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Lisa Pauli, 47, who says she wants to apply for medical assistance in dying (MAiD) when she is eligible because of her severe anorexia, looks on, in Toronto, Ontario, Canada June 9, 2023.
Canada: A great place to die?
Canada’s medical assistance in dying (MAiD) regime is garnering criticism, as its rapid growth threatens to make the country the world capital of assisted suicide - if it’s not already. Health Canada has just released the statistics for 2023 that show Canada sat just behind the Netherlands in terms of the number of assisted deaths. In both countries, one in 20 deaths are due to medical assistance - a total of 15,343 Canadians in the 2023 calendar year. However, it took the Netherlands 22 years to reach that proportion; it has taken Canada just seven.
The original intent of the legislation was to offer a painless death with dignity to those with a terminal disease. Since then, court challenges have opened medical assistance in dying to people who do not have a “grievous and irremediable” condition. The most worrying statistic for opponents of expanding the regime was the revelation that 622 people with non-terminal illnesses received assisted dying. Nearly half of them cited “isolation or loneliness” as one of the causes of their suffering. Rejections of MAiD remain much higher for non-terminal applicants, but yet more liberalization of the regime is coming, unless a future government steps in to block it.
As of March 2027, people with mental illness as their underlying condition will be eligible for MAiD, a development that has many experts worried. The change was due to come in last March but was punted down the road by parliamentarians spooked by expert testimony that indicated the difficulties of predicting mental illness outcomes. One witness told members of Parliament that the long-term prognosis of a person with mental illness is wrong one half of the time.
The voices of concern will grow louder if the 2024 numbers confirm that Canada is now medically assisting the deaths of more of its own citizens than any other country on earth.
A man is seen using the OpenAI ChatGPT artificial intelligence chat website in this illustration photo on 18 July, 2023.
Is AI responsible for a teen’s suicide?
Moments before Sewell Setzer III took his own life in February 2024, he was messaging with an AI chatbot. Setzer, a 14-year-old boy from Florida, had struck up an intimate and troubling relationship — if you can call it that — with an artificial intelligence application styled to simulate the personality of “Game of Thrones” character Daenerys Targaryen.
Setzer gave numerous indications to the chatbot, developed by a company called Character.AI, that he was actively suicidal. At no point did the chatbot break character, provide mental health support hotlines, or do anything to prevent the teen from harming himself, according to a wrongful death lawsuit filed by Setzer’s family last week. The company has since said that it has added protections to its app in the past six months, including a pop-up notification with the suicide hotline. But that’s a feature that’s been standard across search engines and social media platforms for years.
The lawsuit, filed in federal court in Orlando, also names Google as a defendant. The Big Tech company hired Character.AI’s leadership team and paid to license its technology in August, the latest in a spate of so-called acqui-hires in the AI industry. The lawsuit alleges that Google is a “co-creator” of Character.AI since its founders initially developed the technology while working there years earlier.
It’s unclear what legal liability Character.AI will have. Section 230 of the Communications Decency Act, which largely protects internet companies from civil suits, is untested when it comes to AI chatbots because it protects companies from speech posted by third parties. In the case of AI chatbots, the speech is directly from an AI company, so many experts have predicted that it won’t apply in cases like this.
FILE PHOTO: Canada's Minister of Health Mark Holland rises to table a report in the House of Commons on Parliament Hill in Ottawa, Ontario, Canada September 18, 2023.
Euthanasia for mentally ill off the table in Canada – for now
In most US states, medically assisted suicide remains illegal, with only 11 jurisdictions offering legal medical aid in dying for the terminally ill. In Florida, there is a charge of manslaughter for anyone assisting another person “self-murder.”
As such, it must seem utterly bizarre to many Americans that Canada was on the brink of legalizing medically assisted dying for people with mental illness, which would have made it one of the most liberal euthanasia regimes in the world.
At the insistence of the courts, Canada legalized assisted death in 2016 for people with terminal illnesses and expanded it to people with incurable but not terminal illnesses in 2021. As part of that expansion, a provision to cover people whose only underlying condition is mental illness was included, but its implementation was delayed until this coming March 17. In the meantime, a special joint committee of members of Parliament and appointed senators was asked to verify that the health system is ready to safely apply medically assisted dying for the mentally ill.
That committee reported back this week that Canada is not ready, and according to expert witnesses may never be ready to institute such a regime. The central sticking point was less about logistics and more about ethics. The concern of many expert witnesses is the nature of mental illness.
“The committee heard it is difficult, if not impossible, to accurately predict the long-term prognosis of a person with a mental disorder,” the report concluded.
According to one witness, Dr. K Sonu Gaind, chief of the department of psychiatry at Sunnybrook Health Sciences Centre in Toronto, there is evidence that clinicians’ predictions are wrong one-half of the time.
Preparations to introduce medically assisted dying for those with mental disorders will continue, but the committee heard a majority of psychiatrists are not in favor of the expansion.
Nor, for the moment, is the federal government. Mark Holland, the health minister, introduced legislation today that will push back the implementation three years, to March 17, 2027.