By Ramona Coelho and David Shannon
August 6, 2025
Authors are both members of the Chief Coroner of Ontario’s MAiD Death Review Committee (MDRC). Stated positions, arguments, recommendations and conclusions are personally derived.
I. Background and Current State
Since its legalization in 2016, Canada’s Medical Assistance in Dying (MAiD) regime has expanded rapidly. Framed as the exceptional use of euthanasia or assisted suicide at the end of life for those experiencing intolerable suffering, MAiD, of which 99.9 per cent consists of euthanasia, has since deteriorated in both law and practice. In 2021, Canada legislatively extended eligibility to individuals who have physical disabilities but are not near death (Track 2) and, in the near future, to individuals whose sole underlying medical condition is mental illness. As legislators and MAiD lobbyists campaign for “access” and “choice,” evidence suggests that the safeguards intended to ensure free and informed consent while protecting vulnerable populations from wrongful death often fail or are bypassed.
Ontario’s MAiD Death Review Committee (MDRC) reports, government data, and investigative journalism illustrate how MAiD can be rushed forward without a thorough exploration of the reversible sources of suffering, robust capacity assessments, or alternative options such as palliative, social, and disability supports. Under some circumstances, MAiD is more accessible than basic care, particularly for those experiencing poverty, isolation, or inadequate medical and social support. This Commentary reviews the failures of current MAiD safeguards and proposes policy changes to address them. These include improving oversight, strengthening consent and capacity assessments, and ensuring access to meaningful alternatives, especially for disabled and marginalized people at risk of wrongful death under the current regime.
Evolution of MAiD legislation and safeguards
Bill C-14 (2016): Legalized MAiD for adults with a “grievous and irremediable medical condition,” provided they were nearing the end of life (i.e., reasonably foreseeable natural death), underwent a mandatory 10-day reflection period, and confirmed consent immediately prior to the provision of MAiD (“final-day consent”).
Bill C-7 (2021): Retained a “reasonably foreseeable natural death” criterion for a Track 1 pathway but eliminated the 10-day reflection period, introduced a “waiver of final-day consent”, to be agreed upon in advance, for those who might experience a loss of capacity by the day of MAiD provision. It created a Track 2 pathway for individuals whose natural death is not reasonably foreseeable but who have physical disabilities. Track 2 includes a minimum 90-day assessment period (to be shortened only if both assessors agree that capacity loss is imminent) and mandates specialist input of some kind if neither assessor has expertise in the MAiD applicant’s medical condition.
Under the Criminal Code all MAiD applicants must
- Be at least 18 years old, capable of making healthcare decisions, and eligible for publicly funded health services in Canada.
• Have a grievous and irremediable medical condition, defined by:
- A serious and incurable illness, disease, or disability.
- An advanced state of irreversible decline in capability.
- Enduring physical or psychological suffering that is intolerable to the individual.
- Suffering that cannot be relieved under conditions acceptable to the person.
-
- For those applying under Track 1: Natural death is reasonably foreseeable.
- For those applying under Track 2: Natural death is not reasonably foreseeable.
- Have made a voluntary request free from external pressure.
• Have given informed consent after being advised of alternative means to relieve suffering
Procedural Safeguards
- A dated, written request signed by the applicant.
- Two independent MAiD assessments.
- Minimum 90-day assessment period for Track 2.
- Consent immediately before provision.
- Applicants be informed of available palliative, mental health, and disability supports.
- (Track 1 only) Possibility for a waiver of final-day consent, allowing MAiD even if the applicant loses capacity by the date of MAiD provision.
Canadians were assured that eligibility criteria and safeguards would prevent wrongful, premature deaths. However, disability experts consistently warned Parliament that the protections were inadequate and that expanding access would result in such outcomes. Those warnings were disregarded, and the consequences are now unfolding nationwide.
Serious problems in MAiD practice have emerged and have been revealed in coroner’s reviews, media reports, and the testimony of disability experts and grieving families who say their loved ones died due to unmet medical or social needs. These concerns appear to resonate with the broader public. An NIH study found that Canadians who support the MAiD law appear unaware that MAID cases they do not support are compatible with that law.
