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Takeaways from AP's report on euthanasia, doctors and ethics in Canada

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Takeaways from AP's report on euthanasia, doctors and ethics in Canada

TORONTO (AP) — Canada has arguably the world’s most permissive system of euthanasia — the practice of doctors and nurse practitioners killing patients with an injection of drugs at their request. Canada allows euthanasia for people who aren’t terminally ill but are suffering unmanageable pain.

As Canada pushes to expand euthanasia and more countries move to legalize it, health care workers here are grappling with requests from people whose pain might be alleviated by money, adequate housing or social connections. And internal data obtained exclusively by The Associated Press from Canada’s most populous province suggest a significant number of people euthanized when they are in unmanageable pain but not about to die live in Ontario’s poorest areas.

Here’s a look at the main takeaways from an AP investigation into euthanasia in Canada, commonly known there as medical assistance in dying, or MAiD.

Some doctors fear providing euthanasia, even in legal cases

Canada allows euthanasia for people with “irremediable suffering” from serious but nonfatal medical conditions and disabilities.

After euthanasia was legalized in 2016, doctors and nurses set up email discussion groups as confidential forums to discuss potentially troubling cases, with limited patient details. They’re now run by the Canadian Association of MAiD Assessors and Providers, an educational and research organization.

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Dozens of messages provided to the AP by a participant in the forums — on condition of anonymity, due to the confidential nature of the messages and cases — show a fraught process where medical professionals test the limits of what conditions warrant euthanasia.

In one case, a middle-aged worker whose ankle and back injuries made him unable to resume his previous job told his doctor the government’s measly support was “leaving (him) with no choice but to pursue MAiD.” His doctor told forum participants the patient met legal criteria, with severe pain, strained social relationships and inability to work.

Others agreed, but the doctor hesitated because the man cited reduced government payments as a key factor — and the doctor noted fear of being portrayed in the media as having euthanized someone “in a case where services were inadequate.”

Case of homeless people spark debate

Cases of homelessness appear regularly on the private forums.

One doctor wrote that although his patient had a serious lung disease, his suffering was “mostly because he is homeless, in debt and cannot tolerate the idea of (long-term care) of any kind.” A respondent questioned whether the fear of living in a nursing home was truly intolerable. Another said the prospect of “looking at the wall or ceiling waiting to be fed … to have diapers changed” was sufficiently painful.

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One provider said any suggestion they should provide patients with better housing options before offering euthanasia “seems simply unrealistic and hence, cruel,” amid a national housing crisis.

Data suggest marginalized people are affected

Government officials have largely refuted the idea that socially disadvantaged people are being euthanized.

But in Ontario, more than three-quarters of people euthanized when their death wasn’t imminent required disability support before their death in 2023, according to data from a slideshow presentation by the province’s chief coroner, shared with AP by both a researcher and a doctor on condition of anonymity due to its sensitive nature.

Of people killed when they weren’t terminally ill, nearly 29% lived in the poorest parts of Ontario, compared with 20% of the province’s general population living in the most deprived communities, the data show.

The figures suggest poverty may be a factor in Canada’s nonterminal euthanasia cases.

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But Dr. Dirk Huyer, Ontario’s chief coroner, told AP that the data was only an early analysis and “it’s tough to know exactly what it means,” saying that his job was only to present the statistics.

Poverty doesn’t appear to disproportionately affect patients with terminal diseases who are euthanized, according to the leaked data. Experts say no other country with legal euthanasia has seen a marked number of deaths in impoverished people.

Overall for Ontario, the data show, nonterminal patients account for a small portion of all euthanasia cases: 116 of 4,528 deaths last year. But the presentation and discussion among Ontario officials and medical professionals show rising awareness of euthanasia deaths for social reasons.

Privately, officials admit concern

Canadian officials have examined worrisome cases that haven’t been publicly disclosed.

