This article originally appeared in The Hub.
By Ramona Coelho, January 5, 2026
At his appointment, a Canadian man with ALS, a neurodegenerative disease, was told by his specialist that he was the only patient left in the practice who had progressed this far; everyone else at his stage of the disease had chosen MAiD.
As a physician who writes extensively on the topic of Canadian euthanasia and assisted dying, called medical assistance in dying (MAiD), I hear stories like his often. They reveal a truth that Health Canada’s Sixth Annual Report on MAiD mentions but barely analyzes: MAiD deaths among people with ALS far exceed natural ALS deaths. Health Canada suggests this is because treatments are limited, but that explanation is insufficient.
People with ALS, like many disabled Canadians, have many health-care needs but face limited services, inadequate disability supports, and fears of burdening others. When their MAiD deaths outnumber natural deaths, it likely reflects a system unable or unwilling to provide what they need to live.
This pattern of system failure is evident in individual stories like Sathya Kovac’s, who had ALS. “It was not a genetic disease that took me out, it was a system.” The system failed to provide adequate home care but gave her MAiD instead. Her experience echoes warnings from the Canadian Association for Suicide Prevention: MAiD can create a perceived duty to die among those who feel unsupported.
Health Canada’s report relies primarily on data from MAiD assessors and providers, but it does not include the detailed case reviews such as conducted by Ontario’s MAiD Death Review Committee (MDRC), of which I am a member. Without this scrutiny, Canadians cannot be reassured that coercion, deprivation, or system failures are not contributing to deaths. While Ontario’s MDRC reports included recommendations to Health Canada, it has declined to implement them, despite previously producing national MAiD guidelines. This abdication leaves no one responsible for preventing harm.
The scale of the program continues to grow. MAiD now accounts for 5.1 percent of all Canadian deaths. In 2024 alone, 16,499 Canadians died by euthanasia. Since legalization through 2024, 76,475 Canadians have died under the program. Health Canada maintains MAiD shouldn’t count as a cause of death, yet on a proportional basis, it is Canada’s fourth leading cause of death.
Track 2 MAiD, for people whose natural death is not reasonably foreseeable, rose 17 percent in one year, with 62 percent of these cases occurring in Quebec. Of these recipients, 56.7 percent were women, younger than Track 1 recipients (for people whose death is reasonably foreseeable), and women in both tracks were more likely than men to live in lower-income neighbourhoods. These patterns should alarm anyone concerned about structural vulnerability.
The report also downplays poverty and unmet care needs as factors in choosing MAiD, relying on limited statistical evidence. Some findings are based on postal code data, which, as disability activist Gabrielle Peters notes, can misclassify lower-income residents who live in subsidized housing located within middle-income neighbourhoods. This likely understates the true burden of poverty among MAiD recipients. The analysis also minimizes the many patients who cite fear of being a burden, loneliness, or social isolation as drivers of their suffering, all of which represent a profound social failure.
Although the report emphasizes self-identified disability, all MAiD recipients are disabled by definition. Disability refers to any long-term impairment that limits participation in life. MAiD is legal for individuals with a “grievous and irremediable” condition, an incurable illness causing irreversible decline in capabilities. Anyone meeting these criteria is by definition disabled, though not all disabled people should qualify for MAiD.
Common conditions listed for Track 2 MAiD reinforce this point. Diabetes appears frequently, and Ontario’s MDRC documented a man who received MAiD for an essential tremor. These are disabilities, yet they do not usually cause the serious decline that MAiD is intended to address. By emphasizing self-identified disability, the report obscures the real story: MAiD eligibility targets disabled people, a concern highlighted by the disability community, the United Nations and human rights watchdogs, and most recently, the United Nations Committee on the Rights of Persons with Disabilities.
The gentleman with ALS continues to live, but he has been made to know he is an outlier. In a society that values everyone, continued survival should not feel unusual. Canadians should ensure people like him—and all those with disabilities—have the support, care, and dignity to live fully, not feel compelled to die.
Ramona Coelho, MDCM, CCFP, is a senior fellow at the Macdonald-Laurier Institute, an adjunct research professor of family medicine at the University of Western Ontario’s Schulich School of Medicine and Dentistry, and the co-editor of Unravelling MAiD in Canada: Euthanasia and Assisted Suicide as Medical Care.