II. Problems with MAiD
Social suffering, structural coercion, and MAiD as default “care”
Health Canada reports that nearly half of Track 2 MAiD deaths involved suffering from loneliness or isolation, while almost half indicated that they felt like they were a burden. Ontario’s MAiD Death Review Committee (MDRC) found most Track 2 recipients were low-income and 61 per cent were women, a group statistically more likely to attempt suicide yet recover with care. Less than half received mental health or disability supports and less than 10 per cent received housing or income assistance. Many did not name a family member as next-of-kin, suggesting social isolation.
A 2021 University of Guelph study found that during COVID, some disabled people were encouraged to explore MAiD due to lack of resources. And in private leaked MAiD assessor and provider forums, MAiD providers have described ending lives where suffering due to poverty, loneliness, or obesity was driving the request for MAiD.
Though providers must inform applicants of alternatives for relief, there is no obligation to ensure access or assist with navigation. Providers are not required to have expertise in relevant disability or social supports, and applicants are not required to be offered information from people with lived experience who could help them navigate existing systems and offer peer support. In practice, the appearance of choice is often not backed by real alternatives.
Neglect of palliative care/rushed MAiD deaths
Canadians lack adequate palliative care and can subsequently suffer high symptom burden, which can drive MAiD requests. Health Canada reports high levels of palliative care before MAiD deaths but does not track the timing or quality of palliative care. This tracking is self-reported by MAiD providers, which may inflate the appearance of access. For instance, in MDRC Report 2024-4, Mrs. B, denied hospice, died quickly by MAiD after her overwhelmed spouse sought urgent MAiD access. MDRC data shows clustering of same-day and next-day MAiD deaths, suggesting some providers may be more inclined to expedite MAiD over exploring the remediation of suffering.
Dr. David Henderson, a palliative care physician with the Nova Scotia Health Authority, testified that health professionals have effectively been given “a licence to kill” without sufficient safeguards. He testified that MAiD assessments often bypass the root causes of suffering.
While polls show that Canadians prioritize expanding palliative care over MAiD, access to the former remains inadequate while MAiD expands.
A lack of free and informed consent/ limited virtual assessments
As early as 2020, Ontario’s chief coroner identified cases where patients received MAiD without well-documented capacity assessments, even though their medical records suggested they lacked capacity. MDRC reports also raise serious concerns about cases where MAiD proceeded despite questionable consent or capacity. These include instances where patients showed signs of cognitive decline or were heavily sedated, or where assessments were rushed or based on minimal interaction. Some relied on prior waivers without confirming whether the patient still wished to die. Some patients were even assessed virtually, raising serious concerns about the integrity of the capacity and evaluation process.
CAMAP’s influence on MAiD practice and Health Canada’s carelessness
The Canadian Association of MAiD Assessors and Providers (CAMAP) wields immense influence over clinical MAiD practice through educational curricula. Its work is funded by at least $3.3 million from Health Canada. CAMAP’s materials encourage providers to raise the options of MAiD with eligible patients, shifting the initiative from a patient-led request to a clinician-suggested intervention. One BBC documentary recounted how hospital staff repeatedly raised the option of MAiD to a dying woman. This cultural normalization has spread beyond MAiD specialists: a disabled veteran seeking home supports had a Veterans Affairs caseworker suggest MAiD instead.
CAMAP guidance allows for interpretation of the “reasonably foreseeable natural death” criterion to permit Track 2 patients to decline treatments, worsening their health status to make their death reasonably foreseeable, thereby qualifying them to have their life immediately ended as at least one MDRC reviewed case has documented.
Health Canada has created a “Model Practice Standard for MAiD,” which, among other troubling provisions, includes labelling all clinicians who object to providing MAiD, even in specific cases, as conscientious objectors. This designation can trigger mandatory referral obligations in certain provinces and entrenchs a system that funnels patients toward death. In a recorded CAMAP training session a trainee asks about withdrawing if MAiD is being driven by socioeconomic reasons. The expert affirms the right to withdraw but concludes, “You’ll then have to refer the person on to somebody else, who may hopefully fulfill the request in the end.” This “effective referral” mechanism subverts any pause or stopping MAiD for genuine assessment or care.
