What Is Medical Aid in Dying?

Overview and Issue Summary

Last updated: March 23, 2023

This issue summary on medical aid in dying (MAiD) is part of Decency LLC’s ongoing efforts to promote thorough consideration and discussion of nuanced issues that potentially affect large numbers of patients in the healthcare system.

This information is based on research, secondhand opinions, and the author’s experience answering calls on crisis lines in Rhode Island and Massachusetts (five cumulative years as a volunteer or staff/employee) and working in additional capacities with individuals who have chronic, disabling physical or behavioral health conditions. Not having personal experience (“lived experience”) with suicidal ideation or a diagnosed medical condition lending itself to MAiD in any jurisdiction, the author does not know firsthand, and cannot comment on, the ways that a legal MAiD option might affect the decisions and wellbeing of patients who wish to end their lives. 

Beyond the information presented here, the perspectives of individuals who have at some time wished to die, including those who changed their minds, could help readers understand how patients may view and respond to legal MAiD options, in order to better understand or predict MAiD laws’ impact on the public.

A Brief History of Legislative Efforts in the U.S. and Abroad

MAiD bills—which would give terminally ill patients access to lethal drugs—have reached the legislature in Massachusetts (one of Decency LLC’s home jurisdictions) every year since voters narrowly rejected a death with dignity ballot question in 2012.[1][2] The aid-in-dying movement has generally gained momentum in the United States and abroad over the last decade.[3][4] Currently, MAiD is legal in ten U.S. states and the District of Columbia.[3] MAiD proponents expressed hope for success in Massachusetts, as well, in 2023, framing the practice as a matter of bodily autonomy, similar to the right to reproductive choice.[1]

In the discussions surrounding legalization of MAiD in Massachusetts, various parties have cited a need to incorporate limitations and safeguards, should legislation eventually pass. For example, when the Massachusetts Medical Society voted to rescind its longstanding opposition to MAiD in 2017 and adopt a policy of “neutral engagement,” the organization specified that physicians should not be compelled to participate in MAiD if it violates their personally held ethical principles.[5] More recently, in 2022, a spokeswoman for the Massachusetts governor indicated that legislation would be supportable if it “include[d] sufficient safeguards for both patients and providers.”[1]

Use Statistics and Systemic Impact

Various sources have reported statistics on the use of MAiD in jurisdictions where aid-in-dying is legal. 

For example, use of MAiD has “increased exponentially” in Canada since 2016, when the practice was first legalized.[6]

A 2017 report in the Canadian Medical Association Journal, analyzing the prospective cost impact of MAiD for the Canadian healthcare system, and finding that MAiD could reduce yearly healthcare spending across Canada by $34.7-136.8 million,[6][7] based its projections on estimates that 1-4% of Canadians would end their lives by MAiD, and that 50% of those individuals would fall between the ages of 60 and 80.[7]

In 2021, more than 10,000 patients died by MAiD in Canada, with MAiD accounting for more than 3% of deaths in the country that year.[2] 

According to the “Third annual report on Medical Assistance in Dying in Canada 2021,” 81% of all MAiD applications in the country had been approved, with an additional 13.2% of applicants dying during the application process.[8] The number of written requests submitted overall in 2021 was 12,286, a 27.7% increase over the number of written requests submitted in the previous year.[8] The report indicated that 2.2% of the patients accessing MAiD in Canada were not terminally ill, 65.6% had cancer, 18.7% had a cardiovascular condition, 12.4% had a chronic respiratory condition, and 12.4% had a neurological condition.[8][9]

According to the Canadian Broadcasting Corporation (CBC) in 2022, between April 2021 and March 2022, 5.1% of deaths in the Canadian province of Quebec were medically assisted; 4.8% of deaths in the Netherlands were medically assisted; and 2.3% of deaths in Belgium were medically assisted.[10]

The CBC noted that “[m]ore people, per capita, [were] dying with medical assistance . . . in Quebec than anywhere else in the world,” and requests for MAiD had more than doubled in the province since the start of the COVID-19 pandemic.[10]

The CBC also noted variations in MAiD application approval rate by geography across Quebec, with a 98% approval rate in Chaudière-Appalaches, 75% of applications approved in Quebec City, and 54% of applications approved in Montreal.[10]

