Academics and members of Parliament are raising concerns about the curriculum used to train doctors and nurses in medical assistance in dying (MAID).
Since 2023, the Canadian Association of MAID Assessors and Providers (CAMAP) charity has provided a national course to teach Canadian health-care workers about MAID. It is the only national, accredited curriculum for health-care workers about MAID.
Three members of a working group that created part of CAMAP’s curriculum have resigned. Some have said they have serious concerns about what the curriculum is teaching.
Catherine Frazee, a professor emerita in disability studies at Toronto Metropolitan University, is one of those members.
In a journal article published in April, Frazee said the curriculum reinforces negative assumptions about living with a disability and discouraged medical professionals from exploring if social suffering was prompting MAID requests.
“Practitioners were trained to verify cognitive capacity and document voluntariness, but not to examine how suffering might have been rooted in abandonment, systemic inequality, or internalized oppression,” she wrote.
This is particularly dangerous for people with disabilities, she wrote. The curriculum “presumes that disabled people’s lives are not just harder, but plausibly unlivable,” the article continues.
Dr. Stefanie Green, a founding member of CAMAP who helped create the MAID curriculum, told a parliamentary committee on April 27 that the curriculum was “rigorously developed” with “robust editorial review.”
The committee is studying whether people whose sole medical condition is a mental illness should be eligible for MAID. Canada is set to allow this in March 2027.
‘Lack of hesitation’
Doctors and nurses who want to assess for or provide MAID are not required to complete specific training on MAID, or to take CAMAP’s curriculum. However, there is a professional expectation that health-care workers will only provide services they have the skills to provide.
CAMAP’s curriculum is funded by Health Canada and accredited by the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada and the Canadian Nurses Association.
Since the curriculum was launched in 2023, more than 2,900 professionals have registered to take it, CAMAP told Canadian Affairs in a statement. For context, in 2024, there were just over 2,200 doctors and nurses who provided MAID.
In an interview with Canadian Affairs, Frazee said her time working on CAMAP’s curriculum left her with serious concerns about how individuals are approved for MAID.
Her working group also included an ethicist and five MAID providers. The group worked on a section of the curriculum about determining how vulnerabilities such as stigma, social abandonment or poverty can impact someone’s request for MAID.
In her article, Frazee says the group discussed several cases where a person with a disability requested MAID under what is called Track 2 MAID. Track 2 MAID is MAID for people whose deaths are not reasonably foreseeable.
In one case, a homeless, 19-year-old man with cerebral palsy who was fleeing an abusive home was approved. In another case, a young man with disabilities was approved after expressing fear that he would never have a family of his own. According to Frazee’s article, his mother supported his decision.
Most assessors did not appear bothered by these cases, says Frazee.
“It was that lack of hesitation or doubt that really troubled me,” said Frazee.
The curriculum included a fictitious scenario about a mother of young children who was recently paralyzed because of a spinal cord injury. The woman said she wanted MAID because she did not want someone to help her use the bathroom.
The working group said that the woman’s distress over needing help from others was a personal value and should not be questioned, Frazee said.
Frazee was concerned that there was no discussion about challenging a patient’s negative attitudes about living with a disability.
“The cultural forces that are toxic to certain groups of people, forces like racism and sexism and ableism, we cannot ever embrace those toxic forces as if they were values,” she said.
Frazee resigned from the working group in August 2023 when her suggested curriculum changes were denied.
More resignations
Frazee was not the last to leave.
In September 2023, Dr. Madeline Li, a professor at the University of Toronto, also resigned from the working group, which she chaired. Li was also the scientific lead for CAMAP’s entire curriculum. Li, who joined CAMAP in 2017, left the organization in 2025.
Li declined to elaborate on her reasons for resigning from the working group and eventually leaving CAMAP.
“We went into that [curriculum process] really well meaning,” Li told Canadian Affairs in an interview. “We really thought that we were going to — or at least I really thought that we were going to — develop a curriculum that would safeguard the practice.”
Li supports MAID, but has often expressed concerns about the way MAID is approved for people who are not at the end of their lives.
“[MAID has] evolved over time, and the practice needs to change a bit to be more protective,” she said.
Some medical professionals involved in MAID focus primarily on patient autonomy, and can get “defensive” about critiques of MAID, she says.
But in her opinion, most CAMAP members, including herself, fall into the “messy middle.” They want MAID to be available for some patients, and done well when it is best for patients. But they are also concerned about people requesting and receiving MAID because of social vulnerabilities.
Legal vs. ethical
Dr. Timothy Christie, a bioethics professor at Dalhousie University in Halifax, was the third member to resign in January 2025.
Christie studies MAID extensively, but is not a MAID assessor or provider or CAMAP member.
Christie says he told CAMAP that he could not endorse the final product of the working group. His objections were not noted, he says, and he was told he would have to resign.
Christie, like Frazee, has concerns that the working group ignored how social vulnerabilities such as homelessness could motivate a person’s request for MAID.
“Although it was a group that was originally supposed to look at vulnerable people, we had a very hard time even accepting that someone could be vulnerable when receiving MAID,” he said.
The working group was not interested in considering the social conditions that motivate people to request MAID — an approach that concerns him.
“The reasons the person is asking to be euthanized are very relevant,” he said. “This committee would say that if a person is autonomous, their reasons don’t matter.”
Christie does not oppose MAID in all cases. But he says that just because something is legal does not mean it is ethical. “When the suffering is because of social injustice, we shouldn’t be using euthanasia to solve social injustice,” he said.
Christie says the highly influential MAID curriculum is “based on some fundamentally flawed ethics.”
“They’ve just basically assumed that if it is legal, then it is ethical.”
‘Robust conversations’
In an email to Canadian Affairs, CAMAP said it is “unfortunate” that not every curriculum working group could come to consensus about what the curriculum should include.
“Dissenting opinions lead to more robust conversations and a more fulsome outcome, we did not suffer from the lack of consensus, but are better for it,” the statement says.
“We deeply value the input that was given by people who chose not to have their names associated with the final product, but the overall content of the [MAID curriculum] is richer as a result of their important contributions.”
CAMAP does not regulate MAID practice or decide which medical professionals can be involved in MAID, the organization said in a statement.
“While it is not mandatory, the curriculum is a nationally recognized educational resource that helps clinicians build the competencies required to provide MAiD safely, ethically, and in alignment with current legal and clinical standards. “
Frazee says her experience being on the working group showed her the federal government has put too much trust in medical professionals to oversee MAID.
“The reason that the court and Parliament entrusted the MAID system to the medical profession is because the medical profession is held as being very trustworthy and of very high quality of judgment,” she said.
“Yet I’m afraid that we’re seeing evidence that that faith that we held was unrealistic.”
The federal government has allowed a small group to interpret the law and teach others to do the same with very little accountability, she says.
“The law has produced a regime where vulnerable people are dying prematurely and tragically for reasons that have nothing to do, or little to do, with their medical condition, and that isn’t what the [Supreme Court] intended [when it struck down prohibitions on MAID],” she said.
“No one is taking responsibility for it.”