This effective referral loophole is exemplified by an Ottawa woman who was referred to a Brampton MAiD provider after multiple local assessors deemed her ineligible for MAiD.
Legislative ambiguities and oversight failures
Canada’s MAiD framework suffers from significant legislative ambiguity and lacks real-time oversight. The Criminal Code defines a “grievous and irremediable medical condition” using vague and subjective terms. “Irreversible decline in capability,” “intolerable suffering,” and, for Track 1, a “reasonably foreseeable natural death, “provide no objective medical metrics or standardized thresholds” and so have been open to broad interpretation by MAiD assessors, with no requirement for external validation.
MAiD is governed under the Criminal Code of Canada, so violations such as inducement or failure to meet eligibility and procedural safeguards must be proven beyond a reasonable doubt, a deliberately high legal threshold. Physicians and nurse practitioners can claim a defence of acting in good faith, even if they do make a mistake. This makes accountability for criminal negligence or abuse extraordinarily difficult to establish.
Alan Nichols, who had hearing loss and mild cognitive disabilities, was admitted under the Mental Health Act and was approved for MAiD during his admission, despite having no known terminal illness and over his family’s objections. In another case, Donna Duncan, who sustained a concussion and had been awaiting specialized care, received MAiD within days of her first assessment, despite her adult daughters’ serious concerns. Both families have had no recourse despite endless efforts, including contacting the relevant regulatory and police authorities. Former Justice Minister Lametti has insisted that oversight lies with families to make complaints after a death yet their remains no process to do so.
Marketed as “choice,” but international alarm over coercion and suicide contagion
Canada’s MAiD regime is frequently framed as an expression of personal autonomy and choice. Yet a troubling reality exists: vulnerable individuals can be steered toward MAiD in ways that mirror structural coercion and violate established suicide prevention principles.
A patient seeking emergency psychiatric care for suicidality was instead informed about MAiD. Such responses undermine the core principles of suicide prevention where messaging that promotes death and access to lethal means, of which MAiD does both, exacerbates risk of suicide.
A striking example of MAiD’s romanticization is the short film All is Beauty, sponsored by Canadian retailer Simons. It depicts a young woman, Jennyfer Hatch, surrounded by loved ones in peaceful natural settings as she reflects on the beauty of life just before having MAiD. A national news outlet revealed that Hatch had spoken publicly (under a pseudonym) about her struggles to access palliative care that she hoped would make her life better. This marketing campaign transformed a preventable tragedy into aestheticized “choice,” aiming to mask the systemic abandonment that ended her life.
Canada’s increasingly permissive MAiD legislation and practice has also drawn sharp international rebuke. Canada’s MAiD regime broadened rapidly and by 2027 is set to include requests based solely on mental illness. Quebec’s advance directive model has proceeded unchallenged despite breaking federal criminal law. In March 2025, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) condemned Canada’s MAiD expansion as inherently discriminatory and ableist. The Committee called for an immediate repeal of Track 2 eligibility (non-terminal conditions), a moratorium on advance requests and MAiD for mature minors, and urgent reforms to restore protections and real oversight.
III. Recommendations for Better Safeguarding MAiD
Building on critiques from the disability community, medical and legal experts, insights from MDRC reports, investigative journalism, and the United Nations Convention on the Rights of Persons with Disabilities (CRPD) Committee, this proposal outlines safeguards to make MAiD a safer practice.
Abolish Track 2 MAiD
MAiD can function as the path of least resistance rather than a last resort. The UN CRPD highlights how Canada’s MAiD framework perpetuates negative stereotypes rather than acknowledging that discrimination and social exclusion – not disability itself – often create unbearable suffering. Further, the federal MAiD framework does not compel the government to guarantee access to services so those with disabilities can live well. In many instances, essential resources such as palliative care, disability and home supports, community programs, or social workers are simply unavailable. In such contexts, merely listing “options” amounts to little more than lip service, offering no genuine care or effective alleviation of suffering.
Safeguards
- Remove the pathway for persons whose natural death is not reasonably foreseeable, including those with physical disabilities and mental illness.
- Reinstate “natural death” as a mandatory eligibility criterion, clearly defined as a disease prognosis of six months or less.