A document from the Ministry of the Solicitor General in Ontario sent to all euthanasia providers in the province in May noted two cases of “lessons learned” in nonterminal cases. The document was shared with AP by a doctor on condition of anonymity because it wasn’t authorized for release.

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In one, a 74-year-old patient who’d suffered blood pressure, a stroke and blindness was increasingly dependent on their spouse. The patient told their doctor they were interested in euthanasia, citing deteriorating vision loss and quality of life.

Among other issues identified, officials wrote the patient’s euthanasia was scheduled “based on the spouse’s preference of timing” and questioned whether “the patient’s death was genuinely voluntary.”

Canada pushes boundaries

Theo Boer, professor of health care ethics at Groningen University in the Netherlands, said that unlike other countries with legal euthanasia, Canada appears to be providing it for social reasons in some cases.

“That may be what Canadians want, but they would still benefit from some honest self-reflection about what is going on,” he said.

Some of that reflection is happening in the confidential providers’ forums. They’ve debated whether it’s valid to euthanize people for obesity in several cases. They’ve also beem divided over ending the lives of people in mourning.

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Canada’s government said it legalized euthanasia to reduce suffering and support individual autonomy — and polls have consistently shown public approval.

But its laws are now being challenged on all sides. The advocacy group Dying with Dignity filed an August lawsuit in Ontario, alleging it’s “discriminatory” to exclude mentally ill people from euthanasia. Meanwhile, a coalition of disability-rights organizations in another lawsuit argued that euthanasia legislation has resulted in the premature deaths of people with disabilities.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. This story also was supported by funding from a Pulitzer Traveling Fellowship grant. The AP is solely responsible for all content.

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Massive 11,000-carat ruby believed to be second-largest ever found in conflict-ridden country

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Massive 11,000-carat ruby believed to be second-largest ever found in conflict-ridden country

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A massive ruby unearthed in Burma is being hailed as the second-largest ever discovered in the conflict-ridden country.

The ruby weighs about 11,000 carats — about 4.8 pounds — and was unearthed near Mogok in the Mandalay region, the center of Burma’s gem industry and an area affected by ongoing conflict, according to The Associated Press, citing state media. 

The stone was found in mid-April, shortly after the country’s traditional New Year celebrations.

MAN STUMBLES ONTO RARE DIAMOND TREASURE DURING ARKANSAS PARK TRIP WITH FAMILY: ‘KNEW IT WAS DIFFERENT’

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Burma’s newly discovered ruby is displayed at the president’s office in Naypyitaw on May 7, 2026. (Myanmar Military True News Information Team/AP)

Although it is roughly half the size of a 21,450-carat ruby discovered in 1996, experts say the new find could be more valuable because of its higher quality, the outlet reported.

It has a purplish-red color with slight yellow tones, moderate transparency and a highly reflective surface.

Burmese President Min Aung Hlaing and his cabinet have already inspected the stone in the country’s capital of Naypyidaw.

ONCE-IN-A-CENTURY TREASURES DATING BACK 4,500 YEARS UNEARTHED IN LEGENDARY CITY

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Burmese officials inspect a newly discovered ruby at the president’s office in Naypyidaw on May 7, 2026. (Myanmar Military True News Information Team/AP)

Burma produces up to 90% of the world’s rubies, mostly from Mogok and nearby Mong Hsu. 

The gem trade — both legal and illegal — is a major source of income in the country.

However, rights groups, including Global Witness, have long urged jewelers to avoid buying Burmese gemstones, saying the trade helps fund the country’s military governments, according to The Associated Press.

RARE 10-CARAT BLUE DIAMOND AMONG $100M WORTH OF GEMS GOING UP FOR AUCTION

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This photo taken on May 16, 2019, shows miners working in a ruby mine in Mogok, north of Mandalay. (Ye Aung Thu/AFP via Getty Images)

Gem mining also finances ethnic armed groups fighting for autonomy, contributing to Burma’s long-running conflicts.

