The number of Canadians killed by physician-assisted suicide nearly doubled between 2017 and 2019, according to a report released by the Canadian government. More than a third of those who opted for “medical assistance in dying” cited concerns of being a burden to family or carers.

The “First Annual Report on Medical Assistance in Dying in Canada 2019” was published in July. It follows a series of interim reports that were published over the last year.

In 2019, a total of 5,631 Canadians ended their lives through the country’s “Medical Assistance in Dying,” or “MAID” protocols. This amounts for 2% of the total deaths in Canada, an increase from 2018’s percentage. In 2018, the number of MAID deaths accounted for 1.12% of the total number of deaths in Canada.

The report found that cancer was the most common condition among those who ended their lives with MAID, followed by respiratory conditions and neurological ailments. Slightly over two thirds of those who used MAID had cancer as an underlying condition.

Along with having a “reasonably foreseeable” natural death, a person who wished to receive MAID also had to show that their condition was causing them “enduring physical or psychological suffering that is intolerable to them and cannot be relieved in a manner that they find acceptable.”

In just over a third of 2019’s MAID deaths, a “perceived burden on family, friends or caregivers” was one of the reasons cited, and in 13.7% of cases, “isolation or loneliness” was a factor.

“When asked to describe the nature of the suffering prompting their request, patients most often reported ‘a loss of ability to engage in meaningful life activities’ followed by ‘loss of ability to perform activities of daily living’ reported in 82.1% and 78.1% of cases, respectively,” says the report.

“Inadequate control of pain” was cited in 53.9% of cases, followed by “loss of dignity” in 53.3% of cases.

In U.S. states with legal physician-assisted suicide, less than one half of one percent of deaths are due to euthanasia, the lowest rate in the world. If Canada’s numbers were extrapolated to the United States, approximately 50,000 people each year would end their lives with MAID. This would put euthanasia in the top 10 causes of death for the United States, just above “intentional self-harm (suicide)” and just below kidney disease.

Countries that permit physicians to administer euthanasia and do not mandate self-administration have higher percentages of deaths from euthanasia. Similar to countries such as Belgium and the Netherlands, Canadian law permits doctors to administer the lethal dose of medication to the patients. In the United States, the drugs must be self-administered.

While Canadians have the option to self-administer the drugs, the number of people who chose to do so last year was “fewer than seven.”

In 2019, the average age of a person who received MAID in Canada was 75.2 years, but 103 people between the ages of 18 and 45 received MAID.

Last year, 92.2% of requests for MAID were approved, out of a total of 7,336 applications.

Only 3.6% of people who were deemed eligible for MAID withdrew their request.

Of those who were deemed ineligible for MAID in 2019, about a quarter were denied because death was “reasonably foreseeable,” and an additional quarter were denied due to not being “in an advanced state of irreversible decline in capability.” Those requirements are likely to change for future years.

In September 2019, the Superior Court of Quebec found that the requirement that a person who receives MAID have a “reasonably foreseeable natural death” was unconstitutional. The Canadian government later announced that they do not intend on appealing this decision, and a piece of legislation titled Bill C-7 was introduced in February 2020 to further expand MAID criteria.

In addition to removing the requirement of a reasonably foreseeable death, Bill C-7 would also allow for advanced directives.

Cardinal Thomas Collins, the Archbishop of Toronto, released a statement in February criticizing Bill C-7 for expanding the criteria for MAID without expanding the availability of palliative care.

“Where is the political will to push forward on palliative care for all Canadians? Only 30% of Canadians have access to quality palliative care even though we know that pain and loneliness are among the biggest fears of those who are suffering. Palliative care can address these issues,” said Collins.

“If all Canadians had access to quality palliative care, fewer would seek lethal injection. But instead of developing an overall culture of care, we are rushing towards death on demand,” adding that doctors will be forced to comply with requests for euthanasia as Canada does not have conscience rights protections for medical professionals.

“We should take time to be truly present to those who may feel that they are on the margins in our community,” said Collins.

“Those who feel that their life no longer has value must be assured by all of us that this is absolutely not the case — there is dignity within each human life, not just when we are young, healthy and able, but even more so, when we are fragile and vulnerable.”