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Canada euthanised 10,064 people in 2021

August 9, 2022

Canada’s Third Annual Report on Medical Assistance in Dying in Canada (2021) was published at the end of July.

Euthanasia in Canada in its legal voluntary form is called medical assistance in dying (MAID) and it first became legal along with assisted suicide in June 2016 to end the suffering of terminally ill adults. In March 2021, the law was further amended by Bill C-7 which permits assisted euthanasia in additional situations, including for certain patients whose natural death is not reasonably foreseeable, subject to additional safeguards.

Remarkably, there has been little media attention either in Canada or elsewhere. The daily euthanising of around 30 individuals of any other mammal species would hardly go unnoticed. Yet, it probably is a very good thing that assisted dying in Canada happens quietly and without fuss. Hopefully the system is sufficiently robust to prevent misuse.

The average age of the euthanised was 76.3 years. The main reasons for requesting MAiD were loss of ability to engage in meaningful activities (86.3%) and the loss of ability to perform activities of daily living (83.4%). Concern about pain was a reason for wanting to die for 57.6%. Around 20% indicated loneliness or isolation as a reason for wanting to die.

I observe that my views about medical assistance in dying have evolved over the years. Now at 74, I find that reduction of suffering and preventing the indignities of dementia take precedence.

BioEdge writes:

  • In 2021, there were 10,064 MAID deaths, representing 3.3% of all deaths in Canada.
  • This is an increase of 32.4% over 2020.
  • The total MAiD deaths since Canada’s 2016 legislation is 31,664.

….

Even if the MAiD annual report flew under the radar, the media has not ignored the issue. CTV News Toronto recently interviewed a Toronto woman in her 50s who is suffering from long Covid and has applied for MAiD. “[MAiD] is exclusively a financial consideration,” she said. “My choices are basically to die slowly and painfully, or quickly. Those are the options that are left.”

At the moment, the Canadian government is studying whether to expand eligibility for MAiD by extending it to people with mental illness. A doctor who is the physician chair of a hospital MAiD team expressed his alarm. Writing in the National Observer, Dr Sonu Gaind said:

It is a myth that expanded MAiD is just about autonomy. Expansion may increase privileged autonomy for some to die with dignity, but it does so by sacrificing other marginalized Canadians to premature deaths for escaping painful lives that we failed to allow them to live with dignity.

Highlights

Growth in the number of medically assisted deaths in Canada continues in 2021

  • In 2021, there were 10,064 MAID provisions reported in Canada, accounting for 3.3% of all deaths in Canada.
  • The number of cases of MAID in 2021 represents a growth rate of 32.4% over 2020. All provinces continue to experience a steady year over year growth.
  • When all data sources are considered, the total number of medically assisted deaths reported in Canada since the Parliament of Canada passed federal legislation that allows eligible Canadian adults to request medical assistance in dying in 2016 is 31,664.

Profile of MAID recipients

  • In 2021, across Canada, a slightly larger proportion of men (52.3%) than women (47.7%) received MAID. This result is consistent with 2020 (51.9% men vs 48.1% of women) and 2019 (50.9% men vs 49.1% women).
  • The average age at the time MAID was provided in 2021 was 76.3 years, slightly higher than the averages in 2019 and 2020 (75.2 and 75.3 respectively). The average age of women during 2021 was 77.0, compared to men at 75.6.
  • Cancer (65.6%) is the most commonly cited underlying medical condition in the majority of MAID provisions during 2021, slightly down from 69.1% in 2020. This is followed by cardiovascular conditions (18.7%), chronic respiratory conditions (12.4%), and neurological conditions (12.4%). Three-quarters of MAID recipients had one main condition, while one-quarter had two or more main underlying medical conditions.
  • In 2021, 2.2% of the total number of MAID provisions (219 individuals), were individuals whose natural deaths were not reasonably foreseeable (non-RFND) (in Quebec since 2019 and the rest of Canada after the passage of the new legislation on March 17, 2021). The most commonly cited underlying medical condition for this population was neurological (45.7%), followed by other condition (37.9%), and multiple comorbidities (21.0%). The average age of individuals receiving MAID who were non-RFND was 70.1.