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The mining regions remain unstable. 

Mogok was seized in July 2024 by the Ta’ang National Liberation Army (TNLA), an ethnic armed group. Control later returned to the military under a ceasefire deal brokered by China late last year.

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The Associated Press contributed to this report.

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‘We need to make up our mind’: EU split over direct talks with Russia

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‘We need to make up our mind’: EU split over direct talks with Russia

The European Union is still struggling to decide if, how, and when it wants to talk directly with Russia to advance negotiations towards a lasting peace in Ukraine, as member states remain split on whether the benefits would outweigh the risks.

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The absence of political unity, an indispensable precondition for such a significant undertaking, was laid bare on Monday during a meeting of foreign affairs ministers in Brussels, where several representatives urged fresh sanctions rather than dialogue.

“(Vladimir) Putin is really not interested in real peace talks yet. So we need to put more pressure on Russia in order to change the calculus and make him interested,” Sweden’s Maria Malmer Stenergard said upon arrival.

“What will we discuss? What will be our demands? Can we agree on our demands on Russia?” said Lithuania’s Kęstutis Budrys. “What is our strategy and agenda, and what’s the goal? What’s the end state? It’s not dialogue as dialogue per se.”

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Italy’s Antonio Tajani said the EU was “not at war” with Russia and it was “important” to be part of the ongoing negotiations, while Austria’s Beate Meinl-Reisinger noted it was time for Europeans to become active participants through their own team.

“We need to make up our mind,” said Finland’s Elina Valtonen.

The only point on which ministers agreed was that Europeans themselves should pick their envoy. The Kremlin’s suggestion to nominate Gerhard Schröder, the former German chancellor who has worked for Russian energy firms, was unequivocally dismissed.

At the end of the meeting, High Representative Kaja Kallas acknowledged that the topic was not yet mature and required further reflection among governments.

“The EU has always supported attempts to achieve a just and lasting peace,” Kallas said.

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“For Europe to take a more active role, we must agree amongst ourselves what we want to talk to Russia about and what our red lines are.”

The High Representative, who previously said the EU should not “humiliate” itself by seeking direct talks with Russia, has been trying to bridge gaps among capitals with a draft document outlining the concessions Moscow should make.

The confidential document will be discussed later this month when foreign ministers meet again for an informal gathering in Cyprus. However, given the considerable divergences, a unified position is unlikely to emerge any time soon.

“We are not there entering the negotiations in any way,” Kallas cautioned. “Right now, we don’t see that Russia is really negotiating in good faith.”

If, how and when

The question of whether the EU should engage directly with Russia to end its war of aggression has been popping up in and out of the conversation since US President Donald Trump unilaterally launched a diplomatic process to end the war in Ukraine.

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Earlier this year, French President Emmanuel Macron, who last spoke with Putin in July 2025, and Italian Prime Minister Giorgia Meloni publicly called on the bloc to change policy, arguing the fate of European security could not be left in American hands.

The debate lost traction after Macron’s advisor, Emmanuel Bonne, travelled to the Kremlin for exploratory talks and was given the cold shoulder.

But it has once again risen to prominence as a result of the conflict in the Middle East, which has shifted Washington’s focus and slowed down the mediation in Ukraine.

Last week, Ukrainian President Volodymyr Zelenskyy, who seems increasingly frustrated with the White House’s course of action, asked Europeans to take a more active role.

“We need to find a workable diplomatic format, and Europe must be at the table in any talks with Russia,” Zelenskyy said at a summit in Armenia. “It would be good to develop one common European voice for talks with Russia.”

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A few days later, European Council President António Costa said there was “potential” for the bloc to negotiate one-on-one with the Kremlin.

“I’m talking with the 27 national leaders to see the best way to organise ourselves and to identify what we need effectively to discuss with Russia when it comes to the right moment to do this,” Costa said in Florence, Italy.