In December 2022, Dr. Michel Bureau, the chair of Quebec’s commission on end-of-life care, observed that the trend of growth in MAiD usage had continued in 2022, and opined that the trend would likely continue, moving forward into 2023.[10]

The Question of Necessary Limitations and Safeguards

Expansion of Eligibility to Minors

Discussions surrounding MAiD lend themselves to a “slippery slope” argument regarding the provisions’ expansion to mature minors, children, and infants. In some jurisdictions, expansion of legalized aid-in-dying to cover minors has already occurred or is in debate as of 2023.

Currently Belgium allows MAiD for children of all ages; euthanasia was legalized in the country in 2002 (note generally that jurisdictions may distinguish between euthanasia and MAiD), and the law expanded in 2014 to cover children “in a hopeless medical situation of constant and unbearable [physical] suffering that cannot be eased and which will cause death in the short term.”[4][11] In that country, pediatricians wrote a letter, published in two newspapers, “demanding an expansion of the practice of euthanasia to sick children.”[12]

The Netherlands likewise extend MAiD to severely ill infants and to terminally ill children ages 1 to 12.[13][14] In that country, providers employ the Groningen Protocol, a checklist, to assist in determining which infants can be terminated in this way.[14] The protocol asks providers to consider (1) whether there is a certain diagnosis and prognosis; (2) whether there is hopeless and unbearable suffering; (3) confirmation of the diagnosis, prognosis, and unbearable suffering by at least one independent doctor; (4) consent from both parents; and (5) whether the termination procedure is performed according to the accepted medical standard.[14][15]

Canada does not currently offer MAiD to children, though discussions are underway in Parliament regarding expansion of MAiD to mature minors.[16] (“There is no set definition of what would be considered a ‘mature minor,’ but there is [a] common law ‘mature minor doctrine,’ Canada’s Department of Justice [has] said on its website.”[16]) A report based on these discussions was expected in February 2023.[16] The Collège des médecins du Québec (a professional organization for physicians in Quebec) released a report in 2021 advocating for expansion of MAiD to infants, citing the experience of jurisdictions including the Netherlands.[6][17]

It is important to note that the argument regarding patient autonomy may become more tenuous in cases involving young children or infants, who may be too young to make reasoned and informed decisions to end their lives.

Expansion of Eligibility to Individuals with Dementia

Discussions surrounding MAiD likewise lend themselves to a slippery slope argument regarding the provisions’ expansion to individuals with dementia, who may not be competent to determine independently if they wish to die.[18] These cases may give rise to clinical ambiguity and legal challenges for providers.

In Canada, pursuant to 2021’s Bill C-7, a patient with dementia would be able to sign a “waiver of final consent,” a written agreement for MAiD to be provided on a specified future date, if the patient loses decision-making capacity.[18] In this case, at the point of termination, the patient’s earlier self would dictate their later intent.

In one reported case in the Netherlands, in 2016, a patient giving prior consent for euthanasia later resisted termination, stating in the days leading up to the procedure that she did “not want to die,” and was sedated and forced to go through with the procedure based on past intent and her provider’s clinical judgment.[19][20] The case was referred to a Regional Review Committee, and the doctor was found to have acted in good faith.[19] The case also became the first in the Netherlands, since the Termination of Life on Request and Assistance with Suicide Act was introduced in 2002, in which a doctor was prosecuted for euthanasia.[21]

Expansion of Eligibility to the Elderly

Discussions surrounding MAiD likewise lend themselves to a slippery slope argument regarding the provisions’ expansion to individuals who are elderly but not necessarily in poor health.

