Regulators of Ontario’s euthanasia program have identified 428 cases of non-compliance by assisted suicide providers since 2016, but none of those violations were reported to the public or law enforcement. 

Alexander Raikin’s report “A Pattern of Noncompliance” in The New Atlantis reveals that lack of adherence to protocol began back in 2016 and 2017 with the first 100 medical assistance in dying (MAiD) fatalities. The visiting fellow in bioethics and American democracy at the Ethics and Public Policy Center (EPPC) uncovered a June 2017 academic paper published in Academic Forensic Pathology co-authored by Chief Coroner of Ontario Dirk Huyer.

One of the standout excerpts from this study was that “MAiD regulations require clinicians to notify the pharmacist of the purpose of the MAiD medications before they are dispensed; however, some physicians listed that they did not abide by these regulations.” Only 61 per cent of pharmacists in the first 100 MAiD cases were told the purpose of prescription.  

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“This is a safeguard,” said Raikin. “If they knowingly don’t follow the safeguard it is punishable up to years in prison. This is in the Criminal Code.”

Raikin noted it is striking that “exactly when you would assume that MAiD providers would be (at their) most diligent and most scrupulous in following the law because it’s a new legislation” there was instead an abundance of breaches.

According to the Canadian writer and researcher, the sole reason why this analysis of the first 100 MAiD deaths is public domain is because one of the authors, Alexandra Rosso, wrote the paper as part of her honours study program at the University of Ottawa.

In an Oct. 9, 2018, memorandum provided to The Register by Raikin, the Office of the Chief Coroner (OCC) noted “some case reviews have demonstrated compliance concerns with both the Criminal Code and regulatory body policy expectations, some of which have recurred over time.” 

As a result, Huyer’s office decided to implement a new system on Nov. 1, 2018, that would see each compliance issue get allotted a “level” of severity — level one being the least serious and level five the gravest. Level one violations would garner an informal conversation/email, escalating to level five where a report would be made to police and College of Physicians and Surgeons of Ontario (CPSO).

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Of 76 compliance issues documented by the new system between Nov. 1, 2018, and Sept. 15, 2020, there were 16 level one cases, 51 level two infractions and nine level three violations. Not a single protocol transgression was elevated to investigative scrutiny. 

“A Pattern of Noncompliance” does contain quotes from Huyer and other euthanasia practitioners that project a message the safeguards in Canada and Ontario are fastidious and the consequences of violating regulatory policies are severe. Raikin included an Aug. 8, 2018, article from The Register in his report where Huyer declared “Ontario has the strongest oversight of any province or territory in Canada. Every case is reported. Everybody has scrutiny on all of these cases.”

Despite these pronouncements, Raikin discovered comments made by Huyer during a private monthly webinar of Ontario nurses in December 2018 — available as an unlisted YouTube video — regarding a “very small handful” of practitioners not deviating from their approach despite educational intervention. 

“And so, we see a pattern of noncompliance, we see a pattern of not following legislation, a pattern of not following regulation, and frankly we can’t just continue to do education to those folks if they’re directly repeating stuff that we’ve brought to their attention,” said Huyer.

Raikin’s report says the case treated with the most severity occurred in 2017 before the level system. Dr. Eugenie Tjan was reported to the CPSO. The regulatory body conducted an investigation and found her care “did not meet the standard of practice and showed a lack of skill, knowledge and judgment.”

The Independent Opinion provider (IO) called upon to scrutinize Tjan declared she “continued to underestimate the magnitude of providing medically-assisted death and the responsibility attached.”

Tjan continues to this day as a licensed physician in Ontario but remains barred from performing assisted suicide. She may continue practising palliative care as long as she is supervised by another doctor. 

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Raikin wrote that “if this most ‘blatant’ case of violating Canada’s criminal law on euthanasia did not trigger a criminal investigation, no wonder the compliance concerns that Huyer’s office identifies have received so little public attention. Meanwhile, out of sight, the number of concerns continued to rise.”

To read Raikin’s full report, visit https://www.thenewatlantis.com/publications/compliance-problems-maid-canada-leaked-documents.