Try reading this with autism.
Hundreds of people would seek an assisted death in the first year of a service being available, with that number potentially rising to just over 4,500 after 10 years, according to a government report.
A 149-page impact assessment into the Terminally Ill Adults (End of Life) Bill, measuring the financial impact of the proposed legislation, was published on Friday afternoon.
It estimated there could potentially be between 273 and 1,311 people applying for an assisted death in the first year, rising to between 1,737 and 7,598 in year 10.
And it found the establishment of a Voluntary Assisted Dying Commissioner and panels would cost an estimated average of between £10.9m to £13.6m per year.
The impact assessment found healthcare costs at the end of life could be reduced by as much as an estimated £10m in the first year of an assisted dying service and almost £60m after 10 years.
But, the document noted that cutting end-of-life care costs "is not stated as an objective of the policy".
The bill passed its second reading in the House of Commons on 29 November 2024 with a vote of 330 to 275.
Speaking after publication of the document, she said: "I am grateful to the government for these detailed and thorough assessments of the impact of the Terminally Ill Adults (End of Life) Bill currently going through parliament.
"I'm pleased that MPs now have two full weeks to consider the assessments before the next Commons debate at Report Stage on 16 May."
Supporters of assisted dying will be confident the impact assessment's findings will not sway any MPs and the bill will pass in May and not be derailed ahead of the final vote expected on 13 June.
The timing of the document, which has been prepared by civil servants, has caused some anger among opponents of the bill.
Some have suggested the report was deliberately released to coincide with the results of the local elections.
'We need better care not killing'
Responding to the publication of the impact assessments, Dr Gordon Macdonald, CEO of Care Not Killing, said: "At a time when we have seen how fragile our cash strapped health care system is, how the hospice movement has a £150m black hole in its budget, and when up to one in four Brits who would benefit from palliative care but aren't currently receiving it, introducing so-called assisted dying would be an incredibly dangerous policy that would put pressure on vulnerable, elderly and disabled people to end their lives prematurely.
"We need to fix the UK's broken and patchy palliative care system so everyone can have a dignified death.
"We need better care, not killing."
Changes to the bill since the original vote mean the High Court will no longer need to sign off on assisted dying cases.
Instead, decisions will go through a new panel of medical and legal experts.
On 31 January, 2024, Wade was running out of time. He had tried everything to persuade his 28-year-old daughter, Marge, that she could get better. But Marge had been scheduled to die by assisted suicide at 2 p.m. the next day at the family’s home in Alberta, Canada. He was horrified. Marge was autistic, vulnerable, and had no diagnosed physical illness. Her autism made her different from her peers — and lonely, no doubt — but Wade knew this was no reason to terminate a young life.
He had to do something. So he went to the courts. The legal claim he filed on that frigid winter day would put Wade on a quest no father should have to face: saving his daughter’s life from a Canadian health system that at times appears more committed to delivering death than protecting health. By taking legal action, he managed to delay Marge’s death for a while. But he is set to lose the battle.
Wade and Marge aren’t the real names of this story’s subjects. The case is under a Canadian publication ban issued by a provincial court in Alberta, leaving Marge’s family reluctant to speak on the record. Yet with the pro-euthanasia Liberals re-elected to power in Canada and assisted-suicide legislation swiftly clearing obstacles in Britain and New York state, among other jurisdictions, their story must be told: for it highlights the slippery-slope expansion of the categories of patients deemed eligible for suicide-by-doctor, once the practice is legalised.
After the January notice came the details. The last physician to assess her for assisted suicide, a family doctor practicing with the Alberta Health Services (AHS), took fewer than 24 hours to review and approve her application. And although the neurologist treating her for fatigue and pain assessed her as “normal”, another family doctor, unknown to her parents, declared her to be terminally ill. The clinic at which this family doctor practices referred UnHerd’s request for comment to AHS, which told UnHerd that “as this is before the courts, we are unable to provide comment”.