In Belgium between 2003 and 2013, when the number of patients using MAiD to end their lives increased nearly eight-fold, significant increases in MAiD cases were seen among patients over 80 years old, patients without cancer, and patients not expected to die in the near future, according to the Canadian Medical Association Journal.[22][23]

According to the German news outlet DW in 2014, elderly individuals in Belgium were expressing concerns that they would “not receive proper medical treatment anymore because they [thought] in the long run, euthanasia is more economical than years of costly care.”[12]

In contrast, the Dutch Review reported in 2013 that a group of Dutch citizens had “requested that everyone over the age of seventy should have the right of euthanasia in the Netherlands.” The author noted the possibility that elderly individuals could face social pressure to seek euthanasia, despite wanting to continue to live.[24] 

More than once in recent years, the Netherlands have considered proposed extensions of the right to assisted suicide to cover healthy individuals over 75 years of age who feel their lives are complete.[19][25]

Expansion of Eligibility to Individuals with Mental Illness

Discussions surrounding MAiD likewise lend themselves to a slippery slope argument regarding the provisions’ expansion to individuals whose only ailment is psychiatric. 

In 2021, Canada extended MAiD provisions to individuals with mental illness with Bill C-7.[26] The Canadian government recently determined that additional time may be necessary to implement the new law.[26]

In the Netherlands, where MAiD covers individuals with mental illness, patients making use of the law have included a 41-year-old man who struggled with alcoholism[27] and a woman in her 20s who suffered from depression and anorexia.[27]

In 2022, the European Court of Human Rights ruled that the 2012 euthanasia in Belgium of a 64-year-old woman with depression violated Article 2 of the European Convention on Human Rights.[28]

Expansion of Eligibility to Cases of Psychological Suffering

Discussions surrounding MAiD likewise lend themselves to a slippery slope argument regarding the provisions’ expansion to individuals experiencing psychological suffering.

In 2014, European media covered the case of a Belgian jail inmate who was not incurably ill, but requested euthanasia on the grounds that conditions in jail had caused “extreme psychological suffering.”[12]

In the same year, a 44-year-old Belgian man underwent euthanasia following a failed gender-reassignment operation, on the grounds of “unbearable psychological suffering.”[12]

In 2017, Belgian psychiatrists, psychologists, and academics published a letter remarking on the vagueness of the criteria for “unbearable and psychological suffering.” The signatories claimed that some patients were dying unnecessarily.[29]

Integration of Organ Donation

Jurisdictions permitting MAiD may face considerations of how to incorporate organ donation into this practice in an ethical manner.

In Canada, doctors have expanded the availability of organs through donations by patients undergoing MAiD, though ethicists have raised concerns that agreeing to organ donation may put pressure on patients who might otherwise decide not to end their lives.[30]

In the first 11 months of 2019, MAiD patients in Ontario supplied 18 organ and 95 tissue donations, an increase of 109% over 2017.[31] In 2019, MAiD-associated donations accounted for 5% of all organ donations in Ontario.[31] 

Organ donation in Ontario is facilitated by the Trillium Gift of Life Network, which proactively reaches out to individuals approved for assisted death to discuss donation.[31]

In addition to Canada, Belgium collects donated organs from individuals undergoing lethal injection.[32] However, in Belgium, organ donation must be initiated by the patient.[31]

Integration of Suicide Prevention Efforts

In Canada in December 2022, the Association of Chairs of Psychiatry, which includes heads of 17 medical schools in Canada, issued a statement calling for a delay in expanding MAiD to mental illness, in part due to lack of public education concerning suicide prevention.[33]

Additional research could shed light on the impact of legalized MAiD on individuals who experience suicidal ideation.

Anti-Disability Bias—Critiques from Individuals with Disabilities

Among the critics of Canada’s MAiD expansion through Bill C-7, Catherine Frazee, a disabled woman and professor emerita in the School of Disability Studies at Toronto Metropolitan University, opined regarding the legislation in 2021:

“For those of us who pay careful attention to the social trends and the social implications of ableism, and the eugenic history of ableist policies, there’s a very vividly red flag that goes up when the state says that persons who have a disability can ask to be made dead, and we the state will provide agents of the state, doctors, to perform this service of killing free of charge as part of our healthcare system. . . . It is and felt like a very cruel irony that those of us who have been on the front lines of disability justice work for decades have fought for every small breadcrumb of support, of legislated recognition, of opportunity for access to education; to employment; to transportation; to disability supports; to a decent income; to accessible, supportive, safe housing, all of these battles go on and on and we take them to court, and the courts are cautious, and never do we get these things, as a matter of right, that are indeed critical to living a dignified life. Never do we hear our parliamentarians standing up with any kind of meaningful expression of support for these measures, that would be dignity and life-affirming. And the moment a disabled person raises their hand and says, I would like to die, then all manner of support is expressed. The courts are on board, our lawmakers are on board. That kind of support from our able-bodied neighbors, from our physicians, and many of our care providers, that is deeply unsettling when it comes in the wake of years of neglect . . . And not only do they celebrate this as a great victory, but they celebrate it as a human rights victory, and a victory for people with disabilities, as if they were speaking for us. And that really is why we felt with the [Disability Filibuster] that enough is enough, we shall speak for ourselves. You will pass this bill, but you will not be able to claim that you did it for us.”[34]

