Euthanasia is a corruption of medicine

Over the past 50 years, both lay and medical communities in many Western nations have gradually accepted the idea of ​​assisted dying. There is no guarantee that UK MPs will follow suit when the euthanasia bill comes before parliament at the end of November. But momentum certainly seems to be on the side of assisted dying advocates.

If the Terminally Ill Adults Bill – to give it its full title – is passed, practical measures must be taken to protect patients as much as possible. Kim Leadbeater, the MP who proposed the bill, has insisted that appropriate safeguards can be put in place, although many of the details of the bill have yet to be made public.

This is hardly reassuring. The experience of other countries has shown that maintaining strict safety measures for physician-assisted dying always fails. It is certain that if assisted dying is legalized, patients who should not die will die. But two factors seem to offer patients at least some degree of protection: the eligibility criteria for assisted suicide and the role of doctors in the process. We can see this in the contrasting experiences of two places that have legalized euthanasia: Canada and California.

The populations of Canada and California, at about 40 million each, are comparable. The overall demographics, although not identical, are similar and there are no significant differences in the leading causes of death, overall death rates or access to palliative care. Still, the difference in the number of assisted deaths between Canada and California is huge. Between 2016 and 2021, California recorded 3,344 assisted deathswhile Canada recorded 31,664.

In fact, there was only 2021 10,064 assisted deaths in Canada. This accounts for 3.3 percent of all deaths nationwide. That same year in California there was 486 diedwhich accounts for just 0.15 percent of all deaths in the entire country.

The first reason for the inequality is clear. The standard a patient must meet before he or she is eligible for assisted dying is much higher in California than it is in Canada. In California, a patient must have an incurable disease and death is reasonably expected within six months. In Canada, there is no requirement that the patient have a terminal illness and death does not have to be imminent. Under Canadian law, a patient may actually be eligible by claiming to be suffering “intolerable suffering” from a medical condition. There is also no requirement that doctors have tried other options to alleviate a patient’s suffering. In Canada, a patient’s apparent willingness to die matters more than what they are diagnosed with and what treatment they have received.

Not surprisingly, the looser Canadian criteria drastically expand the number of candidates for assisted suicide. They also raise legitimate concerns about the safety of disabled people, people with mental illness or depression, and patients with chronic but not terminal illnesses.

Social factors also play a role here. Is assisted dying really an ‘autonomous choice’ if it is made by those who are vulnerable, facing deep poverty, inadequate social services or failing health systems? Data from Canada do not suggest. A recent expert committee that reviewed euthanasia deaths in Ontario, Canada’s largest province, found that a significant number of people receiving euthanasia lived in the province’s poorest areas. People who requested euthanasia were also more likely to claim disability benefits and be socially isolated. As one doctor on the expert committee put it: ‘To finally get a government report that acknowledges these matters of concern is extremely important. We have been on fire for so many years raising fears about people (accessing assisted suicide) because they were poor, disabled or socially isolated.’

There is another major reason for the difference between Canada and California – the role of doctors. California only allows doctors to prescribe drugs for patients’ oral self-administration when the patient has decided to die. Doctors are not allowed to administer lethal injections. This accounts for the low number of patient requests actually performed in California—in fact, only 1.9 percent of all requests in 2021 resulted in death. Most patients either change their minds or die before they find it necessary to take their lethal medicine. There were no recorded cases of doctors administering lethal injections in the 486 assisted deaths in 2021. In Canada, however, doctors play a much more hands-on role, administering euthanasia via lethal injection. Of the 10,064 assisted deaths in Canada in 2021, 10,057 were by lethal injection.

Canadian law allows doctors to euthanize patients with impunity. There is no prosecution for inappropriate practice. Commenting on cases in the Ontario report, Trudo Lemmens, a professor of health law and policy at the University of Toronto, said medical professional bodies and judicial authorities appear to be ‘reluctant to restrict practices that appear ethically problematic… Either the law is too broad, or the professional guidance is not precise enough, or it is simply not seen as a priority to protect some of our most vulnerable citizens’.

There is no greater power than that over life and death. This is what euthanasia legislation gives doctors. It cannot help but muddy the relationship between patients and doctors. Will patients look their doctors in the eye and wonder what’s in the back of their mind when they recommend assisted suicide?

A tenet of the medical profession, dating back to Hippocrates of Cos, is that ‘I will not give a deadly substance to anyone if asked, nor will I advise such a plan’. Any legislation involving assisted dying surely compromises this responsibility to patients. As Dr. Sonu Gaind, professor of medicine at the University of Toronto, put it, “what we do in many cases is the opposite of suicide prevention”.

And there’s the rub. Legalizing assisted dying undermines the ethos of the medical profession itself. What happened to ‘first do no harm’?

Cory Franklins new book, The Covid diaries 2020-2024: Anatomy of an infection when it happenedis now available on Amazon in Kindle and book form.