Surge in medically assisted deaths under Canada’s MAID program outpaces every other country

Dr. Sonu Gaind, head of the psychiatry department at Sunnybrook Hospital, said he is concerned about what the surge in medically assisted deaths ”says about our society.” Giovanni Capriotti

The number of Canadians ending their lives through medically assisted death has grown at a speed that outpaces every other nation in the world.

As Canada is poised to expand eligibility criteria under medical assistance in dying (MAID) legislation, data from all 11 countries where the controversial end-of-life treatment exists shows Canada is the fastest-growing adopter in history, an analysis by the Investigative Journalism Bureau and the Toronto Star has found.

Some experts see the rapid growth as a human rights triumph that allows Canadians to make their own choice about when they wish to die with the full support of the state and their doctors. Others fear that failures in the health-care system and social safety net may be contributing to the surge.

Assisted deaths accounted for four per cent of all deaths in Canada in 2022 — up from one per cent in 2017, the first full year the legislation was in place. The number of MAID deaths quadrupled during that time. In 2022, the total number hit 13,000 nationwide — a 31 per cent jump from the previous year.

In the past two years alone, more people have died under Canada’s assisted death regime than in any other nation in the world, the IJB/Star analysis shows.

“We’ve gone in a trajectory that no other country on the planet has gone,” says Dr. Sonu Gaind, chief of psychiatry at Sunnybrook Hospital. “We don’t know what the full impact is going to be.”

Canada poised to lead world in MAID deaths

At its current pace of growth, Canada’s percentage of MAID deaths is poised to lead the world as soon as next year — surpassing countries that have had similar laws for decades longer. More Canadians still are expected to pursue medically assisted death due to the federal government’s promise to expand eligibility in March to include Canadians whose sole underlying condition is a mental disorder.

One in five Canadians are impacted by mental health challenges.

The Netherlands — where assisted death has been legal for more than two decades — still has the highest global physician-assisted death rate at 5.1 per cent. Some Canadian provinces already exceed that. Quebec’s MAID mortality rate reached 6.6 per cent in 2022 and British Columbia’s rate was 5.5 per cent.

In some of the countries analyzed by the IJB / Star, medically assisted death is only legal in some states.

The Ultimate Choice

For more on this topic, listen to The Ultimate Choice podcast from TVO Today in partnership with the Toronto Star and the Investigative Journalism Bureau. Hosted by the Star’s Robert Cribb, the series explores the political and social realities of the MAID debate and how it affects the everyday lives of Canadians.

It took 14 years for assisted death cases in the Netherlands to reach four per cent of deaths. And assisted dying rates for Switzerland and Belgium dating back to the early 2000s have never reached four per cent.

In Canada, it happened in six years.

“Canada is the fastest in terms of the slope of growth. I don’t think there’s any dispute about that,” says Dr. Scott Kim, a psychiatrist and researcher at the National Institutes of Health in Washington D.C. who has studied international assisted-death rates and reviewed the IJB/Star data.

Surge in MAID has divided psychiatric community

Canada’s psychiatric community has been divided on the country’s rapid emergence as a global leader in assisted death.

“Who am I to say, ‘You’re suffering, it’s too bad, you just have to find a way to live like this,’” says Dr. Cheryl Rowe, a Toronto psychiatrist who routinely treats vulnerable patients living with the added challenges of poverty and homelessness.

“It’s a failure of medicine. There are so many doctors that believe that they have to keep their patients alive at all costs. And it took a long time for doctors to begin to realize that that wasn’t the case.”

Dr. Cheryl Rowe a Toronto psychiatrist, says she believes patients have a right to die a dignified death. ”Who am I to say you’re suffering, it’s too bad, you just have to find a way to live like this?” *Nick Lachance*

To Gaind, the data shows “there hasn’t been a slippery slope. We’ve had a cliff. We’re falling off it … I’m concerned about what it says about our society.”

He sees the sharply trending upward line as a betrayal of the public trust, especially for vulnerable patients who choose assisted death because they can’t access the help they need to make their lives more livable.

“I’m concerned about the marginalized lives that are going to be lost,” he says. “We didn’t give them the chance to live with dignity, but are all too eager to say ‘Oh, here’s the path to dying with dignity.’ ”

Canada’s ‘unique’ MAID law credited for surge

Canada’s unique legislative approach to assisted dying is largely responsible for the swelling numbers of Canadians seeking a state-sanctioned death, say many experts.