 

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Call him Anonymous

April 6, 2022

Call him Anonymous.

He was born in a middle-size town to middle-class parents and he was then one of about 1,700 million people alive. He was an only child and rarely met his two cousins. He did not want for food or clothing and enjoyed an unremarkable but comfortable childhood. He was not bullied and did not bully anyone else. He was never beaten and never struck anyone. He finished school in the middle of his class. He went to an unremarkable university and graduated, without honours but without any adverse comments. He joined a large textile company as a junior clerk in the accounts department.

In due course he married his unremarkable cousin (twice removed) who was two years older and they had three unremarkable children. One died (a cot-death) in infancy. His children grew up unremarkably and without any great upheavals in their lives. He bought a house and a little car. His wife worked as a shop accountant before their children were born and also after they were teenagers. They did not want for food and clothing and they could afford an unremarkable holiday for a week or two every year. During the War he was seconded as an accountant to the Amy Pay Office. After the war he returned to his textile company employer. His performance as an accountant was always adequate and his career progressed unremarkably through the accounts department. By the age of fifty he had risen to be the Deputy Manager of the Reports and Financial Statement Department. His parents died unremarkably in their 80s.

His wife and he both retired at 60 and their combined pensions allowed them to continue living unremarkably in their house. She continued with her Lunch Club and Dramatic Society and he had his annual subscription to the Football and Bridge Clubs. Their children – and later 2 grandchildren – visited them in the summer and at Christmas. They were always invited to his company’s annual Christmas Party until the company was wound down and vanished after 120 years in business. She died quietly after a stroke when she was 78 and he continued living in his unremarkable little house for another 15 years. When he was 92 his children and the City authorities moved him to a home for the aged. His house was sold and the proceeds together with his pension were sufficient to ensure that he was cared for at a better than average home. He never became senile but his physical abilities gradually withered away. His children continued visiting him once or twice a year. He had no other visitors.

He died 11 years later at 103. It was a quiet death and his heart just stopped beating one night. It was during the pandemic and nobody could visit him. The Home organised his cremation and the disposal of his ashes in consultation with his children. This was in an environmentally approved tip since immersion of the ashes in the local river was not allowed. A short memorial service was live-streamed a month later and 4 people logged in.

He died alone among 7.5 billion people on the planet.

There is no doubt he did exist. An unremarkable living, a forgotten life

His name? Call him Anonymous.

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“To die will be an awfully big adventure” – or will it?

June 8, 2021

“To die will be an awfully big adventure.”  –  J.M. Barrie, Peter Pan

I have never been quite sure if the quote from Barrie’s Peter Pan is terribly profound or utterly banal.

Not because Peter Pan is not a brilliant and captivating reflection on losing innocence and on timelessness and that Neverland – in one way or another – is not something that has been imagined, in some form, at some time, in everybody’s mind. But because I am not sure if death can actually be considered a state at all. Certainly it is not a state that can be observed by the subject. Equally, before birth is not a state that is observable by the subject in question.

The philosophical difficulty I have is in trying to equate negations; to equate different kinds of zeros. Can the not being before birth be equated to the not being after death. In fact, can not being be considered a state at all? The state of the world in 1900 will be some thing other than the state of the world in 2100. Neither of these two states of being will include me. However, in the second case an identity that once was me would be present in records or in memory. That suggests that my not being after my death is somewhat different to my not being before I was born. But they both need an observer – who is not me.

