Canadian Doctors Face Challenges in Euthanizing Vulnerable Patients in Private Forums

TORONTO—A homeless man refusing long-term care, a woman with severe obesity, an injured worker given meager government assistance, and grieving new widows. All of them requested to be killed under Canada’s euthanasia system, and each sparked private debate among doctors and nurses struggling with the ethics of one of the world’s most permissive laws on the practice, according to an Associated Press investigation.

As Canada pushes to expand euthanasia and more countries move to legalize it, health care workers here are grappling with requests from people whose pain might be alleviated by money, adequate housing or social connections. And internal data obtained exclusively by AP from Canada’s most populous province suggest a significant number of people euthanized when they are in unmanageable pain but not about to die live in Ontario’s poorest and most deprived areas.

Some doctors fear moving forward even with cases that meet Canada’s legal requirements, which allow euthanasia for people with “irremediable suffering” from serious but nonfatal medical conditions and disabilities. On private forums, doctors and nurses have expressed deep discomfort with ending the lives of vulnerable people whose deaths were avoidable, according to messages provided to AP by a participant on condition of anonymity due to their confidentiality.

Some of the requests from the forums were approved and acted upon. Others were denied. But the discourse about patients who are poor, disabled or lonely shows a fraught process where medical professionals test the limits of what conditions warrant euthanasia. The controversial cases in the forums have never been disclosed through Canada’s oversight system, even in an anonymized manner.

When Canada legalized assisted dying in 2016, officials said they wanted to reduce suffering and support individual autonomy and freedom of choice—and polls have consistently shown public approval. Prime Minister Justin Trudeau promised then that safeguards would prevent vulnerable people from being euthanized “because you’re not getting the support and care you actually need.”

But experts tasked with delivering euthanasia to people who aren’t dying have called it “morally distressing” and say the legal provisions are too vague to be protective, obliging doctors and nurses to at times end the lives of people they believe might otherwise be saved.

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“I don’t want (euthanasia) to become the solution to every kind of suffering out there,” a physician wrote to colleagues on one of the private forums.

Euthanasia Programs Are Increasing

Canada has the world’s fastest-growing program for euthanasia, the practice of doctors and nurse practitioners killing patients with an injection of drugs at their request. Medically assisted suicide—patients themselves taking prescribed, lethal medication—also is legal.

But virtually all of Canada’s MAiD cases—as it’s widely known here, for medical assistance in dying – are euthanasia, with a doctor or nurse practitioner giving the fatal injection.

Unlike many other countries, Canada doesn’t require that patients exhaust all medical treatments before seeking death.

After legalizing euthanasia in 2016, Canada broadened its law in 2021 to allow people with incurable, but not terminal, conditions—including disability alone—to seek a way to die. This vastly expanded the number of people eligible, and medical groups in some territories and provinces require doctors to inform, offer or help provide euthanasia to any patients who might qualify.

Adults with serious, incurable conditions must have a written request approved by two independent doctors or nurse practitioners. Those with nonterminal cases must be informed of other ways to relieve their suffering, among other requirements, and there’s a minimum 90-day assessment period.

As the eligibility pool has grown, so has criticism among academics, disability advocacy groups and religious communities.