February marks the 10th anniversary of the Supreme Court of Canada’s decision in Carter v. Canada (Attorney General), in which the court unanimously ruled, against both basic logic and its own precedents, that the right to life, guaranteed by the Constitution, included the right to a state-assisted suicide through what came to be known euphemistically as “Medical Assistance in Dying” (MAiD).

At the time, the court dismissed evidence from other jurisdictions that the legalization of euthanasia inevitably led to its open-ended expansion as well as abuse against the vulnerable. Belgium’s disastrous euthanasia experiment, which saw children and people with psychiatric disorders dying at the hands of doctors, was, the court said, the “product of a very different medico-legal culture…. We should not lightly assume that the regulatory regime will function defectively, nor should we assume that other criminal sanctions against the taking of lives will prove impotent against abuse.” There would be no slippery slope, the court promised us.

Ten years later, it is worth pondering how the Supreme Court’s reassurances have aged. In 2016, Parliament legalized MAiD for people whose deaths were “reasonably foreseeable.” A short five years later, unnoticed in the midst of the pandemic, Canada’s euthanasia regime was expanded to cover those with chronic conditions whose deaths were not imminent. At the same time, Parliament legalized euthanasia for mental illness alone to come into force in 2023 (it has since been postponed to 2027), making a mockery of our society’s commitment to mental health and suicide prevention.

The horror stories Canada’s euthanasia regime has generated — the Paralympian who was offered MAiD by a government employee when she asked for a wheelchair ramp, the disabled woman living on welfare who opted for MAiD because she could not secure adequate housing, the cancer patient who chose to kill himself because he could not access chemotherapy in time — have become so commonplace that they have blunted our sense of decency, of what is the minimum we owe to our fellow citizens. Meekly, we have accepted that such horrors, and many more unreported ones, are part and parcel of Canadian society.

We have no answers to the contradictions raised by the legalization of MAiD. The civil servant who suggested it to Christine Gauthier was fired; but why did she lose her job, when MAiD is healthcare and when Gauthier, who is confined to a wheelchair, is eligible for euthanasia under Canadian law because of her disability? Was she not simply doing her job, providing information to those who may need it?

Many expressed disbelief when it was revealed that Saskatchewan’s health-care information phone line had an option for suicide prevention and another option for information about MAiD; but what was wrong with it, since MAiD is considered health care under Canadian law? If autonomy is the beginning and the end of our conversation about death, and if MAiD for mental illness will become legal, should we try to prevent suicides, or are we simply restricting suicidal people’s right to choose their end?

When it was introduced, proponents claimed MAiD would only account for a small number of deaths. In 2023, almost one death out of 20 in Canada was due to MAiD. In Quebec, which has adopted the practice more enthusiastically than virtually any other human society, the figure is 7.3 per cent, the highest such figure anywhere in the world. Last year, Quebec unilaterally legalized MAiD by advance directive — which under the Criminal Code is murder. The federal government’s reaction was to hold a series of national roundtables to discuss the idea more.

What about the “regulatory regime” on which the learned judges of the Supreme Court rested their hopes to protect the vulnerable? In Ontario, the chief coroner’s office recorded at least 428 cases of non-compliance with Canadian law by MAiD providers over a five-year period, in what was described as “a pattern of not following legislation, a pattern of not following regulation.” Most cases led to nothing more than an email to the provider; only four cases were referred to professional regulators. Not a single law-breaker was referred to the police.

In the words of Jocelyn Downie, who received the Order of Canada for her promotion of MAiD, when doctors or nurse practitioners are assessing a patient’s eligibility for MAiD, “you can ask as many clinicians as you want or need” for a second opinion, allowing them to shop around until they find a colleague who will sign off on a MAiD request. On another occasion, she told medical professionals that, when it came to signing off on MAiD requests, “There is no certainty or unanimity required. There is not perfection required.” Legally, she was right: Canadian law does not require medical professionals to be right when they authorize MAiD for someone; they must merely have reasonable belief. The MAiD assessor does not even need to meet the patient face-to-face: a Zoom meeting is sufficient.

As for the courts, which opened a Pandora’s box, they have largely washed their hands from it all. Last year, an Alberta judge ruled that an autistic woman with no apparent diagnosis of a physical illness could receive MAiD, even though the judge himself did not understand how she came to be approved for MAiD and even though at least one doctor had turned down her request.

Some judges are even proud of the role they played in ushering in MAiD: in 2018, Richard Wagner, the chief justice of Canada, agreed the Carter decision and other rulings of its kind made the Supreme Court, as one Vancouver lawyer had characterized, “the most progressive in the world,” and added that he was “very proud of that.”

A decade on, there was no slippery slope; it was a cliff.

National Post

Yuan Yi Zhu is a Canadian academic and writer at Leiden University.