Why does the universe go from a (presumed) simple ground state to a much more complex condition? Not to be – it seems – must always be simpler (in energy and complexity) than to be. Non-existence must be more parsimonious in the scheme of things than existence. Is it time which is the great disruptor? Why existence rather than non-existence remains the greatest mystery of all. “I think therefore I am” may be an indicator of consciousness but it is silent about being. We get tangled between language and philosophy, between philosophy and metaphysics. Nothing or no thing causes problems of language and of metaphysics. A thing must first be defined for a state of no thing to be discerned. Not any thing is quite different – in language – to no thing. It is much wider and encompasses all things. But even not any thing is restricted by human cognition to just those things that can be imagined. What is beyond human comprehension cannot even be addressed. A thing presupposes existence. The state – if it is a state – of not being is equally dependent upon first having in place the concept of being. Shakespeare’s Hamlet was questioning living rather than not living, and the meaning of life. But his “To be or not to be? That is the question ..” is probably more profound than Shakespeare ever intended and is the most fundamental question of philosophy and metaphysics. Why existence at all? What could be the question that existence is the answer to?

The living are irrelevant to a person not yet born. They are equally irrelevant to the dead. But note the inherent contradictions in the use of language. A person not yet born, or a person who is dead, is not a person at all – a non-person. We cannot, logically, speak about relevance to a person who is a non-person. As we age, it is not the state of being dead that causes much concern. The state of others as a consequence may be of concern. The process of dying and the accompanying pain and indignities give concern to many. But being dead is both linguistic and metaphysical nonsense. Being dead translates logically to the self-contradictory being a not-being. Just as an after-life translates to a logically nonsensical life after the end of life. Just as before the beginning is not logically sustainable. A person being dead causes ripples and even large waves in the surrounding world and among other people, but is never of any concern to persons who do not exist.

To be born is indeed an adventure.

I am not sure that to die is any kind of anything.

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Statistical trivia if you are 70+

June 2, 2021

Triggered by somebody I know turning 70 today.

  • You are one of around 500 million people today who are over 70.
  • You were one of just 2.5 billion when you were born but are one of 7.5 billion today (therefore 3 times less important?).
  • However, you are also one of the Elders of the World and among the 7% of the world population over 70 (15% in Sweden, 14% in the US, 8% in China and 4% in India).
  • Globally the over 70s (7%) own about 40% of the world’s household wealth. (For reference, Bill Gates is not yet 70).
  • You are 4 times more likely to own your own home than the average adult.
  • It is more likely that your medical costs exceed what you spend on your car.
  • You are among the safest drivers on the roads but renting a car gets more difficult.
  • At an airport you are 10 times less likely to be profiled as dangerous.
  • You know what a slide rule was used for, can remember receiving a telegram and can recognise a telex machine.
  • The American Civil war was to you as World War 1 is to someone born today. 
  • Somebody who was 70 when you were born had lived through 2 World Wars.
  • 70 years before you were born there were no aircraft, no radios, no refrigerators, no X-ray machines, no steam turbines, no automobiles, no diesel engines and no zippers. But the telephone had been invented (just).

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Covid-19 and dwindling peers but, paradoxically, less loneliness

May 24, 2021

The data is still accumulating but it does seem globally that around 80% of all deaths due to Covid-19 are of those over 70 years old. In Sweden, 89% of deaths are of those over 70; in the US, 82% of deaths are of those over 65. Males are more likely to die of Covid or Covid induced conditions than females. All over Europe longevity statistics have been noticeably affected. Male longevity has reduced by close to 1.5 years and female longevity by about half that (c. 0.8 years).

My peers were dwindling anyway but they are dwindling faster due to Covid. Over the last year, eleven friends on my “frequently mailed list” (c. 4.5%) have disappeared (not all due to Covid).  But the paradox is that loneliness has not increased. The enforced physical self-isolation has led to a massive increase in digital contact methods. (I do not mean social media which I find more trouble than it is worth). Zoom calls, video calls, on-line contacts leading to more direct video and audio calls, have all increased markedly. I have seen and talked to many people – some after many years – who I probably would not otherwise have done. I have seen and talked to relative strangers by video calls which I would not otherwise have done. I have made new friends.

