More than 2,000 Canadians have ended their lives legally with the help of a doctor, and most of them were suffering from terminal cancer.
According to the latest report from Health Canada, there were 1,982 medically assisted deaths in the one-year period after it became legal in June 2016. There have been another 167 in Quebec since it was legalized in that province in December 2015, the report said.
The total has been rising faster, with 803 assisted deaths in the first six months after it became legal nationally and 1,179 in the following six months from January to June 2017.
That marks a 47 per cent increase, but it still represents less than one per cent of all deaths in Canada.
Cancer was the most common underlying medical condition, representing about 63 per cent of assisted dying cases. That is in line with other international jurisdictions, including Oregon (72 per cent), Belgium (69 per cent) and the Netherlands (71 per cent.)
Other common reasons for having an assisted death are neuro-degenerative disorders and circulatory or respiratory system failures.
People who received medical assistance in dying ranged in age from 18 to 91.
The majority were between 56 and 85 years old, and the average age was 73.
More deaths outside hospital
The report also noted an increase in the number of assisted deaths outside of a hospital.
Between Jan. 1 and June 30, 2017, about 42 per cent of all assisted deaths occurred in hospital, compared with 50 per cent in the previous six months. Other deaths have taken place in homes, hospices or seniors' residences.
It's still too early to say whether that trend "is the beginning of a longer-term shift attributable to improved system integration and policies designed to facilitate home-based assisted death," the report said.
The shift could also be due to other factors "such as barriers to providing medical assistance in dying in hospitals in some jurisdictions or lack of infrastructure for providing this service in institutions in some smaller communities," it said.
Law too restrictive?
Only five of the reported cases were self-administered deaths, known as assisted suicide. The report notes that health care providers are "less comfortable" with self-administration because of concerns about the patient's ability to properly self-administer the series of medications, and because of the complications that can occur.
No drug commonly used for self-administration in international jurisdictions has been submitted for market approval in Canada, and the report says Health Canada is working with the provincial and territorial governments on "solutions for access to effective and appropriate drugs for self-administration."
Because several provinces do not track the number of requests for assisted death, it is difficult to gauge the ratio of requests that are granted to those that are turned down. But the report noted that the loss of mental competency and the fact that death is not foreseeable are the top reasons for refusal.
The legislation allowing medically assisted death was criticized by some Canadians as too restrictive. The government tasked an independent, arm's-length review of cases involving mature minors, advance requests and cases where mental illness is the sole underlying medical condition.
That study by the Council of Canadian Academies is due to report by December 2018.
Shanaaz Gokool, CEO of Dying With Dignity Canada, said that restricting assistance to those whose death is "reasonably foreseeable" is unconstitutional and is causing more suffering for people who should qualify for medical assistance.
She said she is troubled that many Canadians have died while waiting for an assisted death.
"We have been contacted by people from all over the country who have faced barriers to access," Gokool told CBC News. "We know the longer it takes for a person to receive help, the greater the risk may be that they will lose capacity or die before they can access their right to medical assistance in dying."