Euthanasia in Ontario: over 400 breaches of the euthanasia law result in only reminders of the law

In Canada, since its decriminalization in 2016, doctors practicing medical assistance in dying (MAID) must assess the eligibility of people requesting euthanasia, respect all safeguards against abuse and notify each request and each death. Dr. Dirk Huyer, the Chief Coroner (Public Officer), supervises the compliance of the practice of euthanasia with criminal law.
Back in 2018, Dr. Huyer announced to Ontario healthcare professionals that a new system would be implemented “to address concerns raised by potential compliance issues”. This was prompted by the realization that “some case reviews have revealed problems with compliance with the Criminal Code and regulatory expectations, some of which have recurred over time”. The system provides for a graduated response to problems identified by euthanasia regulators, with a five-level response scale. The first is an informal discussion in the event of a breach of good practice or unfamiliarity with the guidelines, and the final level is a report to the police in the event of flagrant non-compliance with the requirements of the law. The Chief Coroner's report of 2024 reveals that between 2018 and 2023, of the 428 cases of non-compliance identified, only four resulted in a report to a regulatory body, and none to the police. Given this finding, the question arises as to whether this system is really effective in protecting vulnerable people from potential abuse.

Worrying breaches of legal requirements
As early as 2020, Dr. Huyer identified various problems of compliance with the legislation in his report presented at a symposium of the Canadian Association of Medical Aid in Dying Evaluators and Providers, which was not made public until 2024. The problems identified concerned, on the one hand, eligibility for euthanasia: it was found that some doctors were transmitting incorrectly completed or incomplete assessment notes, or not transmitting certain documents, which made it impossible to verify that the patient actually met the legal criteria for euthanasia. The report also mentions doctors' difficulties in assessing patients' capacity to consent to euthanasia, particularly in the case of patients suffering from cognitive impairment or dementia. Euthanasia evaluators' conclusions concerning patients' capacity to consent were found to be “incompatible or contradictory” with clinical assessments presented in medical records. It also emerged that patients with dementia or cognitive impairment would have required additional specialist consultations and a better assessment of their capacity to consent to euthanasia. These shortcomings only triggered a response from the coroner ranging from level 1 to level 3, the latter being an e-mail warning.

A worrying rush in the euthanasia procedure
In 2021, the law governing euthanasia in Canada was revised, so that it is no longer necessary for natural death to be reasonably foreseeable for a person to be eligible for MAID (except for people suffering solely from mental illness, who are, for the time being, excluded from this possibility). When natural death is not reasonably foreseeable, the law requires the physician to respect a delay of “at least 90 days between the day of the first evaluation” and “the day on which medical assistance in dying is provided”. However, the 2024 coroner's report mentions the concern of many members of the euthanasia oversight committee about people who are not terminally ill and who suffer from complex medical conditions. For these individuals, “the guarantee requiring an assessment period of at least 90 days may be insufficient to meet the complex care needs of the applicant”. The difficulty lies in the fact that the applicant may be in “a transitory physical or psychological state”. In such circumstances, additional time may be required to “assess the reversibility of the stressor”.
These concerns highlight the inherent problem of euthanasia taking place in a context of suffering and/or illness, where it is difficult to ascertain the person's true wish to die. This situation is likely to be even more complex in Quebec, where since October 30, 2024, a person can give advance consent to receive medical assistance in dying, in the future, on the basis of an anticipated request. In this context, the patient will no longer be able to consent to euthanasia at the time of the act. An example would be a person diagnosed with a serious and incurable illness leading to incapacity to consent to care (e.g. Alzheimer's disease). While the person must certainly be capable of consenting at the time of the anticipated request, the context of the announcement of the illness and the fear of loss of capacity could constitute additional incentives to the possibility now offered of requesting death in advance.
On this subject, see also the EIB's opinion on the proposed law to extend early declaration to persons who have become incapable of expressing their will in Belgium.