As Canada mulls a controversial plan to allow medical assistance in dying (MAID) for mental illnesses, the country’s current model is facing a new round of attacks, both at home and abroad.
There is rampant misinformation about MAID, such as when Joe Rogan recently told Conservative Leader Pierre Poilievre that a Canadian man received the procedure for “seasonal depression.” MAID for mental illness is not allowed in Canada, but that is set to change in March 2027.
In Alberta, the government has introduced legislation to restrict MAID to people whose death is imminent. Currently, a parliamentary committee is hearing from people both for and against allowing MAID for psychiatric conditions. Polls indicate that is opposed by a majority of Canadians, leaving the future of the expansion uncertain.
Canada’s model loomed large in recent discussions on an assisted-death bill in the United Kingdom that failed to pass. One British legislator, Baroness Tanni Grey-Thompson, told the Star she believes Canada’s approach to MAID is a cautionary tale, characterizing it as “dystopian,” while here at home, critics point to how Canada had the fastest-growing assisted death program in the world.
But has MAID in Canada gone too far? As with most things involving this debate, it depends who you ask. While the Canadian model for assisted death has been misrepresented, it’s also clear there are complicated cases that raise ethical challenges.
As we approach 10 years since the procedure was made law, here’s what we know about the latest death data and the issues that have critics most worried.
How many people are dying of MAID in Canada?
MAID is split into two tracks: Track 1, for those with terminal illness and whose death is reasonably foreseeable, and the more controversial Track 2, for people with conditions that can’t be cured and cause “intolerable suffering,” but are not terminal. In 2024, MAID accounted for five per cent of all Canadian deaths. However, 95.6 per cent of those were Track 1 cases. Track 2 accounted for 732 individuals. While Track 2 represented 4.4 per cent of MAID cases in 2024, they represented nearly a quarter (24.2 per cent) of all MAID requests that were denied.
Of 22,535 MAID requests in 2024, 16,499 received the procedure. In total, 76,475 Canadians have died of MAID since it was legalized in 2016. The median age of MAID recipients was 77.9 years (78 for Track 1 and 75.9 for Track 2).
Critics have said Canada’s annual rate of growth in the number of people receiving MAID is alarming. In recent years, there has been a steep decrease: the growth rate declined from 36.8 per cent between 2019 and 2020 to 6.9 per cent between 2023 and 2024. Some analysts have said it was expected to grow at a rapid rate in early years due to more people learning about the procedure’s availability, but has since predictably plateaued. For others, the fact it’s still growing at all is cause for concern.
What are critics most worried about?
Some worry Canada’s current model goes too far. Alberta has introduced legislation that would effectively ban Track 2, which is also the subject of a constitutional challenge that argues it discriminates against people with disabilities by encouraging them to end their lives if they can’t get needed support.
Trudo Lemmens, a University of Toronto professor of health law, said Track 2 lacks sufficient safeguards to protect people with disabilities from premature death, and those that are in place are often “circumvented.”
He pointed to a document by the Canadian Association of MAiD Assessors and Providers that advises assessors a patient’s death could be deemed reasonably foreseeable if they have “demonstrated a clear and serious intent to take steps to make their natural death happen soon,” for example, refusing antibiotic treatment or not eating or drinking.
“MAID has been introduced as medicine, with only vague and open-ended criteria and ill-defined standards,” he said.
Allowing people to access MAID if they are only suffering from mental illness is also deeply divisive. Alberta Premier Danielle Smith has said “being depressed or having PTSD, that’s recoverable, and we should be giving people hope and supporting them in their mental health journey.”
Dr. Donna Stewart, a University of Toronto professor who has practised psychiatry for more than 50 years, said she believes people with mental illness at least deserve a MAID assessment, provided it includes a psychiatrist.
Stewart, who has assessed more than 400 MAID applications, said it’s important for assessors to ensure patients exhaust all options to get better before considering MAID, but added, “anybody who’s practised psychiatry as long as I have knows there are some people who simply do not get better,” even after treatment.
She noted that in countries that do allow assisted death for psychiatric conditions, such as Belgium and the Netherlands, only about one per cent of people who apply get approved and receive MAID.
Are people really getting MAID for being homeless?
There have been reports that people in Canada have applied for or accessed MAID for issues such as food and housing insecurity, social deprivation, or mental illness.
People cannot receive MAID solely for mental illness or social distress, and the advocacy organization Dying with Dignity Canada has said there’s no evidence anyone has ever died of MAiD for reasons other than a medical condition.
But there are complex cases where illness and social factors converge that have proven to be “extremely ethically problematic,” said Kerry Bowman, a bioethicist and assistant professor at the University of Toronto.
“Even if you say, I don’t think this is an autonomous decision, because this person is on the verge of losing their housing, what are you saying?” Bowman said. “That someone in Rosedale can have medical assistance in dying, but someone that’s struggling can’t? You’ve got a whole new set of ethical problems.”
A recent Ontario coroner’s report on “Mr. A” — a man with inflammatory bowel disease, mental health challenges and no social network, who was dependent on family for housing — raised questions about whether social supports could have addressed his desire to die. He was approved for MAID.
The review says while Mr. A was believed to have the ability to make decisions, his substance use was not explored in his MAID assessments, and that some committee members said he “may have benefited from greater consideration of social and mental health supports to address unresolved issues during the MAID process.”
What do the numbers say about who’s getting MAID?
Health Canada data shows recipients are not overrepresented in low-income areas. In fact, Track 1 recipients (whose deaths are reasonably foreseeable) are slightly more likely to come from high-income neighbourhoods.
There’s a slightly higher rate of Track 2 recipients (with an incurable but non-terminal condition) in the low-income bracket. One possible explanation is that poverty is strongly linked to higher rates of chronic illness, Stewart said. The Health Canada report notes that Track 2 recipients tended to have a greater number of medical conditions for a longer period of time when compared to Track 1 recipients, and were nearly twice as likely to report having a disability.
One area that has drawn attention is the types of suffering listed by people applying for MAID. Track 2 MAID recipients were much more likely than Track 1 recipients to report isolation, loneliness and loss of dignity as sources of suffering.
Dr. James Downar, a critical care and palliative care physician and University of Ottawa professor, said there’s a well-established link between social distress and chronic illness. He contends that those sources of suffering are associated with the conditions that make people eligible for MAID in the first place, rather than a broader societal failing.
“What happens when you have a serious illness, that advanced state of irreversible decline and capability, is that your ability to do things that define you are taken away from you,” he said. “That is a gross assault on your sense of personhood.”
A Leger360 survey found that while a strong majority of Canadians (77 per cent) support MAID in its current form, only 42 per cent support allowing it for psychiatric conditions.
Bowman said he’s not confident that will ever happen because the issue is too “politically contentious.”
“I think Canada is just going to have to probably try and live with a lot of complexity and ambiguity on this front.”