“She tells us that she’s getting [Medically Assistance in Dying], and of course we freak out”, Wade tells me. “I was new to MAiD. I didn’t know anything about it.” He describes his daughter, Marge, as an intelligent young woman. He loves her, and he was saving money for her to be independent, to move her from the family home to her own apartment. She was healthy, but convinced she was sick.
Her only diagnosed conditions were autism and ADHD, which made it difficult for her to keep in touch with her friends during Covid lockdowns or to hold down a job. Her life was nocturnal and online, and that worried him, as did the sort of online peer pressure that bears down especially on younger women. Wade says: “For the last eight years, she has spent a lot of time online researching medicine and adverse medical conditions”. She slept through the day and stayed up most nights until 4 a.m. or later as she accessed “online support groups and chat rooms with other people who share her sickness”.
Canada has become a warning light for the limits of enforcing safeguards for euthanasia. Even though hundreds of reported violations of Canada’s criminal law on euthanasia were never fully investigated by authorities, Marge’s story is different. She has thus far refused to make public the diagnosis on which she based her application for suicide. Her father, however, insists that it’s her autism that has caused to her become fixated with being sick — terminally so.
In Canada, intellectual disabilities or mental illness alone are no reason for people to receive MAiD. That’s unlike the Netherlands, where at least five people with intellectual disorders younger than 30 cited autism as their primary motivation for euthanasia. Canada is supposed to be different — at least, until 2027, when the country will expand the law to approve assisted-suicide requests for cases of mental illness alone.
As it is, to qualify for euthanasia in Canada, you need any two physicians or nurse practitioners to say you meet the eligibility requirements. You must be over 18 years of age, mentally competent, eligible for health care, and have a “grievous and irremediable” physical illness or disability. Marge’s autism, her parents have argued in court, means that his daughter “is vulnerable and is not competent to make the decision to take her own life”.
It was 2021 when Marge first filled out the form — without telling her parents — asking to die. AHS, the public health-care system, connected her with two physicians. Although one physician deemed her eligible without any diagnosed physical symptoms, according to Wade, the second denied her application, presumably because she had no terminal illness. She seems to have only met some of the requirements, although it is impossible to know for sure without access to her MAiD assessment. Alberta’s policy was that in the case of a tie, the suicide would not proceed.
But Marge was determined.
In 2022, she went doctor-shopping. She found another physician, an Alberta family practitioner, who intervened and supported her (their clinic didn’t reply to UnHerd’s request for comment). Unknown to the family, this doctor signed a change in her “Goals of Care Designation”, which is the medical standard used in Alberta to indicate how severely ill someone is. The doctor switched it to the most extreme category, which in some Canadian provinces indicates the likelihood of imminent death; that was almost three years ago.
The following year, in 2023, she applied for assisted dying a second time. Once again, the two physicians consulted disagreed. (The clinics at which these two practice didn’t reply to UnHerd’s request for comment; AHS declined to comment, citing the court case.) This time, however, the so-called MAiD navigator, who sherpas patients through the process, connected Marge with a third doctor as a “tiebreaker”. The chosen physician was the same one who had approved Marge’s MAiD application the first time, and did so again, within 24 hours.
It was only then that her parents found out from Marge that she had been approved for assisted suicide. Her parents pushed back. Tempers flared. And the MAiD navigator claimed that Wade was a “safety risk given his threats” fewer than two weeks before she was set to die.
Her father couldn’t understand how any doctor could think Marge was qualified to die. “I thought MAiD was for, like, you’re dying anyway. So, we’ll just speed it up because you’re suffering. That’s what I thought it was for”, he tells me. “And I’m thinking, well, how could this be for Marge?” So, the day before her “MAiD provider” was meant to pay a final house visit, when a physician and a nurse would bring the lethal but now routine injection of a sedative, a coma-inducing agent, and a neuromuscular tranquiliser, Wade filed a last-minute court challenge. He claimed that Marge did not have a “grievous and irremediable medical condition”, that her only diagnosed illnesses were mental, not physical, and that her second tie-breaking assessor was not independent.