The European Commission also weighed in. “We can see the merit of having one single figure speaking on behalf of the 27,” a spokesperson said.

Both Costa and the Commission were quick to note that direct talks would only make sense once the Kremlin showed willingness to compromise and make concessions. Putin insists that Kyiv give up the entire Donbas region and that the West recognise the occupied territories aslegally Russian — both demands that Zelenskyy firmly rejects.

Brussels is keen to avoid creating the impression that it is attempting to replace Washington, which might give Trump a reason to walk away for good.

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On Monday, Ukrainian Foreign Minister Andrii Sybiha said the EU should not pursue “alternative peace talks” but rather play a “complementary” role in the ongoing process.

Russia’s relentless bombardment of Ukraine’s civilian infrastructure, including a kindergarten last week, is another factor that makes officials and diplomats think twice.

Instead, some capitals prefer to wait and weaken Russia’s hand at the negotiating table. The country has begun to show signs of economic strain after 20 rounds of sanctions and was forced to pare down its Victory Day parade over fears of Ukraine’s strikes.

At the same time, Kyiv’s standing has been reinforced by the approval of the EU’s €90 billion assistance loan and the signing of multiple defence deals with Gulf countries.

“Russia must be pushed back to Russia,” Estonia’s Margus Tsahkna said. “Putin is not ready to talk about a lasting and just peace at all.”

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What Middle Powers Fear from the Trump-Xi Summit

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What Middle Powers Fear from the Trump-Xi Summit

Poland will soon host production lines for South Korean tanks. Australia is buying warships from Japan. Canada will send uranium to India, while India offers cruise missiles to Vietnam, and Brazil builds military transport planes for the United Arab Emirates.

All of these deals were sealed in the past few weeks. Each one represents an attempt by middle powers to protect themselves as the conflict in Iran throttles global energy supplies, and as a high-stakes summit between President Trump and Xi Jinping of China looms.

Global polls show the world has little trust in the United States and China. Mr. Trump and Mr. Xi have both used their enormous leverage over trade and security to coerce or punish. And in response, smaller nations are behaving as if they are stuck in “Godzilla” or “Dune” — moving quietly in small groups, trying not to provoke the wrath of petulant giants.

“It’s fifty shades of hedging,” said Richard Heydarian, a Filipino political scientist at Oxford University. Or, as Ja Ian Chong, a security analyst in Singapore put it, “No party wants to cross Beijing and now Washington, too.”

For countries watching from afar, dread and hope hover over the Trump-Xi meeting in Beijing, which is scheduled for this week. In Asia, which has been hit hardest and fastest by oil shortages caused by the war and China’s tight control of oil-product exports, the mood is particularly grim. Interviews with officials, and statements from leaders traveling the globe to secure trade and defense deals, suggest that most middle powers feel overwhelmed by the deteriorating world order.

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Many believe the summit carries more potential for harm than help. And Mr. Trump’s gut-driven approach to complex issues is the main source of anxiety.

For months, officials in Asia have worried that the president might be too eager to make a deal with Mr. Xi, ending weapons sales to Taiwan or agreeing to softened policy language that could make it easier for China to undermine the democratic island.

“That would be the biggest nightmare,” said one Taiwanese official who spoke on condition of anonymity to discuss internal government matters. He insisted that reduced support from the U.S. was unlikely.

But any concession on Taiwan could lead other American partners to fear abandonment. Beijing’s push for compliance on contested territory elsewhere would be bolstered, from the border with India to the South China Sea.

Vietnamese officials said that if President Trump makes a conciliatory gesture or flatters Xi, even without bigger compromises, China will gain leeway to press harder on smaller countries.

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Another concern being discussed across the region: that Mr. Trump might alter long-term security plans in exchange for better economic terms with China.

Mr. Trump’s decision to redirect a carrier strike group from the Pacific and munitions from South Korea for the war in Iran may have created momentum for broader redeployments. When the Pentagon announced it would pull at least 5,000 troops from Germany after Mr. Trump expressed annoyance with the German chancellor, allies in Asia were again reminded how quickly collective deterrence can be weakened.

