Dr Paul Saba

Dr Paul Saba

As the United Kingdom’s House of Lords debates the legalization of medically assisted dying—commonly called MAID (Medical Assistance in Dying) in Canada—I want to warn the people of the United Kingdom not to go down this wrong and dangerous road that Canada has embarked on since 2016. 

The first reason not to legalize assisted suicide is that the eligibility for ending patients’ lives expands dramatically over time. This leads to unnecessary deaths for people who may have many years, if not decades, left to live. 

When Canada first legalized MAID in 2016, it was supposed to be for only a handful of terminally ill patients with just days to live. In 2016, there were 1,018 assisted deaths. By 2023, the number had increased to 15,343. From the inception of the law to the end of 2023, 60,301 Canadians had their lives ended by physician-assisted death. The numbers continue to rise each year. (Link) 

Québec, the province where I practise medicine, has the highest rate of euthanasia in both Canada and the world, at 7.6% of all deaths in the province. In 2024, the Commission sur les Soins de Fin de Vie—a government body that oversees end-of-life care—reported 6,058 euthanasia deaths between April 1, 2023 and March 31, 2024. (Link) 

The law was extended from those with terminal illnesses to those with chronic conditions and disabilities in 2021, following the passage of Bill C-7. Those with fragile health are also considered candidates for assisted dying. 

Starting in March 2027, those with mental illness will be eligible for physician-assisted death. I am strongly opposed to this expansion, as are many in the medical and psychiatric communities, who have raised concerns about the dangers of offering assisted suicide to vulnerable individuals with mental health challenges. This move has been highly controversial in Canada, with many experts warning about the risks of premature death among those who could otherwise recover or improve with treatment. 

As a physician, I sit on a review committee at one of Canada’s medical centres that assesses assisted deaths. The majority of the cases I have reviewed include people with medical conditions or disabilities, most with associated psychological and social factors that greatly influence their decision to request physician-assisted death. These factors include social isolation, feeling that they are a burden, loss of autonomy, and psychological distress. Based on my observations, physical pain was the least common reason. My experience is confirmed by Canada’s recent report on physician-assisted death. (Link) 

The State of Oregon was the first US state to legalise assisted suicide. In that state, the reasons for assisted suicide shows a similar pattern to Canada with loss of independence, wanting to control the time and manner of death, the fear of worsening pain or quality of life and the inability to care for themselves heading the list. (Link) 

Another reason not to go down this dangerous road is because of diagnostic errors. Physicians are human. When doctors give a patient a diagnosis, they can be wrong. In fact, errors in diagnosis for severe, life-threatening conditions may be as high as twenty percent in hospitalized patients. (Link) 

Several years ago, one of my patients, Jim (a pseudonym to protect his identity), came to me with a cough, thinking he had a cold. I ordered a chest x-ray. According to the radiologist’s report of the chest film, Jim appeared to have lung cancer. 

I sat down with Jim and said: 

“We need to do a scan right away. We need to get you to see a specialist. We need to do a bronchoscopy….” 

Jim responded: 

“Dr. Saba, I know you’re against assisted suicide, but you know what? I don’t necessarily agree with you. If I’m going to die, if my time is up….” 

I replied, 

“No, no. You have to go through the process because this is only a preliminary diagnosis. Even if it is lung cancer, it is treatable today. There are new treatments. It may not even be lung cancer.” 

I spoke to the radiologist who performed the lung scan, who said, 

“We’re not sure what it is. It appears to be lung cancer but it may be a lymphoma, which would be highly treatable.” 

Jim is an intelligent, well-informed man, an engineer, who thought he had a cold, then was told he might have cancer. He could have resigned himself to a medically assisted death before he even knew what we were dealing with, since Canadian law does not require that all diagnostic avenues be exhausted before a person is deemed eligible for MAID. Under current policy, a person can be eligible without undergoing every investigation necessary to confirm the diagnosis or rule out effective treatment. He could have given up hope while the situation was still filled with hope. The power to move people to give up is one of the dangerous and misleading aspects of medically assisted dying. 

However, I was able to get his attention and persuade him that the situation was hopeful and that he should get more tests and undergo treatment. The result? He called me in the summer of 2019 to thank me because there was no further evidence of disease, which is still the case today. He had finally been diagnosed with Hodgkin’s lymphoma, which is a condition that is highly curable with proper medical treatment. 

A Canadian study found that 13% of patients with a diagnosis of “lung cancer” who died by MAiD did not have a biopsy-proven diagnosis of lung cancer. Moreover, only a third of those diagnosed with advanced lung cancer underwent systemic treatments despite the availability of known effective treatments. (Link) 

This is what happens when the door is opened to assisted dying. Jim could have been another assisted dying fatality. I am a doctor who believes medicine must be grounded in solid science, in what research and experience teach us about how the body works and heals. 

Another reason not to go down the deadly road of assisted suicide is because it becomes an excuse for a faulty healthcare system lacking resources. Canada‘s publicly funded healthcare system lacks access to care for family physicians, specialists, investigative studies and has long waiting times for surgeries. In fact, Canada is considered one of the worst healthcare systems among OECD countries. (Link) 

Inversely, Canada has one of the fastest growing assisted dying programmes in the world. (Link) In contrast, palliative care for people seeking end-of-life care is not available for 70% of the population. The resources used for assisted dying should be rerouted to treat these patients. (Link) 

Canada like the United Kingdom has a publicly funded healthcare system. In Canada, assisted dying has become the default procedure for a healthcare system that has seriously failed to adequately care for its population. Similarly, Australia, which is given as an example for the British assisted suicide Bill, also has failed at providing quality palliative care. (Link) 

The conclusion—hope is one of the most powerful forces for good medical care. When I say hope is a powerful force for health, I mean that hope counsels us to patience, to seeing processes through, and to regarding every step as part of the great gift of being made for life. Assisted dying destroys that hope and leads people to giving up on life before their time. 

Dr. Paul Saba is a physician currently practicing family medicine in Lachine, Québec. He has worked in Canada and around the world. He is a co-founder of the Physicians Alliance Against Assisted Suicide (https://collectifmedecins.org/en/about/) and is the author of the book Made to Live (madetolive.com) +1 514-886-3447 pauljsaba@gmail.com