That day, an initial judge granted the temporary injunction to block physicians from ending the life of Wade’s daughter. But then the case went to trial.
This was the first time anywhere in North America that a legal assisted suicide for a non-terminally ill patient, approved by any two physicians, was stopped by a court, at least in its preliminary stage. The judge, Justice Colin Feasby, of the Court of King’s Bench, Alberta, ruled that Marge’s father had a reasonable cause of action that the correct protocols around assisted dying weren’t followed. Marge had no terminal illness. Neither of the MAiD assessors appeared to be experts on Marge’s autism. And the independent assessor appointed as tiebreaker wasn’t, either.
Once it came to ruling on the substance of the dispute, however, the judge wouldn’t consider whether Marge qualified for assisted suicide; no evidence was accepted on even naming the condition for which she was approved. Any criminal prosecution, the judge ruled, could only happen after Marge is dead: “Parliament has put its trust in doctors and nurse practitioners, and it is not for this Court to second guess that choice.”
In Britain, Kim Leadbeater — a member of Parliament whose proposal to legalise the practice is set for a critical vote in the House of Commons this May — recently claimed that “there would be an injunction” by the parents of a person with a learning disorder if their child was choosing to die for the wrong reasons. In response to this, Wade says, “I know it won’t work”. When his injunction was thrown out, the judge ruled that his doubt didn’t matter. “As a court”, Judge Feasby held, “I can’t go second-guessing these MAiD assessors … but I’m stuck with this: the only comprehensive assessment of this person done says she’s normal”.
The ruling was no surprise. Since the Supreme Court of Canada decriminalised euthanasia, scarcely any judges in Canada have found problems with euthanasia safeguards. Rather, past rulings reinforced that MAiD wasn’t expansive enough. The 2019 Truchon v. Canada case expanded the practice to include nonterminal illnesses. Failing those who weren’t dying, the ruling said, would be tantamount to discrimination against people without a terminal illness.
One of the two plaintiffs, Jean Truchon, a 51-year-old euthanasia advocate with spastic cerebral palsy, requested to die because he was suffering from a severe disability that prevented the use of his arms. Yet Truchon also told a friend that he would have chosen to live if he received adequate support at home.
The Trudeau government chose not to appeal the decision, despite opposition from virtually every prominent disability-rights organisation in Canada.
In Marge’s case, too, Canadian disability groups mobilised against the ruling; they agreed with Wade that disabilities shouldn’t be compared to a terminal illness. At stake is a future where disability supports are neglected for immediate and cheaper death-on-demand, only for those whose disabilities are too profound or serious for the state to support
In September, some of the largest Canadian disability groups launched a constitutional challenge against euthanasia based on nonterminal disabilities. The suit claimed it is an “appalling injustice” to offer suicide just on the grounds of disability. “It is not just wrong”, says Krista Carr, the executive vice president of Inclusion Canada, in an email to me. “It is discriminatory and violates our most fundamental rights.”
Yet even if that constitutional challenge triumphs, it will be too late for Wade. He says he has spent more than $150,000 in legal fees, half of it through credit-card debt; a further legal appeal would have to come from money he doesn’t have. But the expense did not bother him: “This is just money. We can make it. We can’t go to the store and buy another Marge. I don’t regret it at all.”
His legal challenge failed, but it restarted Marge’s assisted-dying process from the beginning. He tells me she had applied again. Meanwhile, in April 2024, Wade appealed the court’s decision, which delayed any further assisted-suicide approval until October that year, when his appeal case was to be heard. But Marge began starving herself that June, so he dropped the appeal a week later.
More recently, I received another message from Wade. Marge’s third application to die had been approved. Wade waits, angry and terrified, to receive the scheduled appointment of his daughter’s death. It could happen anytime.