Professor Frazee also opined that the disability rights perspective had been underplayed in media coverage surrounding Bill C-7.[34]

Professor Frazee’s observation regarding access to appropriate resources echoes sentiments shared earlier in a Facebook post by 41-year-old Canadian Sean Tagert, who struggled to get 24-hour care prior to choosing a medically-assisted death in 2019. Tagert wrote: “I know I’m asking for change. I just didn’t realize that was an unacceptable thing to do.”[35] Tagert suffered from amyotrophic lateral sclerosis and told his Facebook community that his decision to die was due to emotional and physical exhaustion from fighting the healthcare system for additional funding, so that he could stay at home with his family and specialized communications equipment.[36]

Improper Use of MAiD Laws

Since the legalization of MAiD in Canada, news coverage has periodically revealed inappropriate use of MAiD laws by individual employees within the veterans’ affairs or healthcare systems.

In one case, Canadian disabled veteran and five-time world champion athlete Christine Gauthier was offered MAiD through Canada’s veterans’ affairs office (“VAC”) when requesting a home wheelchair lift. An investigation revealed that the same VAC employee who offered Gauthier MAiD had also suggested this service to other veterans in four similar cases. Veterans responded to the news saying that they were fearful to reach out to VAC to request services. Gauthier remarked, regarding the VAC employee’s offer: “I can’t believe that you will . . . give me an injection to help me die, but you will not give me the tools I need to help me live.”[37]

Patients may also face pressure from healthcare providers to consider MAiD. In one case, Roger Foley, a Canadian man with a degenerative brain disorder, began recording conversations with staff during a hospital stay after feeling coerced to consider MAiD. Foley had not previously mentioned euthanasia to his providers, and in one recording obtained by the Associated Press, the hospital’s director of ethics was heard telling Foley that the cost of remaining in the hospital would be “north of $1,500 a day.” When Foley asked what the hospital’s plan was for his long-term care, the ethicist responded: “Roger, this is not my show. My piece of this was to talk to you, (to see) if you had an interest in assisted dying.”[35]

In another instance, in 2017, Candice Lewis, a 25-year-old Canadian woman with cerebral palsy and spina bifida, came to an emergency room in Newfoundland with her mother. According to Lewis’s mother, a doctor informed her during Lewis’s hospital stay that Lewis was a candidate for assisted death, and that it would be “selfish” if Lewis’s mother chose not to pursue the option.[35]

Legality of Conscientious Objection

When the Massachusetts Medical Society voted to rescind its longstanding opposition to MAiD in 2017 and adopt a policy of “neutral engagement,” the professional organization specified that physicians should not be compelled to participate in MAiD, for example if it violates their personally held ethical principles.[5]

In 2014, opponents of MAiD in Belgium told the German news outlet DW that “family members, hospital staff and doctors [were] extremely burdened” by the law, and that, “[d]espite its [euthanasia’s] legal status, many doctors [were] refus[ing] to euthanize people.”[12]

In 2022, one doctor in Canada described discomfort with conscientious objection, given changing societal standards:

“I distinctly recall the day when it dawned on me that those of us who refused to participate in assisted death would be regarded as physicians of questionable ethics. We might be seen as more concerned for our own personal moral hang-ups than for the welfare of the patient. Where causing death was once a vice, it was soon to be a virtue.”[38]

Consideration of Doctor Shopping

Jurisdictions where MAiD is legal may consider the possibility of “doctor shopping” for the purpose of circumventing legal safeguards.

