47-year-old Canadian woman wants help to die

TORONTO: Lisa Pauli wants to die. The 47-year-old has wrestled with the eating disorder anorexia for decades; she says she has had a warped relationship with her body since age 8.

These days, Pauli says, she weighs 92 pounds and may go days without eating solid food. She says she is too weak to carry groceries home without stopping for breaks.

“Every day is hell,” she said. “I’m so tired. I’m done. I’ve tried everything. I feel like I’ve lived my life.”

Pauli cannot legally get medical help to die – yet.

An expansion of the criteria for medically assisted death that comes into force in March 2024 will allow Canadians like Pauli, whose sole underlying condition is mental illness, to choose medically assisted death.

Canada legalized assisted death in 2016 for people with terminal illness and expanded it in 2021 to people with incurable, but not terminal, conditions. The legal changes were precipitated by court rulings that struck down prohibitions on helping people to die.

The new mental health provision will make Canada one of the most expansive countries in the world when it comes to medical assistance in dying (MAID), according to an expert panel report to Canada’s parliament.

Proponents of assisted death – which is still a novel concept in many parts of the world – say it is an issue of personal autonomy.

But six disability rights and religious advocates told Reuters that the pace of the planned changes to the assisted death framework in Canada brings additional risks of people opting for MAID because they are unable to access social services – the lack of which could exacerbate their suffering.

Canada’s Justice Minister, David Lametti, dismissed criticism that the country was moving too fast or opening up the system to abuse. Some disability advocates have demanded rolling back the current framework because they argue it puts people with disabilities at risk.

“We have gotten where we are through a number of very prudent steps,” Lametti said in an interview with Reuters in June. “It’s been a slow and careful evolution. And I’m proud of that.”

In 2021, the most recent year available, 10,064 people died through medically assisted death, about 3.3% of deaths in Canada that year. That compared to 4.5% in the Netherlands and 2.4% in Belgium, where assisted dying has been legal since 2002, according to each country’s official data.

The vast majority of assisted deaths in Canada conformed to the legal rules but provincial authorities deemed a small number worthy of investigation, according to previously unreported provincial government data. Provinces and territories are responsible for health care in Canada.

In 2021-22, Quebec found 15 assisted deaths, 0.4% of the total, did not follow the rules. The province referred the cases to Quebec’s self-governing medical body and medical facilities, provincial spokesperson Marie-Claude Lacasse said. In six of those cases, the person did not have a serious and incurable condition, according to a provincial commission.

In British Columbia, government officials have referred 19 assisted death cases to regulatory bodies and a further two to law enforcement since 2018, according to a provincial spokesperson who did not provide further details.

None of the referrals in the two provinces resulted in disciplinary action for doctors, regulatory bodies said, declining to provide further details.

Four other provinces reported no problematic cases of medically assisted death. Other provinces and territories including Ontario, Canada’s most populous province, did not respond.

30,000 MEDICALLY ASSISTED DEATHS

More than 30,000 people have died with medical assistance in Canada since 2016, more than 10,000 of them in 2021 when the law was expanded to people whose deaths were not “reasonably foreseeable.”

Even after the change in the legislation, about 98% of the assisted deaths in 2021 were people deemed near their natural death, according to Health Canada data.

“So far nothing I see would suggest that we need to worry about having gone too far,” Lametti said.

The procedure is only available to people covered by a Canadian healthcare program. It requires a written application and assessments from two independent medical practitioners, including at least one specialized in their condition if the applicant is not near their natural death. The procedure frequently involves an injection administered at home.

Lametti said the federal government is considering recommendations from a parliamentary committee to allow advance requests and “mature minors” – people under 18 deemed capable of making this decision – to access assisted death.

Quebec passed a law June 7 that would allow people to make advance requests for assisted death that would go into effect when they reach a predetermined point of incapacity due to Alzheimer’s or similar conditions.

But Georges L’Esperance, president of the Quebec Association for the Right to Die with Dignity, said it could take up to two years for the provision to go into effect.

Dying With Dignity Canada has organized nearly 10,000 letters this year to government officials seeking to legalize advance requests across Canada, spokesperson Sarah Dobec said.