I wrote the post below about 3 years ago but I am – paradoxically – more hopeful about combating loneliness now. Not social media but digital/video contact could be the medium for mitigation. Surprisingly, and even though my peers continue to dwindle, the last year has demonstrated ways of maintaining contact and even of forging increased contact with younger generations. I see that apartment designs are already beginning to include a work-from-home space. Old-age and care homes will need to design-in digital, voice-activated, video contact facilities to a much greater degree than they do. Video contact cannot replace physical proximity but it could provide a tool to battle loneliness.

Dwindling peers or The loneliness of the long-distance survivors

Of those aged 50, the annual mortality rate is about 300/100,000. By the age of 60 this has increased to about 800/100,000 and then increases sharply to around 25,000/100,000 by 90 and encompasses virtually everybody by the age of 100. (There are currently about 300,000 people world-wide who are 100 years old and a handful who have reached 115 years old). On average women live around 4 -5 years longer than men.

Defining “peers” to be those of a similar age, I assume that most people probably reach a maximum number of peer-acquaintances at a little over the age of 50. In my own case I would guess that this was probably when I was around 55.

An increasing mortality then applies to a dwindling cohort of peer-acquaintances. The longer one survives the faster one’s peer-acquaintances shrivel.


Setting peer-acquaintances to be 100% at 50 (and ignoring accretion of new peer acquaintances), their number has dropped to around 80% at 70, and have halved by the time one has reached 80. At our 50th school graduation anniversary when we were all around 65, around 10% of our classmates had passed away. By the age of 90, peer-acquaintances have dwindled to less than 10% of those who were alive at 50. Those who live to 95 have virtually no acquaintances of their own age left alive.

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The great success and the great betrayal of the Swedish coronavirus strategy

July 3, 2020

The Swedish lockdown has been more voluntary than enforced. The over 70’s were told to quarantine themselves to protect the health system. Since the compliance with the voluntary social distancing requirements has been quite high, the spread of infection has not been much worse than in many countries enforcing very strict lockdowns. In total number of deaths due to the Chinese virus, Sweden sticks out among its Scandinavian neighbors who enforced much stricter lockdowns. But Sweden is not an outlier among other European countries. Economically, Sweden will probably be among the countries which recover fastest.

The Swedish strategy has been both a great success and a great failure. The numbers tell the tale.

source: worldometers

There is no right or wrong to the various strategies applied by different countries. Decisions have probably been made in good faith though these have been dominated by the culture of fear and risk aversion that permeates the world today. The fear of alarmist, imaginary crises has meant the world was totally unprepared for a real crisis. The impotence of a politicized WHO and the duplicity of a terrified Chinese bureaucracy has not helped. The stupidity of relying on imperfect and alarmist mathematical models was very evident.

But diving into the Swedish statistics also shows great successes among some very great betrayals.

Only 10% of the deaths have been of those under 70. Based on the National Board of Health and Welfare (Socialstyrelsen) criterion of “expected remaining life”, the loss of expected remaining life has been kept to a minimum. The 90% of deaths of those above 70 do not contribute much to “expected remaining life”. Among the “productive” population the loss of life has been kept down to about 50/million of population. That is the great success. 

Also among the successes have been:

  • intensive care places were more than doubled in a very short time
  • intensive care places were never overwhelmed
  • restarting the economy is well under way, and
  • herd immunity may not yet have been achieved but the risk of infection to the general population under 70 is greatly reduced. (Effectively, Swedish policy excludes the +70s from the herd).

