MAID: Decision of Last Resort in Canada

"I think most people in Canada would at least acknowledge that we've gone way beyond an exceptional practice that is a last-resort measure."

"It is troubling that documented problematic applications of MAID have not yet resulted in either criminal or professional regulatory intervention."

"Some of the frequent providers will say there's a high provision because there's a high demand. 'It's the law of the market'." 

"But I think it's still appropriate to say that it's quite extraordinary, it's simply a fact, that MAID has been prioritized and is so easily accessible." 

Trudo Lemmens, health law and policy professor, University of Toronto 

 

"The current legal regime for delivering MAID is enormously popular among Canadians. That is a lot of potential demand."

"If we  regard an increasing number of joint replacements or abortions as a success, with supply having risen to meet demand, why should we think that an increasing number of MAID provisions is a failure, or somehow a problem."

"If more awareness, more providers and more support are good things for these other services, why are they a bad thing for MAID?"

"Of course, I think MAID is very different from a lot of other medical procedures, just by virtue of its very nature." 

"[MAID], both causes death and is intended to do so. That makes it special enough to require a statutory exemption from the  general legal prohibition of consensual homicide and assisting a suicide."

Professor emeritus Wayne Sumner, University of Toronto

The Office of the Chief Coroner for Ontario. (AP Photo/Angie Wang)

 

In Canada almost ten years ago, the Criminal Code saw medical assistance in dying (MAID) become law, permitting medical staff under certain conditions to end the life of a consenting person living with constant pain and foreseeably approaching imminent death. Since its original guidelines there have been some changes that relax the strictness of those guidelines. The result has been over the years to the present that one in 20 deaths in Canada is now attributable to MAID. In 2024, a total of 16,499 individuals died by physician-administered lethal injection.

 

In Ontario, 88 percent of 4,356 MAID deaths that took place in 2024 met all legislative requirements to legally proceed with the procedure. Still, concerns noted by the death review committee which Dr. Lemmens is a member of, include legislated safeguards being given lax interpretation, along with minimal or careless assessment of an individual's legal capacity to opt for assisted death. As well, minimal discussions respecting alternatives for the relief of suffering, risks of coercion from burnt-out family members, along with doctors taking nods and hand squeezes as assent before lethal injection, were also flagged. 

 

The law itself has been significantly altered over the years, leading to setting aside the rigid requirement of death being foreseeable, nor must all available options to relieve suffering be exhausted before MAID can be considered. Moreover, it is possible to access MAID more readily than vital medical care that might prevent it, pointed out Dr. Lemmens, given Canada's overburdened and tardily-accessible health care system. Further inclusive expansion of  MAID is of particular concern to Dr. Lemmens and his think-alike colleagues. 

 

People in the lowest ‘material resource’ category represent 20 per cent of the general population, but they make up 28.4 per cent of Track 2 MAiD recipients, compared to 21.5 per cent of Track 1 recipients. (Shutterstock)

 

Although MAID sees wide public acceptance, the potential of permitting people with degenerative diseases like Alzheimer's to plan for a written request while they still can, prompted Dr. Lemmens to respond "Who will decide when the time has come? On what basis will these judgments be made? How can we  expect physicians or nurse practitioners to end the life of a person who has no clue as to why they are being sedated or getting a needle inserted into their arm?"

 

Since MAID was legalized in 2016, 75,475 MAID 'provisions' were carried out. The number of  Canadians whose suffering was "enduring and intolerable", but their natural deaths not reasonably foreseeable, who were euthanized as 'Track 2' cases reached 732 in total. "These are 732 people who would be alive (today). We have to ask, in all these 732 cases of people who suffered intolerably, were there no other options? I have my doubts", charged Dr. Lemmens.

 

Canada's record of 5.1 percent of MAID deaths within the total of death from all causes, eclipsed that of Belgium, with 3.6 percent of all deaths in recent years and where since 2002 euthanasia has been legal. Netherlands has a 4.8 percent of total deaths by euthanasia occurrence. However, within Canada, the province of Quebec's average MAID deaths reached 7.9 percent of all deaths; the most globally prolific. 

 

People who chose medically assisted death when they were not terminally ill were more likely to be marginalized than those who chose MAiD when death was already imminent. (Shutterstock)