MAID: Sweeping Canada’s Inequity Under the Rug

Image By: University of Minnesota

Medical Assistance in Dying, or MAID, came with the passing of Bill C-14 in 2016 after a landmark Supreme Court decision struck down the prohibition on physician-assisted suicide. Since then, it has only grown in scope and size. Though it originally required patients to have a “reasonably foreseeable” death, that restriction was lifted in 2021, meaning anyone with a physical condition deemed serious enough would be eligible for euthanasia. Seven years after its inception, MAID has become one of the most liberal and largest assisted-dying programs in the world, now representing over four percent of all deaths in Canada, with more than forty-five thousand people having now received medically assisted deaths. In 2022 alone, nearly fourteen thousand people died through MAID, an increase of over thirty-one percent from the prior year. It is already on pace to surpass the per capita usage of Europe’s most lenient assisted-dying programs (those with criteria including non-terminal physical conditions and chronic mental conditions), such as those of Belgium or Holland, both of which have continued to see growth in their much older programs. Perhaps most troublingly, MAID is broadening once more, allowing patients to be eligible purely on the basis of mental illness. Though it was delayed last year, there is no sign that this will happen again despite the fact that there has not been any analysis of equity and diversity issues with MAID, a measurement set to be included beginning a 2024 report. 

However, there is no need to speculate if one were to identify problems with this policy. Cases where Canadians are euthanized because they simply see no other option out of financial desperation are not infrequent. In 2016, when asked about the risk of patients being coerced into MAID due to financial or social pressures, Prime Minister Trudeau said that “that simply isn’t something that ends up happening.” Despite this, cases have occurred. For example, Sean Tagert, a forty-one year old father with ALS, received assisted suicide out of an inability to pay the $264 a day he needed to pay for his care. Nurses are required to ensure that the patient is not seeking MAID due to a lack of other health and social supports, but it is unclear how healthcare providers should proceed in those circumstances.

Tagert is not alone. Les Landry is a sixty-five-year old former truck driver who has chronic medical problems due to complications during surgery. He received a fixed income of roughly eighteen hundred dollars until the day he turned sixty-five, the age at which disability benefits are cut off. “I really don’t want to die. I just can’t afford to live,” he said. He is currently in the process of being approved for MAID. Landry has repeatedly called attention to the fact that 2021’s expansion of MAID criteria to include non-terminal problems has come in spite of a lack of significant legislation improving benefits for disabled Canadians, particularly seniors. Canadians as a whole are in need, as financial insecurity reaches new highs. Thirty-five percent of Canadians cannot cover an unexpected expenditure of five hundred dollars. More than 40% are not confident they can cover their living expenses in the next year and nearly 2.5 million Canadians reported having unmet healthcare needs in 2021. Statistically, there is some basis for  the fear that MAID is and will disproportionately affect the poor. Though there has been remarkably little thorough inquiry on the subject, existing research suggests that Canadians of lower socioeconomic status have been more likely to pursue MAID than those of higher status. As a matter of fact, income is a primary driver of health inequality; those with higher income have access to better diets, lifestyles, and healthcare. 

As a result, the planned March expansion is the most troubling development yet. The Canadian Mental Health Association strongly opposes the expansion, emphasizing that it is “not possible” to tell whether a given case of mental illness will be curable or not. While the government has rejected the notion that it might be abused by people with depression as a low-risk suicide method, many cases display the contrary. Alan Nichols made headlines when he was euthanized, with the only condition listed as “hearing loss” after being initially hospitalized for suicide risk. The cited hearing loss was the result of a stroke suffered years prior. “Alan was basically put to death,” said Gary Nichols, his brother. One study found that of patients who were not terminally ill and received MAID, two thirds were also mentally ill; one third were not even presented with available treatment. 

 We live in a time when mental illnesses like depression and anxiety are soaring to new highs among young people. 1.2 million children in Canada struggle with mental illness; by the age of 25, about 20% of Canadians will have developed a mental illness. Yet, less than a fifth of these receive adequate treatment and less than a quarter of children with mental disorders have access to specialized treatment. It seems irresponsible to offer MAID to people for whom proper treatment access is so inadequate, a concern shared by Health Minister Mark Holland, as well as some of his provincial counterparts. The expansion, no doubt, comes in part due to the work of Dying with Dignity, a lobbying organization that seeks to expand MAID access in Canada. Among its efforts today is expanding MAID to allow access for “mature minors”, those over the age of 12. It calls the restriction preventing children, individuals with undeveloped brains and decision making processes, “illogical”. Minors above the age of 16 would not be required to obtain parental consent.

The government needs to start focusing on making the lives of Canadians easier. This means improving social programs, expanding benefits for the neediest, and providing adequate support for those with mental illness. MAID is not an evil idea. However, the program has and is moving far beyond that additional mission, rapidly growing out of control. Not only must the upcoming expansion be entirely thrown out, but many aspects of the program more largely must be seriously evaluated, with improved safeguards and checks put into place to protect the country’s most vulnerable.