Euthanasia Errors: When Canada’s MAiD Procedures Fail Patients and Families

Canada’s state-run euthanasia program — Medical Assistance in Dying (MAiD) — became legal on June 17, 2016, with the passage of Bill C-14. Since then, MAiD deaths have risen sharply, from 1,018 in its first year to 15,343 in 2023. By the end of that year, over 60,000 Canadians had chosen to end their lives through the program, which now accounts for nearly 1 in 20 deaths nationwide.

But as MAiD expands, so do quiet concerns about what’s happening behind closed doors; particularly when it comes to complications with the procedure. Public records on complications arising from MAiD in Canada are limited, but the drugs used in the procedure — a mix of sedatives, anesthetics, and paralytics — can offer insight into the kinds of adverse events that may occur when things don’t go as planned.

Given the high number of MAiD deaths recorded in Canada each year, it’s reasonable to assume that hundreds of adverse events likely occur annually, even if they’re not being formally tracked or reported.

One study analyzing 3,557 MAiD cases in Ontario and Vancouver between 2016 and 2020 reported a complication rate of 1.2 percent equating to approximately 12 adverse events per 1,000.

This suggests that out of the 60,000 Canadians who have died through MAiD since its legalisation, approximately 720 may have experienced complications during the procedure.

The procedure and adverse events

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The process typically begins with the administration of a sedative such as Midazolam or Propofol. Once the patient is unconscious, a coma-inducing drug is used to deepen sedation. Finally, a paralytic agent like Rocuronium or Cisatracurium is administered to stop breathing and induce cardiac arrest.

Based on a combination of peer-reviewed research and clinical observations from Canadian and international studies, adverse events due to the procedure include IV administration issues, delayed death, agonal breathing or muscle twitching, unexpected consciousness, seizures or distress reactions, and in rare cases where oral medications are used, vomiting.

The most common adverse effect is trouble finding veins, leakage or equipment issues, impacting roughly four to seven people per 1,000.

Delayed death — when patients take longer than 10 minutes to pass away — typically impacts between three and five people per 1,000 and while often distressing for families, it is not proven that the patient is suffering, however there are concerns.

Some of the more rare complications include agonal breathing or muscle twitching and unexpected consciousness, which impacts less than one person per 1,000.

Unexpected consciousness occurs in extremely rare cases where a patient regains consciousness due to factors like improper dosing or rapid metabolism of sedatives.

First hand accounts and case studies

While records of adverse events are sparse, there have been several cases where patients and their families have suffered needlessly due to malpractice, procedural errors, and inadequate oversight during the MAiD process.

In 2017, Dr. Eugenie Tjan administered MAiD using incorrect medications — scopolamine and Ativan — leading to significant suffering for the patient and family. She left the patient’s bedside for over two hours to obtain additional drugs after the initial ones failed. The College of Physicians and Surgeons of Ontario investigated and prohibited her from providing MAiD but allowed her to continue practicing palliative care under supervision.

In 2024, a British Columbia judge issued a rare injunction to prevent the medically assisted death of a 53-year-old Alberta woman. The woman suffered from akathisia, a movement disorder linked to medication changes. Physicians in Alberta denied her MAiD request, citing the condition’s potential treatability. However, she sought approval from Dr. Ellen Wiebe in British Columbia, who authorized the procedure after a single virtual consultation. The woman’s partner filed a legal claim alleging negligence and potential criminal liability, arguing that proper MAiD standards were not followed. The court’s injunction halted any medical procedure to end her life for 30 days, highlighting concerns about the adequacy of assessments and adherence to legal requirements in MAiD cases.

Then there’s the case of Alan Nichols, who had a history of mental health challenges but no terminal illness. He was admitted to Chilliwack General Hospital in 2019 under the Mental Health Act. Despite family concerns and lack of communication from the hospital, Alan received MAiD. Notably, an earlier attempt to administer MAiD had failed due to procedural errors, including the absence of a doctor and lack of family notification.

MAiD to be expanded

Despite a number of red flags, lawmakers in Canada are forging ahead, with plans to expand the program to include children and people suffering from mental illness as a sole condition.

The most significant planned expansion was to include eligibility for individuals whose sole underlying condition is a mental illness. Originally set for March, 2024, this expansion has been delayed multiple times.

On February 29, 2024, Bill C-62 received royal assent, postponing this eligibility until March, 2027.

Lawmakers say the delay aims to give provinces, territories, and healthcare systems more time to prepare, including developing regulations, guidance, and training for practitioners to handle complex cases involving mental illness.

In addition, a 2023 report from the Special Joint Committee on MAiD recommended exploring eligibility for “mature minors.” Mature minors are children under the age of 19 who are deemed capable of making a decision to pursue MAiD.

The proposal has faced significant opposition, particularly from disabled rights advocates and those concerned about the impulsivity of youth and potential for coercion.

In the short term, practitioners are preparing to administer the procedure to people afflicted with chronic mental illness and in the long-term, depending on parliamentary review, they are preparing to administer the procedure on children.