Researchers who study medical assistance in dying (MAID) say Canada needs greater transparency about why people request MAID and how patients are deemed eligible for it.
Last month, Ontario’s chief coroner’s office released its latest report describing expert concerns with how MAID is practised in the province.
That report, which Canadian Affairs was first to report on, was not released publicly. None of the five reports the committee has released since last fall have been.
When asked by Canadian Affairs about why these reports are not made public, the office said it is developing a plan to do so in the future.
“We are currently working to identify a mechanism to post the reports for public access while respecting the individuals and families whose loved ones may recognize certain details of the deaths reviewed within the reports,” Stephanie Rea, issues manager for the chief coroner’s office, said in an email to Canadian Affairs.
Salina Pirzada, a doctoral candidate at the University of Manitoba who is interviewing MAID patients about their decisions to pursue MAID, says public reports are needed to understand why people ask for MAID.
“The more we know about why these people are opting for MAID, the better infrastructure we can create in terms of palliative care, social support and funding,” she said.
Concerns about eligibility
In 2024, Ontario established a MAID Death Review Committee, a 16-person committee that examines MAID deaths that have been flagged as raising concerns. This includes concerns about whether all the legal MAID eligibility criteria are met.
The committee’s reports are sent to government ministries and professional associations involved in MAID. Members of the public must request to receive them.
The committee’s August report describes patients being approved for MAID after rejecting all medical treatments, which goes against Health Canada guidelines that say patients cannot make themselves eligible by refusing medical treatment.
A committee report released in April described a woman who was approved for MAID hours after doctors requested she be moved into palliative care because of her spouse’s caregiver burnout.
Reports released last fall described people, particularly people with disabilities, seeking MAID because of unmet housing or social needs.
Canada has been sharply criticized for approving people with disabilities for MAID, even when they are not dying. In March, the United Nations told Canada to repeal that part of the law and not allow the planned expansion of MAID for people whose only medical condition is a mental illness in 2027.
Controversy and transparency
Ontario is currently the only province with an interdisciplinary committee that examines MAID deaths and writes reports with details of specific cases.
The committee’s reports should “absolutely” be public, says Dr. Scott Kim, a researcher at the National Institutes of Health in Maryland who has studied international MAID laws for more than a decade.
Canada’s lack of public reports about controversial MAID cases contrasts sharply with the Netherlands, the first country to legalize medically assisted dying.
There, regional committees review every MAID death to see if the law was followed. The committees’ reports include detailed explanations for the committees’ decisions and are posted online.
“The premise of the Dutch system is: if it’s causing controversy, then it is an important basis for increasing transparency, so that there can be genuine public understanding and discussion for policy making,” said Kim.
“In my experience that is not the Canadian approach.”
Health Canada releases annual reports about the number of MAID requests and MAID deaths each year, as well as information about the medical conditions and causes of suffering of MAID recipients. There are currently no public reports that detail specific MAID cases.
“It’s not a transparent system,” said Kim. Public reports are particularly needed because Canada’s MAID criteria are vague, he says.
For example, laws in several American states and other jurisdictions require someone to have prognosis that they will die within six months or less to qualify for MAID. Canadian law has never had that requirement, even when eligibility was restricted to patients with “reasonably foreseeable” deaths.
Canadian doctors and nurses interpret MAID eligibility criteria in vastly different ways, says Kim.
“There’s bound to be tremendous variation [in how patients are approved for MAID], and you can’t evaluate the nature of that variation given the way [MAID is] reported now.”
Public interest
In an email to Canadian Affairs, Ontario’s chief coroner’s office explained why the MAID Death Review Committee reports are not currently made public.
The MAID committee was modelled after other death review committees, including committees that examine child and youth deaths and certain deaths resulting from domestic violence.
These committees produce annual reports that are public, but do not include details of each death to protect privacy, the chief coroner office’s email says.
The office recognizes the “interest in MAID within the public discourse and [is] taking steps to have that information made available,” the office’s email said. The office did not say when the reports would be made public.
However, the office noted that few people have requested the MAID Death Review Committee reports.
Salina Pirzada, at the University of Manitoba, says Ontario’s MAID Death Review Committee reports should be public so Canadians better understand why people request MAID.
Most MAID patients she has interviewed request MAID because of psychosocial suffering, not necessarily illnesses or disabilities. Health Canada’s MAID reports do not adequately describe this type of suffering, or if palliative care relieved it.
“The publicly available information is not detailed enough for us to actually understand some of the psychosocial issues that we can work to address,” she said.
Kim, at the National Institutes of Health, says Canadian policymakers’ reluctance to make details of MAID deaths public raises questions about what they prioritize.
“The system isn’t willing to ask the question, ‘When these people seek MAID because of their socioeconomic circumstances regarding basic resources, what’s more important: giving them means to die, or giving them means to live?”
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