Euthanasia in Canada (oops) MAID

"While the data suggests that the number of annual MAID [medical assistance in dying] provisions is beginning to stabilize, it will take several more years before long-term trends can be conclusively identified."

"[People who receive MAID don't disproportionately come from lower-income or disadvantaged communities; they're] more likely to be represented in higher income neighbourhoods."

"Loss of ability to engage in meaningful activities was the most commonly reported source of suffering]." 

Health Canada's 6th annual report on MAID

According to the latest update, 95.6 per cent of Canadians who died by MAID last year had a "reasonably foreseeable" death. Photo by Getty Images

 

Health Canada was in receipt of 22,535 MAID requests last year of which 16,499 were approved to proceed. Of those not having been approved, 4,017 of those requesting medical assistance in dying, did so before MAID could be provided, while 1,437 people were found to be ineligible and another 692 changed their minds, withdrawing their request for MAID. In that same year of 2024, 2,255 doctors and nurse practitioners were actively involved in providing MAID. Of that total it was a small group of medical volunteers who were responsible for providing 38 percent of all requests (6,185).

 

In 2025, the United Nations Committee on the Rights of Persons with Disabilities called for a repeal of the 2021 law in Canada expanding MAID eligibility to those whose deaths are not reasonably foreseeable, concerned that people with disabilities seek MAID as a result of "unmet needs, a systematic failure of the State party". Groups representing the rights of those with disabilities lobbied government not to include those with disabilities in the expanded eligibility list for MAID, fearing the expansion would take the place of workable medical interventions.

 

Altogether MAID deaths in Canada account for 5.1 percent of all deaths in the past year, representing a small increase from 2023 of some 0.4 percent. Since the introduction of MAID in 2015, 76,475 MAID deaths have been registered, according to Health Canada. In 2024 alone, a total of 16,499 people died by MAID. The vast majority (85.6 percent) of hose who died by MAID (averaging 76 years of age and older) last year qualified for 'Track 1' deaths, representing the category of a 'reasonably foreseeable' death qualifying them for MAID approval.

 

Questions are being raised around how MAID is being approved in Canada for people with dementia. Photo by Getty Images

 

Doctor-assisted deaths where natural deaths  were not reasonably foreseeable, saw a majority of women (56.7 percent), slightly younger qualifying, with autoimmune conditions and chronic pain, along with neurological conditions were most often cited among people asking for MAID, who were not on the verge of dying. There was some controversy linked to MAID requests by individuals suffering the effects of mental conditions making their lives impossible, where medical intervention might make a difference.

 

Concerns that some MAID deaths are driven by loneliness, hopelessness and isolation and that some physicians are stretching the qualification provisions of the law have also emerged. The principal criterion of MAID qualification is that a person must be experiencing intolerable and "enduring physical or psychological suffering". Those applying for MAID approval often report multiple sources of suffering impacting their lives.

 

The most common in 2024 was loss of capacity to engage in meaningful activities, as well a loss of ability to perform daily routines such as eating, drinking, dressing and moving about. Track 1 applicants were likelier to report inadequately controlled symptoms, "while Track 2 MAID recipients were more likely to report isolation or loneliness and loss of dignity". Other findings indicate that MAID applicants are less likely to live in remote areas, thus lack of access to health services is not an issue. 

 

The most frequently reported condition in most all age groups of those who died by MAID in 2024 was cancer, in particular lung, colorectal, pancreatic and blood cancer. With the exception of those 85 and older "for whom 'other conditions' were the most frequently cited". 

 

A screen displays a patient's vital signs during open heart surgery at the University of Maryland Medical Center in Baltimore on Nov. 28, 2016. THE CANADIAN PRESS/AP, Patrick Semansky (Patrick Semansky)

 

Chronic Pain Differences Between the Sexes

"The more excitability [in the neurons sending pain messages to the brain], the more potential for increased pain."

"[The research and growing urgency to improve understanding of male-female differences in pain processing had] invigorated [the field]. It is also a challenge. It means we have to double the amount of experiments."

"They [pharmaceutical industry] don't want to invest a lot of money in developing something that may not work."

Michael Hildebrand, neuroscientist, principal investigator, Carleton University

 

"Women are disproportionately impacted by the burden of chronic pain. They are more likely than men to report low back pain, neck pain, orofacial pain, and neuropathic pain, and twice as many women report common migraines or headaches."

"[Taking into account sex differences and the rising health crisis of poorly managed chronic pain, it becomes essential to] systematically investigate the neurobiological underpinnings of pain processing in both sexes."

"Unfortunately, the vast majority of preclinical pain research has been conducted in male rodents only."

Research Team 

Illustration by Paddy Mills

 

Neurosurgeon Dr.Eve Tsai, a scientist at the Ottawa Hospital Research Institute, pioneered use of donated spinal tissue for research. She has collaborated with Annemarie Dedek, a post-doctoral fellow, and neuroscientist Michael Hildebrand, in research into sex differences in spinal pain processing. The team of researchers owe their breakthrough discovery to human spinal cord tissue obtained from organ donors.

The result thus far of their research is a first-time discovery that neurons in the spinal cord, process pain signals differently in women than in men. Recently published in the journal BRAIN, the work has gained attention, reflecting its potential implications for future development of drugs in the more effective treatment of chronic pain. There is an urgency for improved treatment in the management of chronic pain,  highlighted by the deadly opioid epidemic.

 

The researchers point out that future studies are required to fully understand how the biological differences potentially contribute to sex differences in signalling of chronic pain. In this way, the research has the effect of an introduction to the fundamental issue of biological differences already known to exist but insufficiently studied. 

The team of neuroscientists originally were in the process of studying pain signalling mechanism neurons in the spinal cord that could lead to chronic pain. Their research made use of rat models prior to access to human spinal cord tissue through the Trillium gift of Life Network managing organ donations in the province. Ottawa represents one of few centres making use of human models from donor tissue for research.

The contrast in the research with the use of rat models followed by the use of human tissue, revealed the "light bulb moment" when researchers realized they were witnessing a different response in pain messaging in males and females. All the rats used for the study were male, common in scientific research, whereas the human models included female donors, which turned out to be a key findings difference.

Where conventionally research made use of male animal models with the understanding at the time that no difference would exist between outcomes for both sexes, the world of research now understands that was a misconception. Research must include both males and females. "We have a lot of catching up to do", remarked Dr.Hildebrand. 

 

Women suffer chronic pain at a higher rate than do men, and more fully realizing mechanisms for transmitting pain signals is a gain toward the improvement of treatment for various forms of chronic pain. A realization far too long in the thought stage, now moved into the action stage.