Woman Euthanised 'Against Her Will' Following Husband's Caregiver Burnout
A Canadian woman in her 80s was medically assisted in dying against her expressed wishes, just one day after she formally withdrew her request, according to a disturbing official report. The case, involving a patient referred to only as Mrs B, has raised profound questions about safeguards within Canada's Medical Assistance in Dying (MAiD) programme, particularly when family caregivers experience extreme stress.
A Deteriorating Health Condition and Initial Request
Mrs B's health had significantly declined following a coronary artery bypass graft surgery, which led to serious complications including respiratory failure. After deciding to cease further active treatment, she was transferred to palliative care and sent home, where her husband became her primary caregiver. As her condition worsened, Mrs B reportedly informed her family of her desire to access MAiD, the Canadian law permitting eligible patients to seek a medical professional's help to end their life.
Her husband, described as suffering from severe caregiver burnout, contacted a MAiD referral service on her behalf the same day. This set in motion a rapid and controversial sequence of events.
A Withdrawn Request and Rushed Assessments
The following day, a MAiD practitioner assessed Mrs B for eligibility. Crucially, during this assessment, Mrs B told the practitioner she wished to withdraw her MAiD request. She cited personal and religious values, stating that pursuing in-patient palliative or hospice care was more aligned with her end-of-life goals.
Despite this clear withdrawal, the process accelerated. The next day, Mrs B was taken to a hospital emergency department where she was found to be medically stable. However, medical notes highlighted her husband's acute caregiver burnout. Her palliative care doctor urgently requested in-patient hospice care, but this was denied for not meeting specific end-of-life criteria.
That same day, her husband requested a second, urgent MAiD assessment. A different assessor evaluated Mrs B and deemed her eligible. When the original assessor—who had documented Mrs B's withdrawal—was informed, they objected strenuously, raising concerns about the necessity for urgency, the drastic change in the patient's stated goals, and the potential for coercion due to her husband's burnout.
Overruled Concerns and a Virtual Approval
The original practitioner's request to revisit Mrs B the next day was declined by the MAiD provider, who insisted the clinical circumstances required urgent provision. Instead, a third assessor was brought in to conduct a virtual assessment. This assessor agreed with the second, confirming Mrs B's eligibility. Mrs B was euthanised later that evening.
Review Committee Highlights Systemic Failures
A report by Ontario's Chief Coroner, reviewing MAiD practices, expresses deep concern over this case, suggesting safeguards are being eroded. Members of the MAiD Death Review Committee identified multiple failures:
- The extremely short timeline prevented a thorough exploration of Mrs B's social circumstances and care needs.
- There was no clear clinical justification for conducting assessments and provision on the same day, given the complex situation.
- Key issues like the denial of hospice care, additional care options, caregiver burden, and inconsistent MAiD requests were not adequately assessed.
- Assessments were completed with the spouse present, potentially creating pressure on Mrs B.
- The committee questioned whether family members should be allowed to initiate MAiD referrals, due to risks the request may not be self-directed.
The committee noted that Mrs B's spouse was primary in advocating for MAiD access, with limited documentation showing the process was patient-led. Her abrupt change of mind was never properly discussed or documented.
Expert Condemns 'Worrying Trend' of Rushed MAiD
Dr. Ramona Coelho, a GP and committee member, authored a scathing critique. She argued the focus should have shifted to ensuring adequate palliative care for both Mrs B and her overwhelmed husband.
"Hospice and palliative care teams should have been urgently re-engaged," Dr. Coelho wrote, highlighting that the MAiD provider expedited the process despite the first assessor's and patient's own concerns.
She pointed to a worrying trend in regions like Western Ontario, where same-day and next-day MAiD deaths occur most frequently. "This raises concerns that some MAiD providers may be predisposed to rapidly approve patients for quick death rather than ensuring patients have access to adequate care or exploring if suffering is remediable," she stated, warning that speed is being prioritised over patient-centred care and ethical safeguards.
This tragic case underscores a critical tension within assisted dying frameworks: the imperative to respect patient autonomy must be balanced against robust protections to ensure that decision is free from external pressure, especially in contexts of family strain and inadequate support systems.
