'I could live 30 years - but want to die': Has assisted dying in Canada gone too far?

Before she was approved for Maid, April was assessed by two independent physicians who were required to inform her of ways to alleviate her suffering and offer alternative treatments.

"The safeguards are there," she says, when we press her about disabled people who feel threatened by assisted dying, or whether Maid is being used as a shortcut to better quality care. "If it's not right for you and you're not leading the charge and choosing Maid, you're not going to be able to access it unless it's for the right reasons," she adds.

There were 15,343 Maid deaths in 2023, representing around one in 20 of all deaths in Canada - a proportion that has increased dramatically since 2016 and is one of the highest in the world. The average age of recipients was 77.

In all but a handful of cases, the lethal dose was delivered by a doctor or nurse, which is also known as voluntary euthanasia. One doctor we spoke to, Eric Thomas, said he had helped 577 patients to die.

Some 96% of Maid provisions are under "track one" where death is "reasonably foreseeable". Dr Trouton says that means patients are on a "trajectory toward death", which might range from someone who has rapidly spreading cancer and only weeks to live or another with Alzheimer's "who might have five to seven years".

The other 4% of Maid deaths come under "track two". These are adults, like April, who are not dying but have suffering which is intolerable to them from a "grievous and irremediable medical condition".

That is in stark contrast to Labour MP Kim Leadbeater's bill to legalise assisted dying in England and Wales, which says patients must be expected to die within six months. The Westminster bill would not allow doctors to give a lethal dose – rather patients would have to self-administer the drugs, usually by swallowing them.

Death via intravenous infusion normally takes just a few minutes, as the lethal drugs go straight into the bloodstream, whereas swallowing the drugs means patients usually take around an hour or two to die, but can take considerably longer, although they are usually unconscious after a few minutes.

Dr Trouton told me she regarded the Canadian system as quicker and more effective, as do other Maid providers. "I'm concerned that if some people can't swallow because of their disease process, and if they're not able to take the entire quantity of medication because of breathing difficulties or swallowing difficulties, what will happen?"

But opponents argue it's being used as a cheaper alternative to providing adequate social or medical support.

One of them is Dr Ramona Coelho, a GP in London, Ontario, whose practice serves many marginalised groups and those struggling to get medical and social support. She's part of a Maid Death Review Committee, alongside Dr Trouton, which examines cases in the province.

Dr Coelho told me that Maid was "out of control". "I wouldn't even call it a slippery slope," she says "Canada has fallen off a cliff."

"When people have suicidal ideations, we used to meet them with counselling and care, and for people with terminal illness and other diseases we could mitigate that suffering and help them have a better life," she says. "Yet now we are seeing that as an appropriate request to die and ending their lives very quickly."

While at Dr Coelho's surgery I was introduced to Vicki Whelan, a retired nurse whose mum Sharon Scribner died in April 2023 of lung cancer, aged 81. Vicki told me that in her mum's final days in hospital she was repeatedly offered the option of Maid by medical staff, describing it as like a "sales pitch".

The family, who are Catholic, discharged their mother so she could die at home, where Vicki says her mum had a "beautiful, peaceful death". "It makes us think that we can't endure, and we can't suffer a little bit, and that somehow now they've decided that dying needs to be assisted, where we've been dying for years.

"All of a sudden now we're telling people that this is a better option. This is an easy way out and I think it's just robbing people of hope."

So is Canada an example of the so-called slippery slope? It's certainly true that the eligibility criteria has broadened dramatically since the law was introduced nine years ago, so for critics the answer would be an emphatic yes and serve as a warning to Britain.

Canada's assisted dying laws were driven by court rulings. Its Supreme Court instructed Parliament that a prohibition on assisted dying breached the country's Charter of Rights and Freedoms. The extension of eligibility for those who were not terminally ill was in part a response to another court decision.

In Britain, judges in the most senior courts have repeatedly said any potential change to the law around assisted dying is a matter for Parliament, after the likes of Tony Nicklinson, Diane Pretty and Noel Conway brought cases arguing the blanket ban on assisted suicide breached their human rights.

April knows some people may look at her, a young woman, and wonder why she would die.

"We're the masters of masking and not letting people see that we're suffering," she says. "But in reality, there's days that I just can't hide it, and there's many days where I can't lift my head off the pillow and I can't eat anymore.

"It's not a way I want to live for another 10 or 20 or 30 years."

Additional reporting by Joshua Falcon.