U.S. state laws typically require assisted death applicants to be within months of dying from their physical condition.

California, which has a similar population to Canada, launched its assisted death legislation in the same year as Canada with very different results. With eligibility in the state limited to terminal patients, assisted deaths in the state have remained below 0.3 per cent — a total of 3,275 since 2016, which is nearly 15 times lower than in Canada.

Meanwhile, unlike Dutch and Belgium laws, which require provision of MAID as a last resort option, “Canada does not,” says Kim from the Institutes of Health.

“Canadian law is unique. It gives doctors almost free rein on what to do if someone has a diagnosis and they’re miserable with it,” he said. “Then you marry it to a very-well organized delivery system — your healthcare system. It gives the medical system and your sociopolitical system an out when you abandon people.”

Kim has consulted on Canadian MAID legislation several times since 2016 and gave expert witness testimony before the Canadian Senate Committee on Legal and Constitutional Affairs in 2020.

Kim says the deliberations about the roll-out of MAID in Canada took place largely behind closed doors where physicians and lawyers appointed by the government pushed hard for broad accessibility to assisted death for Canadians.

“The aggressive philosophy of implementation, in coordination with advocacy groups rather than wide input from varying perspectives, has been truly astonishing.”

Canada’s planned MAID expansion remains controversial

The federal Liberal plan to expand MAID eligibility to those with mental health conditions was first slated for last year. But the government put it on hold until this March pending further review. It has remained controversial.

While public polling on MAID has shown a majority of Canadians support the legislation, that support falls dramatically on the specific question of mental health eligibility.

Only 31 per cent of Canadians said they support MAID for mental illness according to a February 2023 poll by the Angus Reid Institute. And 82 per cent of Canadians said access to mental health care should be improved before MAID eligibility is expanded to include mental illnesses, another national poll last September found. The poll surveyed 1,872 Canadian adults with a margin of error of +/- 2 percentage points, 19 times out of 20.

Dr. Donna Stewart, a senior scientist at the Toronto General Hospital Research Institute, doesn’t believe there will be a jump in MAID deaths if eligibility is expanded to mental health conditions.

“When I hear people fear-mongering by saying, you know, we’re going to be slaughtering thousands of Canadians with this legislation, I think that this is an unreasonable assumption to be making,” says Stewart, who also sat on the federal expert panel on MAID and mental illness.

“I think it’s going to be a very small number and hopefully they’re going to be very, very carefully assessed.”

Mason, a 29-year-old who lives in Kitchener, Ont., is patiently waiting to apply for MAID based on what he calls a lifetime of mental health misery. Mason, who asked that his last name not be published, says he has attempted suicide 15 times since the age of seven and continues to live with suicidal thoughts.

“It’s kind of like my mind’s little Holy Grail,” he said of the government’s promise of accessing a physician-assisted death. “I’ve always been living my life with one foot out the door.”

Jeff Kirby, a professor emeritus in the department of bioethics at Dalhousie University in Halifax, was a member of the federal expert panel tasked by the government in 2021 with drafting safeguards for the expansion of MAID into mental health.

While he isn’t opposed to the idea, he stepped down from the panel prior to its final report in May 2022, saying safeguards suggested by experts ought to be legally entrenched rather than simply guidance.

He remains fearful that the new rules welcoming mental health patients to seek MAID lack the rigor and protection to prevent tragedy.

“I really think that Canada as a whole will have lost if it proceeds to March 2024 with no changes,” he says. “I think we have lost a chance to adequately protect members of vulnerable, disadvantaged social groups in a way that we should have.”

With files from Max Loslo and Charlie Buckley, Investigative Journalism Bureau

This article was also published in the Toronto Star.

About
Latest Posts

Robert Cribb

Robert Cribb is the founder and director of the Investigative Journalism Bureau. He has received national and international reporting awards for investigations into offshore tax evasion, child exploitation, human trafficking, dangerous doctors, environmental threats and public safety. He was part of the international reporting team that produced the Pulitzer Prize-winning Panama Papers investigation in 2017. Cribb is the former president of the Canadian Association of Journalists, the first international board member of Investigative Reporters and Editors, and current president of Canadian journalism charity, Veritas. He teaches investigative reporting at Toronto Metropolitan University’s School of Journalism and the University of Toronto.