Experts from Canada, where assisted dying is legal, have given evidence to a committee of MSPs examining proposed legislation to legalise the practice in Scotland.
The Assisted Dying for Terminally Ill Adults (Scotland) Bill, proposed by Liberal Democrat MSP Liam McArthur, would give people aged 16 and older with a terminal illness the right to request an end to their life.
Some groups have expressed concerns this could lead to terminally ill people, the disabled and elderly feeling pressured to end their life.
On Monday, Holyrood’s Health Committee questioned two Canadian doctors about their assisted dying legislation, called medical assistance in dying (MAiD). It was introduced at a federal level in June 2016.
They were asked whether a shortage of palliative care was a reason for people opting for assisted dying, which has been a key concern raised by those opposed to the Bill in Scotland.
Dr Stefanie Green, founding president of the Canadian Association of MAiD Assessors And Providers, dismissed the suggestion, saying 96% of all people accessing MAiD in Canada had received palliative care.
She added that cancer patients, who have access to some of the best palliative care in the country, were the group with the most MAiD requests.
“If you believe that access to palliative care would reduce the incidence of assisted dying, you would expect a dramatically lower incidence of MAiD in the group that’s receiving the better palliative care,” she told MSPs.
“But in fact, you see the exact opposite in the data.”
However, Dr Ramona Coelho, a physician and member of the MAiD death review committee, said 21% of those accessing assisted dying only received palliative care for two weeks before they died, which she said indicated they had been granted palliative care “only after they requested MAiD”.
She added that in Ontario data showed it took an average of 2.2 days to contact a MAiD assessor, but that it could take weeks, months or even years to access other services.
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The committee also asked about measures to guard against marginalised people – such as those with disabilities or with non-medical issues like homelessness or isolation – from turning to assisted dying due to a lack of support or other options.
Dr Coelho said people in Ontario were being approved for MAiD “on the basis of psychosocial factors”, including a “lack of social support”.
She explained that while a patient may have a medical condition, the “intolerable suffering” required as a precondition of accessing assisted dying could be the product of something unrelated to that condition.
Dr Green disputed this interpretation, saying that in Ontario MAiD recipients were “substantially less marginalised than people who die without MAiD”, adding that it was the illnesses suffered that led people to accessing assisted dying that were associated with “higher rates of marginalisation”.
She also said it was “not news” that economic deprivation contributed to mortality but there was no evidence in reports she had seen that this was driving people towards an assisted death.
The committee also asked about safeguards to prevent people being coerced into assisted dying, thereby ensuring that only those who fully meet the criteria can access the procedure.
Dr Green said there was “zero evidence” people were being coerced into assisted dying, and that the only coercion she had seen was by friends and family convincing a loved one to stay alive.
However, Dr Coelho said “we have no robust safeguards to prevent coercion”, adding that it was “very scary” to her that “certain types of people” were being treated as less worthy of care.
She gave the example of a man who had been approved for assisted dying after getting seven different assessments, which she said showed he was able to “doctor-shop until he found two favourable assessments for his case”.
The MSP committee also asked about the numbers accessing the service in Canada, which they noted had risen between 2019 and 2022.
Dr Green said the Canadian figures were “entirely as expected”.
She said that since 2016 assisted dying accounted for 4.1% of all deaths in Canada annually, compared with an annual rate of 5.5% in the Netherlands, which she said had similar laws.
She accepted that the numbers accessing MaID had risen since the practice was made legal, but said this was inevitable as more people became aware of it and as the infrastructure to administer it was put in place.
Dr Coelho said when assisted dying was first legalised in the state of Quebec a politician had said there would be fewer than 100 requests per year.
Now, she said, assisted dying accounted for 7.3% of annual deaths in Quebec, while the state of Ontario was seeing an average of 400 cases completed each month.
Commenting after the session, Dr Gordon Macdonald from Care Not Killing, which opposes the Bill, said the evidence showed how quickly assisted dying can “get out of control and be expanded to include people who are not terminally ill and those with mental health issues”.
He added: “With people accessing assisted suicide and euthanasia because they are lonely, can’t get access to disability supports or out of fear of being made homeless, Canada has become a warning to the rest of the world of how dangerous this law is in practice.”