In 2010, a British think tank suggested that patients in Oregon could be seeking “physicians more inclined to process an application for physician-assisted suicide without insisting on psychological screening for depression or a mental health problem.”[39] The suggestion was based on a finding that “when the Oregon law was enacted, about a third of all people who requested help in committing suicide were referred to psychiatrists, but by 2009 no one was being sent for counseling.”[39]

In 2022, a court decision in a case brought by Compassion & Choices opened Oregon’s MAiD laws to out-of-state residents. Critics voiced concerns that Oregon could become an “assisted suicide tourism capital.”[40]

Limitations on Providers Suggesting MAiD to Patients

Jurisdictions where MAiD is legal may limit which providers are allowed to raise the topic with patients.[35]

In Canada, while health professionals are allowed to inform qualifying patients about MAiD as a clinical care option, in light of scandals involving misuse of the law, Canada’s veterans’ affairs office has implemented mandatory training to ensure that employees avoid discussing MAiD with veterans.[35][37]

The Impact of Poverty on Patient Autonomy

In practice, in some cases, patients have exercised their choice to pursue MAiD for financial reasons or rescinded their decision to die after receiving appropriate social and financial supports. These examples raise the possibility that patient autonomy could be influenced by, and viewed in light of, systemic factors such as poverty and lack of access to appropriate care and resources.

Media reports have indicated that, in one case, a Canadian woman experiencing long-COVID symptoms for two years applied for MAiD because her illness did not qualify for the Ontario Disability Benefits Program. She stated that she submitted her MAiD application exclusively for financial reasons.[41]

In another case, a 31-year-old Canadian woman diagnosed with multiple chemical sensitivities told media that she applied for MAiD “essentially . . . because of abject poverty.”[42]

In another case involving multiple chemical sensitivities (MCS), a 51-year-old woman underwent MAiD, suggesting to friends in correspondence that her death was a protest against lack of response to her requests for appropriate resources, “If my death helps to show the government that those of us with MCS will keep on having MAID if they don’t act soon, then I’m glad I could help someone else not have to suffer the way I have.”[43] In news coverage of this case, Canadian ICU physician Scott Anderson noted  that he was “seeing more patients with chronic conditions asking for assisted death because they can’t get services to live well.”[43]

In another case, Amir Farsoud, a Canadian man in his 50s with multiple health conditions, was in the 90-day waiting period for MAiD, and decided not to die after receiving unexpected financial support through a crowdfunding campaign.[44] Previously, Farsoud had been relying on assistance from the Ontario Disability Support Program and facing homelessness when he applied for MAiD.[45] He later wrote regarding his experience: “The real issue isn’t whether or not someone like me should be able to access MAID. It’s whether or not we, as a society, wish to continue making people’s lives miserable and hopeless enough that suicide — assisted or otherwise — becomes a viable option.”[44]

In 2022, Visiting Professor of Disability Rights at Osgoode Hall Law School (Canada) and disability rights advocate David Lepofsky opined, regarding the Canadian law: “We’ve now gone on to basically solving the deficiencies in our social safety net through this horrific backdoor, not that anybody meant it that way, but that’s what it’s turned into.”[42]

The Potential Impact of MAiD Laws on Individuals at Risk for Suicide

Jurisdictions where MAiD is legal may consider the laws’ potential impact on individuals at risk for suicide.

In 2017, a psychiatrist in Belgium observed that availability of legal euthanasia for mental disorders was changing her relationship with her patients: 

“[P]eople with less severe and readily treatable mental disorders — such as borderline personality disorders — request euthanasia more often than seriously ill patients. The offer really creates the question. Euthanasia has become a new symptom. Often it’s a cry for help: ‘Am I still worth living, or are you giving up on me?’ But it is a symptom with particularly dangerous consequences. . . . If you refuse to take the euthanasia question seriously, you put the relationship with the patient at risk and lose your trust. . . . Since the euthanasia law there has been some kind of madness in our work. After the threat of suicide, for which you must be constantly on guard as a psychiatrist, there is now the threat of euthanasia.”[29]

The Potential Impact of MAiD Laws on Demand for Life-Ending Care

Jurisdictions where MAiD is legal may consider the impact of legalization on demand for life-ending care. 

