Safeguard failures in Canada’s MAiD system

Canada’s Medical Assistance in Dying (MAiD) regime was introduced in 2016 and expanded in 2021. Within its framework, euthanasia accounts for almost all cases. MAiD operates through two legal pathways: Track 1, for those whose ‘natural death is reasonably foreseeable’ (RFND), and Track 2, for persons with chronic disabilities whose deaths are not reasonably foreseeable, whereas MAiD for sole reasons of mental illness remains suspended by federal legislation until 2027.1 The MAiD statute requires that requests be voluntary, individuals have decision-making capacity and patients be informed of reasonable means to alleviate suffering. However, these safeguards have not consistently been applied as intended. Case studies, media investigations, parliamentary reports and official reviews increasingly document cases of concern. These failures point to systemic weaknesses in safeguards, particularly for those experiencing psychosocial distress, disability-related pressures or fluctuating cognitive states. Here, we discuss cases of the Ontario Chief Coroner’s MAiD Death Review Committee, of which we are members.2 Case 1: A housebound, severely obese woman with comorbidities, including depression, and disengaged from care for years, requested MAiD. When offered, she refused therapy, documented to potentially improve or reverse her conditions. MAiD assessors determined that she met the criteria for Track 1 MAiD due to her decision not to pursue treatment, and she received MAiD. Case 2: A man with cerebral palsy living in long-term care voluntarily stopped eating and drinking, leading to renal failure and dehydration. He was deemed eligible under Track 1 because his death was considered ‘reasonably foreseeable’. No psychiatric expertise was consulted despite evidence of psychosocial distress. Case 3: A man in his 70 s with essential tremor, whose MAiD provider documented that the request was primarily driven by emotional suffering and bereavement. Analysis: Case 1 demonstrates how some assessors may judge suffering as intolerable without establishing an accurate prognosis …