But the cost has been the betrayal of the elderly. The unvoiced, undercurrent of opinion is that “but they were going to die soon anyway”. Care homes became virtual prisons for their inmates. Following the Socialstyrelsen’s publishing of their criteria for prioritizing lives based on “expected remaining life”, there were cases of those infected in care homes being denied oxygen and respirators. There have been cases where they have been put directly onto palliative care (sometimes a euphemism for a self-fulfilling, end-of-life care). The Swedish government through up its hands and abdicated its responsibilities to the bureaucracy of the Public Health Agency (Folkhälsomyndigheten) and of the National Board of Health and Welfare (Socialstyrelsen). The Public Health Agency were, I think the heroes, at least for honesty and fidelity and for stepping-up, if not always for compassion. The Health Services were also among the heroes. The bureaucrats of the Socialstyrelsen were hypocritical, mealy-mouthed and less than impressive. The reality, which is the opposite of what they often voiced, is that the elderly are second, or even third, class citizens in Sweden. The Swedish herd has protected itself by excluding the elderly from the herd.

I am over 70 and may be a trifle biased. But the villains of this pandemic internationally are the Chinese bureaucracy, the Alarmist Brigade and the WHO. Within Sweden, the villains are the government and the National Board of Health and Welfare (Socialstyrelsen).

And even if herd immunity is achieved, the over 70’s will remain at great risk until such time as a vaccine is developed. Every herd protects itself by sacrificing the weak and the sick. And the old.

 

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Loneliness has become policy

June 27, 2020

A friend of ours has beginning Alzheimer’s and entered a care home for alternate weeks at the beginning of March. Then came the Chinese virus. He happened to be in the home when Sweden banned all visits by relatives because of the pandemic. His wife lives only 3 km away but she has not been able to see him since then.

I wrote this a few years ago.

When all your email is only spam

 

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Humans are not equal

April 25, 2020

The coronavirus pandemic brings the delusion of human equality into stark relief.

There is a myth that institutions, from the UN to countries and NGO’s, like to propagate. This is the fantasy that humans are born equal and that their lives are of equal value. All across the world we now see that the infection carriers are mainly younger and asymptomatic. The dead are mainly among the old and the weak. Everyone is now seeking “herd immunity”, but a herd is always on the move. Its security lies in leaving behind and sacrificing the old and the infirm to satisfy the predators. The coronavirus is predatory. It is the younger and stronger who can get the economies to start up again. And the old and the infirm are being left behind.

It has happened in Spain and Italy and the UK as well but I take Sweden as an example where the myth that human lives have equal value is particularly strong. It has become exceedingly clear that the lives of those who may place a greater burden on the nationalised health services are worth less than of those who won’t. Almost 90% of all deaths attributed to the coronavirus in Sweden, (actually 87% currently), are of those over 70 years of age. Many of these were because the infection entered the care homes where the elderly were trapped, mainly through asymptomatic care workers. Unions have then blocked care workers from providing care in some infected care homes. Government institutions have even formally promoted the downgrading of the value of the lives of the elderly. The Swedish Board of Health and Welfare (Socialstyrelsen) has explicitly lowered the priority to be given to those with a lower “expected remaining life”. It is not just coincidence that some Stockholm hospitals have rejected some of the elderly from available intensive care places, in case younger patients with a greater chance of survival might have need of them. (Expressen 23rd April)

There is nothing right or wrong with the reality that humans are not equal. Far better to openly accept the reality than hide behind a delusion.

Humans are not born equal, nor do they live equally and they do not die equal.

Humans are born genetically unique. In one estimate by the FBI for identifications in court, the chance of a DNA profile being matched by another person is much less than 1 in 260 billion. All the humans who have ever lived over 200,000 years as “anatomically modern humans” number about 110 billion. No two have ever been genetically alike or have had identical DNA profiles.

Humans are not born “equal” in their genes. The capability envelope – physical, mental and behavioural – for any individual is already set at birth (actually soon after conception). Nurture then determines what an individual can actually achieve within the capability envelope. But, no amount of nurture (nourishment, upbringing, training, learning or experience) can enable an individual to break out of the predetermined envelope of capability. Nurture may have enabled me to run faster than I can, but no amount of nurture would have made it possible for me to run as fast as Usain Bolt.