As put by Carine Brochier of the European Institute of Bioethics in Brussels: “The supply of euthanasia is building the demand for euthanasia. The more you offer it the more people will ask for it.”[11]

In Canada in 2022, in the context of a rapid increase in requests for MAiD in Quebec, Dr. Georges L’Espérance, president of the Quebec association for the right to die with dignity, said he expected the number of people using the procedure to rise along with awareness of MAiD among doctors and patients.[10]

Conclusions

The purpose of this issue summary is to put MAiD laws and proposals in a national and global context, and to prompt consideration of a variety of challenges previously faced in various jurisdictions, which could be taken into account when determining what may or may not constitute an adequate set of legal limitations and safeguards for patients and providers.

The experiences of other jurisdictions can provide a roadmap for understanding how MAiD laws might be implemented in practice, what problems might be preempted with appropriate safeguards, and what pressures jurisdictions may face in the future to modify or remove the limitations built into these laws, based on changing societal standards.

References

[1] Robert Weisman, “Lawmakers, citing new momentum, plan to reintroduce right-to-die bill in January,” Boston Globe, December 11, 2022, https://www.bostonglobe.com/2022/12/11/metro/lawmakers-citing-new-momentum-plan-reintroduce-right-to-die-bill-january/.

[2] Jeff Jacoby, “Assisted suicide’s slippery slope,” Boston Globe, January 3, 2023, https://www.bostonglobe.com/2023/01/03/opinion/assisted-suicides-slippery-slope/.

[3] “States with Legal Medical Aid in Dying (MAID),” ProCon.org, last modified December 19, 2022, https://euthanasia.procon.org/states-with-legal-physician-assisted-suicide/.

[4] “Euthanasia & Medical Aid in Dying (MAID) around the World,” ProCon.org, last modified July 7, 2022, https://euthanasia.procon.org/euthanasia-physician-assisted-suicide-pas-around-the-world/.

[5] “Medical Aid In Dying (MAID),” Massachusetts Medical Society, accessed January 8, 2023, https://www.massmed.org/News/Medical-Aid-In-Dying-(MAID)/.

[6] Valerie Hudson, “Perspective: Poor people are dying because of Canada’s lax euthanasia laws,” Deseret News, November 25, 2022, https://www.msn.com/en-us/health/medical/perspective-poor-people-are-dying-because-of-canadas-lax-euthanasia-laws/ar-AA14zrdK.

[7] Kelly Malone, “Medically assisted deaths could save millions in health care spending: Report,” CBC, January 23, 2017, https://www.cbc.ca/news/canada/manitoba/medically-assisted-death-could-save-millions-1.3947481.

[8] “Third annual report of Medical Assistance in Dying in Canada 2021,” Government of Canada, July 2022, https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2021.html.

[9] Holly Baxter, “ ‘It’s meaningful work’: The doctor who performs euthanasia in Canada — and the doctor who refuses,” INDEPENDENT, December 21, 2022, https://www.independent.co.uk/news/world/americas/euthanasia-feature-b2246951.html.

[10] “Requests for medical aid in dying doubled in Quebec since start of pandemic, commission says,” CBC, December 10, 2022, https://www.cbc.ca/news/canada/montreal/maid-quebec-increase-1.6681630.

[11] Adrianne Jeffries, “Belgium legalizes euthanasia for children,” The Verge, February 13, 2014, https://www.theverge.com/2014/2/13/5409240/belgium-removes-age-limit-for-euthanasia.

[12] Bernd Riegert, “Euthanasia Law,” DW, February 13, 2014, https://www.dw.com/en/belgian-lawmakers-vote-on-euthanasia-for-kids/a-17245525.

[13] “Netherlands backs euthanasia for terminally ill children under-12,” BBC, October 14, 2020,  https://www.bbc.com/news/world-europe-54538288.

[14] Eduard Verhagen and Pieter J.J. Sauer, “Perspective: The Groningen Protocol — Euthanasia in Severely Ill Newborns,” The New England Journal of Medicine 352 (2005): 959-962, https://www.nejm.org/doi/full/10.1056/NEJMp058026.