- Exclude remediable causes of suffering, such as psychosocial suffering, from the definition of suffering.
Reinstate and strengthen reflection periods
The push for expedited MAiD access overlooks the essential need for thoughtful, deliberate decision-making in the face of the irreversible option of ending someone’s life. True autonomy requires true consent—it demands time for patients to fully comprehend their options, for emotions to settle, and for alternative avenues of care to be genuinely explored. Rushing patients to death under the guise of urgency converts MAiD from a last resort to a default response to systemic failures. Moreover, rapid access can exacerbate vulnerability, especially for those grappling with transient crises, mental health struggles, or external pressures.
Safeguard
- Reinstate a mandatory 10-day reflection period for all MAiD requests (Track 1), recognizing that more time may be needed to deliberate or remediate suffering.
Ban waivers of final-day consent
Allowing waivers of final-day consent undermines the core ethical principle that MAiD requires clear, voluntary, and informed consent. Capacity and wishes can fluctuate, especially in vulnerable patients experiencing pain, delirium, or sedation. Proceeding based on a prior waiver disregards the possibility that a patient’s current state may no longer reflect their true desires or best interests. This not only exposes patients to the risk of premature or unwanted death but also weakens essential protections designed to safeguard autonomy and dignity. In essence, waivers create a one-time permission for the future—failing to account for changing circumstances or second thoughts.
Safeguard
- Eliminate the “waiver of consent” provision. If an applicant loses capacity, MAiD must be suspended. Family or substitute decision makers should focus on comfort measures.
Guarantee access to palliative and mental health care, along with disability and social supports
Guaranteeing access to comprehensive palliative care, mental health services, and social supports is essential to uphold the promise of equitable health and social care for all in Canada. Our health care system has a fundamental obligation to address the root causes of suffering.
Allowing MAiD to fill the gaps left by underfunded or inaccessible services normalizes death as a response to systemic failure. This distorts the principles of care and compassion that underpin a socialized health care system and risks coercing individuals into choosing death out of despair, not genuine, informed choice. During parliamentary discussions on Bill C-7, a senator requested a cost analysis for MAiD. This introduces a perverse disincentive to prioritize savings over care, since MAiD will always be cheaper than care, and risks creating a “duty to die.”
Palliative care, in particular, has well-documented benefits for improving quality of life, managing pain, and reducing emergency room visits and hospital stays. Yet it remains chronically underfunded and is often introduced too late to be effective. Similarly, access to mental health and disability supports remains uneven and inadequate for many Canadians.
The government’s failure to invest in timely, comprehensive, and equitable care not only undermines the safety of the MAiD regime – more importantly it breaches the public’s trust in the health care system as a whole.
Safeguards
- Governments must commit to funding targets that will ensure that Canadians have timely and meaningful access to palliative care, mental health care, and to disability, social, and housing supports.
- Track and publicly report the type, timing, and quality of palliative care and disability services to which MAiD applicants have access.
Independent real time oversight and complaint mechanism
An accountable medical system requires meaningful oversight. MAiD is not a medical decision; it is a legal act defined under the Criminal Code, with specific eligibility criteria and procedural safeguards that must be met. In all areas where legislation governs life-and-death decisions, meaningful, real-time oversight is essential. Currently, there is no real-time, independent mechanism for families or clinicians to raise concerns before MAiD is carried out. Most oversight occurs only after death, often through brief coroner summaries or reviews that lack transparency, investigative power, or enforceable consequences. Families have reported being excluded from decision-making, denied access to records, or finding out about a loved one’s death after the fact. In such an environment, there is little recourse for preventing questionable or wrongful deaths before they occur.
This creates serious risks for abuse, negligence, and erosion of public trust. Without a system to pause or investigate concerning cases in real time, MAiD can go unchallenged until it is too late. MAiD, as a state-sanctioned mechanism to end life, demands oversight structures that are independent, proactive, and responsive to ethical concerns.
Safeguards
- Establish a federal MAiD oversight commission, independent of Health Canada, with the authority to audit cases, receive complaints from families or professionals, and conduct prompt investigations.
