This article originally appeared in National Newswatch.
By Ramona Coelho, September 10, 2025
Some Canadians who receive medical assistance in dying (MAiD) do not receive the care needed to relieve their suffering. Lives are ended because treatments are denied or deemed optional for people in crisis. MAiD, which is both assisted suicide and euthanasia, has become a possible substitute for care. Ontario’s MAiD Death Review Committee’s (MDRC) latest report, Evaluating Incurability, Irreversible Decline, and Reasonably Foreseeable Natural Death, highlights an observation I have made for a long time—the human cost of inadequate medical and social supports. The committee holds diverse views, I share my perspective as a member.
MAiD is only legal for individuals with a “grievous and irremediable” condition, which includes a serious, incurable illness and an advanced, irreversible decline in capabilities. Health Canada has clarified that under Track 1, a person’s natural death must be reasonably foreseeable (RFND) —a term with no clear medical standard, but intended to indicate they are near the end of life. If an illness is likely to cause death only after several years, it generally does not meet this criterion. Track 2 is intended for people with disabilities who are not dying. Previous MDRC reports have specifically raised safety concerns about it.
Health Canada clarifies that “irreversible decline” means a severe loss of function, and a person can only be considered incurable if there are no reasonable and effective treatments available. They explicitly state that individuals cannot refuse all treatments to render themselves incurable, and thereby qualify for MAiD.
However, this report highlights cases that seemingly conflict with Health Canada.
Consider Mrs. A: isolated, severely obese, depressed, and disconnected from care; she refused treatment and social support but requested MAiD. Instead of re-engaging her with care, MAiD clinicians deemed her incurable because she refused all investigations, and her life was ended.
Or Mr. B: a man with cerebral palsy in long-term care, he voluntarily stopped eating and drinking, leading to renal failure and dehydration. He was deemed eligible under Track 1 because his death was consequently considered “reasonably foreseeable.” No psychiatric expertise was consulted despite signs of psychosocial distress.
Or Mr. C: a man in his 70s with essential tremor, whose MAiD provider documented that his request was mainly driven by emotional suffering and bereavement.
The case of Mrs. A illustrates how some assessors may deem suffering irremediable while failing to establish an accurate prognosis or provide appropriate care. In my view, determinations of incurability must never be based on patient neglect. Similarly, Mr. B, who refused food and drink yet was deemed eligible under Track 1, highlights the Canadian Association of MAiD Assessors and Providers (CAMAP) long-standing guidance that permits broad interpretations of “reasonably foreseeable natural death” (RFND), allowing Track 2 patients to qualify under Track 1 when they refuse interventions that cause a deterioration in their health. For Mr. C, essential tremor is incurable but does not usually cause a serious decline in capability. All these practices appear to contradict guidance from Health Canada.
Sadly, many MAiD deaths are driven by untreated suffering: isolation, feelings of being a burden, and lack of care. Ableism and ageism play a role, with some assessors judging certain lives as less worthy of living. Disability is often equated with illness, yet disabled individuals are members of a community recognized under the UN human rights standards, and their community faces systemic barriers. Too often, MAiD decisions are made on a case-by-case basis, relying on an outdated medical model of disability and overlooking how lived experience, lack of support, and systemic factors contribute to broader societal inequities that perpetuate disadvantage for people with disabilities.
In March 2025, the United Nations Committee on the Rights of Persons with Disabilities condemned Canada’s MAiD expansion as inherently discriminatory and ableist. Among its findings, it called for genuine oversight to prevent abuse and an immediate repeal of Track 2, including the expansion to mental illness as the sole criterion of eligibility scheduled for 2027.
Canadian oversight is sorely lacking, failing to implement enforceable standards and raise public awareness of human rights transgressions. In British Columbia, internal government documents recently included a briefing note with a recommendation against strict MAiD oversight to avoid discouraging providers amid “high demand.” This raises serious questions about whose interests are being served in the provision of MAiD.
Canada’s legal safeguards are failing. Federal guidelines are being ignored. The public deserves to know: Is Canada building a system that truly protects all Canadians—or one that expedites death for the vulnerable?
Dr. Ramona Coelho is a family physician whose practice largely serves marginalised persons in London, Ontario. She is a senior fellow at the Macdonald-Laurier Institute and co-editor of the new book “Unravelling MAiD in Canada” from McGill University Press.
