How Medically Assisted Suicide Went Wrong in Canada

Canada's Medical Assistance in Dying (MAiD) law, in effect since March 17, 2021, has sparked considerable debate and ethical considerations. As a legal framework allowing physicians and nurse practitioners to assist individuals in suicide, MAiD has faced growing scrutiny regarding its impact on the dignity of life, potential abuses of people with disabilities, and the evolving landscape of euthanasia in the country.

MAiD Statistics and Trends

Since its adoption, MAiD has lead to more than 31,664 medically assisted suicides, with a steady annual growth in provision. In 2021 alone, there were 10,064 MAiD-related suicides, now accounting for 3.3% of all deaths in Canada. Reasons for choosing MAiD often revolve around intolerable physical or psychological suffering, emphasizing the challenges faced by those seeking relief from their conditions.

The Framework of MAiD

MAiD provided exemptions from criminal liabilities related to suicide and safeguards for various stakeholders involved, including pharmacists, healthcare providers, and family members. While the law grants a legal right to voluntary euthanasia, the Supreme Court ruling that led to its implementation was based on the argument that the prohibition on medical assistance in dying violated the Canadian Charter of Rights and Freedoms.

Ethical Concerns and Public Perception

Despite being in effect for over five years, MAiD continues to raise safety and ethical concerns, particularly for those who view it as a form of euthanasia undermining the intrinsic value of life. The expansion of MAiD to include psychiatric illnesses has added a concerning layer of complexity, with questions arising about potential abuses and the impact on individuals with psychiatric disorders.

The line between serious illness and fatal illness is blurred. Serious illness is not necessarily fatal, and the ability to bear difficult conditions related to an illness is not a question that can be answered by checking a box on a form. The availability of an escape via suicide could tempt individuals who might otherwise have been successfully treated or lived long enough to  a benefit from a cure. Disability experts say such stories are not unique in Canada, which arguably now has the world's most permissive euthanasia rules.  In Canada, people with disabilities can choose to be killed or be put on that path by relatives or caregivers.

Severe psychiatric disorders tend to cloud the judgment of those afflicted; therefore some have questioned who benefits from this law. It could potentially remove from society individuals who are  labeled as "unproductive" or "burdensome" to others. There are instances when individuals were encouraged to end their lives as a "service" to their relatives or even their county, blurring the distinction between voluntary and compulsory actions. 

The Canadian government has postponed the expansion of MAiD for individuals with mental illness by a year.  This decision brought forth numerous reports highlighting known abuses of MAiD.  The ability to utilize MAiD was granted during COVID isolation, which brought on physical suffering and depression, often in temporary situations of inadequate staffing and care.  Were these carefully considered decisions, or a rush to action?

Eligibility Criteria and Evolving Regulations

MAiD eligibility criteria includes age, voluntary requests, informed consent, and a "grievous and irremediable condition." Notably, the law never strictly required a root terminal illness, raising questions about the nature of the diagnoses that qualify. The exclusion of mental illness as a standalone criterion was set to change in 2023; had it been included, it would have allowed individuals with psychiatric conditions to qualify for MAiD. 

Critics of MAiD are quick to point out that once the door is opened, even a crack, to medical aid in dying, it can be easily expanded.

Access to Support and Disability Advocacy

Access to home-based personal support has been a longstanding struggle for people with disabilities in Canada – this pre-dates the legalization of MAiD. Disability rights activists have warned that legalized assisted dying could threaten people with disabilities, potentially pushing them to opt for state-sanctioned, medically-certain death.

Critics argue that more needs to be done to safeguard populations vulnerable to suicide, as Canada considers further expansions of the MAiD law.  Of notable concern: 1) allowing people to take their own lives exclusively for mental health reasons and 2) widening the net of who can choose to take their own lives by including "mature" minors under the age of 18.

Medically-assisted suicide is a complicated issue.  As the government navigates the expansion of MAiD to include mental health reasons and potentially "mature" minors, it is important they think through all of the potentially dangerous outcomes.

For more information on physician-assisted suicide, visit the NH Coalition for Suicide Prevention website at:  www.zerosuicidesnh.org.