MAID -- At Your Service

"[Only 25 percent of Californians said they were aware that MAID was legally available as an option if they had a terminal illness such as advanced cancer, compared to 67 percent of Canadians who were aware] that MAID [Medical Assistance in Dying] as an option -- were such a calamity to befall them."

"[Other] standout [factors included the number of MAID practitioners in Canada and higher] institutional support."

"In Canada, every provincial and regional public health authority in Canada makes accessing MAID straightforward."

"[Researchers tested ten hypotheses to understand the 15-fold variation in MAID deaths between Canada and California; to determine what factors might be driving Canada's higher MAID uptake], or, conversely, preventing Californians from taking advantage of a legal route toward relieving unnecessary suffering."

Dr. Peter Reiner, professor emeritus, neuroscience and neuroethics, University of British Columbia

Public awareness of MAiD in Canada and California.

 

"MAID is being promoted as a form of therapy], even for only remotely disease-related suffering."

"Canadian patients are much more frequently confronted with offers of MAID and with a physician providing it as a form of care."

Dr. Trudo Lemmens, professor of law and ethics, University of Toronto

Canada's 'dignity in dying' legislation ('death on demand') has gradually altered the safeguard requisites it had originally put in place -- to reflect the gravity of a situation where people in unassuageable pain or living with the prospect of imminent death, prefer ending their lives over continued suffering -- to expand the death-service by softening pre-qualifications to apply for MAID. The requirement of facing a "reasonably foreseeable death" such as terminal cancer has been lifted to offer Canadians MAID when a "grievous and irremediable" condition occurs, absent of the imminence of natural death.

In 2016, both the State of California and Canada, with similar population numbers, granted their citizens access to medical assistance in dying. Between the two no real differences occur in leading the causes of death, or in overall death rates. So it is a bit of a puzzle why so many people in Canada choose MAID in contrast to relatively few in California. A newly published study has attempted to analyze the two populations for an explanation respecting the vast differences in public uptake of the death service.

In 2022, Californians numbering 843 individuals chose to die by MAID. In comparison, 13,241 Canadians chose to die by MAID which in 2022 accounted for 4.1 percent of all deaths in Canada in comparison to 0.27 percent of all deaths in California. The Canadian provinces of British Columbia's and Quebec's rate of uptake are respectively 5.5 and 6.6 percent, numbers that outpace the assisted-suicide pioneers of Belgium and the Netherlands.

 

Moral acceptability of MAiD by modality in Canada and California.

The study suggests that 25 percent of Canadians would select to die by MAID as a solution when facing a long and painful death from any disease. The team of Professor Peter Reiner and co-author Adrian Byram, (a member of advocacy group End of Life Choices California), conducted online surveys of 228 adults from age 60 and up, reflecting the age group accounting for most requests for MAID, in both California and Canada. While 67 percent of Canadians said they were aware "that MAID was an option", only 25 percent of Californians said they knew that MAID was legally available if they had a terminal illness. 

In Canada, explanatory information is available on government websites as well as those for advocates of MAID where well informed staff is made available to provide assistance in navigating the process of applying for, accessing and succeeding in the relief that MAID offers to those wishing to take advantage of it. In comparison, assistance of this kind is not available in California. 

 

No differences in moral acceptance was found by the researchers. Two-thirds of both Canadians and Californians felt MAID to be morally acceptable. In California criteria for accepting a request for MAID requires death to be anticipated within six months, while "both jurisdictions recognize that any such prognosis is fraught with uncertainty", the authors qualified. More explicit punishment for failure to comply with safeguards or reporting standards, exist in Canada as compared to California. 

Assisted deaths as % of total deaths in Canada and California from 2016 to 2022.