Elderly Woman Euthanized Within Hours Despite Withdrawing Request
An elderly woman in her eighties was euthanized within hours of her husband requesting the procedure, despite her having previously withdrawn her application citing personal and religious beliefs. The case, referred to as 'Mrs B', has been highlighted in a concerning report by Ontario's Medical Assistance in Dying (MAiD) Death Review Committee, which warns that safeguards are being eroded, leading to questionable deaths.
Rapid MAiD Assessment Raises Alarm Bells
Mrs B had suffered complications following coronary artery bypass graft surgery, leading to a severe decline in her health. She initially opted for palliative care and was discharged home with support, where her elderly husband became her primary caregiver. As her condition deteriorated, her husband reportedly struggled with the caregiving burden, even with nursing visits.
According to the committee's report, Mrs B expressed a desire for MAiD to her family. On the same day, her spouse contacted a referral service on her behalf. However, when the first assessor arrived, Mrs B explicitly stated she wished to withdraw her request, citing personal and religious values, and instead requested inpatient hospice care.
Caregiver Burnout and Expedited Process
The following morning, her husband took her to hospital where doctors found her condition stable but noted her husband was experiencing significant caregiver burnout. Her palliative care doctor applied for inpatient hospice care due to this burnout, but the request was quickly denied.
Later that same day, her husband requested an urgent second MAiD assessment. A different assessor arrived, judged her eligible, but the original assessor—contacted as per protocol—objected. This practitioner expressed concerns about the necessity for urgency, the drastic change in her end-of-life goals, and the possibility of coercion or undue influence due to caregiver burnout.
The original assessor's request to meet Mrs B the next day was declined by the MAiD provider, who stated the clinical circumstances necessitated urgent provision. Instead, a third assessor was sent, who agreed with the second, and Mrs B was euthanized that evening.
Committee Members Voice Serious Concerns
The Ontario MAiD Death Review Committee, in its report released by the Office of the Chief Coroner, raised multiple concerns about how this case was handled. Many members believed the short timeline did not allow for adequate exploration of Mrs B's social circumstances, end-of-life care needs, the impact of being denied hospice care, additional care options, caregiver burden, and the consistency of her MAiD request.
The report noted particular concern about possible external coercion arising from the caregiver's experience of burnout and lack of access to palliative care in an inpatient or hospice setting. Members were also troubled that Mrs B's spouse was the main person advocating for and navigating access to MAiD, with little documentation that she had actually requested it herself. The assessments were completed with her husband present, raising additional concerns about potential pressure.
Critical Review from Committee Physician
Dr Ramona Coelho, a family physician and member of the committee, wrote an extremely critical review of Mrs B's case. She argued that the focus should have been on ensuring adequate palliative care and support for both Mrs B and her spouse, with hospice and palliative care teams urgently re-engaged given the severity of the situation.
Dr Coelho noted that the MAiD provider expedited the process despite the first assessor's and Mrs B's concerns, without fully considering the impact of her spouse's burnout. Dr Coelho, who is known for her criticism of MAiD and assisted dying in general, has previously spoken out against media portrayals of assisted suicide, including the Hollywood film 'In Love', which she described as dangerous and irresponsible for romanticising death.
Broader Context of Canada's MAiD Laws
Canada legalised assisted dying in 2016, initially limiting it to terminally ill adults whose deaths were reasonably foreseeable. The law has since expanded to include people with chronic illness and disability, with pending parliamentary review potentially extending it to those with certain mental health conditions. Dementia cases remain particularly controversial due to questions about capacity and consent.
The committee's report highlighted other concerning cases, including an elderly woman approved for MAiD after a single meeting where a family member relayed her supposed wish to die, with consent on the day of death interpreted through hand squeezes. Another case involved a man with early Alzheimer's who had signed a waiver years earlier; after being hospitalised with delirium, he was deemed capable for a brief moment and euthanised.
These cases underscore ongoing debates about safeguards, consent, and the appropriate balance between patient autonomy and protection from coercion in end-of-life decisions.
