Medical organizations have done little to update their guidance about medical assistance in dying (MAID) despite multiple Ontario chief coroner reports detailing concerning MAID cases.
The chief coroner’s MAID Death Review Committee is a 16-person interdisciplinary committee that reviews controversial MAID cases. The committee has published six reports since October 2024. These reports detail cases of patients being approved for MAID after losing their ability to consent to medical decisions, and of patients appearing to request MAID due to isolation or lack of appropriate housing or health care.
Each report contains recommendations to provincial and federal government ministries, professional associations and regulatory bodies.
This includes recommendations to the Canadian Association of MAID Assessors and Providers (CAMAP), a charity that created a national MAID curriculum that is used to train doctors and nurses about MAID assessments and determining someone’s capacity to make medical decisions.
The committee’s reports recommend CAMAP consider updating its curriculum and other educational resources to reflect concerning MAID cases.
In an email to Canadian Affairs, the association said it told the coroner’s office that its curriculum “already addresses” the topics mentioned in the committee’s reports.
In its email, CAMAP said the reports are part of its curriculum review although the organization “does not implement all of [the recommendations].”
The association said it has not set a date for its next curriculum review.
Questionable cases
The committee’s reports say most MAID deaths in Ontario have complied with legal MAID eligibility criteria, which are listed in the Criminal Code. It would be a criminal offence for a medical professional to approve someone for MAID who did not meet the criteria.
However, the reports raise concerns that, in some cases, patients may not have met all the MAID eligibility criteria.
For example, the Criminal Code says only people with the ability to give consent are eligible for MAID. They must also give clear final consent before MAID is administered, unless patients previously signed a waiver of final consent.
A report from April describes a cancer patient who was assessed and approved for MAID after palliative care doctors said he could not consent to medical decisions. He was assumed to give final consent to MAID by nodding his head and mouthing the word “yes.”
Another report from September describes a woman with dementia who was noticeably “overwhelmed” on the day of her MAID death and deemed to give final consent by squeezing the MAID provider’s hand.
Other reports have raised questions about how people who are suffering from sicknesses or disabilities but are not dying are deemed eligible for MAID. Some committee members have raised concerns about how social isolation or lack of appropriate housing influence requests for MAID and how these factors are considered during MAID assessments.
One report from October 2024 suggested that the MAID process for people whose deaths are not reasonably foreseeable should be paused while patients wait for appropriate health care or social services.
“This approach to practice recognizes the importance of addressing and resolving suffering in contrast to procedurally qualifying for a MAID death,” the report says.
Many patients profiled had mental illnesses as well as other sicknesses or disabilities. One man was approved for MAID a year after being injured while attempting suicide. These cases have raised questions about how MAID assessors tell the difference between a request for MAID and suicidality.
Health Canada funding
The committee’s reports are not currently made public upon their release and are generally only available upon request. However, the reports are sent to organizations that have recommendations directed to them.
The reports recommend Health Canada consider using the reports to update its guidance on MAID. They also recommend that Health Canada produce specific guidelines when socially vulnerable people whose deaths are not reasonably foreseeable request MAID.
Health Canada told Canadian Affairs in an email that “the development of practitioner guidance is outside the scope of Health Canada’s responsibilities and expertise.”
“Health professional bodies are best positioned to develop practitioner guidance,” the email said.
However, Health Canada has published guidance for the medical profession about MAID. In 2023, Health Canada published advice to the medical profession and a model practice standard to help medical professionals determine whether a patient is eligible for MAID.
Health Canada also funded the national MAID curriculum created by CAMAP and launched in 2023. Its funding enables medical professionals to take the course for free.
Between 2021 and 2026, CAMAP received nearly $5 million from Health Canada to develop this curriculum. This includes $1 million this fiscal year and additional funding to help CAMAP create a peer-reviewed journal about MAID, Health Canada told Canadian Affairs in an email.
CAMAP’s MAID curriculum is not publicly available.
“The curriculum is an accredited professional education program — not a public information product,” the association said in an email. “While Health Canada’s funding enabled the development of the curriculum, it was done explicitly to strengthen the education and competencies of MAID assessors and providers.”
The committee’s reports also recommend that the College of Physicians and Surgeons of Ontario, which regulates the provinces’ doctors, consider using these reports to update its MAID policies.
The College of Physicians and Surgeons of Ontario told Canadian Affairs in an email that it reviewed its MAID policies in 2023.
“The college continues to monitor new MAID Death Review Committee findings and will consider further updates as appropriate,” the email said. The college did not say whether it had made any changes to its policies because of the committee’s reports. It also did not say when it would review them again.
‘Non-binding’
CAMAP provided Canadian Affairs with its written responses to the chief coroner’s reports. Two of them, dated December 2024, were signed by Dr. Konia Trouton, who was then president of CAMAP. Her presidency ended April 7, CAMAP said in an email.
Trouton, who sits on CAMAP’s board as past president, is a member of the Ontario MAID Death Review Committee.
“Members are not on the committee as representatives of their respective organizations,” Stephanie Rea, issues manager for the chief coroner’s office, said in an email.
Committee recommendations are not made by consensus, she wrote, and not every committee member needs to agree with the recommendations.
“Recommendations are non-binding so there is no legal requirement for them to be implemented,” she said.
MAID is the most humane option Canadians have to end their lives with dignity. Yes, there may be occasional problems BUT overall MAID is a truly wonderful option which one would expect to find in an advanced society.