- Require all MAiD providers to submit detailed case dossiers (including physician notes, capacity assessments, and documentation of alternative supports offered) to the commission before MAiD is provided.
- Enable interim injunctions to suspend planned MAiD if family or clinicians raise red flags about procedural breaches or other concerns.
- Prohibit “doctor-shopping” among assessors; if the two initial assessors disagree, the case must not move forward and instead be reviewed by the commission.
Mandate comprehensive assessments including capacity evaluations
The foundation of MAiD rests on the premise that individuals are making a free, informed, and voluntary choice to end their lives. Yet in practice, capacity assessments are often brief and superficial, failing to capture the complexity of patients’ decision-making abilities. Unlike legal or financial settings where evaluators are trained and required to document their methodology and rationale in detail, MAiD assessors typically receive no specialized training in capacity assessment beyond their general clinical education. CAMAP offers guidance, which does not reflect the rigorous approach that experts use in complex capacity evaluations.
Without robust and standardized procedures, decisions to pursue MAiD may be made without a full understanding of the consequences of that decision or its alternatives. Ensuring that capacity evaluations are thorough, transparent, and conducted by qualified professionals is essential to upholding the integrity of consent and protecting those at risk of coercion or impaired judgment.
Safeguards
- Require capacity evaluations to follow rigorous standards akin to those used in financial decision-making: extended interviews, collateral histories, chart reviews, and standardized tools. Consider requiring psychiatrists with specialized training to be involved.
- MAiD clinicians must review the entire patient chart.
Prohibit virtual MAiD assessments
The use of virtual platforms to assess MAiD eligibility presents serious ethical and clinical concerns. While virtual care has value in certain contexts, it is not an appropriate substitute for the nuanced, high-stakes evaluation required when the outcome is euthanasia or assisted suicide. Determining whether someone is capable of consenting to MAiD, whether their suffering is enduring and intolerable, and whether they are acting free of coercion or undue influence demands close observation, comprehensive interaction, and access to full contextual information. These are not conditions that can be reliably met virtually.
Remote assessments also undermine the involvement of family members or support teams who might raise concerns or help ensure a more balanced and informed process. Allowing virtual MAiD assessments prioritizes efficiency over patient safety. For decisions of this gravity, only in-person evaluations can ensure the integrity, depth, and accountability required.
Safeguard
- All MAiD assessments must be conducted in person to ensure thorough capacity and consent evaluations, reduce coercion risks, and allow proper engagement with the patient, family, and supports.
Ban clinician-initiated MAiD discussions
Clinician-initiated discussions of MAiD introduce a dangerous power imbalance into an already vulnerable moment in a patient’s life. When a trusted health care provider presents death as a legitimate or even advisable option, it can exert undue influence. For patients who are isolated, living in poverty, facing discrimination, are desperate and afraid, or are facing a new diagnosis, a clinician’s mere suggestion of MAiD may reinforce internalized stigma and despair, causing them to request death when what they really needed was care and connection. This practice directly contradicts the principles of suicide prevention, which emphasize fostering hope, resilience, and support networks.
Encouraging or normalizing clinician-initiated MAiD discussions not only undermines therapeutic trust, but medicalizes despair rather than addressing it.
Safeguards
- Ban clinicians from raising the option of MAiD except in direct response to a patient-initiated inquiry.
- Prohibit advertising of MAiD to prevent society at large from accepting the message that death is an attractive solution for suffering.
- Remove any guidelines or policies (e.g., CAMAP) that encourage providers to proactively introduce MAiD.
Implement stricter expertise requirements
Track 1 MAiD is intended for people whose natural death is reasonably foreseeable, yet the determination of this criterion has been highly subjective and varies among MAiD providers; some allow individuals who may have many years to live to qualify. Without specialist input or evidence-based guidelines there is a significant risk that physicians or nurse practitioners – who may lack deep familiarity with a patient’s specific illness trajectory or treatment options – will make premature or inaccurate judgments about prognosis. This is particularly concerning where symptoms may appear severe but remain manageable or reversible with appropriate interventions.
Specialist oversight provides not only greater clinical precision but also a deeper understanding of whether all reasonable care options have been explored. Approvals made without such input can lead to situations where patients are wrongly deemed to be at the end of life or having irremediable suffering and proceed with MAiD instead of treatment, rehabilitation, or palliative alternatives.