Mr. Trump has threatened in the past to make troop withdrawals from Japan, which hosts around 53,000 American military personnel — more than any other country — and South Korea, where another 24,000 Americans are stationed. If he could get something big from Mr. Xi for a drawdown, would he turn down the deal?

Analysts noted that plans opposed by China, such as AUKUS, a pact between Australia, England and the U.S. designed to counter Beijing’s influence by equipping Australia with nuclear-powered submarines and advanced technology, could also be suddenly canceled.

“The sense that U.S. allies have to look to one another because they can no longer look to America is very real,” said Hugh White, a former Australian intelligence official who teaches strategic studies at the Australia National University.

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That sentiment is much stronger than “the cautious public language” of national leaders might suggest, he added.

European and Asian officials often talk privately in frank terms about giving up their faith in America, prompting a no-turning-back effort to diversify away from the United States. In casual discussions with reporters, they can sound a lot like Prime Minister Mark Carney of Canada, who received a standing ovation in Davos this year for a speech that declared, “We are in the midst of a rupture, not a transition.”

But in public, they’re more circumspect. Some officials admit their countries are trying to buy time and evade Mr. Trump’s fits of pique, while continuing the performance of imperial fealty.

South Korean officials have simply expressed resignation over American military diversions, after making clear they felt betrayed in 2004, when President George W. Bush announced plans to move troops from Asia to the war in Iraq. Australia, Taiwan and Japan publicly and repeatedly stress the value of American leadership without caveats — even as U.S. tariffs and the war Mr. Trump started with Iran kneecap their economies.

No one wants to be seen stepping out of line.

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Japan’s new prime minister, Sanae Takaichi, has been bolder than most in trying to foster stronger relationships with other countries. Yet even as she crisscrossed the region promoting military cooperation, officials in Tokyo worried about how Washington would view her efforts.

“The Japanese don’t want Takaichi’s security cooperation and tour, especially to Australia, to be seen as a version of Mark Carney,” said Michael J. Green, the author of several books on Japan, and chief executive of the United States Study Centre at the University of Sydney.

Others have apparently reached the same conclusion. Mr. Carney’s recent visits to India and Australia did not yield strong statements from their leaders echoing his criticism of great power rivalry or his warning that if middle powers are “not at the table, we’re on the menu.”

At the same time, many countries — including some that are benefiting from the thickening of middle-power bonds — have been careful not to anger the world’s other hegemon, China.

Nations managing their own disputes with Beijing, such as Indonesia, have done less to rally around Japan than some in Tokyo would have liked, since Ms. Takaichi became embroiled in a diplomatic crisis after telling her Parliament that if China attacked Taiwan, Japan could respond militarily.

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Vietnamese officials even pressed Ms. Takaichi to avoid directly criticizing China in her speech at a university on May 2 in Hanoi, according to diplomats who spoke on condition of anonymity to describe sensitive discussions. It is not clear if adjustments were made. Chinese officials later condemned her diplomatic efforts as “war preparation.”

And yet, in a sign of how middle powers are still doing more while saying less, the two countries signed six cooperation agreements, including one on satellite data sharing and another to secure deliveries for Vietnam’s largest oil refinery, potentially easing shortages.

“The U.S. has become more unreliable, so it makes sense to try to develop alternatives,” said Robert O. Keohane, an international relations professor at Princeton University. Even if what’s been formed so far is insufficient, he added, “having a weak alternative is better than having no alternative at all.”

Reporting was contributed by Tung Ngo from Hanoi, Vietnam; Javier C. Hernández from Tokyo; Amy Chang Chien from Taipei, Taiwan; Jim Tankersley from Berlin; Ian Austen from Ottawa; and Matina Stevis-Gridneff from Toronto.

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