Three Things Most People Don’t Know About Physician-Assisted Death

The cadence is increasing of jurisdictions introducing, normalizing and expanding laws allowing doctors to help people commit suicide.
Rosemary Frei, MSc
April 12, 2021

The cadence is increasing of jurisdictions introducing, normalizing and expanding laws allowing doctors to help people commit suicide.


Is this purely in the service of relieving unbearable physical or mental suffering? Or do other factors predominate?


I used to believe the former, but my recent re-examination of the issue suggests the latter is more likely.


On March 17, 2021, Bill C-7 came into effect across Canada. The new law significantly increases the proportion of the population eligible to undergo physician-assisted death (PAD). C-7 expands PAD eligibility to, for example, people whose death is not reasonably foreseeable.


On March 18, Spain passed federal legislation that for the first time allows PAD there; it goes into effect in June.


The same thing has happened in New Zealand: the federal ‘End of Life Choice Act’ goes into effect in November.


And on April 8 the French federal parliament debated whether to make euthanasia the law of their land. The majority of the parliamentarians favour legalizing euthanasia. However, the law was not passed because there wasn’t enough time for them to go through the thousands of amendments proposed by legislators who oppose PAD.


(Other terms for the act of doctors helping people commit suicide include physician-assisted suicide, voluntary assisted suicide and medical assistance in dying. And the difference between euthanasia and PAD is the latter requires patients to request it.)


Other countries, such as the UK, are similar to France: active euthanasia is illegal  but most residents and physicians approve of it. Therefore in these countries many physicians perform euthanasia without being punished and there is a considerable push to legalize it.


Holland and Belgium were the first countries to decriminalize euthanasia and PAD, bringing their laws into effect in 2002. In Luxembourg a similar assisted-death law came into effect in 2009.


All three countries allow people to undergo PAD if they have a serious medical condition, disability or psychiatric disorder, whether their death is imminent or not.


For the last few years years Holland has been moving towards voting on legalizing PAD for people 75 years of age or older who are ‘tired of life.’ And there has been a steady and very significant increase in the overall number of people undergoing PAD in Holland and  Belgium.


PAD currently can also be legally performed in five other countries, either across the whole country or in parts of it: Canada, the US, Australia, Germany and Switzerland.


In the U.S. each state can decide whether PAD is permitted there. So far, eight states plus Washington, D.C. have legalized it. Similarly, in Australia it’s a state issue; so far the state of Victoria has brought into effect a law allowing PAD and on July 1 the state of Western Australia will follow suit.


In Canada PAD was first legalized federally in 2016. Now Bill C-7 expands PAD by, among other measures:

  • no longer requiring a 10-day ‘reflection’ period between the time a person whose natural death is reasonably foreseeable consents to PAD and when they receive it;
  • allowing people who have a very serious illness or disability but whose natural death is not imminent to access PAD as long as they meet certain conditions (previously, PAD was only allowed in people whose natural death was reasonably foreseeable);
  • allowing PAD for people who have previously requested it, been found eligible to receive it and their natural death has become reasonably foreseeable but they’ve lost the capacity to consent; and,
  • starting in 2023, no longer banning PAD for people who have a mental illness alone, and no other underlying medical conditions or disabilities.

The government and mass media largely paint all of this as giving more people more right to choose how and when they end their lives.


Pro-PAD groups and opinion leaders refer to it in positive terms such as ‘right to die’ and ‘death with dignity.’


Other institutions have an overt pro-PAD position; among these is the Hastings Center in the US.


And additional influential groups and organizations -- Wikipedia, for example -- have a more subtle but definitely detectable pro-PAD slant in the information they provide to the public about PAD.


Most of the individuals and groups that oppose PAD do so on religious grounds.


But there are at least three facts that most people don’t know about physician-assisted death.




Expanding PAD is a serious potential threat to people with disabilities, dementia and Alzheimer’s.


That’s because what the vast majority of these people want and need is good care and services – but those services are becoming very hard to access, particularly in this era of Covid.


Most countries’ PAD laws require health-care providers to inform people of available services for relieving their suffering as alternatives to PAD and to offer referrals to professionals who can provide these services. But those laws don’t also require that the services be made accessible to all of these people, via increased government funding.


And there already have been documented cases of people with disabilities being pressured to undergo PAD.


That’s why many disability advocates oppose expansion of PAD.


Catherine Frazee, a professor at Ryerson University in Toronto and a leading disability advocate, gave powerful testimony to the Canadian parliamentary Standing Committee on Justice and Human Rights’s Bill C-7 hearing in November 2020.


She told hearing attendees that the Quebec Superior Court’s 2019 decision allowing disabled Quebec resident Jean Truchon to undergo assisted death even though his death was not reasonably foreseeable – which the Canadian federal government used as a springboard to create Bill C-7 -- does not in fact translate into the need to make it easier for disabled people to kill themselves.


Frazee said that, rather, “the deprivations of institutional life that choked out his [Truchon’s] will to live [and resultant request for PAD] were not an inevitable consequence of disability.”


Krista Carr, executive vice-president of Inclusion Canada, has voiced a similar sentiment.


“This bill has got to be stopped, or it will end the life of people. It will end the life of way too many people with disabilities who feel they have no other options,” she’s quoted as saying in a February 8, 2021, Canadian Press article.




In 2014, Belgium became the first country to expand PAD to apply to people as young as one year old.


In Holland, ever since its PAD law went into effect in 2002, the country has allowed assisted killing of children -- in cases where they're considered to be incurably ill -- of as young as 12. And the Dutch government is now considering following Belgium’s lead and lowering that minimum age to as young as one.


This expansion wouldn’t involve a change in federal law in Holland. Instead, it would be done via changes to the ‘Groningen protocol.’ This set of guidelines was created in 2004 for the killing of newborns and infants with very serious illnesses or deformities such as spina bifida.




There is significant controversy about allowing assisted suicide for people who have a psychiatric disorder alone and no other conditions.


Currently only Holland, Belgium and Luxembourg permit this, as part of their original assisted-death laws.


Under Bill C-7, Canada will allow it in 2023.


The Canadian Psychiatric Association (CPA) released a position statement last year saying it “did and does not take a position on the legality or morality of MAiD [medical assistance in dying] as this is a decision reflecting current Canadian ethical, cultural and moral views.”


This prompted two former CPA presidents to post an open letter to Canadian psychiatrists highlighting that the CPA did not engage its membership in a consultation process before releasing its position statement.


The two past presidents asked the CPA to “revisit the Statement by temporarily withdrawing it, to allow for a proper engagement process and development of evidence-based recommendations to inform any future Position Statement on MAiD.”


The CPA did not do this.


The American Psychiatric Association released its PAD position statement in 2016. It states, in whole: “The American Psychiatric Association, in concert with the American Medical Association’s position on medical euthanasia, holds that a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”


The American Medical Association’s Code of Medical Ethics states, in part, that “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.”


It certainly makes one wonder why the public isn’t given all of this information.


Instead, the rush to expand access to PAD around the world in the name of humaneness is holding sway.

After obtaining an MSc in molecular biology from the Faculty of Medicine at the University of Calgary, Rosemary Frei became a freelance writer. For the next 22 years she was a medical writer and journalist. She pivoted again in early 2016 to full-time, independent activism and investigative journalism. Her website is

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