When "No" Doesn't Mean No in Canada
The Story of Johan Jansen at Abbotsford Regional Hospital I Bill Vassilopoulos
10/6/20263 min read
When "No" Doesn't Mean No in Canada: The Relentless Solicitation of MAiD in Our Hospitals
By Bill Vassilopoulos
Subtitle: The Story of Johan Jansen at Abbotsford Regional Hospital
When Medical Assistance in Dying (MAiD) was codified in Canadian law, the public was assured that absolute safeguards would govern the system. Chief among these was the foundational requirement of uncoerced consent—that no patient would ever be pressured, harassed, or repeatedly solicited to end their life.
Yet, a deeply troubling reality continues to unfold across healthcare facilities. Consider the case of Johan Jansen, a senior who was admitted for cancer care at Abbotsford Regional Hospital in British Columbia. While lying in a hospital care area, Johan was repeatedly approached by medical staff offering MAiD. Despite saying no, hospital staff made six separate offers of MAiD to him, pairing the inquiries with warnings about controlling his pain.
Johan maintained his refusal through all six solicitations. His persistence bought him another eight to ten months of life—time spent mending family relationships, making new friends in hospice, and saying a proper, dignified goodbye.
His sister, former MP Tamara Jansen, brought these events to public light, highlighting the severe emotional burden placed on vulnerable patients. As Tamara pointed out, not every frightened, frail patient lying in a hospital bed has the fortitude to stand their ground and say "no" six separate times to the healthcare staff charged with their care.
When a senior must repeatedly defend their choice to live against state-sanctioned lethal options, a line has been crossed. In Canada's modern healthcare apparatus, "no" is increasingly treated not as a definitive refusal, but as an administrative baseline to be probed and re-evaluated.
The Erasure of Boundaries in Patient Care
The fundamental principle of medical ethics is informed consent, which includes the absolute right to decline a procedure without repeated solicitation. When healthcare providers repeatedly suggest lethal intervention to an elder who has already refused, it fundamentally alters the care environment:
Informed Consent vs. Systemic Solicitation: There is a crucial difference between answering a patient’s direct request for end-of-life information and repeatedly presenting lethal injection to someone who has explicitly turned it down.
The Vulnerability of Hospitalized Seniors: Elderly patients in acute care facilities are often physically frail, exhausted, and reliant on medical staff. In that setting, persistent inquiries about MAiD carry an overwhelming weight of authority, leaving patients to question whether their recovery is seen as a burden.
Erosion of Sanctuary: When hospital routines permit staff to repeatedly target non-seeking patients with MAiD options, the hospital ceases to function solely as a sanctuary for care and healing.
Systemic Pressure and Administrative Convenience
Why do cases like Johan Jansen's occur? The answer lies in the structural pressures facing Canadian healthcare.
Overcrowded emergency rooms, hallway nursing beds, multi-year waitlists for specialized care, and severe shortages in home support create an environment where long-term care is resource-intensive. When systemic capacity is stretched to its limit, offering lethal intervention costs the system virtually nothing, whereas providing comprehensive palliative care, rehabilitation, or long-term housing requires sustained institutional investment.
When a senior at Abbotsford Regional Hospital is asked six times if he wants to die, it highlights an ethical failure: a system struggling with bed capacity and care access, yet remarkably persistent in putting lethal options on the table.
Protecting the Dignity of Our Elders
A healthcare system that honors human dignity must establish clear, enforceable boundaries regarding how MAiD is raised:
Patient-Initiated Requests Only: Healthcare providers should be restricted from repeatedly offering or suggesting MAiD to patients who have not requested information.
Honoring the Initial Decision: Once a patient declines MAiD, that decision must be respected, documented, and left undisturbed.
Independent Oversight: Health authorities must establish formal reporting mechanisms to review instances where patients or their families report repeated, unwanted solicitations.
When the boundaries of consent erode for our seniors, public trust in the healthcare system erodes with them. Every patient—regardless of age, diagnosis, or hospital bed placement—deserves to know that when they enter a Canadian hospital, the priority will always be to preserve their life, relieve their suffering, and honor their choices.
To dive deeper into these systemic issues, qualitative interviews, and frontline insights, digital and audiobook editions of Eyes Above the Water are available on my website.
Folks remember: you are irreplaceable, unrepeatable, highly valued... and you are more than a number.
BC woman claims to be offered MAID in hospital before other treatment options
This video is relevant because it reports on a Canadian senior who was offered MAiD as an initial option during a hospital stay in British Columbia, illustrating the real-world systemic concerns regarding end-of-life solicitations in Canadian emergency care.
Warmly, your friend,
Bill