A new Health Canada report on medically assisted deaths has reignited debate about whether social vulnerability influences people to seek MAID.
The report says 15,343 Canadians died by MAID in 2023, the highest number since the practice was legalized in 2016.
In four per cent of these cases, MAID was obtained by sick or disabled people whose deaths were not reasonably foreseeable, or what is referred to as Track 2 MAID. Deaths by Track 2 MAID were up 34 per cent from the year before.
These numbers worry some disability advocates.
“From the time that Track 2 MAID became legal in 2021, to the end of 2023, we lost — on average — a person with a disability a day,” said Krista Carr, CEO of disability organization Inclusion Canada, in a statement. “That’s 1,304 people, who were not otherwise dying, in 1,019 days.”
According to the report, Track 2 patients were more likely than Track 1 patients to have disabilities. They were also more likely to live in long-term care homes, shelters and prisons or in neighbourhoods where many people rent and live alone. They were also more likely to be women.
These factors are concerning, Carr said in her statement. In September, Inclusion Canada launched a Charter challenge claiming Track 2 MAID violates constitutional rights to life and equality for people with disabilities.
The organization is not the only one claiming Canada’s MAID laws are unconstitutional.
This week, the family of a B.C. man who died by MAID launched a lawsuit alleging Canada’s MAID laws are unconstitutional because they fail to protect mentally ill people who also have a physical illness or disability. The deceased — who had a history of mental illness and back pain — got MAID while on a day pass from a hospital where he was receiving psychiatric treatment.
The Health Canada report addresses concerns about people with disabilities accessing MAID.
“Having a disability in and of itself does not automatically make one eligible for MAID,” the report says. “One must meet the legislative eligibility criteria.”
Those criteria include having an incurable illness, disease or disability and being in an irreversible state of decline. Individuals also must be experiencing physical or psychological suffering they consider intolerable and that cannot be relieved in a way they consider appropriate.
The suffering criteria is not strict, some legal experts say.
Suffering is interpreted subjectively, says Trudo Lemmens, a professor and the Scholl Chair in Health Law and Policy at the University of Toronto. “If a person with a disability says they’re suffering unbearably, they are very likely to get access to MAID.”
People found eligible for MAID “meet just about every definition of disability [in human rights law],” Isabel Grant, a law professor at the University of British Columbia said in an email to Canadian Affairs.
“That doesn’t mean that everybody with a disability can access MAID, but it does mean that everybody who accesses MAID according to these criteria is disabled,” Grant said.
‘Red flag’
The report also indicates many people seek MAID because of loneliness.
This is a “red flag,” says Lemmens.
Nearly half — 47 per cent — of Track 2 patients reported suffering from loneliness and isolation; 49 per cent listed feeling like a burden on others. Among Track 1 patients, 27 per cent listed loneliness and isolation and 45 per cent listed feeling like a burden.
“Nobody should end their lives because they’re lonely,” Lemmens said. “We need to address loneliness.”
As in previous years, the top causes of suffering were inability to participate in meaningful activities and the loss of ability to engage in tasks of daily living. Both Track 1 and Track 2 patients listed these as their main sources of suffering.
Peter Copeland, deputy director of domestic policy at the think tank Macdonald-Laurier Institute, says these answers indicate despair factors into many MAID requests.
“So much of the suffering here is psychological,” he said. “It can be alleviated through better provisions of support and care through palliative care, but also through one’s own attitude to the nature of suffering.”
People often feel lonely, isolated or like a burden near the end of life, Dying with Dignity Canada, an organization that advocates for MAID access, told Canadian Affairs in a statement.
“We believe that everyone should have both the right to live and the right to choose their end-of-life,” its statement says.
‘Many layers’
Health Canada’s report indicates there were almost 20,000 requests for MAID in 2023. Nearly a thousand were deemed ineligible, and about 500 were withdrawn. In nearly 3,000 cases, a person approved for MAID died before MAID was administered.
“We worry that this is due to systemic barriers or a lack of access to MAID services in some regions of the country,” Dying with Dignity Canada’s statement says. “This is an area in which more information would help to identify possible barriers and system navigation concerns.”
Others say more information is needed to understand why people request MAID.
“There’s many, many layers behind why someone requests MAID,” said Salina Pirzada, a PhD candidate at the University of Manitoba.
Pirazada is conducting the first Canadian study asking patients about their motivations for MAID. The goal is to examine MAID’s impact on vulnerable Canadians, she says.
The Health Canada report says most people who received MAID had access to palliative care or disability supports. But the report does not say if a patients’ suffering was alleviated, Pirzada says.
“We have a moral obligation to understand why people are prematurely wanting to end their lives,” she said. “There is a high possibility that the reasons that they are pursuing MAID are reasons that can be remedied.”
Leave a comment