Humans are not equal either in the nurture they receive. The reality is that all humans are born naked, with no resources, no debts, no liabilities and with only those privileges as may be granted, or liabilities that may be imposed, by the surrounding human society. They are born utterly dependent upon surrounding humans for their survival. Nourishment and upbringing are determined by the far from equal capabilities of parents. Education and learning and experience vary according to the means of the parents and the surrounding society. The vastly varying levels of support they receive from others, at birth and through their upbringing, further emphasizes that they are not equal. They differ in nourishment, upbringing, training, learning and experience. They differ in what they contribute to, or receive from, their surroundings.

Humans do not behave equally. From birth and through their lifetimes, they differ in their actions and behaviour and interactions with others. They differ in the people they interact with. They behave differently from each other, to each other and differently through their lives.

Human lives are not lived equally. The value any creature places on its own life is entirely subjective and not something that can be estimated by others. Presumably this value is at the maximum possible for the individual concerned. The value of any human life within its own society varies with manifested behaviour and over time. The value to its own surrounding society is also a subjective judgement. However, it varies across societies, from one human to the next and over the life of that human. It is neither static nor a constant. The value of an undistinguished human life may be priceless to friends and relatives, but quite low in its immediate society and may approach zero to a distant society. The value of a distinguished life may extend far beyond the boundaries of the local society and long after that life is over. 

And when a human, no matter how distinguished or productive earlier, is committed for life to a care home or a hospice, the reality is that the current value of that human life, to that society, has dwindled to not very much.

Humans are not born equal, nor do they live equally and they do not die equal. 

There is nothing right or wrong with that. It just is. Far better to openly accept the reality than hide behind a delusion.

 

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Fatality League: Without the 70+ deaths, Sweden would be doing very well

April 14, 2020

The pandemic is far from over, but as some countries contemplate or begin to relax their lockdowns, it is not too early to begin to look at some of the emerging data.

With its 10.1 million population Sweden has suffered over 1,000 deaths due to Covid-19. In the fatality league (deaths/million of population), Sweden has by far the worst numbers in Scandinavia and lies among the worst 10 globally (and in Europe) as of 14th April 2020. (Countries with fewer than 100 deaths are not included). Almost 90% of the fatalities in Sweden are of those over 70. Without these included, Sweden would have a fatality rate just one tenth of that observed.

I merely observe that in a mathematical model which gives little value to the lives of those over 70, Sweden would be doing very well indeed.

The questions are accumulating but any attempt at answers will have to wait at least a year.

Death League (as of 14th April 2020)

Some of the questions that will have to be addressed in Sweden at some time are:

  • Most countries have used “worst case” models (which are always ridiculously alarmist) but Sweden has used, it seems, “best case” models. Why?
  • Do the mathematical models give a lower “value” to the lives of the 70+?
  • Policy has been to restrict the movement of those over 70 to reduce load on the health service in case they are infected. However the infection carriers are the young and the mobile. Has the policy led to more of the 70+ being infected or less?
  • How much of the spread of infection was initiated/due to returning, asymptomatic tourists from the Alps who were neither tested nor quarantined?
  • Almost 90% of the dead in Sweden are 70+. Was this modeled at all?
  • How many of the 70+ were “prisoners” to infection in their care homes?
  • Was the main source of infection in the care homes through infected but asymptomatic staff?
  • Sweden has more than doubled Intensive Care Places in the last month. By establishing “priorities” for intensive care, Sweden has succeeded in ensuring that they have not been full to the limit. How many of the 70+ were denied Intensive Care due to the “priorities” established by the Social Welfare Board? (Priority is based on “expected life remaining”).
  • Was it optimal that unlike in other countries, leadership was abdicated by politicians in favour of the officials of the National Health Board.
  • …….
  • ….

 

 

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Covid-19 and the culling of humans

March 3, 2020

It’s early days yet to have a clear picture of the effects of the Covid-19 coronovirus outbreak.

In all but being formally declared it is pretty close to being a pandemic.

But what is already pretty clear is that it targets and culls humans by age.

https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

data from worldometers.info

 

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