[15] “Neonatal Euthanasia: The Groningen Protocol,” American College of Pediatricians, February 2014, https://acpeds.org/position-statements/neonatal-euthanasia-the-groningen-protocol.

[16] Jeff Cercone, “Canada’s Medical Assistance in Dying law does not extend to children now, but issue is being studied,” POLITIFACT, December 7, 2022, https://www.politifact.com/factchecks/2022/dec/07/instagram-posts/canadas-medical-assistance-in-dying-law-does-not-c/#sources.

[17] “Recommandation de positionnement du groupe de réflexion sur l’aide médicale à mourir et les soins de fin de vie,” Collège des médecins du Québec, December 10, 2021, http://www.cmq.org/publications-pdf/p-7-2021-12-13-fr-recommandation-positionnement-groupe-reflexion-sur-amm-et-soins-fin-de-vie.pdf?t=1673101476523.

[18] Jocelyn Downie and Stefanie Green, “For people with dementia, changes in MAiD law offer new hope,” Options, April 21, 2021, https://policyoptions.irpp.org/magazines/april-2021/for-people-with-dementia-changes-in-maid-law-offer-new-hope/.

[19] Giulia Crouch, “Female Dutch doctor drugged a patient’s coffee then asked her family to hold her down as she fought not to be killed - but did not break the country’s euthanasia laws,” MailOnline, January 28, 2017, https://www.dailymail.co.uk/news/article-4166098/Female-Dutch-doctor-drugged-patient-s-coffee.html?offset=0&max=100&jumpTo=comment-175426032#comment-175426032.

[20] “Euthanasia allowed for dementia patients who give prior consent: Supreme Court,” NL TIMES, April 21, 2020, https://nltimes.nl/2020/04/21/euthanasia-allowed-dementia-patients-gave-prior-consent-supreme-court.

[21] “Doctor acquitted of murder in euthanasia for dementia patient,” NL TIMES, September 11, 2019, https://nltimes.nl/2019/09/11/doctor-acquitted-murder-euthanasia-dementia-patient.

[22] Reuters, “Euthanasia rising in Belgium, including more who are not terminally ill,” FOX NEWS, September 16, 2016, https://www.foxnews.com/health/euthanasia-rising-in-belgium-including-more-who-are-not-terminally-ill.

[23] Sigrid Dierickx, Luc Deliens, Joachim Cohen and Kenneth Chambaere, “Euthanasia in Belgium: trends in reported cases between 2003 and 2013,” Canadian Medical Association Journal 188, no. 16 (November 1, 2016): E407-E414, https://www.cmaj.ca/content/188/16/E407.

[24] Alexia Symvoulidou, “Dying by choice: Euthanasia in the Netherlands,” DUTCHREVIEW, December 23, 2013, DR, https://dutchreview.com/expat/euthanasia-in-the-netherlands/.

[25] Senay Boztas, “Euthanasia law proposed for healthy over-75s who feel their lives are complete,” DutchNews.nl, July 19, 2020, https://www.dutchnews.nl/news/2020/07/euthanasia-law-proposed-for-healthy-over-75s-who-feel-their-lives-are-complete/.

[26] Leyland Cecco, “Canada delays right to physician-assisted death for mentally ill people,” The Guardian, December 18, 2022, https://www.theguardian.com/world/2022/dec/18/canada-medically-assisted-death-delay.

[27] Bradford Richardson, “Mark Langedijk, Dutch man, euthanized over alcoholism,” The Washington Times, November 30, 2016, https://www.washingtontimes.com/news/2016/nov/30/mark-langedijk-dutch-man-euthanized-over-alcoholis/.

[28] J-P Mauro, “Court finds Belgium violated right to life in 2012 euthanasia case,” Aleteia, October 5, 2022, https://aleteia.org/2022/10/05/court-finds-belgium-violated-right-to-life-in-2012-euthanasia-case/.

[29] Michael Cook, “Is euthanasia for psychological suffering changing Belgian medicine?”, BioEdge,  November 4, 2017, https://bioedge.org/end-of-life-issues/is-euthanasia-for-psychological-suffering-changing-belgian-medicine/.