Safeguards
- For Track 1 cases, require mandatory review by a physician with expertise in the patient’s primary condition (e.g., oncology or neurology, or a palliative care specialist).
Transparent post-mortem reporting and death certificates
Although Health Canada publishes annual MAiD reports, its oversight mechanisms are fundamentally insufficient to ensure accountability or safeguard against error and abuse. These reports are based almost entirely on self-reported data from providers with no independent verification, case audits, or third-party scrutiny. As a result, potential violations of legal safeguards or clinical standards can go undetected, and families or health professionals concerned about wrongdoing have no formal avenue to raise complaints or trigger reviews.
Without transparent, detailed, and disaggregated data, it is impossible to assess whether MAiD is being accessed voluntarily, equitably, or in compliance with the law. Furthermore, the omission of MAiD from death certificates in certain provinces conceals its true prevalence and prevents accurate public health tracking.
In matters of life and death, Canadians cannot tolerate opaque reporting and weak enforcement. For those seeking justice or redress, a credible oversight regime must be rooted in transparency, independent review, and accessible accountability.
Safeguards
- Require that MAiD be explicitly recorded on death certificates to ensure public accountability.
- Include demographic breakdowns of MAiD recipients (age, sex, socioeconomic status, disability status, Indigenous identity), reasons for request, prior supports accessed, and any documented procedural issues in annual reports.
Protect conscientious objectors and MAiD-free institutions
The normalization of MAiD within Canadian health policy has, in many cases, eroded the professional judgment and ethical autonomy of clinicians and institutions. Although more than 98 per cent of clinicians do not participate in MAiD assessments, a vocal minority persist in normalizing and proliferating its provision. Policies have treated any professional concerns about MAiD eligibility as conscientious objection, which in turn have triggered the requirement for the patient to be referred to another clinician. This shift undermines the clinical discretion of healthcare professionals who may see remediable suffering, systemic neglect, or coercion at play, and who wish to explore alternatives and focus prioritizing care and upholding the core principles of medicine.
As one of the authors of this commentary (Ramona Coelho), writes in the chapter “Conscience and MAiD” in the 2025 book Unravelling MAiD in Canada, conscientious objection is a critical safeguard that protects clinician integrity and patient safety. Penalizing professionals or institutions for opting out of MAiD not only suppresses healthy discussion and dissent but risks silencing those best positioned to identify situations where death is being pursued for preventable reasons.
Moreover, for many Canadians – especially those with disabilities, trauma histories, or mistrust in the medical system – access to MAiD-free spaces is vital for them to feel secure in seeking care. A robust healthcare system must respect diverse ethical perspectives and protect places that prioritize life-affirming care.
Safeguards
- Enshrine the right of healthcare institutions and individual practitioners to refuse to participate in MAiD without penalty.
- Ensure that governments and regulators do not penalize institutions that choose not to host MAiD services. Acknowledge that MAiD-free spaces are essential for many Canadians to feel safe seeking healthcare.
Strengthen criminal accountability
Despite well-documented procedural failures, no criminal prosecutions related to MAiD have occurred. This is likely due not only to vague legal standards, the absence of real-time oversight, and weak enforcement by regulatory colleges and systems of medical care, but also to a troubling reluctance to cooperate with investigations or refer cases to law enforcement. Importantly, documented cases appear to indicate the possibility of negligence causing death or even manslaughter – serious offenses that warrant thorough police investigation and potential prosecution.
Currently, the legal framework’s emphasis on liberty rights, to the exclusion of equality, under the Charter of Rights and Freedoms may justify amending the Criminal Code. The United Nations March 2025 framework underscores that, to fulfill its human rights obligations, Canada must revisit its MAiD legislation to incorporate an equality analysis and align with international recommendations. Such amendments are necessary to ensure robust accountability mechanisms and protect vulnerable populations from wrongful death.
Several disability organizations have launched a court challenge seeking to limit MAiD. They assert that Track 2 has resulted in premature deaths and increased discrimination and stigma toward people with disabilities across the country. While they are not contesting Track 1 in this case, they note that it, too, can pose significant risks for people with disabilities.
