID since its introduction. “There is no real governance of this national programme, which relies for the purpose of collecting information about applicants and deaths entirely on self-reporting by providers,” he said. “I’m concerned about the possibility of people choosing MAID without the full or correct diagnosis, especially in cancer when oncologists are not involved. Options for a cancer patient should not be assessed just by a general practitioner or nurse practitioner so I worry patients are not fully informed about alternative options with different treatments and more comfortable outcomes.”

Such warnings become even more pertinent in light of the surging MAID toll on Vancouver Island, a haven for wealthy retirees with its beautiful beaches, forests and mountains. Euthanasia campaigners often reject claims that reform leads to a “slippery slope”, although numbers keep rising and icriteria have been expanded in nations that led the way. In the Netherlands — which in 2002 pioneered assisted dying for patients — it accounts now for one in 20 fatalities, with 58 couples dying together last year and the rules extended to include terminally ill children.

Canada has also seen MAID cases soar each year — and once again, protections have been eroded. In 2021, the central rule that natural death had to be “reasonably foreseeable” was removed. Latest figures disclosed that 13,102 people ended their lives under the scheme in 2022, a rise of 30% over the previous year despite postponement until 2027 of the controversial expansion to people with chronic mental illness. The country is catching up fast on Holland’s rate with 4.1% of deaths aided by doctors. Its annual MAID report also revealed that more than one-third of those choosing to die felt themselves a burden on family, friends or caregivers. Inevitably, there have been significant controversies with reports of pressurised fatalities involving disabled, elderly and impoverished citizens.

Meanwhile, the rate of MAID cases under Vancouver Island’s health authority is more than twice as high as the rest of Canada; indeed, it may well be the world’s highest since it accounts for almost one in 10 deaths. I heard various explanations for this, ranging from the struggling state of the region’s cancer services through to a history of legal, social and medical activism in support of euthanasia.

Prominent practitioners include Stefanie Green, founding president of the Canadian Association of MAID Assessors and Providers, who has assisted more than 400 deaths. She spent two decades as a family doctor focusing on maternity and new-born care before turning to assisted dying. “I’d always been interested in the intersection between medicine and ethics,” she told me. “The more I looked into it, the more I was drawn to it. The skill set was almost identical. It required a knowledgeable person to take people through a natural event. I would be with them during a very intimate event. It would take time to build up the trust. It is intense, it is intimate, there are the family dynamics.”

When I asked if medically induced death was really “a natural event”, she insisted that “the death is imminent” before adding that she found the work deeply moving. “Patients are grateful, families are grateful, and I am facilitating their final wishes. I am certain in all the cases they are 100% eligible, both legally and medically. The work is done properly. It is not for me to decide on their situation. It is their personal autonomy.”

Green is both passionate and proud of her work: intriguingly, she faces far more protests over the single day a week she spends performing infant circumcisions from campaigners who argue it is an infringement of the child’s rights. She agrees, however, that patients such as Allison have every right to feel disappointed. “She should feel aggrieved that the Canadian health system is not working efficiently and failed her. I will also demand better resources with more doctors and nurses. The government has failed — but that is not reason to cancel the MAID programme. It needs to be delivered carefully and cautiously.” Likewise, she agrees society often fails people with disabilities. “We must act to remedy this — but this shouldn’t mean we cancel desired, needed, legal medical services.”

Green stresses that MAID requires people to make their own request to terminate their lives. “It cannot be triggered by anyone else. It cannot be coerced — subtly or explicitly. It must be consistent with their own values; they must demonstrate capacity. It is far, far more common to see people coerced out of their request for MAID than to have someone show up who has been coerced into making this choice — which we then note and find them ineligible.”

This debate is a moral minefield, with emotive and valid arguments on both sides. There is, however, a global drift towards legalisation of assisted dying, from Ecuador to Germany. In Britain, as lawmakers across the Channel prepare to debate assisted dying, YouGov polling suggests similar legislation would be backed by 44% of voters, although 31% remain unsure — and surveys have suggested twice as many people with disabilities would be concerned by a change in the law as support it, despite claims from campaigners to the contrary.

Christopher Lyon, a social scientist at the University of York, believes Britain should be very cautious in following Canada’s lead after witnessing his father’s assisted death in a drab Victoria hospital room in the summer of 2021. He was left highly disturbed by the experience, believing his father failed to meet the correct criteria for being moved rapidly to the category of “reasonably foreseeable” death, as well as being depressed and possibly drunk when giving consent. “It was absolutely horrific,” he said. “Britain would be wrong to go down this path. You see some people making the same arguments as in Canada about personal autonomy, control and the right to make decisions to end your life. It is perhaps a choice for people in very rare cases with extreme and unmanageable suffering at the very end of life, which is not what we see in Canada. But there is no doubt the evidence points towards a slippery slope with widening access — although it is really more of a cliff face. Ultimately, I doubt any assisted death system can be made safe.”

Lyon told me he was neutral on this issue before seeing his 77-year-old father die. “It is horribly hard to see your father in distress being killed by a doctor with no attempt to help. It is almost indescribable. It came across as so cruel — but also so avoidable.”