[30] Sharon Kirkey, “Doctors harvesting organs from Canadian patients who underwent medically assisted death,” NATIONAL POST, March 20, 2017, https://nationalpost.com/health/doctors-harvesting-organs-from-canadian-patients-who-underwent-medically-assisted-death.

[31] Bruce Deachman, “Medically assisted deaths prove a growing boon to organ donation in Ontario,” Ottawa Citizen, January 6, 2020, https://ottawacitizen.com/news/local-news/medically-assisted-deaths-prove-a-growing-boon-to-organ-donation-in-ontario/.

[32] Sharon Kirkey, “Doctors worry how organ donations will be affected by Supreme Court ruling on assisted suicide,” NATIONAL POST, March 17, 2015, https://nationalpost.com/health/doctor-assisted-dying-organ-donations-ethics.

[33] Irelyne Lavery, “Feds looking to delay expansion of assisted dying: ‘Need to get this right,’” Global News, December 15, 2022, https://globalnews.ca/news/9352016/medically-assisted-death-maid-expansion-lametti-announcement/.

[34] Scott Neigh, “LISTEN: A new wave of anti-ableist and anti-eugenics organizing in Canada,” YouTube, May 18, 2021, https://www.youtube.com/watch?v=oPcvfr70uNs.

[35] Maria Cheng, “ ‘Disturbing’: Experts troubled by Canada’s euthanasia laws,” AP, August 11, 2022, https://apnews.com/article/covid-science-health-toronto-7c631558a457188d2bd2b5cfd360a867.

[36] Penny Daflos, “ ‘We need a public outcry’: B.C. father with ALS ends life after struggle to stay at home,” CTV News, August 9, 2019, https://bc.ctvnews.ca/we-need-a-public-outcry-b-c-father-with-als-ends-life-after-struggle-to-stay-at-home-1.4543983.

[37] Sean Boynton, “Trudeau says assisted dying offer to veterans ‘unacceptable’ as cases mount,” Global News, December 2, 2022, https://globalnews.ca/news/9321582/veterans-affairs-maid-cases-trudeau/.

[38] Ewan C. Goligher, “Canada Euthanized 10,000 People in 2021. Has Death Lost Its Sting?”, CHRISTIANITY TODAY, October 17, 2022, https://www.christianitytoday.com/ct/2022/november/canada-euthanized-10000-people-in-2021-maid-assisted-suicid.html.

[39] “Doctor-Shopping For Assisted Suicide?”, America, November 8, 2010, https://www.americamagazine.org/issue/754/signs/doctor-shopping-assisted-suicide.

[40] Madeline Fitzgerald, “Medically Assisted Suicide in Oregon Is No Longer Limited to Residents,” U.S. News, March 29, 2022, https://www.usnews.com/news/best-states/articles/2022-03-29/out-of-state-residents-can-now-seek-medically-assisted-suicide-in-oregon.

[41] Abhya Adlakha, “ ‘Canada is very ill-prepared for the future’: Medical Assistance in Dying for people with mental illnesses has left experts worried,” Yahoo News Canada, December 2, 2022, https://sg.news.yahoo.com/medical-assistance-dying-canada-rules-mental-illness-185533347.html.

[42] Avis Favaro, “Woman with disabilities nears medically assisted death after futile bid for affordable housing,” CTV News, April 30, 2022, https://www.ctvnews.ca/health/woman-with-disabilities-nears-medically-assisted-death-after-futile-bid-for-affordable-housing-1.5882202.

[43] Avis Favaro, “Woman with chemical sensitivities chose medically-assisted death after failed bid to get better housing,” CTV News, April 13, 2022, https://www.ctvnews.ca/health/woman-with-chemical-sensitivities-chose-medically-assisted-death-after-failed-bid-to-get-better-housing-1.5860579.

[44] Amir Farsoud, “I couldn’t afford to live, so I asked doctors to help me die - and they said yes,” INDEPENDENT, November 27, 2022, https://www.independent.co.uk/voices/assisted-dying-maid-suicide-canada-homeless-b2233845.html.

[45] James Moore, “Matt Hancock’s latest idea is the most insulting yet,” INDEPENDENT, December 13, 2022, https://www.independent.co.uk/voices/matt-hancock-maid-canada-assisted-dying-b2244229.html.