However, previous MAiD rulings have shown strong deference to autonomy-based claims, often ignoring equality and social protection concerns. This autonomy-based framework treats treatment decisions as isolated from social context – failing to account for how inadequate healthcare or pain management, poverty, inadequate housing, grief, or systemic disadvantage can distort what appears to be a free choice. As a result, the current MAiD regime lacks a necessary intersectional human rights analysis, making it vulnerable and exclusionary for marginalized populations. For example, in the Carter decision, the Supreme Court of Canada declined to include an equality analysis. It is fair to criticize the Court for omitting this important balance in such a foundational ruling—one that arguably shaped the current legislation now drawing serious criticism from the United Nations.
As a result, even well-founded legal challenges may face an uphill battle without a significant shift in judicial interpretation. Should Parliament attempt to reintroduce more stringent eligibility criteria or safeguards for vulnerable populations, such reforms would likely face constitutional challenges. In this context, some legal scholars and policymakers have suggested that invoking the notwithstanding clause could be necessary to preserve such amendments in the face of judicial invalidation.
Safeguards
- Clarify the Criminal Code to define specific breaches as offences for which practitioners could be found guilty of manslaughter or other crimes under the Criminal Code.
- Reduce evidentiary thresholds in gross negligence cases involving MAiD, recognizing the irreversible outcome and public interest.
IV. Conclusion
Canada’s experience with MAiD has become a cautionary tale of how legalized euthanasia and assisted suicide can erode into a system of structural abandonment. MAiD can currently function as a default response to unresolved suffering driven by poverty, disability, mental illness, and social isolation. Investigative reporting, testimonies from the disability community, and findings from Ontario’s MAiD Death Review Committee have demonstrated that individuals have received MAiD in response to unmet health and social needs.
The regime’s emphasis on “choice” and “access” ignores the reality that desperation driven by systemic neglect can lead individuals to pursue MAiD under coercive conditions. Safeguards such as final consent, capacity assessments, and offerings of access to care are either unenforceable or routinely bypassed in practice, which undermines both the public discussion and the foundational principles upon which MAiD was legalized in Canada.
Moreover, the disproportionate impact of MAiD on marginalized populations, particularly disabled persons, women, and those in socioeconomically precarious situations, underscores the government’s failure to respect equality and non-discrimination. As the UN Convention on the Rights of Persons with Disabilities reaffirmed in March 2025, Canada’s Track 2 framework rests on ableist assumptions that conflate disability with suffering.
To enable MAiD to function with more ethical, medical, and legal integrity, Canada must take urgent and systemic action. This includes abolishing Track 2 entirely, reinstating and strengthening safeguards such as reflection periods and final-day consent, mandating in-person and specialist-led assessments, and ensuring guaranteed, funded access to palliative care, mental health, and disability supports for all Canadians. Comprehensive oversight mechanisms must be established to allow real-time intervention to protect life and to hold practitioners accountable for violations of the criminal code. Public reporting must become transparent and detailed, enabling trends and breaches in safety to be evaluated.
Upholding human rights, public safety, and the integrity of medical care may ultimately require us to reconsider whether such a regime can ever be safely maintained. MAiD must not stand in for a failing health care system or the absence of the necessary supports that help people to live. If MAiD is to remain at all, it must be an exceptional act – tightly regulated, thoroughly scrutinized, and available only when death is truly near and suffering genuinely irremediable.
About the authors
Ramona Coelho, MDCM, CCFP is a senior fellow for domestic and health policy, at the Macdonald-Laurier Institute, an adjunct research professor of family medicine, Schulich School of Medicine and Dentistry, Western University, and the co-editor of Unravelling MAiD in Canada: Euthanasia and Assisted Suicide as Medical Care (McGill-Queen’s University Press, 2025).
David Shannon, CM, OC, OOnt, LLM is a Canadian lawyer and disability/human rights activist. Shannon has advised governments across Canada and is the recipient of both the Order of Canada and Order of Ontario for his contributions to human rights. He is the co-editor of Medical Assistance in Dying (MAiD) in Canada: Key Multidisciplinary Perspectives (Springer, 2023).
